BACKGROUND In Africa, cancer burden is increasing at a rate projected to double by 2040 from 1,055,172 new cases in 2018 to 2,123,245 by 2040. In Africa late-diagnosis partly explains the wide mortality-to-incidence ratio for most cancers, delays related to low population health literacy and a weak health system in most African countries. Cancers otherwise curable if detected early carry a poor prognosis (e.g. 10-20% 5-year survival for childhood cancers vs. 80-90% in high income countries). Consequently, most people in Africa view cancer as a death sentence and delay seeking medical care when discovering early signs and symptoms due to denial, anxiety, paranoia, fear, and unsavory experiences. The challenge is further compounded by poor capacity of front-line medical practitioners to provide appropriate counselling and messaging for patients and their immediate circle of relations.
Role of Psycho-Oncology in comprehensive cancer care and UHC Psycho-oncology, a recognized field of practice improving outcomes, is still nascent in Africa and often absent in routine cancer management. With the Sustainable Development Goals, all countries committed to achieving universal health coverage (UHC) by 2030. Psycho-oncology has a unique role in this agenda by ensuring better treatment outcomes and promoting quality cancer care at all stages of the cancer continuum. Through effective communication, including factual elements and empathy, we can also impact utilization of prevention and control interventions. IPOS and WHO are uniquely positioned to promote comprehensive cancer care including adaptation of national guidelines to resource-limited settings.

Psycho-oncology is the psychosocial management of cancer patients in order to reduce stress, enhance their coping strategies and improve their quality of lives along the cancer care continuum. The field started in Nigeria in the early nineties through the initiative of Professors Campbell, Jude Ohaeri and Dr Tony Marinho. This initiative was revived and enhanced in 2004 through the efforts of Prof Chioma Asuzu. In 2008 the Psycho-Oncology Society of Nigeria (POSON) was formed with the aims of development, promotion, enhancement, research and training in order to improve the quality of life of cancer patients and their caregivers with the guidance of Dr Jimmie Holland. Psychosocial Care in Ibadan is based on an altruistic model. POSON organizes yearly psychosocial conferences all over Nigeria. The association became a member of the Federation of Psycho-Oncology Societies in 2011. With the continued support of Jimmie Holland the IPOS Association for Psycho-Oncology in Africa (APOA) was inaugurated in 2013 in Durban and the second conference of APOA was held in Nairobi, Kenya. The unit of Psycho-Oncology was established in the Department of Radiation Oncology, Department of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan. This unit developed a Master’s program in Psycho-Oncology. IPOS has contributed immensely to the growth and development of Psycho-Oncology in Africa through training academies, which have been organized in the various parts of Africa.

Good communication with patients and their families contribute to improve patients’ knowledge about their disease and how to better manage their life, emotions and behavior, it has the potential to reduce patients’ anxiety and uncertainty, identify their unique concerns and needs, and lead to appropriate referrals for necessary care. Good communication skills enable clinicians to provide clinical information in a sensible way tailored to patients’ needs and preferences, promoting patient-centered care, compliance with treatment, patient’s adaptation and satisfaction with care, contributing to improve patients’ outcomes. Good communication skills is considered a key component of good medical practice, and a core competence for clinical training for healthcare providers, particularly for doctors and nurses. We will discuss why are good communication skills the first level of psychosocial care for patients and families. We will also present current clinical guidelines for patient-clinician communication (e.g., ASCO), and discuss recommendations for continuous communication skills training in clinical settings.

The Global Action Plan for the prevention and control of NCDs (2013-2020) aims a 25% reduction in NCD-related premature deaths by 2025. Hand in hand with this plan, IPOS and WHO have been collaboratively promoting psycho-oncology as a standard of universal care in the context of low-middle-income (LMI) countries including on the continent of Africa. This symposium will describe the contribution of psycho-oncology and IPOS collaboration to the attainment of Universal Health Coverage in Africa, the history and evolution of psycho-oncology in Africa and the role of IPOS Federated APOA, and a framework for adapting psychosocial clinical guidelines to LMI countries.
BACKGROUND Clinical practice guidelines have mostly been developed in high income countries and may need modifications to be culturally-relevant to the LMI country context. We used a knowledge translation framework to better understand communication practices and needs around breaking bad news to adult and pediatric populations in African oncology settings, with a focus on identifying barriers and facilitators to breaking bad news.
METHODS A World Café methodology was used to gather qualitative data for this study. The World Café was conducted in English and comprised 114 professionals working in oncology in Africa.
RESULTS Participants underlined the centrality of good doctor-patient communication in optimizing outcomes. Barriers and facilitators to communication included: medical setting structure and scarce access to specialists; shortage of staff; workload and time; language, level of education, and socio-economic disparities in understanding; fear of demoralizing the patient; belief around what children understand and their degree of involvement in medical care and decision-making; the need for age-appropriate communication; cultural and religious beliefs; stigma surrounding cancer causes; and the central role of family and cultural traditions.
CONCLUSION Our study suggests the need to adapt guidelines to the African context to disseminate communication skills training in a culturally relevant way. Conjunctly, within this context it appears important to embed parallel public health strategies and health care structural changes to mitigate any unintended effects of cancer diagnosis disclosure on patients and families. As IPOS pursues its mission to translate knowledge in the LMI country context, particular attention is required to culture and context.