OBJECTIVE Human Papillomaviruses (HPV) are small virus non-enveloped double-stranded circular DNA (Desoxyribonucleic acid). They infect epithelial cells. Many studies have indicated that having multiple sexual partners may lead to higher HPV transmission. Thus, female sex workers (FSWs) may be at greater risk of infection. In female sex workers (FSWs), the risk of HPV infection and cervical cancer is especially high. The aim of this work is to determine the prevalence and the genotypes of HPV that circulate in female sex workers populations in Cote d’Ivoire.
METHODS From Dec’ 2015 to May’ 2016, cervical samples from 350 female sex workers were tested for some High-Risk HPV(HR-HPV). HPV DNA was amplified using PGMY09/11 primers which generated 450 base pairs at the L1 region. The samples harbouring HPV DNA were genotyped using the multiplex PCR with HPV 16, 18, 31, 33, 35, 45 and 51 primers.
RESULTS The mean age of this population was 32.5 years. On 350 female sex workers, HPV DNA was obtained in 51.5% of the population. A total of 168 (94.38%) specimens harbouring HPV DNA were genotypes using multiplex PCR versus 5.61%, which were not genotyped using HPV 16,18, 31, 33, 35, 45 and 51 by multiplex PCR. These 168 strains permit to identify 204 strains of HPV on whom 88.69% with single infection while 11.30% with a multiple infection. Among multiple infections, 36.84% had respectively double and triple HPV infection and 26.31 % had four HPV infections. HPV genotypes prevalence was HPV16 (22.47%), HPV18 (26.97%), HPV35 (11.23%), HPV31 and HPV33 (7.86%) respectively and HPV45 (7.30%). Any case of HPV genotype 51 was founded.
CONCLUSION The prevalence of HPV infection in female sex workers is high. The most genotypes which circulate in this population are HPV type 16 and type 18.

INTORDUCTION Worldwide, the common malignant diseases of childhood are leukaemia and lymphomas. In Africa, the distribution of childhood cancers is quite similar, commonest being Kaposi sarcoma and Burkitt’-s Lymphoma. Kaposi Sarcoma is associated with HIV infection. Burkitt’-s Lymphoma is associated with Epstein–Barr virus. The study aimed to describe the burden of infection-defining malignancies among children in Uganda.
METHODS This was a retrospective surveillance study which involved a review of cancer patient’s information from Kampala cancer registry which collects information on cancers diagnosed within included children (0-14 years). We also reviewed the literature on the burden of Kaposi Sarcoma and Burkitt’-s Lymphoma among children in Uganda.
RESULTS 752 children were diagnosed with cancer between January 2009 and December 2014. 12% of cases were Kaposi Sarcoma and 21% were Hodgkin lymphoma. From the review, 92% of the Burkitt’-s lymphomas in a study done in 2015 were positive for Epstein–Barr virus. Overall, the association of Non-Hodgkin Lymphoma with HIV was weaker than what has been reported from other countries. In a study on about 200,000 monthly medical records, a positive correlation coefficient of 0.26 was found in Pearson’s correlation between calendar time and the prevalence of Kaposi’s sarcoma. Kaposi Sarcoma seroprevalence was higher among children with HIV infection (29% vs 10%; odds ratio: 3.1, 95% confidence. interval: 1.2 to 8.3) or malaria parasitaemia (30% vs 10%; odds ratio: 4.1, 95% confidence interval: 2.4 to 7.0) than in children without.
CONCLUSION Cancer registries are potential sources of cancer surveillance data. Burkitt’s Lymphoma and Kaposi sarcoma among Ugandan children are associated with the same infections as those in other countries.

OBJECTIVE We sought to establish the patterns of HIV-testing amongst newly diagnosed black cancer patients before (2004–2010) and after (2011–2016) SA implemented the updated HIV counselling and testing (HCT) policy.
METHODS Between 2004–2016, newly diagnosed black cancer patients were recruited at a tertiary referral hospital in Johannesburg, SA. Trained study staff administered questionnaires to collect information on demographics, previous HIV-testing, and other factors associated with previous HIV-testing. HIV-status was determined using an ELISA test and compared to self-reported HIV-status. HIV prevalence was calculated as number of cancer patients who were ELISA positive over total number tested. We used multivariate logistic regression to identify factors associated with HIV-testing among cancer patients.
RESULTS Among 13786 patients, the overall HIV prevalence in cancer patients was 37.6% (95%CI: 36.7-38.3), with 10.8% (95%CI: 9.9-11.6) of HIV-infected participants unaware of their status. Participants recruited in the post-PICT era self-reported a higher proportion (65.1%) of previous HIV-testing compared to pre-PICT era (28.4%). Logistic regression analysis indicated that male participants recruited after implementation were over 2 times more likely [OR=2.22 (95% CI: 1.82-2.71)], to have been previously tested for HIV after adjusting for level of education. Female participants recruited after implementation were over 2 times more likely [OR=2.72 (95% CI: 2.36-3.13)] to have been previously tested for HIV after adjusting for level of education, hormonal contraceptive use, having a child under the age of five, and the type of cancer (non-AIDS defining).
CONCLUSIONS We found that having a secondary/tertiary education and recruitment after implementation of PICT were significantly associated with having had a previous HIV test for both men and women. Despite improved HIV-testing, 10.8% of HIV-infected black cancer patients were still undiagnosed. There is a need for cancer patients to be included as a key population in national HIV testing policies for targeted opt-out HIV testing through PICT.

BACKGROUND Tumor infiltrating lymphocytes (TILs) have been associated with favorable clinical outcomes in triple-negative breast cancer (TNBC) and with adverse outcomes in luminal A breast cancer in women of European ancestry. However, there are limited studies on the clinicopathological and epidemiological significance of TILs among sub-Saharan African women, who are disproportionately affected by TNBC.
METHODS This analysis comprised of 801 women with invasive breast cancer in the Ghana Breast Health Study, a population-based study conducted from 2013 to 2015 in three hospitals in Accra and Kumasi, Ghana. Using supervised machine-learning on digitized hematoxylin and eosin-stained slides, we quantified TILs in intra-tumoral and peri-tumoral stromal regions of slides. Automated TILs were validated by comparing with those from two pathologists in 500μm×500μm square regions-of-interest (n=24). Associations between TILs and tumor clinicopathological (age, grade, ER, PR, HER2, size) and risk factors (parity, breastfeeding, menarche, body size phenotypes (lean, average, heavy), family history) were tested in multivariate linear regression models.
RESULTS We observed good correlation between automated and pathologists’ TILs (r2 =0.81). Percent TILs (defined as the area occupied by TILs over total stroma area) was significantly higher in tumors of larger size and higher grade at P<0.05. Among the risk factors evaluated, %TILs was most strongly associated with body size, independently of tumor size and subtype, but varying in relation to grade (P=0.02): %TILs was higher in heavy (median=8.2%) than in lean (median=6.2%) women with low grade tumors (P=0.005) whereas in those with high grade tumors, %TILs was lower in heavy (median=9.9%) than lean (median=11.8%) women (P=0.010). No significant relationships at P<0.05 were seen with other clinicopathological and epidemiological risk factors.
CONCLUSION In this population, we found %TILs to be associated with poor prognostic tumor characteristics and to show discrepant associations with body size depending on histologic grade. These findings suggest interactions between body size, %TILs, and grade to mediate clinical outcomes in breast cancer.

OBJECTIVES
1. To explore the knowledge on risk factors for breast and cervical cancers in Busia and TransNzoia Counties in Western Kenya
2. To explore the knowledge on signs and symptoms for breast and cervical cancers in Busia and Transnzoia Counties in Western Kenya.
METHODS A cross sectional study design was used to conduct the survey in Busia and TransNzoia Counties. An interviewer assisted questionnaire was administered to the general adult population at household level targeting 1801 respondents. Stratified sampling was used to ensure representation at sub counties and village level. All consenting participants were interviewed using a Knowledge questionnaire that covered different aspects of the diseases. Each of them was then graded on their awareness of at least one risk factor and one sign/symptom. Data was entered into a pre-programmed Redcap database and analysed using Statistical Analysis Software(SAS).
RESULTS 913 Males and 888 Females over the age of 18 were interviewed. Knowledge on at least one risk factor for breast cancer was 10.2% for Males and 8.5% Females. And on one risk factor for cervical cancer was 0% for Males and 9.6% for Females. While knowledge on at least one sign/symptom for breast cancer was 14.5% for males and 26% for females. And on one sign/symptom for cervical cancer was 3.2% for Males and 7.6% for Females.
CONCLUSION There is very low knowledge on risk factors and symptoms/signs of breast and cervical cancers which provides an opportunity for awareness campaigns and training of community health workers at the village level on these cancers that will lead to increased uptake of screening services and early detection, hence better treatment outcomes. This study was done as part of the Integrated NCD project (PIC4C) funded by the World Bank in Kenya.

Despite the high incidence (21.7%) and mortality (21.7%) of cervical cancer in Uganda, there remain gaps in awareness. This approach employs a creative way to raise cervical cancer awareness through leveraging family networks for awareness.
METHODS The Thrive A Woman Uganda (TAW) approach utilizes networking as a means to gain the multiplier effect by growing numbers of membership that join the network. Ambassadors and champions are identified within the network, who become both agents of change, but also are charged with marketing the organization's initiative to ensure recruitment of new family members. Equally, all members become agents of change and recruitment. The network in addition to being change makers in the family, utilizes social gatherings to reaffirm commitment, orient new members and build partnerships for sustainability. Social media including Facebook, Twitter and WhatsApp, is a core component of the initiative where the organization, HPV vaccine and cervical cancer information is shared.
RESULTS From an initial group of 7 founding members, TAW has registered 50 individuals and a good number of interested persons over a period of 6 months since it's pilot. The social media accounts are getting active with yearnings for information. The next network event (tea party) is attracting over 200 participants leading to increased TAW visibility, attracting membership and funds for sustainability.
CONCLUSIONThis is a new approach to awareness creation since it targets the very core of the community (family). We recommend that various groups including government, corporate bodies, civil society, philanthropists, international and local donor agencies, families and individuals join TAW and use this approach to foster cervical cancer awareness in Uganda, and equally support through allocating resources towards the achievement of the next events.

OBJECTIVES To review the literature for evidence of implementation and effectiveness of community-based resources such as community health workers (CHWs) and community-based organisations (CBOs) in increasing the uptake of women in CC screening, in the setting of high HIV burden, in SSA.
METHODS We searched MEDLINE, EMBASE, PsycINFO, Global Health, CINAHL Plus, Web of science, ASSIA, Cochrane central, Open grey, Google scholar, ProQuest dissertation and Thesis global, AIM, AJOL and AORTIC databases, plus hand-searching and citation-tracking, from 1980 to date. We looked for studies with a community focus, reporting impact of CHWs and CBOs in SSA with and without comparison groups, and without language or study design restrictions using pre-specified search strategies. We identified 22, 710 articles, after de-duplication and title and abstract screening, 132 full-text articles were assessed for eligibility: 87 were excluded, and 45 articles, (reporting on 49 studies) met the inclusion criteria. Methodological quality was assessed using EPHPP tools.
RESULTS The 49 studies were representative of SSA regions; West (n=13), East (n=14), Central (n=4) and Southern (n=18). There were 30 cross-sectional, 6 RCTs, 6 pre-test/post-test, 5 qualitative, 1 mixed-methods and 1 cohort, studies respectively. Most studies were of moderate quality (n=26). Screening methods included were VIA/VILI, Pap smear, HPV-testing or a combination. CHWs were involved in awareness raising, screening provision (in a minority of studies), and in follow-up of individual women. The role of CBOs was primarily in organising screening campaigns and providing screening within their institutions. Overall, we found acceptability of these approaches within communities, and some evidence of effectiveness and use of CHWs and CBOs in increasing uptake in CC screening in SSA.
CONCLUSIONS This review showed that CHWs and CBOs can sustain the WHO recommended task-shifting in resources-limited SSA, more so, they provided culturally appropriate support because of their understanding of the context

OBJECTIVE The aim of this study was to assess the knowledge of, attitude to and practices of prostate cancer prevention among men in Lagos, Nigeria.
METHODS A descriptive cross-sectional study involving 426 male participants in a selected Local Government Area of Lagos State, Nigeria was conducted. The participants were selected using a multistage sampling technique. A pre-tested self-administered questionnaire was used for data collection and data analysis was done using Epi Info. Chi-square statistics was used to test the association between the variables at the level of significance of 5%.
RESULTS The mean age of the respondents was 42.6±7.6years. Majority (72.3%) of the respondents were married. The major sources of information about prostate cancer prevention were media and health worker. More than half of the respondents (62.4%) had good knowledge of prostate cancer and its prevention. Almost all (98.0%) the respondents had positive attitude towards prevention of prostate cancer. However, only 8.9% of the respondents reported previous screening for prostate cancer. The major reasons for screening for prostate cancer were based on the recommendation by their doctor (43.8%) and on the information from social media (34.5%). Reasons for not screening for prostate cancer include fear of being diagnosed of prostate cancer (12.8%), lack of awareness (23.3%) and lack of doctor’s recommendation (40.4%). There was a statistically significant association between the level of education and knowledge of prostate cancer. There were also statistically significant associations between knowledge, attitude and preventive practices of prostate cancer.
CONCLUSIONS Majority of the respondents had good knowledge and good attitude towards prostate cancer prevention but only a few had been screened for prostate cancer. There is a need for a community-based health education for men on prevention of prostate cancer and training of health care workers on the recommendation of prostate cancer screening in order to increase the screening practices for the prevention of this disease.

OBJECTIVE Doxorubicin (DOX)-induced hepatotoxic animal models are purposefully being used to investigate its mechanism of toxicity for insight into developing interventions for militating against toxicity during cancer management. This study was designed to investigate the protective potential of Annona senegalensis stem bark extracts (ASE) on DOX-induced mitochondrial membrane damage and oxidative stress in liver of albino rats.
METHODS ASE was subjected to phytochemical screening and acute toxicity study. Thirty male Wistar strain albino rats (13 weeks old; 150 -160g) were randomly divided into six (6) groups (n= 5 per group). Group A (control) received distilled water, Groups B, C, D, E, and F received DOX only (20mg/kg), DOX (20mg/kg) + ASE (100mg/kg), DOX (20mg/kg) + ASE (200mg/kg), DOX (20mg/kg) +ASE (400mg/kg), ASE (400mg/kg) only, respectively. ASE was pre- administered orally for 7 days to rats in group C, D, E and F, before administered DOX intraperitoneally on day 7 to group B , C, D and E. Rats were sacrificed and biomarkers of oxidative stress and liver membrane damage were evaluated. Data were analysed using SPSS16.0 and values were expressed as mean ± SEM.
RESULTS Phytochemical screening revealed presence of tannin, saponin, phenol, flavonoid, alkaloids, terpenoids, reducing sugar, cardiac glycosides and absence of combined and free anthraquinone. The total flavonoid, phenol, tannin and reducing sugar content of ASE were 13.11 ±1.09, 27.19 ± 0.61, 8.98 ± 1.2, 27.3 ± 1.6 mg gallic acid equivalent, respectively. No deaths were recorded, and the lethal dose was > 2000mg/kg body weight. Orally pre-administered ASE concentration –dependently increased level of glutathione and activities of catalase and superoxide dismutase in both hepatic mitochondrial membrane and post mitochondrial fractions (PMF) compared to DOX only-treated animals. Malondialdehyde levels gradually and significantly (p<0.05) decreased concentration dependently.
CONCLUSIONS The results revealed that stem bark of ASE has chemo-protective potential on liver mitochondria and PMF against DOX-induced toxicity attributable to its constituent phytochemicals.

OBJECTIVE Men of African descent have the highest burden of aggressive and lethal prostate cancer (PrCa). In Sub-Saharan Africa (SSA), PrCa accounts for 19% of all cancer-related deaths. However, there has been no large-scale PrCa survival studies in SSA. The objective of this study was to assess the feasibility of establishing a PrCa survival cohort in SSA, and ascertain cancer treatment, vital status/ cause of death, and determine willingness of PrCa patients to participate.
METHODS A total of 137 PrCa patients, who were initially enrolled in an ongoing PrCa genetic study across seven hospitals in West and South Africa (U01CA184374) in the MADCaP consortium, were followed from their cancer diagnosis and enrolment into the main study through date of death, date of last contact or end of follow-up: 12/31/2018. Follow-up was carried out by direct phone contact of patients and/or their next-of-kin and by reviewing medical records of follow-up hospital visits. PrCa patients alive at contact were invited to participate into the pilot study and completed a brief survey to assess their general health and symptoms as well as quality of life.
RESULTS The average age of 137 PrCa patients was 68 years old (range 40-88), 70 (51%) and 41 (30%) of them were diagnosed with Gleason score 8-10 cancer, or advanced tumour stage (T3/T4), and the median PSA at diagnosis was 100 ng/ml. Majority of patients received either radiation or hormone deprivation therapy; although there was variability across centres. During an average 20.3 months of follow-up, a total of 29 (21%) patients had died, and 23 (17%) were lost to follow-up; 69% of deaths were due to PrCa. Interestingly majority of patients who died (62%) and those lost to follow-up (61%) had Gleason score 8-10 cancer. Among PrCa patients alive (N=85) at contact, 95% agreed to participate in the pilot study and completed the protocol.
CONCLUSIONS This feasibility study demonstrated the ability to follow-up PrCa patients across several centres and highlighted the advanced clinical characteristics of PrCa and relatively low survival among African men. However, larger studies are needed to better understand the clinical and epidemiological risk factors for PrCa survival in Africa and develop strategies to address survival bias and lost to follow-up.

BACKGROUND Women of West African ancestry are more frequently affected by early onset, ER-negative (ER-) breast cancers than other populations, potentially due to genetic susceptibility. However, genetic studies have largely been performed among women of European ancestry.
METHODS The study population included up to 899 breast cancer cases and 1,630 controls from GBHS, a population-based case-control study of breast cancer. Approximately half of the tumors were ER-. Protein truncating mutations in 35 known or suspected breast cancer genes were determined using the BRIDGES targeted sequencing panel. A polygenic risk score (PRS) based on 313 common variants that was previously developed by the Breast Cancer Association Consortium (BCAC) in women of European ancestry was determined using genotyping arrays and imputation. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) of breast cancer risk.
RESULTS The percentages of cases/controls with truncating mutations in any of six established breast cancer genes were 7.78%/1.15%, respectively: BRCA2 (n=34/n=23), BRCA1 (n=22/n=17), PALB2 ( n=9/n=9), ATM (n=4/n=7), TP53 (n=1/n=1) and CHEK2 (n=0/n=0). OR (95%CI) for mutation carriers by ER+ and ER- tumor status were: BRCA1 [5.48 (1.02-29.51) / 26.98 (7.46-97.6)], BRCA2 [9.05 (3.73-21.97) / 5.90 (2.23-15.64)], and PALB2 [36.61 (4.17-321.63) / 6.74 (0.41-111.28)]. Of all the other genes, only mutations in RAD50 were significantly associated only with ER+ disease [8.19 (1.31-51.07)]). The OR (95%CI) per 1 SD of the PRS was 1.22 (1.13-1.33), and the OR (95% CI) for women at the highest 5th percentile compared to average risk was 1.87 (1.40-2.51).
CONCLUSION Truncating mutations in some established breast cancer genes have large relative risks and affect ~8% of cases in the general population. The 313-variant PRS stratifies women according to risk, albeit less-so than in women of European ancestry. Additional larger breast cancer genetic studies in West Africa are needed to improve genetic risk stratification in this population.

OBJECTIVE Epstein-Barr virus (EBV) is a human herpes virus that infects over 90% of the world’s population and is linked with cancer development. Risk of EBV-driven cancers increases with immune suppression (IS). Organ transplant recipients receive IS to prevent graft rejection and are at highest risk of developing EBV-associated lymphomas known as post-transplant lymphoproliferative disease (PTLD). Reducing the level of IS medication may control PTLD but often leads to graft-rejection. The focus of our research is restoring or enhancing EBV-specific immunity to promote long-term protection from EBV-driven cancers.
METHODS We developed a vaccine to bolster EBV-specific immunity by targeting the EBV immediate early protein, BZLF1. We specifically delivered the protein (BZLF1) to dendritic cells (DCs) through its endocytic receptor DEC205. Antigen-loaded DCs were co-cultured with autologous peripheral blood mononuclear cells (PBMCs). To test the EBV vaccine in-vivo, we utilized a human-murine chimeric model of EBV-driven lymphoproliferative disease (EBV-LPD). Severe combined immune deficient (SCID) mice were engrafted with PBMCs from EBV+ donors. Mice were immunized with DCs loaded with DEC205-BZLF1 or DEC205-control at the time of PBMC transplant and received booster doses at day 14 and 28. Cell from the co-culture and human cells recovered from mouse spleen were analysed by mass cytometry and by flow cytometry HLA-tetramer assay.
RESULTS DEC205-BZLF1 co-cultures showed increased expansion of EBV-specific cytotoxic T lymphocytes (CTLs) (p-value: 0.0002) capable of abundant IFNγ production and potent cytotoxicity against autologous tumour. This vaccine significantly improved survival in vaccinated mice (p-value: 0.035). Splenocytes from mice in the DEC205-BZLF1 vaccination group revealed higher responsiveness to autologous targets compared to controls as determined by ELISpot.
CONCLUSIONS These results further support pre-clinical and clinical development of vaccine approaches utilizing the BZLF1 protein as an immunogen to harness adaptive cellular responses to prevent EBV-associated LPD in vulnerable patient populations.

Advances in high-resolution genomic studies enabled the identification of a plethora of molecular targets that cooperate to drive the progression of primary breast cancer to metastasis supporting a potential relevance as therapeutic targets. Thus, in contrast to narrow selectivity agents directed against one single target, multi-hit agents targeting dual or multiple cellular targets is gaining interest in the field of anticancer drug discovery. In this context, we characterized novel small molecules selectively targeting distinct kinases that cooperate to promote breast cancer cell survival and progression, including Aurora, Jak, and Pkc kinases based on high-throughput enzymatic and cell-based assays using a panel of cancer models representative of major breast cancer subtypes. Among lead molecules, a selective and potent pharmacological molecule (referred herein as SLLN-15) was identified to selectively induce autophagy, an evolutionarily conserved catabolic process activated in response to metabolic stresses and recognized to fulfill either pro-survival or pro-death function depending on cellular context. SLLN-15 induced a superior dose-dependent anti-proliferative activity in a panel of triple negative breast cancer cell lines (e.g. MDA-MB-231, BT-20, 4T1) associated with induction of autophagy and autophagic flux. SLLN-15-induced autophagy correlate with selective inhibition of the AKT (a serine/threonine kinase known as protein kinase B) and MTOR (mammalian target of rapamycin) at nanomolar concentrations. On the other hand, we demonstrated that the activity of SLLN5 is distinct from rapamycin, a known autophagy inducer and MTOR inhibitor. Inhibition of autophagy by siRNA-/Crispr-mediated targeting of the autophagy regulators BECN1 (Beclin 1), ATG5 (autophagy-related 5) and ATG7 (autophagy-related 7) significantly protected against SLLN-15-induced inhibition of cell viability, further supporting that SLLN-15 induced inhibition of breast cancer cell proliferation was autophagy-dependent, which was associated with decreased aurora kinase A expression, AKT phosphorylation and MTOR activation. In vivo, SLLN-15 given orally is well tolerated and revealed a potent anticancer and anti-metastatic activity in mice bearing human breast cancer xenografts. In summary, this study supports the clinical utility of autophagy inducers as a therapeutic for advanced breast cancer. Supported by QBCF and CIHR.

L'objectif de cette recherche est de décrire la prise en charge des patients en fin de vie par les infirmiers à l'institut national d'oncologie. Les infirmiers ne donnent pas d'importance à la prise en charge globale, ils intéressent au soins techniques au dépend des soins relationnels et éducatifs. Cette recherche a été entamée par élaboration d'un cadre de référence, qui est conceptuel fournissant les différentes dimensions de la prise en charge des patients en fin de vie, se basant sur le caring, le modèle de soins de soutiens et la recensions des écrits. L'enquête a été menée auprès de 25 infirmiers travaillant au niveau de cinq services à l'INO, choisis par choix raisonné, avec un taux de participation de 84 %. Les participants ont répondu à un questionnaire visant à décrire la PEC des patients en fin de vie. L'analyse des données révèle que ; a) les infirmiers sont en majorité des IDE mais ne font pas de planification et ni de projets de soins au niveau des unités, b) 43% n'organisent pas de séances éducatives, c) les besoins du patients ne sont pas identifiés par les infirmiers par plus de deux tiers et d) la majorité ne prennent pas en charge la phase terminale et d'agonie qui est une phase très vulnérable. Ceci explique par le fait que la prise en charge des patients en fin de vie nécessite une approche pluridisciplinaire où les compétences de chaque intervenant sont reconnues. Enfin des propositions de recommandations pour la pratique infirmière sont proposées pour une amélioration de la prise en charge des patients en fin de vie.

BACKGROUND Survivors of childhood cancers are at risk of developing subsequent primary leukaemias (SPLs), but the long-term risks beyond 20 years of treatment are still unclear. We investigated the risk of SPLs in five-year childhood cancer survivors using a large-scale pan-European (PanCareSurFup) cohort and evaluated variations in the risk by cancer and demographic factors.
METHODS This largest-ever assembled cohort comprises 69,460 five-year childhood cancer survivors from 12 European countries. Standardised incidence ratios (SIRs) and absolute excess risks (AERs) were calculated.
RESULTS One hundred fifteen survivors developed an SPL including 86 myeloid leukaemias (subsequent primary myeloid leukaemias [SPMLs]), 17 lymphoid leukaemias and 12 other types of leukaemias; of these SPLs, 31 (27%) occurred beyond 20 years from the first childhood cancer diagnosis. Compared with the general population, childhood cancer survivors had a fourfold increased risk (SIR = 3.7, 95% confidence interval [CI]: 3.1 to 4.5) of developing leukaemia, and eight leukaemias per 100,000 person-years (AER = 7.5, 95% CI: 6.0 to 9.2) occurred in excess of that expected. The risks remained significantly elevated beyond 20 years from the first primary malignancy (SIR = 2.4, 95% CI: 1.6 to 3.4). Overall, the risk ratio for SPML (SIR = 5.8, 95% CI: 4.6 to 7.1) was higher than that for other SPLs.
CONCLUSIONS We demonstrate that beyond 20 years after childhood cancer diagnosis, survivors experience an increased risk for SPLs compared with that expected from the general population. Our findings highlight the need for awareness by survivors and their healthcare providers for potential risk related to SPL.

OBJECTIVE Prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer death in men, thus constituting a major public health issue worldwide. It is observed that prostate cancer screening seeking behaviour among Nigerian men is worrisome though there is dearth of empirical information to support this. On this premise this study was designed to assess the pattern of utilization of prostate cancer screening services among male workers in one of the Nigerian tertiary healthcare facilities.
METHODS This cross-sectional descriptive study utilized a structured questionnaire to elicit information form purposively selected 250 male workers. The data were analysed descriptively and inferentially using the Statistical Package for Social Science (SPSS) version 21.0. The results were presented in tables and charts.
RESULTS The mean age ± standard deviation of the male workers was 41 ± 12.5 years. Close to 30% of the male workers had never heard of prostate cancer screening, while over 50% exhibited inadequate knowledge of the screening as the time of data collection. Moreover, approximately 40% expressed negative attitude towards utilization of prostate cancer screening services, and therefore had never utilized it. Besides, the male workers with fewer years of work experience exhibited better attitude towards the use of prostate cancer screening than their colleagues who had more years of work experience; p-value < 0.05.
CONCLUSION The finding shows that, akin to non-healthcare workers, the health workers may need motivation and mobilization programmes to improve their health-seeking behaviours regarding prostate cancer screening.

OBJECTIVE In Uganda, over 32,000 new cancer cases and 21,000 cancer related deaths occurred in 2018. Currently, 56,238 people are living with cancer. Late presentation, limited access to diagnosis and treatment services contribute to the high death rate. The Kampala Cancer Registry is one of the oldest population-based cancer registries in Africa dating back in 1951. Due to its central location and low population coverage, there was need to document the burden of cancer in other geographical areas that have significantly different risk patterns and population dynamics. The Mayuge Cancer Registry (MCR) was established to address this gap. We examined the feasibility of establishing a cancer registry in a rural setting.
METHOD With financial and technical support from World Bank Trust Fund Regional Program for cancer registration through ECSA-HC, MCR was prioritized. MCR is located in Eastern Uganda with a geographical coverage of 2,340312 people from 7 districts. The Uganda Cancer Institute (UCI) oversees cancer registry activities and provides the technical aspects of the project. UCI works hand in hand with the local government that provides human resources and infrastructure. The major inputs include; a) Registry staff training, b) knowledge exchange workshops, c) Equipment’s: ICT and Furniture.
RESULTS Data collection is on-going. We have retrospectively (2015-2017) collected 439 cancer cases; 72% (316/439) of cases are females, 46% (202/439) were in age-group 30-49. Among males, Prostate 14%, (18/123), Kaposi’ s Sarcoma 23% (28/123) and Lymphomas 7% (9/123) while among females cervix 58%,(183/316), Breast; 7% ,(22/316) Kaposi’s Sarcoma; 3% (11/236); are most common cancers.
CONCLUSION Cancer registry in this rural setting has been initiated. In addition, MCR has acquired ICT equipment,furniture and competent human resource that are essential for Cancer registration,with the experience of knowledge exchange and networking with other cancer registries cross the East African community has been the greatest achievement and good practice.

Nursing is an essential component for conducting a clinical research.
OBJECTIVE To train nurses at the General Hospital de Mavalane to conduct a clinical research study requiring collection of cervical samples for HPV testing.
METHODS A research partnership between MD Anderson Cancer Center in the USA, Barretos Cancer Hospital and other institutions in Brazil, the Mozambique Ministry of Health and Hospital Geral e Centro de Saúde de Mavalane, Maputo, Mozambique was created to conduct the study. Given the common language of Portuguese, research nurses and laboratory experts from Brazil travelled to Mozambique to train a team of nurses in subject recruitment, informed consent, sample collection, data management, research subjects care and health education delivery.
RESULTS The 5-day workshop consisted of training in conduct of research, ethics and technical skills necessary to implement cervical cancer prevention research in a low resource setting. The nurses received guidance and feedback in consistency and analysis of data collected and the quality of samples. A team of 15 professionals were supervised in hands on training of all steps of the research protocol during the enrolment of the first 26 research subjects. After this, the data for the next 424 enrolled patients were evaluated by visits by the Brazilian team every three months. From the data management findings, one screening failure was identified. Video conferences were held twice a month to follow up and review progress and the theoretical practical training was repeated each three months in the five visits. After the training the nurses had a higher level of confidence in collection of research samples and a greater knowledge regarding ethical and clinical practices in research.
CONCLUSIONS This training may provide support to enable other nurses to conduct research and care for patients participating in a research study in Mozambique. The trained nurses will multiply the knowledge. This can be a first step to the team engagement of evidence-based practice.

OBJECTIVO Contribuir com conhecimento de diferentes variáveis clinicas e histopatológicas de cancro colo de útero no nosso meio. Método: Realizamos uma investigação retrospectiva descritiva e transversal de 150 pacientes portadores de cancro de colo de útero em hospital central de Maputo diagnosticados no ano 2018.Resultados:O grupo de idades de 40 a 50 anos foi o mais numeroso com 26,7% total de pacientes, e idades extremos (menor que 20 anos e maior que 80 anos) não estiveram presentes na amostra. Distribuição por estádio clinico o mais frequentes foi IIIB com 31% de total de pacientes, seguidos de estádio IIB com total 27%,existem um predomínio de estádios de doença localmente avançado, que não permitiu tratamento cirúrgico. Pacientes com serologia negativa por VIH corresponde 52,7% e com serologia positiva por VIH foi de 47.3%. O carcinoma epidermóide representaram 91.9% de total de casos o que coincidi com literatura médica revisado. Grande maioria de pacientes tiveram 7 ou mais partos, sendo a multiparidade um factor risco para esta doença. Conclusão: O carcinoma de colo útero em Moçambique tem alta incidência favorecida por alta prevalência de VIH, ausência de controlo de paridade e deficiência de programa de diagnóstico precoce e prevenção. Palavra chaves: cancro de colo de útero, VIH, estadiamento clínico, tipo histopatológico.

What is the solution to breast cancer in sub-Saharan African, where there is low awareness and no mass screening programs, where peak incidences occur in the 30s, where most presentations are in advanced metastatic states, thereby resulting in high death rate? Mammography is not the answer since they are restricted to urban hospitals and are unaffordable. Most importantly, mammograms are not recommended for women below 40 years which are the most crucial years for screening sub-Saharan women. With breast cancer penetrance of 0.76% in the population, of which 30% are below 35 years, definitely, a reliable, cheaper, available and acceptable screening method is needed in addition to Clinical Breast Examination (CBE). The development of Breast-i, a hand-held optical device designed to detect angiogenesis will be the needed solution for breast screening. Breast-i illuminates the breast with non-radiation red light and degree of light absorbed by haemoglobin depends on blood cells per unit volume and neoplastic tumours are seen as dark spots. Screening over 3000 mostly young females, Breast-i picks suspicious lesions missed by CBE and detected 22 more cases of which 7 had angiogenesis but were not palpable and 15 were missed by CBE due to large breast size. Breast-i, by showing that 35% of the cases were below 45 years confirmed the worrisome sub-region observation. In addition, Breast-i positives always warrant further evaluation as it is potentially cancerous. The presentation will show all the data we have with respect to Breast-i and why we believe that its angiogenetic sensitivity, availability, affordability and acceptability even in strict traditional communities will be the device to early detect breast cancer in the region for increasing treatment success. Our results also recommend adjusting breast cancer screening to early twenties for women and the low cost involved, mean African governments can sponsor nation-wide screening programs and establish national breast cancer registries for control and treatment guidelines

BACKGROUND Patients without health insurance are less likely than insured patients to be screened and treated after cancer is diagnosed.
RESEARCH QUESTION In this study we addressed the following questions: Do insured patients covered by National Hospital Insurance Fund have less advanced stages of cancer than uninsured patients at diagnosis? And, for each stage of disease, do uninsured patients have worse outcomes compared to insured patients?
METHODS Our target population consisted of 359 patients enrolled at cancer programmes at the Chandaria Center for Chronic diseases. The ages of the patients ranged from 23 to 65 years of age. We compared the stage of disease and stage-specific survival among patients with National Hospital insurance Fund (NHIF) with patients without health insurance. We performed a regression analysis to control for age, race, marital status, household income, coexisting diagnoses, and disease stage to estimate the adjusted risk of death for these groups,
RESULTS Uninsured patients and presented with more advanced disease than insured patients (P<0.001 and P = 0.01, respectively). Survival was worse for uninsured patients than for insured patients with local disease (P<0.001 for both comparisons) and regional disease (P<0.001 for both comparisons). The adjusted risk of death was 56 % higher (95% CI 20;84%) for uninsured patients.
CONCLUSIONS The more frequent adverse outcomes of cancer among patients without health insurance suggest that such insurance would improve access to screening and optimal therapy.

INTRODUCTION Breast cancer is the primary cause of cancer death among women globally with most cases occurring in low resourced settings. The disproportionate burden of breast cancer is compounded by poor survival. While most high-income countries have five-year survival rates greater than 85%, no sub-Saharan countries have rates that exceed 60%. In the Krobo-Akwamu Traditional area, Ghana several barriers hamper access to timely breast cancer care: delayed presentation due to misperceptions about breast cancer and treatment from religious/traditional healers, cost, distance to facility and overcrowding of teaching hospitals. Little is known about the epidemiology, morbidity, and mortality of breast cancer in this area.
STRATEGY The VRA Hospital in Akosombo serves the Krobo-Akwamu Traditional area and is the only hospital that offers specialist care. In 2015 a team of dedicated staff came together to form a Breast Care Centre. Through collaboration with multiple organizations, including Motec-Life UK, Korle Bu Teaching Hospital and the University of Utah Center for Global Surgery, several platforms and systems were created from screening and early detection to providing clinical care including:
• Sustained breast cancer awareness campaigns
• Free, weekly walk-in clinical breast (examinations) screenings
• Expanded care including surgery, chemotherapy, and hormonal therapy
• Electronic reporting of pathology
• Electronic breast cancer database
• Training workshops for health staff to promote early disease detection
RESULTS
• People reached directly with awareness campaigns……………………45 700
• Clinical breast screening……………………………………………….1524
• Breast clinic attendance………………………………………………..750
• Breast biopsies …………………………………………………………154
• Confirmed cancer cases ………………………………………………..75
• Total mastectomies …………………………………………………….48
• Completed chemotherapies…………………………………………….26
• Breast reconstruction…………………………………………………...2
CONCLUSIONS The VRA Hospital Breast Care Centre has successfully expanded breast cancer care in a resource-limited environment. Ongoing research and collaboration will continue to support and determine the impact of expanded capacity.

OBJECTIVE Physical inactivity is one of the known modifiable risk factors associated with cancer. Results from the Uganda NCD risk factor survey (2014) showed that Ugandans are becoming increasingly physically inactive especially those living in urban areas. Physical inactivity is known to contribute cancer of the Breast, Oesophagus, Endometrium, and the Colon. Uganda Cancer Society (UCS) held a mass dance fitness event dubbed Sukuma aimed at promoting improved lifestyles as well as providing an avenue for cancer awareness, advocacy and resource mobilisation.
METHODS UCS partnered with Uganda Cancer Institute, Ministry of Health, Kampala Capital City Council Authority, Uganda Police Force and a professional fitness organisation. The concept was in line with the recently launched National Day of Physical Activity, a national campaign to raise awareness on the growing burden of NCDs in Uganda. The event was to last three hours including a brief talk on the importance of physical activity. Publicity was through social media, peer to peer referral, media press briefing and posters. Resource Mobilisation was through sale of dance-kits and the media present was a platform to promote the Uganda’s treatment for all advocacy program.
RESULTS The event was attended by over 500 people with high media coverage evidenced in talk shows, interviews and news airing on national TV. Sell of kits amounted to 9.6 million Uganda Shillings alone excluding other forms of support and these funds were dedicated to supporting activities of UCS such as World Cancer Day. Social media prior during and after this event was high with posts having over 1700 reaches minus boosting.
CONCLUSION The event was successful given the intended outcomes of cancer awareness; advocacy and resource mobilisation were achieved. Further still, the presence of survivors was a point of inspiration prompting those in attendance to sign up for fitness programs.

INTRODUCTION A cancer diagnosis often produces an overwhelming emotional response, including feelings of shock, denial, fear, anxiety, anger, grief, and depression. Because a multitude of medical tests and consultations typically are needed to determine a definitive diagnosis and course of treatment, a cancer patient’s path through the healthcare system can be complicated and confusing. Even worse, some patients may not fully comprehend the importance of prompt evaluation and treatment of their disease. To address these challenges, more and more cancer programs are looking to assist patients through this process. Patient navigation has emerged as an innovative, community-based approach to reducing cancer care access barriers along each step of the cancer care continuum; screening, diagnosis, treatment, and outcomes. There is urgent need to introduce patient navigation training programs in Uganda to equip navigators with skills to help them effectively navigate patients across the care continuum. Trained nurses, social workers, nutritionists, financial counselors, and other professionals can provide a depth of expertise in a cost-effective manner and improve treatment outcomes for cancer patients. A coordinated team will be formed composed of administrators to champion the program; supervisors to provide clinical and administrative support; and navigators to guide cancer patients through the cancer care continuum.
OBJECTIVES i) To improve basic cancer patient navigation skills; ii) To build a coordinated team of cancer patient navigators composed of representatives of cancer hostels, expert cancer patients, Uganda Cancer Institute (UCI) Social workers, clinical and research teams; iii) To develop cancer patients’ navigation action plans at Uganda Cancer Institute and iv) To minimize barriers to care experienced by individual patients
METHODS The training will use a modified Harold P. Freeman Model (1990) and Patient Navigator Training Collaborative Model’s materials for Level 1 patient navigators to train nurses, social workers, nutritionists, financial counselors, and other professionals. Content will be delivered through plenary presentations including navigation best practices and small group work.
EXPECTED OUTCOMES Thirty three navigators equipped with cancer patient navigation skills; patient navigation committee established; Patient Navigation Action Plans in place; improved access to services across the cancer care continuum.
FOLLOW-UP ACTIONS Holding of monthly patient navigators’ meetings. Implementing patient navigation action plans. Compiling and submission of monthly patient navigation reports.

OBJECTIVE Multimorbidity in women with breast cancer may delay presentation and may affect cancer treatment decisions and outcomes. The aim of this study was to describe the multimorbidity profile of women newly diagnosed with breast cancer in South Africa, and to identify its correlates and associations with stage at breast cancer diagnosis.
METHODS We collected self-reported data on five chronic conditions (hypertension, diabetes, cerebrovascular diseases, asthma/chronic obstructive pulmonary disease, tuberculosis), determined obesity using body mass index (BMI), and tested HIV status, in women newly diagnosed with breast cancer between January 2016 and April 2018 in the South African Breast Cancer and HIV Outcomes study (SABCHO), which included 5 public hospitals. Using multivariate logistic regression models, we identified correlates of ≥2 of the 7 above mentioned conditions (defined as multimorbidity), and multimorbidity itself with stage at diagnosis (advanced (III and IV) vs. early (I and II)).
RESULTS Among 2281 women, 1001 (44%) presented with ≥2 chronic conditions; obesity (52.8%), hypertension (41.3%), HIV (22.0%) and diabetes (13.7%) were the chronic conditions that occurred most frequently at diagnosis. Multimorbidity was more common with older age (OR=1.02; 95% CI 1.01-1.03), higher household socio-economic status (HSES) (OR=1.06; 95% CI 1.00-1.13) and enrolment at Kwa-Zulu Natal (KZN) Durban hospitals: (OR=1.89; 95% CI 1.42-2.51) and KZN Greys hospital, Pietermaritzburg: (OR=1.49; 95% CI 1.12-1.97) vs. Soweto, Johannesburg hospital. Ethnicity (Asian OR=0.70; 95% CI 0.50-0.97 and white OR=0.36; 95% CI 0.24-0.54, vs. blacks) was associated with a lower odd of having multimorbidity. Multimorbidity was not associated with advanced stage breast cancer at diagnosis, but for self-reported hypertension there was a lower odd of being diagnosed with advanced stage breast cancer in the adjusted model (OR 0.80; 95% CI 0.64-0.98).
CONCLUSIONS The burden of multimorbidity is high among these patients with breast cancer. Our findings suggest that the presence of multimorbidity had no significant impact on breast cancer stage at diagnosis. There is need to understand the impact of multimorbidity on breast cancer outcomes.

OBJECTIVES Chartrounds (www.chartrounds.com) is a free web-based virtual conferencing platform for radiation oncologists to review cases with leading disease-site experts. Chartrounds was founded in the US in 2010, and in recent years the international member base has grown substantially. To respond to the increased interest in Chartrounds globally, 4 dedicated international Chartrounds sites were developed: Chartrounds India, Chartrounds Africa, Chartrounds Latin America, and Chartrounds China. Following the success of Chartrounds India, Chartrounds Africa was launched in January 2018. Our initial experience with this initiative is reported here.
METHODS The US Chartrounds platform was adapted to create Chartrounds Africa (afr.chartrounds.com). Through a partnership with the African Organization for Research and Treatment in Cancer (AORTIC), Africa-based specialists were recruited, and the potential Chartrounds Africa audience was targeted through the AORTIC membership email list. Clinicians with experience in African clinical settings were also recruited. The first Chartrounds Africa session commenced in January 2018, and one-hour disease site and/or technique focused sessions have continued on a monthly basis at a scheduled time since. After each session, a set of standard questions is posed to all Chartrounds Africa members to collect feedback.
RESULTS Between November 2017 and March 2019, 12 Chartrounds Africa sessions were completed, led by 10 different specialists and covering 6 disease sites/topics (Breast: 1, Gastrointestinal: 1, Genitourinary: 3, Gynecologic: 4, Head & neck: 1, Thoracic: 1). At the conclusion of March 2019, 42 oncologists registered as members. Thirty-three members had participated in at least one Chartrounds Africa session. The average number of participants per session was 3 (range 1-6). Five surveys have been completed with participants rating the quality of the sessions highly (average 4.8, scale 1-5).
CONCLUSIONS Chartrounds Africa has the potential to be a useful online platform for radiation oncology case review and education. Initiatives to increase participation such as incorporation of French-speaking sessions are currently being implemented. In addition, additional feedback through informal channels (i.e. email) will be sought in order to inform future changes to Chartrounds Africa.
ACKNOWLEDGEMENT This project was supported in part by funding from Weill Cornell Medicine.

PURPOSES Radiation therapy centres in developing nations are beginning to adopt 3D-CRT. Standardized instruments for assisting RT professionals as they transition from 2-D to 3D-CRT planning are lacking. We pilot-tested a two-week curriculum to provide the basic foundations for RT professionals to implement prone 3-DCRT for breast cancer. An additional aim of the project is to assess feasibility as a model for wider application in other centres. The pilot site, the Institut de Cancerologie in Libreville, Gabon acquired a CT simulator and linear accelerator in 2012. We focused on breast cancer since it is the most common female cancer in Gabon.
METHODS The training curriculum for radiation oncologists (ROs), therapists (RTTs) and medical physicists (MPs) consisted of:
Week 1 (Days 1-5)
1) Assessment of workflow and scheduling of the course
2) Lecture on differences between 2-D and 3-DCRT & 3-DCRT benefits
3) Lecture on prone positioning
4) Review of the RTOG Breast Cancer Atlas
5) 10 questions test pre- & post-training
6) Practical training in supine and prone CT simulation.
Week 2
1) Guided contouring of tumor and normal organs using Educase modules.
2) Practice in designing beam shapes & angles through a dosimetry workshop
3) Simulate, plan and treat first patient
4) Feedback from the participants using focus groups and questionnaires.
RESULTS Thirteen RT professionals participated in the pilot curriculum (6 ROs, 2 MPs and 5 RTTs). All thirteen attended the lectures and participated in the CT simulation. Contouring was reviewed with ROs after patient simulation and based on availability between patient visits. Assessment demonstrated that contouring was widely considered the most useful aspect of the curriculum. Key challenges included (1) achieving individual participation in all aspects of the curriculum in a high-volume department, (2) optimal design of a prone breast board and (3) language barriers.
CONCLUSIONS A pilot curriculum to guide 3-DCRT transition is feasible. It requires availability of a team of RT professionals from both collaborating institutions and sufficient flexibility from all parties. It presents a unique opportunity for exchange of expertise. Based on this initial success, the next phase consists of a curriculum to train RT professionals in 3-D techniques for pelvic cancers. Parallel efforts in refining the curriculum are ongoing for testing the intervention in the next collaborating country.
ACKNOWLEDGEMENT This project was funded by a grant from the Andy Paul Africa Initiative through the Institute for African Development at Cornell University.

OBJECTIVE To identify predictive biomarkers of treatment failure and disease recurrence in acral lentiginous melanomas using a preliminary in vitro approach.
METHODS Two melanoma cell lines (UCT-Mel-1 and A373), one malignant fibroblast cell line (HT1080) and one normal keratinocyte cell line (HaCat) were used. All 4 cell lines were treated with 0.625mM to 10mM of dacarbazine (DTIC) to identify respective IC50 concentration for the cell lines. Cells were induced to resistance and recurrence using concentration-based workflows. Thereafter, cells were harvested and subjected to protein extraction, quantification and digestion. Peptides were desalted using a C-18 solid phase extraction (SPE) technique; lyophilized and resuspended in HPLC grade water containing 0.1% formic acid (v/v). Mass spectrometric analysis was performed on a hybrid quadrupole time-of-flight instrument (IMPACT II, Bruker Daltonics, Bremen, Germany) in line with an ultra-high-performance liquid chromatography (UHPLC) instrument (Dionex® UltiMate 3000 RSLC nano-UPLC system, Thermo Scientific, San Jose, CA, USA). Data generated was pre-processed and analysed using qualitative (ProteinScape-Mascot workflow) and quantitative (Maxquant-Perseus) proteomics bioinformatic algorithms and pipelines. Multivariate statistical analyses were used to identify differentially expressed proteins and molecular signatures. Furthermore, STRING functional pathway analysis was conducted to determine enrichment for various biological processes using the top-ranking differentially expressed proteins.
RESULTS IC50 values were generated and used to establish a recurrent and resistant cell lines. Differentially expressed proteins were identified (false discovery rate (FDR) ≤ 0.05) between resistant/recurrent cells for all 4 cell lines using quantitative proteomic analysis. Key biological pathways and molecules involved in melanoma recurrence and resistance were identified.
CONCLUSIONS These preliminary findings indicate that proteomics and in-vitro modelling may potentially improve the identification of molecular targets for disease treatment. Identified biomarkers would be further validated in formalin-fixed paraffin-embedded (FFPE) archival tissues and xenograft models.

OBJECTIVE The aim of the feasibility is to increase the participation rate in Cervical Cancer prevention programs using an e-Health solution. We started a feasibility e-Health project in Uganda for prevention to find out convenience and customers usability in the hands of midwife guided Health Care Units (HCU).
METHOD We developed an e-Health solution called "MaLife" enabling smart phone applications for customers (frontend device) to be connected with a hospital-based program (backend). The applications collect customer personalized data, medical history and are connected via internet and cloud services according to the highest data safety rules.
RESULTS The "Frontend" mobile device has 3 parts: 1.) educational, 2.) symptom documentation and 3.) HPV testing and result reporting including appointment for medical consultation. The web App "Backend" includes personalized data documentation such as socio-economic data, patient's history and follow up. The data are transferred to a cloud service for data storage and statistical analysis. The project started as a feasibility project in 5 rural areas in Uganda of midwife guided Health Care Units (HCU). The aim is to find out the convenience and usability, how customers understand it and are able to perform documentation. A similar program runs in parallel for maternity documentation. All patients are offered to use self-sampling brushes (Evelyn) to collect vaginal probes. All probes are sent to a Lab (Freiburg; Germany) for HPV testing. The participating midwives were trained to explain to the customers the function of the brushes as well as the function of the application. The midwives were also trained to use a portable colposcope (Eva; mobileODT; Israel). The ODT device can take and store pictures as well as to send those to experts from where recommendations are given. The 5 centres enrol 30 customers each, 15 for HPV and15 for maternity testing. The enrolment time of the pilot project is 4 weeks. After enrolment exists an observational phase to find out how the MaLife application will have been used. All customers receive after the pilot project a short questionnaire asking for convenience and about the benefit of the application.
CONCLUSION After the feasibility project we will improve the applications according to reported issues and include satellite connection devices enabling digital addressing (Ukowapi). Furthermore, we plan a clinical trial to find out if the used algorithm can be implemented in the general health care program of the country.

OBJECTIVES The primary objective: describe the socio-demographic, clinical and pathological features of patients with colorectal cancer in Johannesburg, South Africa and to determine patient outcomes as defined by overall survival.
SECONDARY OBJECTIVES determine whether patient features and outcomes vary within different population groups in South Africa.
HYPOTHESIS black patients present at an earlier age, with a different spectrum of clinical colorectal cancer, and have poorer outcomes than non-black patients.
METHODS Data from 4 academic centres are prospectively collected. Between 28 February 2015 and 31 December 2017, a total number of 359 patients are evaluated. The data pertinent to this study included profies of:
Demography.
Socioeconomic status.
Family history of cancer.
Nutritional history.
Behavioural risks.
Adjusted and unadjusted binary logistic regression are carried out to explore risk factors for CRC diagnosis before and after the age of 50 and Cox proportional hazards models are constructed to identify risk factors for overall survival, with Kaplan Meier curves developed to examine differences in survival by age-group, ethnicity, BMI, education, and AJCC stage.
RESULTS The sample included 521 patients. There was a significant difference in mean age across races: 53.78 years in Blacks and 59.91 years in Non-Blacks. 53.77% of patients had rectal cancer and 46.23% colon cancer. In multivariate analysis of risk factors for all patients less than 50 years, patients are significantly more likely to be:
Black
Smokers
Employed
Educated to the level of high school and are significant when compared to patients aged over 50 years. In Cox Hazards models with univariate analysis significantly poorer outcomes were seen in patients that are:
Blacks
Poorer educated
Underweight/normal weight
Advanced AJCC stage at presentation
CONCLUSION The preponderance of rectal malignancies in this sample is striking. Outcomes in patients treated for colorectal cancer in Johannesburg are significantly worsened by socioeconomic variables.

OBJECTIVE We sought to identify detailed spatial patterns of cervical cancer incidence in the Kampala Cancer Registry catchment area.
METHODS We established a partnership between Makerere University in Uganda and the Medical College of Wisconsin in the USA. Kampala Cancer Registry electronic records for cervical cancer diagnoses between 2006 and 2012 were augmented to include the parish and sub-county of residence at diagnosis. Two MCW medical students identified, entered and quality checked parish and sub-county geographies listed on paper records and entered them into the electronic database. Population data by age and sex was obtained from the Uganda Bureau of Statistics for all parishes in 2014. Adaptive spatial filtering was used to estimate indirectly age standardized (observed/expected) cervical cancer incidence rates continuously across the study area. High resolution maps were created to visualize spatial patterns.
RESULTS A total of 1105 records were included in analysis. Of these, 94% of records included a valid sub-county and 88% of records included a valid parish. The map reveals areas of high cervical cancer incidence in specific parts of Kawempe, Central, Nakawa and Makindye sub-counties in Kampala. Among areas revealed to have high incidence rates are the regions surrounding the Katanga Slum and a women's prison.
CONCLUSIONS There is a growing epidemic of cancer and other non-communicable diseases in sub-Saharan Africa. Targeted, specific, cost-effective strategies are needed to manage the growing burden of cancer, including geospatial analysis. Mapping cancer incidence with high geographic specificity is feasible in Uganda and reveals clear spatial patterns that can inform resource allocation and support additional research. Future work should identify causal factors associated with observed patterns of cervical cancer incidence, identify spatial patterns of additional cancers, and utilize maps to inform cancer prevention and control strategies targeting HPV vaccination and cervical cancer screening in Uganda.

OBJECTIVE The aim of this study was to compare the populations of São Tomé and Príncipe and Portugal in genes related with folate and nitric oxide metabolisms and oxidative stress that are relevant in cervical cancer aetiology.
METHODS We analysed 325 DNA samples from Portugal and 178 DNA samples from São Tomé and Príncipe. The following polymorphisms were studied: the VNTR in intron 4 at eNOS, the SNP rs1801133 at MTHFR and the GSTM1 and GSTT1 polymorphisms. The polymorphisms that were associated with cervical cancer were then selected. For this, a population of 151 Portuguese women with cervical cancer was used, which was compared with a control population of 459 Portuguese women. All statistical tests were performed with SPSS 24.0 software.
RESULTS In a first phase, in which associations were made between the polymorphisms studied and cervical cancer, the following variants have been associated with cervical cancer development: the presence of the 4b allele of VNTR in intron 4 at eNOS (p=0.032) and the null genotype at GSTM1 (p=0.031). In a second phase, after the polymorphisms were selected, comparisons between São Tomé and Príncipe and Portugal were made, obtaining the following results: concerning eNOS, genotypes with the presence of the allele 4b have a higher frequency in Portugal than in São Tomé and Príncipe (p=0.013); in relation to GSTM1, the presence of the null genotype is more common in São Tomé and Príncipe when compared to Portugal (p<0.001).
CONCLUSIONS Our results show differences in the geographical distribution of polymorphisms that potentially influence cervical cancer development. These differences may be related to different selective pressures provided by the different environments in southwestern Europe and equatorial Africa.

OBJECTIVES The vaginal microbiota may modulate susceptibility to human papillomavirus (HPV) and other co-infections. Therefore, we evaluate the association between these infections and vaginal microbiota.
METHODS We evaluated the vaginal bacterial composition in 111 women from a private hospital, mean age 40.7±11.1 (range: 17-68 years old). Vaginal bacterial composition was characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4), then categorized in community state type (CST). The cervical samples were obtained for cytology, HPV, Ureaplasma parvum, Ureaplasma Urealyticum, Mycoplasma Genitalium, and Mycoplasma Hominis detection. HPV was identified using the Roche Linear Array® HPV genotyping test, throughout PCR followed by hybridization. The statistical methods used were Chi-square, ANOVA and binary logistic regression, and significance was attributed if P<0.05 (SPSS v.24).
RESULTS The majority of women had normal cytology (78.7%) and 30.9% presented HPV-positive, being 81% high risk(Hr)-HPV types. Nevertheless, 60.6% had HPV-positive among women with abnormal cytology (P<0.001). Hr-HPV-positive women were younger (<33 years old) compared to HPV-negative (P=0.020). The younger women presented abnormal cytology (54.2%) and hr-HPV-positive (44.1%, P<0.05). For co-infections, the Ureaplasma parvum was the microorganism more prevalent (88.8%). The vaginal microbiota composition constituted by four CSTs, the majority presented CST I (n=63, 56.8%) and CST IV-B (n=26, 32.4%), followed by 2.7% in CST II and 1.8% in CST III. The CST-IV were more frequent in older women (81.4%). Older women had a lower number of copies/mL of Lactobacillus crispatus (P=0.001). Finally, we found a trend for risk HPV-positive for women with co-infections and CST IV, adjusting for age (OR=2.7, 95% CI [0.9-7.8], P=0.081].
CONCLUSIONS These preliminary results revealed that the clearance of virus in younger ages may be preponderant in the future development of cervical injuries such as cervical cancer. The lower predominance of L. crispatus in older women may contribute to increased production of proinflammatory cytokines.

OBJECTIVE The aim of this study was to compare the populations of São Tomé and Príncipe and Portugal in genes related with folate and nitric oxide metabolisms and oxidative stress that are relevant in leiomyomas (benign smooth muscle tumours of the uterus) development.
METHODS We analysed 325 DNA samples from Portugal and 178 DNA samples from São Tomé and Príncipe. The following polymorphisms were studied: the VNTR in intron 4 at eNOS, the SNP rs1801133 at MTHFR and the GSTM1 and GSTT1 polymorphisms. The polymorphisms associated with leiomyomas were then selected. For this, a population of 159 Portuguese women with leiomyomas was used, which was compared with a control population of 459 Portuguese women. All statistical tests were performed with SPSS 24.0 software.
RESULTS In a first phase, in which associations were made between the polymorphisms studied and leiomyomas development, the following genotypes have been associated with the leiomyomas development: the CC genotype of SNP rs1801133 at MTHFR (p<0.001) and the positive genotype at GSTT1 (p=0.018). In a second phase, after the polymorphisms were selected, comparisons between São Tomé and Príncipe and Portugal were made, obtaining the following results: concerning MTHFR, the CC genotype have a higher frequency in São Tomé and Príncipe than in Portugal (p<0.001); in relation to GSTT1, the presence of the positive genotype is more common in Portugal when compared to São Tomé and Príncipe (p<0.001).
CONCLUSIONS Our results show differences in the geographical distribution of polymorphisms that potentially influence leiomyomas development. These differences may be related to different selective pressures provided by the different environments in southwestern Europe and equatorial Africa.

OBJECTIVE The common narrative is that patients present late for treatment in sub-Saharan Africa, however, we have since established that patients see between 8-10 different health caregivers in different periods of time and visit different health care providers before they get an accurate diagnosis. This has been attributed partly to poor referral systems and wrong diagnosis. At AMPATH/MTRH we engaged the services of patient navigators who are cancer survivors to help navigate patients right from the screening points to diagnosis, treatment and post-treatment.
METHODS
• At screening points, the navigators help in encouraging more people to get screened, as survivors the community appreciates that even with the positive diagnosis it’s not a death sentence.
• For suspected malignancies, the navigators help coordinate the biopsies taken and help direct the samples to pathology labs.
• They track the results from the biopsies and in case of positive results, with the help of an oncologist they coordinate the breaking of the news to the patient, by offering moral support.
• During the treatment period they navigate the patient through triage, lab works etc. considering that the AMPATH/ Moi Teaching &Referral Hospital is one of the only two National referral health facilities in Kenya therefore very busy and complex process due to the large numbers.
• They coordinate survivorship programs.
RESULTS Lost to follow up patients has reduced at a ratio of 10:1, that is in ten patients only one is lost to follow, this is attributed to immense value added by the patient navigation system.
CONCLUSION Scaling up patient navigation system across the cancer health care facilities can result to improved clinical outcomes in cancer management, by reducing the patient turnaround time from diagnosis to starting treatment, ultimately this will lead to building a more patient-centred approach to cancer treatment.

OBJECTIVE Given that little information is available on the clinical and molecular epidemiology of cervical cancer in sub-Saharan African women, we aimed to evaluate the histopathological characteristics of cervical cancer in African patients in relation to telomerase alterations and human papilloma virus (HPV) infection.
METHODS 32 Tanzanian women with invasive cervical cancer were included in the study. Histopathological classification and tissue analyses, including immunohistochemistry for telomerase reverse transcriptase (TERT) expression, were performed at the Biosciences Laboratory of Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS (Meldola, Italy). HPV typization was performed by pyrosequencing. The fluorescence in situ hybridization (FISH)-based HPV-associated Cancer Test, FHACT™, was used to identify 3q26 (TERC, telomerase subunit), 5p15 (D5S2095) and 20q13 (D20S911) genetic alterations. Nonparametric ranking statistics (Mann-Whitney test) were used.
RESULTS The majority of cases analysed (75%) were squamous carcinoma and 12.5% were adenocarcinoma of the cervix. Only 4% of cases were grade 1 tumours. HPV infection was present in 26/27 (96.3%) cases. A high percentage of patients were infected with HPV 16 virus of whom 12 (46.2 %) had African type 1 and 4 (15.4%) African type 2. Human (h)TERT expression evaluated in the entire case series showed a median H-score of 130 (range 3-270), and only one case was negative. 88% of samples evaluable for FISH analysis showed an amplification of the chromosomal regions 3q26 (TERC) and/or 5p15, and 20q13, which were associated with a higher median of hTERT expression (p = 0.0226).
CONCLUSIONS This preliminary study showed that cervical cancer in Tanzanian women is characterized by a very high frequency of HPV infection, with a higher prevalence of HPV 16 African type 1 and 2. Despite pre-analytical problems pertaining to sample fixation, hTERT expression analysis was feasible and the protein was more highly expressed in amplified cases.

BACKGROUND Cervical cancer is a global health concern. Over 85% of the cases of cervical cancer occur in developing countries. Timely cervical cancer screening (CCS) can facilitate prevention of cervical disease before progression to cervical cancer among women in all settings. We sought to determine the predictors of cervical cancer screening uptake among Women Living with HIV (WLWH) in Rwanda.
METHODS Using a cross sectional design, a convenience sample was used to select 384 WLWH aged 30-50 years from four health centres in Kigali. Descriptive statistics, bivariate, and multivariable analysis were used to assess the variables and identify factors associated with CCS.
RESULTS Among 384 participants, 224 (58.3%) have been screened for cervical cancer. 311 (81%) and 279 (73%) had knowledge on symptoms and risk factors of cervical cancer respectively. Women who were screened had greater awareness of the importance of early detection and prevention, a sense of feeling at risk of developing cervical cancer, more commonly reported that a physician had recommended screening (P<0.001). Women who were not screened more commonly reported living far from screening services (P=0.007), concerns about the expense of screening (P=0.002), fear of pain from the screening procedures (P<0.001), fear of being diagnosed with cervical cancer (P<0.001), or feel no need for screening (P<0.001).
CONCLUSION Knowledge of the risk factors for cervical cancer and benefits of CCS, are associated with increased screening uptake. On the other hand, lack of access and fear related to CCS seem to negatively affect screening uptake. Integrating cervical cancer information in community health interventions is essential to increase CCS uptake.

OBJECTIVE Rwanda Military Hospital began the first combined Oncology and Surgery breast clinic in all of Rwanda in April 2014 to address gaps in the health system. The aim of this study is to describe the characteristics of patients referred with any breast-related concerns to our clinic.
METHODS This is a retrospective study of breast-related referrals to the combined surgical/oncology breast clinic since from April 2014 to December 2018. We collected data from the files of all the patients that consulted the clinic during the study period. We reviewed, both, electronic medical records and clinic logbooks. Data was aggregated to produce descriptive analysis
RESULTS We received a total of 1536 patients during the study period. The main presenting diagnosis were; breast mass, 1103 (72%), breast pain 304 (20%), nipple discharge 54 (3%). The remainder of patients were referred for axillary mass, nipple lesion, and breast swelling. After evaluation of the cohort and eliminating missing data, 1385 patients had a diagnosis. The most common final diagnosis was breast cancer 410 (31%), breast pain 252 (19%), and fibroadenoma 234 (17%). The remainder of the patients had a normal exam, nipple complaints, gynecomastia, skin infection, and other benign conditions. Of those presenting with breast masses (1057), 407 had breast cancer (43%), whereas 229 (24%) and 121 (13%) had fibroadenoma and normal exam respectively. Only four patients (1%) who consulted for breast pain had breast cancer.
CONCLUSIONS The volume of patients seen demonstrates that a breast clinic is a necessary and integral component of the healthcare system in LMICs, our combined Surgical/oncology approach is a model worth replicating in other low resource settings. Future goals include standardization of referral criteria in order to improve referral patterns and appropriate patient selection.

INTRODUCTION Cervical cancer remains the most frequent cancer in Zambia accounting for over 30% of new cancer cases annually. It is also the most common cause of death for cancer in the country. Women living with HIV (WLHIV) are 4 - 5 times more at risk of developing cervical cancer. Zambia has an estimated 345,000 WLHIV aged between 25-49 years old. The Ministry of Health (MoH) in Zambia, established the national cervical cancer screening program in 2006 using the Visual Inspection with Acetic Acid (VIA) with enhanced digital cervicography. To date over 600,000 women have been screened at least once in their lives of which only about 20% are WLHIV. Zambia has made progress in integrating Human Papilloma Virus (HPV) DNA testing for cervical cancer in WLHIV.
AIM To integrate HPV DNA testing in cervical cancer screening for WLHIV in Zambia.
METHODS The government through the MOH held a series of meetings with key stakeholders, including the Ministry of Health and Wellness from Botswana. Botswana through Jhpiego conducted a feasibility study on self-collection of the samples for HPV DNA testing for cervical cancer screening. Their lessons were shared and adapted to fit the Zambian context.
RESULTS PEPFAR funded implementing partners identified funds from within their budgets to support this initiative. A stakeholder engagement meeting was held to develop guidelines (including tools for M&E) for HPV DNA testing for cervical cancer screening. A training for cervical cancer screening providers was held for 4 of the 10 provinces in Zambia. Procurement of consumables was initiated through the Centre for Infectious Disease Research in Zambia (CIDRZ) central laboratory. Validation of the Hologic Panther to support the GeneXpert as primary tools for DNA were initiated. Screening expected to initiate in August 2019 (two months after HPV vaccination for 14-year-old girls to prevent cervical cancer will start)
CONCLUSION It is possible to integrate HPV DNA testing for cervical cancer screening in WLHIV in a country like Zambia where there is strong government commitment, coordinated approach with implementing partners and support from other governments within the sub-region.

OBJECTIVE To evaluate the evolution and prognosis of patients submitted to radical hysterectomy in Maputo Central Hospital (HCM), taking into account the clinical-histopathological characteristics and the stage of cervical cancer;
METHODS In 2016 at HCM, the training of Mozambican doctors in the oncology área began, in the Department of Gynecology and Obstetrics are still being trained tree doctors for prevention, early diagnosis, surgical treatment and paliation of gynecological cancer, in this context, the accomplishment of this type of complex surgiries requires specific training in the field, which is provided to Mozambican Gynecologists by oncological surgeons members of the International Gynecological Cancer Society, within the framework of the global training curriculum in gynecological oncology;
RESULTS The tree gynecologists performed their first radical hysterectomy in August of 2018, at the moment they have exclusively performed a total of 15 radical hysterectomies, in a patients with cervical cancer in the initial stage, from IB1 to IIA2, part of these patients benefit of chemotherapy as adjuvant treatment;
CONCLUSION The offer of care to patients with gynecological cancer has notorious advances in recent years at Mozambique, since the Mozambican Gynecologists are now able to perform radical hysterectomies, which is a very important tool in the treatment of this type of pathology.

BACKGROUND Cancer is a serious public health challenge in sub-Saharan Africa. Governments are struggling with balancing financing healthcare priorities, as both infectious diseases and non-communicable diseases represent significant health threats in the region. Although, infectious diseases remain leading causes of death, cancer incidence and mortality are increasing. Poor healthcare funding has resulted in limited oncology training, which has contributed to poor treatment outcomes. Funding specialized training abroad is a prohibitive expense for governments in Low Middle Income Countries (LMICs) like Nigeria, hence, there is a need to find innovative and low resource strategies to provide the desired skills with the available resources. This study explores how Upgrade Oncology uses an existing United States Government exchange programme to increase medical oncology knowledge in Nigeria.
METHOD Project PINK BLUE used the American Society of Clinical Oncology (ASCO) and the Union for International Cancer Control (UICC) networks to invite U.S. based Medical Oncologists to provide medical oncology training in Nigeria. Eleven (11) medical oncologists indicated interest and two were later selected by the Nigerian oncology group. The selected medical oncologists spent 14 days in Nigeria providing medical oncology training to 44 radiation oncologists, surgeons and physicians. Pre- and post-tests were designed and administered to the participants to assess improvement in key knowledge areas in oncology.
RESULTS With the pre and posttests, medical oncology knowledge was tested among the Nigerian oncologists. The forty-four oncologists who participated in the training improved test scores from 45% to 59%. The use of exchange programmes is cost-effective for LMICs.
CONCLUSION Specific Training for specialist areas like medical oncology are cost prohibitive for governments using a model of sending Nigerian oncologists to United States or European countries. However, with existing exchange programmes like the Fulbright Specialist Programme, non-profits and governments in sub-Saharan Africa can spend little monetarily to gain more in knowledge exchanges. Project Pink Blue piloted using the Fulbright Specialist Programme, first with a patient navigation program specialist and subsequently with the medical oncology training program described in this abstract. This represents a low resource strategy to strengthen the capacities of cancer treatment in low resource setting.

OBJECTIVE Malawi has among the highest rates of cervical cancer in the world. Since 2004, Malawi has implemented a screening program using visual inspection with acetic acid (VIA) and cryotherapy. However, population coverage is suboptimal and missed treatment of VIA-positive women is common. We will evaluate the feasibility and performance of a novel HPV-based cervical cancer preventive strategy among HIV-positive women in Malawi: self-sampling for HPV testing, same-day VIA for HPV-positive women, and thermocoagulation for ablation-eligible women by colposcopy.
METHODS Between June 2019-May2020, we will enrol 625 eligible HIV-positive women, collect socio-demographic and reproductive health data, and perform testing for pregnancy, CD4+ counts and HIV-1 RNA. We will instruct women to self-collect a vaginal brush for GeneXpert HPV testing. HPV-negative women will continue with routine screening. HPV-positive and every 10th HPV-negative woman will complete same-day VIA, colposcopy with cervical biopsies and endocervical currettings (ECC) if VIA-positive, and thermocoagulation if ablation-eligible by colposcopy. VIA-negative women will undergo colposcopy, cervical biopsies and ECC if abnormal colposcopic findings, and thermocoagulation if ablation-eligible. If colposcopy is normal, a cervical smear and ECC will be collected. Women who undergo thermocoagulation and have CIN1+ will have HPV testing, colposcopically-directed biopsies or smear and ECC performed at week 24 post-treatment.
RESULTS Study outcomes will include the proportion of: a) HPV-positive women who have VIA same-day; b) ablation-eligible women by colposcopy who have thermocoagulation same-day; c) HPV-positive/VIA-positive/ablation-eligible women who would have been treated with thermocoagulation (without colposcopy), but were found to have no CIN2+ (overtreatment rate); d) women with CIN2+ who would have not been treated or referred (undertreatment rate); and 24-week cure rate of CIN2+ among women treated with thermocoagulation.
CONCLUSION This study will provide essential data regarding the feasibility and performance of an HPV-based cervical cancer preventive strategy, and thermocoagulation efficacy, among HIV-positive women in Malawi.

BACKGROUND Cancer care in sub-Saharan Africa (SSA) is hampered by lack of capacity both human and infrastructural to be able to optimally diagnose, treat and follow-up cancer patients throughout their cancer journey. There is also lack of screening technical knowledge amongst health care professionals (HCP) and most programs do not have enough personnel to carry out these activities. As part of the Multinational Lung Cancer Control Program (MLCCP), a SWOT analysis of the participating countries was done that determined the need for capacity building in Eswatini.
OBJECTIVES
1. Creation of an exchange program amongst various cancer experts in the region.
2. Assist in Building Capacity in Eswatini across all cadres of staff.
3. Improve cancer-related outcomes in the Eswatini through standardized care, shared protocols, Virtual Tumour board meetings and scheduled cancer experts exchange program.
4. Create a Network of cancer care experts to be leveraged for future trainings/ clinical trials in SSA.
METHODS Multiple stake-holders meetings identified priority areas for Eswatini. An MOU was drafted and adopted by the participating partners covering the nature, length, depth, logistics and regulatory framework of the partnership. A team of cancer experts was identified throughout the region and the Ministry of Health (MOH) of Eswatini reviewed and approved them, appointing them as exchange Oncologists with each one rotating in-country with specific outlined deliverables for a period of 2-4 weeks coordinated by the Eswatini team.
RESULTS Training of HCP on cancer management is on-going.Cancer treatment protocols, availability of cancer treatments in-country and regular virtual tumour-boards with exchange consultants is being undertaken. Delivery of services through Essential infrastructure is in the process of being created as per the country’s priority with assistance from the exchange Faculty and MOH.
CONCLUSION SSA can leverage the expertise that exists on the continent to improve the quality of care in cancer control-Prevention, screening, treatment, survivorship, palliative care and research in the region.
ACKNOWLEDGEMENTS
1. Ministry of Health, The Kingdom of Eswatini
2. Dr. Ute Dugan MD, PhD, Head, Oncology External Medical Affairs, BMS
3. Phangisile Mtshali|Director: Bristol-Myers Squibb Foundation Secure the Future CANCER Programme
4. All Participating Exchange Oncology Professionals.

OBJECTIVE Non-Communicable Diseases, such as tumours, have reached epidemic proportions in low-income countries. In addition, the use of industrially produced medicines give rise to a significant problem, because a large part of the products available on the local markets are falsified. Therefore, assuming that it was possible in the first place to access the medicines needed for cancer therapy, there is a risk that these are ineffective or fake. Furthermore, the preparation of these therapies requires the availability, in hospitals or in similar facilities, of adequate equipment and trained personnel. In this context the A.P.P.A.® Project (Aid Progress Pharmacist Agreement), which focuses on establishing galenic laboratories in hospitals located in in developing countries, for many years has been recognizing, among its objectives, the importance of teaching local staff how to handle and properly prepare cancer treatments. METHODS In order to guarantee the quality of injectable oncological products, specific operative protocols were studied. Furthermore, in the case of oral anti-cancer medicines, for which the pharmaceutical form did not satisfy the quality requirements, specific handling and re-encapsulation procedures were developed.
RESULTS The operative protocols have been already introduced on site in hospitals located in Haiti, Angola and Chad. The workers' ability to manipulate and prepare oncological medicines and to follow the operative protocols was verified during on-site trips: all workers showed the necessary skills to autonomously manage all phases of the preparation.
CONCLUSIONS The “breast and cervical cancer screening in the Southern and Central regions of Madagascar” Project, developed by the Akbaraly Foundation in cooperation with the NGO “Alfeo Corassori-La Vita per Te”, requires the opening of a new A.P.P.A.® lab in Fianarantsoa (Madagascar) in 2019. Considering both the local incidence of oncological pathologies and the spread of falsified medicines, all the operating procedures developed by A.P.P.A.® for the management of cancer therapies will be introduced on site and the local staff will be trained accordingly.

OBJECTIVES Safety evaluation and communication about HPV vaccine safety is critical because fear of adverse events may lead to a decrease in public trust and confidence in vaccines and a reduction in vaccine coverage, both of which may compromise the global impact of the program. In recent years, we have seen vaccination rates fall drastically in many countries due to episodes that have been erroneously associated with HPV vaccination. This has been the case in Colombia, Japan, Denmark or France. As a specialized and world’s reference centre in the epidemiology and prevention of HPV-associated diseases, the e-oncology program at Catalan Institute of Oncology (ICO) has developed and deployed e-learning activities in cervical cancer epidemiology and prevention. The ICO, e-oncology and the Colombian National Cancer Institute (INC) aimed to develop an ad hoc virtual course on the efficacy and safety of HPV vaccines to reach a large number of Colombian health care professionals and enhance their capacities to increase public confidence in deal with HPV national vaccines.
METHODOLOGY We developed a 10 hours modular online course with the aim of transmitting to all those involved in the prevention of cervical cancer the latest scientific evidence on the efficacy and safety of HPV vaccines. The course includes also specific country information about the epidemiology and prevention developed and endorsed by local institutions. Structure:
• Videos of theoretical lectures given by recognized experts from ICO and INC.
• Additional material: Aimed at those students who wish to go in-deep.
• FAQ's: which include the most frequent questions about the efficacy and safety of the vaccines with their corresponding answers and bibliographical references.
• Activities to reinforce the training.
The course is addressed to general practitioners, pediatricians, nurses, midwives, gynecologists and HCP’s involved in public health vaccination programs. and can be easily translated and adapted to other cultural and geographic environments.
RESULTS More than 4,000 Colombian professionals have accessed the course in the first nine months and the forecast is to reach almost 10,000 professionals during the first year. 61% of participants rated the course as excellent and 30% as good or very good.
CONCLUSIONS The use of e-learning has proven to be very useful to provide in short time a large number of health professionals with evidence-based information on the safety of the HPV vaccine. This experience can be easily migrated to other countries.

OBJECTIVES The management of cancer patient’s is increasingly complex and requires a multidisciplinary approach in which different professionals are involved: oncologists, surgeons, nurses. This changing environment must be taken in account designing HCP’s comprehensive training programs. To facilitate this approach, we have designed a learning methodology that adapts the learning material to each professional profile, and also allows the exchange of knowledge between them. We have first us this approach in the field of immune oncology. Immunotherapy is becoming established as a standard treatment for multiple tumour types, but there is a knowledge gap between highly specialized research centers and most of the healthcare clinical teams staffed by physicians and nurses responsible for the treatment and follow-up of cancer patients. The main goal was to create a sustainable Immuno-Oncology Knowledge Hub which is evidence-based and structured around different educational pathways based on the professional profiles, abilities and/or needs of its users. An additional aim of the project was to establish proof of concept, the Virtual Knowledge Hub methodology will be useful in the training of professional cancer teams.
DESCRIPTION The Hub is designed as an adaptive intelligent system based on the profiles and needs of its users. Professionals are able to use the intelligent system to find knowledge adapted to their needs and/or profile, as well as contributing all the knowledge and experience they want to. To facilitate this main functionality, the system gathers personal information when the user first accesses it and use this to generate a personal profile which the Hub will use to provide knowledge tailored to each professional. The system automatically analyzes user answers and assigned the appropriate learner profiles and they have access to the learning material that best matches their educational needs. It includes videos, e-learning content, virtual scenarios, guidelines, and discussion spaces with experts or peers. The Hub has been tested and implemented in a large European oncology community network. The Hub’s social learning component allows the same professional to be an expert in one subject and a student of another.
RESULTS We present here the design as well as the results of the VIKHI project as an example of a practical application of this methodology.
CONCLUSIONS The use of an educational methodology based on a “Virtual Knowledge Hub” would be useful supporting the management of cancer patients in a multidisciplinary environment.

INTRODUÇÃO O Carcinoma hepatocelular é um tumor maligno primário do fígado que corresponde ao sexto tipo de cancro mais comum ao nível mundial e constitui a terceira causa de morte associada ao cancro. Moçambique é um dos países da África sub-sahariana com maior prevalência desta neoplasia (80%) e está relacionada com a infecção pelo vírus de hepatite B e cereais contaminados por aflatoxina. Este trabalho descreve a frequência do Carcinoma hepatocelular no Serviço de Gastroenterologia do Hospital Central de Maputo entre 2015 a 2017.
METODOLOGIA Trata-se de um estudo retrospetivo, descritivo, qualitativo, baseado na análise da base de dados do Serviço de Gastroenterologia e Serviço de Anatomia Patológica do HCM entre Janeiro de 2015 a Dezembro de 2017, referente a doentes com suspeita ecográfica de Carcinoma hepatocelular. São estudados 635 análises de pacientes com punção aspirativa agulha fina ecoguiadas para confirmação diagnóstica.
RESULTADOS De um total 635 pacientes avaliados durante 3 anos são diagnosticados 336 tumores malignos (52,1%). Em 2015, dos 175 suspeitos, 116 (65%) são positivos para Carcinoma hepatocelular, sendo 80 (72%) do sexo masculino, 31 (28%) do sexo feminino, com idade média de 47 anos. Em 2016 dos 218 suspeitos, 45 (21%) são positivos para este tumor, sendo 26 (58%) do sexo masculino, 19 (42%) do sexo feminino, com idade média de 48 anos. Em 2017 dos 256 suspeitos, confirmam-se 175 (68%), sendo 121 (69%) do sexo masculino e 54 (31%) do sexo feminino, com idade média de 48 anos.
CONCLUSÃO O Carcinoma hepatocelular tem tendência a aumentar no Hospital Central de Maputo durante os anos 2015 - 2017, com predomínio no sexo masculino e idade média de 48 anos, conforme descrito na literatura. Sugerem-se medidas de rastreio ao nível da atenção primária, a fim de reduzir o número de casos de Carcinoma hepatocelular.

OBJECTIVE To evaluate associations between hrHPV, four herpes-viruses, syphilis, C trachomatis and HIV infections among girls in Jos.
METHODS We enrolled 205 girls, aged 9-20 years from 10 schools. After informed consent and assent, we collected data, first-void urine and blood samples from the participants while they self-collected vulvo-vaginal samples using sterile swab stick. We tested the swabs/urine samples for HPV using SPF10-DEIA/LiPA25 version-1 and assayed serum for antibodies against HSV-1, HSV-2, CMV, EBV and C trachomatis using ELISA. We used chromatographic immunoassay strips to test for Syphilis and HIV infections. We tested associations between hrHPV and STI using Pearson’s chi-squared test. We analyzed the data using Stata14®.
RESULTS The mean(SD) age of the participants was 14.9(2.3) years. Some 29.3%(60/205) were positive for any HPV and 16.6%(34/205) were positive for hrHPV. We detected HSV-1 in 98.9%(170/175), HSV-2 in 92.8%(167/180), EBV in 67.8% (113/180), CMV in 24.4%(44/180), HIV in 1.0%(2/201) and C trachomatis infections in 0.6%(1/180) of the girls. None of the girls were positive for Syphilis. All hrHPV positive girls tested positive for HSV-1 (100%, 30/30), while HSV-2 was positive in 96.9%(31/32), EBV in 56.3%(18/32) and CMV in 21.9%(7/32). None (0%, 0/32) were positive for C trachomatis IgG or IgM antibodies, Syphilis or HIV. Among hrHPV negative girls, HSV-1 was positive in 98.6% (143/145), HSV-2 in 91.9%(136/148), EBV in 64.2%(95/148), CMV in 25.0%(37/148), both C trachomatis IgG/IgM in 0.7%(1/148) and no co-infection was found between hrHPV negative girls with syphilis and HIV infections. There was no statistically significant association between hrHPV infection and any of the STIs.
CONCLUSION Our study shows that the prevalence of hrHPV and STI co-infection was high in this population but the STIs were not significantly associated with prevalent hrHPV infection. Future studies should explore relationship between incidental and recurrent STI with risk of hrHPV persistence.

OBJECTIVE We aim to describe prescription patterns and cost of systemic chemotherapy in cancer patients in Botswana during periods of cancer drug stockout.
METHODS Using a retrospective cohort study of the ten most common solid tumor malignancies treated with chemotherapy at Princess Marina Hospital (PMH), Gaborone in 2016, we conducted a subset analysis of suboptimal events during treatment, defined as cycles with ≥7 days delay or therapy switch from initiated guideline regimen, that occurred during drug stockout vs non-stockout periods. We estimated financial cost of therapy per cycle using Management Sciences for Health International Price Indicator Guide. Chi-squared and Wilcoxon rank sum were used for comparisons.
RESULTS 167/378 patients contributed to 320 suboptimal events. 63% (201/320) of events occurred during a drug stockout, of which 43%, 43% and 14% were delays, switches, or both, respectively. There were significantly more delays (56% vs 44%, p<.0001) and switches (75% vs 26%, p<.0001) during stockout periods vs no stockout. The majority of switches during drug stockouts occurred in breast cancer patients receiving curative therapy: 48% (20/42) were “paclitaxel + trastuzumab” ($4673) to “paclitaxel” ($35) in HER2+ patients resulting in a 99% cost decrease; and 29% (12/42) were paclitaxel ($35) to docetaxel ($108) resulting in a 209% cost increase per cycle switched. Colon cancer patients receiving palliative-intent therapy were the second most frequent patients with therapy switches during stockout periods: 42% (8/19) were “capecitabine + oxaliplatin” ($259) to “capecitabine” ($105) resulting in a 59% cost decrease.
CONCLUSIONS Breast cancer patients form the majority of patients treated with systemic chemotherapy at PMH and experienced the most delays and switches in therapy during drug stockout periods. Changes in drug prescription patterns during stockout periods may be associated with switches leading to inferior but less costly regimens, and in some cases costly regimens with higher toxicity.

OBJECTIVE Despite the importance of platelet transfusions in treatment of hematologic cancer patients, the optimal platelet count threshold for prophylactic transfusion is unknown in sub-Saharan Africa. The objective was to determine a safe threshold for platelet transfusion.
METHODS We followed patients admitted to the Uganda Cancer Institute with a haematological malignancy in 3 sequential 4-month time-periods using incrementally lower thresholds for prophylactic platelet transfusion: platelet counts ≤ 30 x 109/L in period 1, ≤ 20 x 109/L in period 2, and ≤ 10 x 109/L in period 3. Clinically significant bleeding was defined as WHO grade ≥ 2 bleeding. We used generalized estimating equations (GEE) to compare the frequency of clinically significant bleeding and platelet transfusions by study period, adjusting for age, sex, cancer type, chemotherapy, baseline platelet count, and baseline haemoglobin.
RESULTS Overall, 188 patients were enrolled. The median age was 22 years (range 1–80). Platelet transfusions were given to 42% of patients in period 1, 55% in period 2, and 45% in period 3. These transfusions occurred on 8% of days in period 1, 12% in period 2, and 8% in period 3. In adjusted models, period 3 had significantly fewer transfusions than period 1 (RR = 0.6, 95% CI 0.4–0.9; p = 0.01) and period 2 (RR = 0.5, 95% CI 0.4–0.7; p<0.001). Eighteen patients (30%) had clinically significant bleeding on at least one day in period 1, 23 (30%) in period 2, and 15 (23%) in period 3. Clinically significant bleeding occurred on 8% of patient days in period 1, 9% in period 2, and 5% in period 3 (adjusted p = 0.41). Thirteen (21%) patients died in period 1, 15 (22%) in period 2, and 11 (19%) in period 3 (adjusted p = 0.96).
CONCLUSION Lowering the threshold for platelet transfusion led to fewer transfusions and did not change the incidence of clinically significant bleeding or mortality, suggesting that a threshold of 10 x109/L platelets, used in resource-rich countries, may be implemented as a safe level for transfusions in sub-Saharan Africa.

INTRODUCTION Le cancer du col utérin représente un problème de santé publique et représente le deuxième cancer de la femme dans le monde, et 80% de ces cancers surviennent dans les pays en vois de développement. La dysplasie, lésion précessive de cancer peut être dépistée et traitée précocémént.
PATIENTES ET MÉTHODES Il s’agit d’une étude prospective de 1000 frottis cervico-vaginaux, collectés lors de dépistages organisés. Les patientes présentant un frottis anormal de bas grade ont refait un frottis à 6 mois, tandis les autres lésions anormales ont bénéficié d’une colposcopie et d’une biopsie.
RÉSULTATS L’âge moyen des patientes était de 41 11,16. L’examen cytopathologique montrait : 822 frottis normaux, 2 frottis non satisfaisants, 176 patientes avec un frottis anormal dont 166 lésions de bas grade, 9 lésions de haut grade et 1 carcinome in situ. Soixante quatre patientes avaient une colposcopie anormale dont l’exploration a montré : 21 lésion de bas grade, 11 lésions de haut grade et 2 carcinomes. Une persistance des lésions de bas grade a été notée dans 25%, une régression dans 72,22% et 1 progression dans 2,77%
CONCLUSION La prévalence des dysplasie était de 17,6%, la discordance entre la cytologie et l’histopathologie sur les biopsies montre l’utilité d’associer au diagnostic cytologique des biomarqueurs pour plus de précision.
MOTS CLÉS frottis cervico-utérin, dysplasie, colposcopie, biopsie

OBJECTIVE Considering the burden of breast cancer in developing countries, the laboratory infrastructure has to be improved. In the clinical routine, patients are taking treatment without knowledge of estrogen receptor (ER), progesterone receptor (PR) and HER2 human epidermal growth factor receptor 2 (HER2) status using immunohistochemistry (IHC). Therefore, introducing a reproducible and cost-efficient method is valuable. The aim of the project is to validate RNA-based method (PCR) for the detection of biomarkers having prognostic and predictive values in cancer.
METHODS Pathologically confirmed invasive breast cancer patients were enrolled into the project. For establishing a PCR detection assay a prospective German cohort was used as a validation study and secondly this assay was transferred to an Ethiopian retrospective study. RNA of formalin fixed paraffin embedded (FFPE) tumor blocks was extracted using MiRNeasy kit (Qiagen), concentrations and quality was measured using NanoPhotometer (EMBELEN). cDNA was synthesized with BioZym cDNA synthesis kit (BioZym) following manufacturer instruction. Endpoint PCR conditions were optimized for the detection of low and high abundant transcripts. In each PCR run, BT474 (positive control) and BT-20 (negative control) cell lines were used as a positive and negative control for each gene of interest (GOI) expression analysis. Gel documentation was done using ImageQuant LAS 4000 machine. Statistical analysis was done by SPSS version 20. Ethical clearance was secured from the respective institutions IRB.
RESULT Out of the validation cohort, IHC result revealed that 58.3%, 41.7% and 41.7% were positive for ER, PR and HER2 status. 25% of the tumors were TNBC. The PAM50 algorithm showed the distribution of intrinsic molecular subtypes which accounts for 17% (Luminal A), 33% (Luminal B), 25% (HER2 enriched), and 25% (Basal-like). The RNA expression was 58% for ESR, 17% for PGR, and 33% for ERBB2. The comparison of IHC with RNA based expression revealed that the positive predictive value and negative predictive value for ESR1, PGR and ERBB2 gene was 71.4% and 60%, 100% and 70 % and 25% and 50%, respectively. A good correlation was observed between IHC and PCR method for the respective genes.
CONCLUSION The majority of tumors were hormone receptor positive. In the validation cohort, good agreement was shown between IHC and RNA based expression level. We suggest the use of PCR in LMICs including Ethiopia.

INTRODUCTION Le cancer est un problème de santé publique dans le monde surtout en Afrique subsaharienne, particulièrement au Sénégal. Plus de la moitié de la population ne bénéficie pas d’une couverture sanitaire alors que la prévalence des cancers va crescendo, notamment celui de la prostate, du sein et du col de l’utérus. Le but de notre étude était d’évaluer la contribution du CSAM en matière de lutte contre les cancers.
MATÉRIELS ET MÉTHODES Nous avons effectué une étude prospective et descriptive, de Mars 2017 à Mars 2019, au CSAM, un centre communautaire qui, en plus des soins, développe une stratégie de lutte contre les cancers axée sur les concepts Information, Education et Communication(IEC). Durant les journées de sensibilisation, les participants bénéficiaient d’un entretien sur la pathologie du cancer ainsi qu’un toucher rectal, un dosage du PSA et une biopsie prostatique au besoin chez les hommes ; un frottis cervico-vaginal, une mammographie chez les femmes. Les cas suspects ou diagnostiqués étaient orientés et suivis dans des centres de référence comme l’HOGGY et le CHU Aristide Le Dantec.
RÉSULTATS Nous avions 148 hommes et 247 femmes. La moyenne d’âge était de 64 ans chez les hommes et 31 ans chez les femmes. Le toucher rectal était suspect chez 14% des hommes et le taux de PSA total était élevé dans 28% des cas. La biopsie prostatique, effectuée chez 27 cas suspects, avait objectivé un adénocarcinome prostatique chez 8 participants, soient 5% de l’effectif. Une prostatectomie radicale était effectuée chez 3 patients. Le reste bénéficie d’un traitement médical. Chez les femmes, nous avions offert 89 frottis cervico-vaginal et 158 mammographies.
CONCLUSION La sensibilisation et la vulgarisation des centres de soins au niveau communautaire peuvent contribuer efficacement à la lutte contre les cancers.
MOTS CLEFS santé, cancer, accès aux soins, Sénégal.

OBJECTIVE Retinoblastoma is a childhood eye cancer with heritable consequences. Our previous research with Kenyan families affected by retinoblastoma revealed their desire for a tangible educational resource explaining the heritable nature of the disease, preferably in the form of a booklet. The aim of this project, therefore, was to develop a patient education booklet through collaboration between doctors, nurses, parents, survivors, and support group leaders.
METHODS A human-centred design approach was employed, in which the study team consulted with clinician and patient stakeholder groups to design, produce and refine an educational booklet. Clinician stakeholders included: doctors and nurses managing retinoblastoma at Kenyatta National Hospital (Nairobi), Moi Teaching and Referral Hospital (Eldoret), and PCEA Kikuyu Eye Hospital (Kikuyu); cancer support group leaders; and child life specialists. Patient stakeholders included: parents of children with retinoblastoma; and survivors of retinoblastoma. Over 3 phases of consultation, the study team met with each stakeholder group to review booklet prototypes and collect feedback for its further refinement.
RESULTS The iterative, phased design process produced an educational booklet rich in images and stories, with complex genetic topics described in simplified terms. The images depict cartoons of families visiting doctors, and simplified diagrams of cells and genes. The booklet employs characters and stories to explain the nuances of heritable and non-heritable retinoblastoma. A guidebook was also created to direct implementation of the booklet during regular clinic visits, with the intention is to promote dialogue between clinicians and patients that would clarify difficult concepts and eliminate confusion.
CONCLUSIONS A novel educational tool for families affected by retinoblastoma was developed through collaboration with clinician and family stakeholders. Next steps include testing of the booklet in a prospective, pragmatic trial to evaluate its effect on knowledge.

OBJECTIVE We present patient care outcomes based on the results of the International Gynecologic Cancer Society (IGCS) sponsored Project ECHO video conference tumour board from Da Nang Oncology Hospital (DOH). We also present the result of a survey of the tumour board participants.
METHODS We retrospective reviewed clinical cases presented at the Da Nang IGCS sponsored videoconference tumour board. The clinical cases presented at tumour board were divided into 3 categories: no change, minor change or major treatment change made after tumor board discussion. An anonymous survey was sent to all participants to determine experience and satisfaction.
RESULTS 40 cases were presented at 20 tumour boards between July 2017 and March 2019. Nine cervical, 20 ovarian/fallopian tube/peritoneal, 2 uterine, 7 vulvar, and 2 unknown gynaecologic cancers were presented. Tumour board review led to major changes in treatment in 75% of cases. Review of pathology showed agreement between local pathologist diagnosis and tumor board pathologists in 21 cases (52%). The median number of attendees for each tumor board was 12. Attendees include gynaecologic oncologists, radiation oncologists, pathologists, medical oncologists, and general gynaecologists from Vietnam, Singapore, Japan, the United States and Canada. Attendees were surveyed with 100% of respondents rated the conduct of the tumour board as good or very good (7/7), and that it was easy to connect online (7/7). 4/7 (57%) agreed that it was easy to understand the discussion. All agreed that the discussion was relevant to the care of their patients (6/6). All respondents liked the format (6/6) of case presentations combined with a short lecture.
CONCLUSION Video-conferencing tumour board improves the care of patients with gynaecologic cancer by connecting physicians throughout the world. Changes in diagnosis and treatment often result from the discussion. Short lectures are a valuable source of didactic learning.

OBJECTIVES There is a lack of evidence/consensus amongst surgeons on optimum frequency or duration of follow-up including mammography for breast cancer patients aged 50 years and older at diagnosis. Mammo-50 has the opportunity to gather patient reported outcomes and their perspectives on follow-up. Understanding unmet patient reported needs helps focus on education and strategic interventions for patients. This is particularly important for low- and middle-income countries who may not have the full range of support and benefits that are routinely offered in the Western healthcare setting.
METHODS Mammo-50 trial has recruited over 5000 women in a randomised trial assessing duration of mammographic surveillance for women over 50 years old at diagnosis and 3 years post curative surgery. 91% of women to date have agreed to participate in a quality of life sub-study (QoL) which collects information about symptoms and long-term side effects. 74% of women to date have consented to enter the Qualitative sub-study (QSS). In addition, a national patient-led survey on follow-up was developed by the Independent Cancer Patients’ Voice (ICPV) to gather patients’ experience of follow-up. Mammo-50 QoL sub-study collected patient questionnaires at baseline and at each follow-up visit. The QSS sub-study carried out focus groups to gather patients’ experiences and perceptions of follow-up, and inform the topic guide for further in-depth, semi-structured telephone interviews from Mammo-50 participants. Ethics and consent were obtained for audio-recordings.
RESULTS Mammo-50 patient questionnaires indicated that 28% of patients had high levels of distress due to concerns about fatigue, sleep, worry/anxiety, memory/concentration, and pain. Mammo-50 focus groups and individual interviews indicated that patients in general were satisfied with their care and happy to be in a trial. The ICPV survey indicated that over 2/3rds of respondents said they had some unmet needs during their follow up period; these were varied and included both physical and psychological needs.
CONCLUSIONS In summary, when given the opportunity to report unmet needs through questionnaires/surveys, patients often report things which could be causing them distress, but which may go unnoticed in routine follow-up. Understanding these unmet needs will help policy makers when defining strategies for follow-up.

OBJECTIVE PERSEPHONE is a Phase 3 randomised non-inferiority trial comparing 6 months of trastuzumab to the standard 12 months in patients with HER2 positive early breast cancer. Patients consented to a quality of life sub-study where information was collected about their experiences. Collecting ‘quasi-qualitative’ data via open-ended questions adds depth and complements quantitative quality of life data. It allows patients to report experiences that may otherwise remain unknown. This is particularly important in some low and middle-income countries where support for patients may be limited.
METHODS Alongside the toxicities reported on the trial case report forms (CRF) and patient booklets being collected, including quality of life (QoL) and Health Care Resource Usage, patients were invited to record any other comments they had about their treatment. Experiences were recorded prior to commencement of trastuzumab, then 3-monthly for a year, then every 6 months up to year 2. Within a mixed methods framework, both the trial researcher and patient representatives explored the information collected using thematic content analysis.
RESULTS Between October 2007 and July 2015, 4088 patients were randomised. In total, 5542 experiences were recorded from 2456 patients across the 6 time-points. Patients offered information on all aspects of the study, including their views on the treatment, their care, the QoL questionnaire and the research. Most often mentioned was the impact the treatment had on participants personally - physically, psychologically or socially. Most frequently cited were aches, pains and fatigue; for many, these did appear to be particularly distressing and intractable. In parallel, CRFs reported 20% of patients reporting a grade 3/4 toxicity during treatment (23% 12 months, 18% 6 months, p=0.004), with significantly higher rates of cough, pain, fatigue, chills and palpitations reported by patients having 12 months trastuzumab (p<0.05).
CONCLUSIONS Patients’ experiences during and beyond trastuzumab highlighted the long-term cumulative effects of their treatment and confirm that patients do suffer from burdensome toxicity, which affects their QoL. These data are important for policy makers when defining supportive care strategies.

OBJECTIVE The objective of the Project ECHO (Extension for Community Healthcare Outcomes) for Knowledge Summaries for Comprehensive Breast Cancer Control (KSBC) is to strengthen capacity to plan and implement evidence-based, resource-appropriate breast cancer control programs using virtual case-based learning within a global network of experts and peers.
METHODS The KSBC ECHO is a collaboration between the US NCI Center for Global Health, Women’s Empowerment Cancer Advocacy Network and Breast Health Global Initiative in alignment with the Breast Cancer Initiative 2.5 campaign to reduce disparities in breast cancer outcomes. Using the ECHO model, we developed a 6-month web-based program to support the development of locally relevant, resource-appropriate cancer control programs through mentorship and use of the KSBCs. The course was advertised via existing networks, conferences and social media. Breast cancer control project teams from around the world applied and were accepted to participate in the KSBC ECHO. Fourteen biweekly ECHO sessions were held via Zoom and included a 10-minute case presentation, a 10-minute didactic presentation and discussion. Projects spanned the care continuum and sessions addressed preplanning; assessing need/barriers; setting objectives/priorities; and implementing/evaluating. Baseline and endpoint surveys were used to evaluate the ECHO program, in addition to review of worksheets and revised project plans. Participants identified a mentor, completed worksheets and presented on the project status.
RESULTS Fifteen project teams from 11 countries (64 participants: advocates, clinicians, policymakers, researchers) were enrolled. Forty-three participants completed the baseline survey: 15 reported basic knowledge about assessing need and barriers, 18 reported average knowledge about setting objectives, and 16 reported basic knowledge about monitoring/evaluation. Endpoint survey data will be presented upon completion of the program and survey data analysis.
CONCLUSIONS The ECHO model encouraged interaction between policymakers, clinicians, advocates and technical experts while using evidence-based tools to develop locally relevant, resource-appropriate implementation strategies and policy recommendations.

OBJECTIVE Oesophageal squamous cell carcinoma (ESCC) is a highly prevalent cancer in sub-Saharan Africa with high mortality. The important roles of smoking and alcohol do not fully account for the risk of ESCC and risk factors vary geographically. We sought to determine the association between cooking fuel type and ESCC risk in southwestern Uganda.
METHODS We conducted a case-control study among patients presenting for Esophagogastroduodenoscopy (EGD) between 2013 and 2018 at Mbarara Regional Referral Hospital, Uganda. Presenting symptoms, cooking fuel, smoking, alcohol, and socio-demographic data were collected. An experienced certified endoscopist performed EGD on each participant. ESCC cases were those with upper- and mid-oesophageal mass on EGD and when possible confirmed by histology. Controls were defined by a normal EGD. Logistic regression determined factors associated with ESCC.
RESULTS There were 138 cases and 376 controls. Among cases, 103 (74.6%) were men, 7 (5.1%) smoked, 21 (15.2%) regularly consumed alcohol, and 95 (68.8%) both smoked and consumed alcohol. Seventy-five cases had tissue histology reports confirming ESCC. Common presenting symptoms were dysphagia (37%) and odynophagia (10.9%). Independent associations with ESCC included; men (AOR 4.16, 95%CI 1.79, 9.63) and age-group 50 to 59 (AOR 19.50, 95%CI 2.11, 180.47) for both genders. Among women, an increased risk was observed for those who both smoked and consumed alcohol (AOR 9.65, 95%CI 1.57, 59.09) than men (AOR 5.19, 95%CI 1.48, 18.28). Using both firewood and charcoal for cooking was associated with a less compatible trend towards ESCC (AOR 4.40, 95%CI 0.43, 45.01). Similar independent associations were found in sub-group analyses of confirmed ESCC and controls.
CONCLUSION In this study, smoking and alcohol, increasing age, and male gender were independently associated with ESCC. Further research is needed to elucidate the role of air pollution from biomass fuel as a risk factor for ESCC in low-income settings.

OBJECTIVE This project assesses the Botswana health system for optimal implementation of a novel point-of-care diagnostic device for lymphoma and breast cancer and determines the feasibility of device implementation into those settings.
METHODS i) Landscape analysis through interviews with key stakeholders from clinics and primary and tertiary hospitals focused on referral pathways and barriers to care for cancer patients. An integrated literature review was also conducted regarding causes of diagnostic delays.
ii) Pilot half-day training was conducted with diverse health worker cadres including varied degrees of lab experience, randomized to either in-person demonstration or simulated remote training with only videos and written materials. Participants were assessed on sample preparation and device use.
RESULTS i) In Botswana there is a long delay (mean 406 days) between first clinic presentation and cancer diagnosis, the longest delay of any step between symptom onset to treatment, in part because the majority of cancers originate in rural areas. This novel technology could reduce diagnostic times by enabling triage of patients from primary hospitals or rural clinics instead of requiring referral to tertiary centres. It could also reduce pathology bottlenecks at tertiary centres. ii) After training, 12/12 lab scientists learned to prepare samples and use the device with in-person or remote training. Of those with intermediate lab background, 6/8 were successful, and 1/5 with no prior lab background succeeded. Most errors were due to basic lab techniques, particularly pipetting. All participants who did not conduct the protocol successfully were confident they could learn with 1-2 more days of training.
DISCUSSION This study shows that inexpensive, rapid molecular testing devices for cancer have potential to decrease diagnostic delays in Botswana and other LMICs. Diverse cadres of health workers are able to prepare samples and operate the device, enabling decentralization and simplification of the diagnostic algorithm.

Background: Quality of life is an important aspect of care in the clinical setting; nurses can improve patients' quality of life by giving patients a high quality holistic care based on effective intervention and providing required and relevant information.
Objective: a- To evaluate the quality of life of patients with cancer in relation to different treatment modalities. b- Evaluate the impact of the information given by nurses on their quality of life.
Methods: A convenient sample of adult patients with different types of cancer recruited from a university hospital, Cairo, Egypt. Data were collected through self-administered questionnaire or patient structured interview.
Tools used: EORTC QLQ-C30 (Version 3) and QLQ-INFO25.
Data analysis includes descriptive statistics and exploration of relationships between key variables; physical, emotional, social wellbeing, type of treatment, information given and quality of life.

Results: Results revealed significant correlation between emotional disturbance and quality of life. Lack of information is also correlated with low quality of life. Patients expressed their needs for more clarification about treatment, coping with disease and future consideration.

Conclusion: Quality of life should be assessed by nurses throughout treatment phases to identify patients at risk. Nurses also should seek accurate and relevant information regarding disease, treatment and general care and disseminate the gained information to patients through proper teaching and counseling in order to promote physical psychosocial balance and improve quality of life.

OBJECTIVE Rates of lymphedema as a complication of breast cancer or related therapy are unknown in resource-limited settings. This pilot aims to provide a proof of concept for simple, low-cost lymphedema measurement and to estimate the baseline lymphedema prevalence.
METHODS A prospective cohort of women with non-metastatic breast cancer with planned or recent mastectomy with curative intent were enrolled beginning in March 2019. Baseline lymphedema arm measurements were taken bilaterally using the validated, segmental circumference method and translated to volumes using the cone frustum approximation. Contralateral arm volumes were used as the normal comparison. All measurements were performed by the same nurse coordinator trained in the technique. Detailed measurement methodology will be presented. Patients completed translated, adapted versions of validated general and breast cancer-specific quality of life surveys (EORTC QLQ-C30, QLQ-BR23). Approximately 50% of the cohort was recruited at the time of preliminary analysis, performed to compare results in relative to existing lymphedema cohort data.
RESULTS 29 women were enrolled with median age 50 (IQR 45-54). All had at least stage II disease (AJCC 2018): 19% (6) IIA; 25% (7) IIB; 31% (9) IIIA; 25% (7) IIIB. Ipsilateral arm volume data was complete for 27 women, with range 1421-3809 cc (SD 545). Difference between ipsilateral and contralateral arm volumes was <5% (no lymphedema) for 67% (18), 5-10% (potential early/sub-clinical lymphedema) for 22% (6), and >=10% (clinical lymphedema) for 11% (3). No significant difference was found by pre-operative versus post-operative status (p=0.13). Self-reported arm or hand swelling did not correlate measured volume but did correlate with self-reported social challenges related to illness (p=0.03).
CONCLUSION Estimated baseline lymphedema in this pilot cohort is 11-33%. Measurement using validated, segmental circumference measurements is feasible, low-cost and yields volume data comparable to existing cohorts. Lymphedema measurement and intervention should be considered for low-resource settings. True lymphedema prevalence would be straightforward to estimate in larger studies using this method.

OBJECTIVE Women living with HIV have an increased risk of persistent high-risk HPV (HR-HPV) infections, pre-cancerous cervical lesions and cervical cancer. However, the effect of antiretroviral therapy (ART) use and duration of use on HR-HPV detection is not well understood.
METHODS HIV-infected Kenyan women without cervical dysplasia (normal VIA) were enrolled at a screening clinic in Kenya. Demographics were collected, and date of HIV diagnosis, initial CD4 count and HIV viral load, and ART details were determined. Enrolment HIV viral load and CD4 count were measured. Adjusted multivariate generalized estimating equations were fit to assess effects of HIV-related factors on HR-HPV detection (tested using the Roche Linear Array) in cervical swabs.
RESULTS 91 women (median age 38; range 21-48) were evaluated at enrolment and one year later. Median time from HIV diagnosis to enrollment was 8.3 years (range 0.1-14.2 years); 95% were receiving ART; median duration of ART use was 4.4 (range 0-10.5) years. Median CD4 count was 473 cells/uL (range 0-1257) at diagnosis and 538 cells/uL (range 17-1474) at enrolment. Longer duration of ART was associated with decreased detection of HR-HPV, aOR 0.84 (0.73, 0.98), A9 HR-HPV types, aOR 0.79 (0.67, 0.94), and HR-HPV types not included in the nanovalent HPV vaccine, aOR 0.84 (0.72, 0.99). The specific ART prescribed had no significant effect on HR-HPV detection.
CONCLUSION Longer duration of ART use was associated with reduced HR-HPV detection in HIV-infected Kenyan women. The majority of the women had an undetectable viral load at enrolment, which may afford a protective effect when the duration of ART is considered. Further studies of larger numbers of women are needed to assess the effect of the specific ART regimen on HR-HPV detection over time. Such data may impact the decisions on the choice of ART for women living in sub-Saharan Africa.

Breast cancer is the second most common type of cancer diagnosed worldwide and contributes to significant morbidity and mortality. In Tanzania, mortality rates are expected to rise by 82% by 2030. Patients may present with various symptoms, with breast lump being the most common. Histology remains the gold standard for diagnosis. Screening and treatment services for breast cancer have contributed to the improvement in survival rates worldwide. However, the African data, Tanzania in particular shows the rate to be as low as 21%.
METHODOLOGY A retrospective cohort study was conducted at Kilimanjaro Christian Medical Centre (KCMC) from January 2013 to August 2018. The study population consisted of all histologically confirmed breast cancer patients within the period.
RESULTS One forty-six patients were enrolled. The median age of presentation was 54 years with a male to female ratio of 1:23. In the female population, 58% were post-menopausal women and about 75 % of the women were multiparous. Breast lump was the common symptom presentation reported in 98% of patients. Seventy five percent were in stage III and IV of the disease, with invasive ductal carcinoma being the frequent histological type. Mastectomy was done in 92% of patients. The overall proportion of patients that survived for a year after diagnosis was 83.2%. All male patients died within one year of follow-up post diagnosis.
CONCLUSION A greater proportion of patients survived for at least a year post diagnosis. Majority of the patients are diagnosed at advanced stages. Reasons for this lie in the fact that patients are unable to recognize certain symptoms as suspicious which may lead to a delay in seeking medical attention.

OBJECTIVE Obesity contributes to the pathogenesis of numerous cancers, including prostate cancer (CaP). In South Africa, the age standardised incidence rate (ASIR) (1986 to 2006) for CaP increased from 16.8 to 30.8 per 100,000, while the obesity rate increased from 29.1 to 31.1% in males. Our objective was to determine whether obesity might contribute to higher rates of advanced CaP at diagnosis, and local spread of the disease.
METHODS Between June 2016 and March 2019, a total of 110 South African men with histologically confirmed CaP (cases), and 122 age-matched men with no history of any cancer (controls) were recruited from Tygerberg Hospital and Groote Schuur Hospital, Cape Town, South Africa. Participants were grouped according to body mass index (BMI) into normal (BMI <25.0; including the underweight individuals <18.5), overweight (BMI 25.0-29.9), and obese (BMI ≥30.0). We investigated statistical differences in clinical, pathological and follow-up characteristics according to the different BMI strata (<25.0 vs. 25.0-29.0 vs. ≥30.0). The investigation was conducted in accordance to the principles of the World Medical Association’s Helsinki Declaration (study number N15/06/054; NIH U01CA184374).
RESULTS For cases and controls, 62% and 55% had a normal BMI (<25.0), 23% and 26% were overweight (25.0-29.0), and 15% and 19% were obese (≥30.0), respectively. The median BMI and median ages between BMI groups for cases and controls, were similar. For cases, a significant difference in median PSA level was observed between the normal vs. obese group (120.00ng/ml vs. 16.00ng/ml; p=0.0063). Similarly, for cases, the normal group had a higher median Gleason Grade Group compared to the obese group (Grade Group 4 vs. Grade Group 2; p=0.0152). The BMI normal group was more likely to harbour an unfavourable pathological tumour stage ≥T3a at diagnosis compared to the overweight and obese groups (39% vs. 5% vs. 1%; p=0.0018). None of the BMI groups was more likely to develop metastasis (18% vs. 7% vs. 3%; p>0.05).
CONCLUSIONS Our data suggest an apparent CaP risk reduction associated with increased BMI in South African men, thereby possibly supporting the counter-intuitive concept of the obesity paradox.

OBJECTIVE Adherence to chemotherapy for moderate-advanced Kaposi’s sarcoma is crucial to achieve remission. Our objective was to assess patient and health system factors related to KS chemotherapy adherence in Kenya
METHODS We performed a chart review of all patients diagnosed with HIV-related KS between 2009-2012 at AMPATH for 18 months post-diagnosis. Chemotherapy adherence (completion of 6 cycles) was defined as: optimal =70d (cycles every 2 weeks), satisfactory=105d (cycles every 3 weeks) and minimally acceptable =140d (cycles every 4 weeks). Patients who died prior to chemotherapy completion or were discontinued early by providers were assigned a chemotherapy adherence status based on adherence up to that time. We performed a multivariate analysis of determinants of achieving minimally acceptable adherence.
RESULTS 587 KS patients were diagnosed during the study period, of which 290 received at least one chemotherapy cycle. Of initiated patients, 65% were male; median age was 34 (IQR 29-39). The most common first-line regimen was Bleomycin-Vincristine (78%). Of 290 chemotherapy initiators, 40% met at least minimally acceptably adherence, with very few (7%) reaching optimal adherence. After adjustment for age and gender, only travel time to clinic >2 hours was independently associated with increased odds of non-adherence (OR 3.20, 95% CI 1.39-7.37). Education level, CD4 count at KS diagnosis, and severity of disease (number of chemotherapy indications) were not associated with adherence. There was a trend for younger women to be more adherent than older women or men regardless of age, though not statistically significant.
CONCLUSIONS Adherence to multiple cycles of chemotherapy, while simultaneously undergoing routine HIV care, is challenging, with less than half of patients achieving minimally acceptable adherence. In Western Kenya, distance to clinic (>2 hours) was the most significant determinant of non-adherence to chemotherapy for KS. This finding highlights the importance of making chemotherapy locally available in the community.

OBJECTIVE By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors.
METHODS We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors.
RESULTS We recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up.
CONCLUSIONS This short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.

BACKGROUND Most women with breast cancer in Ethiopia are diagnosed at an advanced stage. The length of delays attributable to patients and health system, however, are not well documented. Herein, we examined extent of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa¬.
PATIENTS AND METHODS All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study. Patient interval (time from recognition of first symptom to medical consultation), and diagnostic interval (time from first consultation to diagnosis) were computed. Patient interval >90 days and diagnostic interval >30 days were considered delays, and associated factors were determined using multivariable logistic regression.
RESULTS Thirty-six percent of the patients had patient intervals of >90 days, and 69% of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded one year for 18% of patients. Ninety-five percent of the patients detected the first symptom by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptom to other factors. One-fifth of patients had progression of symptoms before seeking medical consultation. Age, family size, using traditional medicine and progression of symptoms before consultation were significantly associated with patient delay. Symptoms recognized while breastfeeding, first consultation at health centres and visiting >4 facilities were associated with higher likelihood of diagnostic delay. However, having clinical breast examination, and progression of symptoms before consultation decreased the likelihood of late confirmation.
CONCLUSIONS Women with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programs to increase knowledge about breast cancer symptoms and the importance of early presentation, and the need for health care provider education in early diagnosis.

BACKGROUND The scarcity of country data (e.g. a cancer registry) for the burden of cervical cancer (CC) in low-income countries (LCIs) such as Swaziland remains a huge challenge. Such data are critical to inform local decision-making regarding resource allocation [1]. We aimed to estimate likely cervical cancer incidence in Swaziland using three different methodologies (triangulation), to help better inform local policy guidance regarding likely higher “true” burden and increased resource allocation required for treatment, cervical cancer screening and HPV vaccine implementation.
METHODS Three methods were applied to estimate CC incidence, namely: 1) application of age-specific CC incidence rates for Southern African region from GLOBOCAN 2012 extrapolated to the 2014 Swaziland female population; 2) a linear regression based model with transformed age-standardised CC incidence against hr-HPV (with and without HIV as a covariate) prevalence among women with normal cervical cytology; and 3) a mathematical model, using a natural history approach based on parameter estimates from various available literature and local survey estimates. We then triangulated estimates and uncertainty from the three models to estimate the most likely CC incidence rate for Swaziland in 2015.
RESULTS The projected incidence estimates for models 1–3 were 69.4 (95% CI: 66.7–72.1), 62.6 per 100,000 (95%CI: 53.7–71.8) and 44.6 per 100,000 (41.5 to 52.1) respectively. Model 2 with HIV prevalence as covariate estimated a higher CC incidence rate estimate of 101.1 per 100,000 (95%CI: 90.3–112.2). The triangulated (‘averaged’) age-standardized CC incidence based across the 3 models for 2015 was estimated at 69.4 per 100,000 (95% CI: 63.0–77.1) in Swaziland.
CONCLUSION It is widely accepted that cancer incidence (and in this case CC) is underestimated in settings with poor and lacking registry data. Our findings suggest that the projected burden of CC is higher than that suggested from other sources. Local health policy decisions and decision-makers need to re-assess resource allocation to prevent and treat CC effectively, which is likely to persist given the very high burden of hr-HPV within the country.

OBJECTIVE In Uganda it is estimated that 7000 children are affected by cancer annually according to the medical registry in the Uganda Cancer Institute (UCI). Of these children 55% survive annually and yet in developed countries 80% of children are cured. This calls for a combined effort towards reducing the impact of cancer in Sub- Saharan Africa. Kawempe Home Care (KHC), a non-profit community based healthcare organization in Kampala, opened New Hope Children’s Hostel in September 2016 to provide palliative care for children with cancer who receive treatment at UCI. With our hostel, we aim to reduce the impact of childhood cancer through increasing access to specialist care for poor and vulnerable children from all over Uganda.
METHOD The hostel targets poor and vulnerable children from upcountry who receive cancer treatment at UCI, but cannot be accommodated at Mulago Hospital due to limited capacity. KHC collaborates with UCI to identify families in need of our service. KHC provides a child and one caretaker (e.g. a relative) with free accommodation, food, psychosocial support and daily transport to UCI. Psychosocial support includes counseling, spiritual care, informative sessions for children and caretakers, play and music therapy for children. Pain management is done by KHC medical staff through proper administering of morphine and other medicines prescribed by UCI. Through the MUAC-scale, we identify children with severe acute and moderate malnutrition and put them on specialized diet. In case of emergency, first aid provided and the child is rushed to UCI for further management. Children discharged from UCI and referred for palliation are linked to hospices nearby their villages for pain management.
RESULTS Between September 2016 and June 2019, 414 children and their caretaker have been hosted at New Hope Children’s Hostel at KHC. Follow-up studies show that until to date 110 children successfully completed their cancer treatment and are now on quarterly routine medical review. 10 are on palliation in their homes, 195 are still on cancer treatment and sadly 99 children passed away. Assessment of child and caretaker psychosocial wellbeing with POS-C (Palliative Outcome Scale, APCA, 2012) indicates that our clients’ overall disease-related quality of life improved throughout their stay at KHC.
CONCLUSION Our analysis shows a strong need for holistic palliative care services in pediatric oncology. The establishment of Patient Hostels can provide a viable solution to the care gap of limited access to specialist care for poor and vulnerable children in Uganda.

OBJECTIVES While breast cancer advocacy has become an integral part of the landscape in high income countries; leading to significant progress in breast cancer early detection, treatment, and survival, it remains in its infancy in low and middle-income countries. We describe a grassroots advocacy movement in Malawi.
METHODS Think Pink Malawi was conceptualized as a breast cancer advocacy organization in 2014. It is a small group of dedicated volunteers that organizes annual community awareness events and has expanded to screening in urban and rural settings. It engages with local government officials, leaders from multilateral and bilateral organization, businesses, and NGOs for sponsorship and support.
RESULTS Breast cancer awareness events have been held 2014-2018. Activities included keynote speeches by members of parliament, followed by a march from parliament along the city’s major road. Further educational talks about breast cancer and stories of survivorship were shared. There has been consistent parliamentary, diplomatic, and UN presence in all events. The amount of money raised (USD) is $350 (2014), $4837 (2015), $5114 (2016), $4008 (2017), $1000 (2018). The number or attendees were 500 (2014), 900 (2015), 600 (2016), 852 (2017), 800 (2018). In 2017, the organization expanded to rural events and free breast and cervical cancer screening. Then, 87 women at rural community events were screened for breast cancer using clinical breast exam, and 2 were referred for further workup. In 2018, 238 women had breast cancer screening and 3 were referred for further workup; 204 women had cervical cancer screening and 6 were referred.
CONCLUSIONS Effective advocacy movements can create an empowered society with a shared agenda, involving multiple stakeholders from medicine, research, government, businesses, and civil society. Think Pink Malawi is helping to catalyse momentum in Malawi, which hopefully will continue to accelerate change to improve outcomes for women with breast cancer.

PURPOSE Colorectal cancer is a major cause of morbidity and mortality globally and its incidence is increasing in developing countries. This study aims to provide baseline colorectal cancer data on stage, treatment, and survival for colorectal cancer patients diagnosed from eleven population-based cancer registries in sub-Saharan Africa.
METHODS We randomly selected 653 patients from logbooks of 11 cancer registries and demographic and clinical characteristics were abstracted from medical records. For evaluation of guideline adherence of therapy, we drafted a stage dependent therapy evaluation scheme based on NCCN Clinical Practice Guidelines. Vital status was ascertained by contacting the patients or their family members by telephone and verifying hospital-level medical records.
RESULTS Median age at diagnosis was 54 years, with 21% of the patients younger than 40 years. Stage IV was the most frequent stage at presentation, representing 26% of the cases. Overall Survival (OS) at one, two and three years was 70.9% (95%-CI 65.5-76.3%), 55.2% (95%-CI 49-61.4%), and 45.3% (95%-CI 38.9-51.7%), respectively. 236 patients (36,1 %) received any form of surgical intervention. Further, only 10% of all patients grouped in TNM stage I, II or III received treatment according to guidelines including minor deviations. For patients grouped in TNM stage I, II, III, we found a strong relationship between risk of early death and the clinical performance of the patients, advanced stage, the human development index of the respective country, and adherence to guideline therapy.
CONCLUSIONS To our knowledge this study is the first to date to investigate cross-sectional and longitudinal data of colorectal cancer patients in a multinational population-based setting in sub-Saharan Africa. Only one in ten patients with early-stage colorectal cancer in sub-Saharan Africa received curative surgery. This underscores the need to improve surgical care in the region through training and enhancing existing infrastructure.

INTRODUCTION In Sub-Saharan Africa cancer diseases are increasing, caused by demographic and epidemiologic transitions [1]. Cancer is a threat to health care systems and show the need for innovative integrative approaches in the education of health care provider [2]. In Tanzania, cancer burden is estimated to increase by 85% by the year 2030 [3]. In 3 hospitals treatment is already possible. However, difficult access to the health system and sparse prevention and awareness programs, early detection contribute to late diagnosis and remaining high mortality rates [4], [5]. A low level of cancer awareness in health care workers is facilitating deficient prevention measures, screening and treatment [6]. This study aimed to evaluate the effects of a repetitive-pilot cancer awareness training for dispensary health care providers, ideally represented by nurses and clinical officers, in the Kilimanjaro Region. Main research interest was to assess the repetitive effects of the training in continuing education on cancer knowledge of dispensary health care providers and its application into practice.
METHOD A group of dispensary health care workers (n=16) attended the cancer awareness training. Three training days were provided for this group, spread over the period of three months (one day per month). A questionnaire was developed to assess cancer knowledge in a pre-/post- training panel survey. Application of this knowledge into practice was assessed at follow-up and complemented with qualitative data.
RESULTS Cancer knowledge increased by 24% (95% CI=13-36%, p=0.002). The dispensary health care providers also started to apply the new cancer knowledge into practice and reported to feel more confident in early detection and cancer control.
CONCLUSION The repetitive pilot cancer awareness training was effective in increasing cancer knowledge and its application. The repetitive teaching sessions proved to be successful in result in better learning outcomes as proven in other studies [7]. In addition, the repeating trainings are important for medical networking. Dispensary health care workers are an important link to the health system for many people in rural Tanzania. More repetitive cancer awareness trainings are needed. This concept could also applicable to other countries in SSA.

BACKGROUND Philadelphia chromosome positive (Ph+) Chronic Myeloid Leukaemia (CML) is a haematologic malignancy and belongs to the group of myeloproliferative diseases. The annual incidence of CML in Europe ranges between 0.7 – 1.0/100,000 with a median age at diagnosis of 57-60 years [1]. Data from the US display an incidence rate of 1.6/100,000 and WHO suggests that no association with race or ethnicity seems to exist [2]. However, due to lack of reliable data, incidence rate for LIC remain an estimation [2], but taking the existing data for extrapolation, the worldwide annual incidence would be above 100,000. It is known that African patients are younger at time of diagnosis with an average of 39,5 years [3] and genetic varieties have been found by Koffi et al. [4]. Poor prognosis and adverse treatment outcome were related to additional chromosomal abnormalities and complex aberrations. Furthermore, the prognostic indices were not conclusive with treatment outcome. Studies on early molecular response under Imatinib treatment has not been published in East Africa yet. We present preliminary data from our study in Northern Tanzania.
METHODS All new diagnosed Ph+ CML patients were included and FBC, EUTOS and Sokal Scores and clinical investigations were performed. 3 months after Imatinib treatment, bcr-abl/abl ratio was obtained using real time PCR and clinical remission was documented.
RESULTS 17 patients were evaluated for early MR and haematologic response. The age range were between 4 and 60 years (mean age 38), WBC at diagnosis between 78 and 499/nl (mean 313/nl), all patients had splenomegaly, 8 patients had hepatomegaly, 16 were in chronic phase and 1 in accelerated phase. 15 patients obtained complete hematologic response, favourable early molecular response (fMR) (bcr-ab-/abl <10%) in 7 patients. No correlation was found between EUTOS and Sokal scores or WBC and fMR, but hepatomegaly was positively correlated with non-fMR (p=0.005).
DISCUSSION This is the first study investigating early MR in Ph+ CML patients in East Africa. Despite the small number of patients, a trend towards fewer early MR as described in different ethnic group was found. Furthermore, hepatomegaly seems to be strongly associated with non-fMR. The same finding was reported 2008 from the Ivory Coast [5] and it was suggested to develop an “African CML prognostic score” that includes hepatomegaly. Our results support these findings. More patient data are needed to confirm our findings and further genetic testing of those with non-favourable response are advisable.

OBJECTIVE:
Implementation of specialty oncology pharmacy services is associated with improved patient care and reduced medical errors. Pharmacy capacity is limited in many low-resource countries, with chemotherapy preparation and administration often being performed by other allied health care pro-viders. At Bugando Medical Center in Tanzania, both nurses and pharmacists are responsible for mixing and administering chemotherapy; however, most nurses do not have specialized oncology training, which increases the risk for medication errors. The purpose of the current study was to assess the effects
of pharmacist participation on therapeutic outcomes, including verified dosage calculations, chemotherapy administration adherence, and dose documentation.
METHODOLOGY:
Chemotherapy encounters were observed over a 1-month period. Recorded observations included adherence to prescribed chemotherapy administration times; errors, including spills and extravasation; and administrative adherence, including dose verification and documentation.
RESULTS :
There were 53 observed encounters—32 with a pharmacist and 21 without; 15 were for pediatric patients. Pharmacist participation increased adherence to prescribed administration time (54% v 19%; P 5 .009) and decreased errors (zero v two extravasations; zero v one spill). Pharmacist participation improved chemotherapy administration documentation (96.8% v 76.2%; P 5 .049); however, patient safety measures, including intravenous catheter placement verification, secondary dose check, and toxicity monitoring during administration, were not done with or without pharmacist participation.
CONCLUSION:
Pharmacist participation increased adherence to prescribed chemotherapy administration and documentation, and reduced extravasation; however, additional patient safety training is needed. A larger study can further evaluate the impact of the participation of a specialty pharmacist on patient-
related outcomes.

OBJECTIVE In response to the growing equity gap in access to affordable, quality cancer services and building on the cancer resolution adopted at the 2017 World Health Assembly, the Union for International Cancer Control (UICC) launched the global advocacy campaign ‘Treatment for All’. Through its national activation workstream, in 2018, UICC worked with member organisations in Indonesia, Mexico and Uganda to equip them with knowledge and skills to raise the profile of cancer and work collaboratively with governments in translating global commitments into national action.
METHODS Through field visits, an advocacy workshop in Geneva, needs assessment and regular remote engagement, Indonesian Cancer Foundation (ICF), Salvati and Uganda Cancer Society (UCS) were supported in positioning their advocacy efforts tailored to national health system needs. Collaboration informs the development of tailored resources and materials, including a toolkit, virtual course, M&E framework and in-person training, to support scale up of the initiative to civil society in 40 countries by 2020.
RESULTS ICF, Salvati and UCS saw the value of working together, with national civil society, with one another and with UICC, to shape their advocacy strategies. Convening platforms helped to generate momentum for improved cancer control policy. National activation enabled strategic direction in advocacy for cancer control, connecting national efforts to a global campaign backed by technical expertise from the cancer community to strengthen impact and sustainability of Treatment for All activities.
CONCLUSIONS In 2018, expressions of interest to join Treatment for All from more than 100 civil society organisations in over 50 countries highlighted the demand for continued capacity building support. Capacity building support for advocacy can help civil society in different countries unite behind a common purpose, finding strategic direction in their advocacy work and leveraging a global campaign to seek improved sustainability and impact of efforts.

ISSUES Until recently, Paediatric Palliative Care in Uganda was ignored, with less than 5% of patients seen at Hospice Africa Uganda being Paediatric patients. African Palliative Care Association (APCA) and Palliative Care Association of Uganda (PCAU) are strongly advocating for Paediatric Palliative Care (PPC) at the national level.
DESCRIPTION APCA and PCAU has been working closely with International Children’s Palliative Care Network (ICPCN) to train health care professionals in Uganda. One major training has been conducted in Uganda since 1998, with over 56 health care professionals being trained and awarded diplomas for the first time in 2015 by Ugandan institution in Paediatric Palliative Care (DPPC) in the history of PPC in Uganda. It began as a certificate course in 2009, when Mildmay Uganda was selected to be one of the three organizations in Africa, to establish a Children's Palliative Care (CPC) Training and Clinical Excellence Centre in order to reduce infant mortality rates and give hope to children with life threatening illnesses. PCAU has conducted symposiums at various PCAU conferences in the country.
LESSONS LEARNT These activities have resulted in awareness on the palliative care needs of children. As a result, there are now 5 government hospitals which have started paediatric palliative care services within their respectful institutions, while all government hospitals that have integrated palliative care have been encouraged to include children in their services.
RECOMMENDATIONS There are still many challenges which need to be addressed. These include integration of PPC in the pre and postgraduates curricula for health care professionals; policies for Paediatric Palliative Care; setting up specific services for children; creating awareness on the need for PPC and de mystifying the common myths about children’s palliative care. This paper will share the journey of Peaediatric Palliative Care in Uganda.

OBJECTIVES Prostate cancer (PC) is the most common type of cancer in men and constitute a major public health issue. In developing countries, available evidence indicates that factors responsible for high PC-related mortality rate include poor knowledge and low uptake of screening practices. This study examined the effect of church based intervention to promote informed decision making for prostate cancer uptake of screening among men attending Saint Mary’s Catholic Church Enugu, Nigeria. The objectives of the study were to determine the knowledge of prostate cancer among the participants, determine the uptake of screening and assess the barriers towards uptake of screening.
METHODS A mixed method research comprising of focus group discussion and a quasi-experimental pretest-posttest research design was used. The participants comprised of 50 adult men aged 40 – 70 years who were willing to participate in the study without any previous history of PC. A researcher developed questionnaire was the instrument used for data collection pre and post intervention. Statistical analysis for association was performed using ANOVA.
RESULTS Results revealed that the mean age of the participants was 54+12.9 years. Majority 36(72%) had not heard of prostate cancer at pre intervention versus 0(0%) at post intervention phase (p < 0.05). Few 15(30%) of the participants were aware of the screening test for prostate cancer at pre-intervention versus 50(100%) post intervention. Few 5(10%) of participants had ever carried out prostate specific antigen (PSA) test in the pre intervention stage in the last one year versus 20(40%) at the post intervention phase. The major barriers to prostate cancer uptake of screening by participants were that being afraid to hear that I have prostate cancer 40(80%) versus 5(10%) and that the PSA test is expensive 46(82%) and 10(20%) at pre intervention and at post intervention respectively.
CONCLUSION It was concluded that initiation of cancer teachings in churches and public places should be intensified to create awareness of PC and informed decision for free uptake of screening for men who are prone to the disease.

BACKGROUND Acute myeloid leukaemia (AML) is a malignant haematological disorder that is characterized by the proliferation and accumulation of > 20% immature myeloid precursors principally in the bone marrow as a result of somatic mutation in the blood cell. AML is the most common acute leukaemia in adults. Despite major breakthroughs in leukaemia therapy in recent times, AML has witnessed very little progress. After more than three decades, the combination of an anthracycline with cytarabine still remain the standard regimen for induction chemotherapy and even at that, disease relapse is virtually certain without further treatments. The search for new drugs becomes imperative either to manage de novo cases, or salvage relapsed AML. Therefore the objective of this study was to ascertain the antineoplastic potential of leaf extracts of Pelargonium inquinans against U937 cell line.
METHODS Pelargonium inquinans is a member of the family Geraniceae native to South Africa. In this study, the anti-neoplastic properties of dry and fresh extracts of various solvents (aqueous, ethanol and acetone) of Pelargonium inquinans were determined in U937 cell line. The cytotoxic effect of the various extracts on the cell was evaluated by MTT assay. The mode of cell death was determined by flow cytometry. The cell cycle distribution as well as the caspase-3 activity was analyzed by flow cytometry.
RESULTS Cytotoxicity was induced in a dose dependent manner. The treatment of U937 cell resulted in Sub-G1 apoptosis, G0/G1 cell cycle arrest which was associated with the activation of caspase 3.
CONCLUSIONS This result suggest that Pelargonium inquinans have antineoplastic properties against acute leukaemia cells.

BACKGROUND While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training.
METHODS An online survey was distributed via national oncology societies and a pre-existing network of contacts to cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs) based on World Bank criteria.
RESULTS 273 physicians who trained in 57 different countries responded to the survey; 33% (90/273), 32% (87/273), and 35% (96/273) in LMICs, UMICs and HICs respectively. 18% of respondents (49/273) trained in an African country. Overall, the countries with the highest number of responses were Canada, Brazil, Turkey, Peru, the United Kingdom, India, Philippines, Sudan, Chile, Nigeria and Saudi Arabia. 60% of respondents were practicing physicians and 40% were in training. The proportion of trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; P=0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; P<0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs. With regards to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice, and understanding of healthcare systems irrespective of country grouping.
CONCLUSION Investment in training by the public sector would be vital to decreasing the prevalence of self-funding in LMIC. Gaps in research training and enhancement of competencies in research dissemination in LMIC require attention. Instruction on cancer care systems and leadership need to be incorporated in training curricula in all countries.

OBJECTIVE Health literacy is the degree of an individual’s knowledge and capacity to seek, understand and use health information to make decision on one’s health. Therefore, health communication programming should be linked to the individual and population health literacy level. However, the functional health literacy level on cervical cancer among women in in Mayuge District in particular and Uganda in general is not comprehensively known. This study aimed to assess the level of cervical cancer literacy among women aged 18 to 65years in Mayuge district.
METHODS The research protocol was approved by Uganda Martyrs University and Uganda Cancer Institute research and ethic committee (UCI-REC). We conducted a cross-sectional study with multi-stage cluster sampling and eligible household participant selected using Kish Grid table of participants selection. Structured questionnaire was used to collect data from 400 women who could read in Lusoga (Local language) or English or both in Mayuge district in August 2017. We assessed five health literacy domains; cervical cancer knowledge, print literacy, Oral (using audio-clip) literacy, numeral literacy and perceived ehealth literacy.
RESULTS The study found the mean percentage score and SD in cervical cancer awareness as 36.4± 21.2%, oral health literacy (74.4± 23.7%), print health literacy (51.9±24.1%), numeral health literacy (27.10± 22.4%) and perceived ehealth literacy (23.72±26.9%). The overall cervical cancer literacy score was 42.7±12.2% amongst the women.
CONCLUSIONS The women in Mayuge District in general have limited cervical cancer literacy except oral health literacy domain. Therefore, health workers should prioritize use of orally disseminated cervical cancer information, improve information processing, use plain language and improve awareness creation effort within the community, schools and health facility settings.

RELATO DO CASO CLÍNICO Paciente I.A.N de 60 anos de idade, M,N, internado no Serviço de Gastroenterologia dia 14 de Março de 2018, com história de disfagia progressiva com evolução de 3 meses, inicialmente a sólidos, posteriormente evoluiu para semi-sólidos e líquidos, sialorreia e perda ponderal, HIV negativo. EDA que revelou tumor do terço inferior (aos 35cm) do esófago. TAC Torácico: presença de tumoração no terço inferior do esófago, com adenopatia periaortíca. (T3, N1, M0, estágio IV). O exame histológico foi compatível compatível com tumor estromal gastrointestinal (GIST), baixo índice mitótico. O paciente foi submetido a cirurgia 3 meses após o dignóstico, com resseção completa do tumor. Evoluiu Com um pós operatório satisfatório, e foi posteriormente enviado a oncologia para quimioterapia adjuvante. Justificativa: Este caso ilustra um tumor estromal gastrointestinal de origem esofágica, muito raro, descrito na literatura com menos de 2% de frequência e que deve estar sempre presente no diagnóstico diferencial de patologias esofágicas estenosantes.

OBJECTIVE Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate sociodemographic and Clinical factors associated with VIA positivity and with cervical high-grade lesions on cytology among women HIV positive and Negative women attending Cervical Cancer Screening in Tanzania
METHODS We conducted a large cross-sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio-demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed as well as VIA test as recommended screening test in Tanzania. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs).
RESULTS The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95% CI: 2.34–5.17) or to high-risk HPV (HrHPV) (OR = 1.97; 95% CI: 1.37–2.85). HrHPV was by far the strongest predictor of high-grade cytology (OR = 110.1; 95% CI: 50.4–240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95% CI: 0.78–2.08). After adjustment for HrHPV, HIV and age, the risk of high-grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity.
CONCLUSIONS Infection with HrHPV is a major risk factor for high-grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.

INTRODUCTION In Africa, breast cancer accounts for 25% of cancer diagnoses and 20% of cancer deaths in women. Breast cancer screening is neither available nor recommended in Malawi. Ultrasound is both cost-effective and a well-established tool to evaluate breast masses. With only two radiologists in Malawi, the surgeons at a tertiary hospital in Malawi implemented symptomatic breast disease clinic using point-of-care ultrasound to aid diagnosis. This study assesses the correlation between surgeon-determined Breast Imaging Reporting And Data Systems (BI-RADS) assessment and biopsy histology.
METHODS We retrospectively analyzed preliminary breast clinic registry data to describe patient characteristics, and to compare the point-of-care ultrasound BI-RADS score to histology results. Patients with BI-RADS <4 (3 probably benign; 2 benign; 1 negative) were compared to those with a BI-RADS>4 (4 suspicious; 5 highly suggestive of malignancy; 6 biopsy-proven malignancy).
RESULTS Of the 174 BI-RADS-assessed patients, 80 patients had both BI-RADS and histology results. Because of limited resources, low risk, benign-appearing patients are not universally biopsied. Patients with BI-RADS<4 were significantly younger. HIV status, age at menarche, and rates of regular breast self-exam in the two populations were not significantly different (Table 1). For patients assessed as BI-RADS<4, 92.9% were confirmed to have benign disease. Among patients assessed BI-RADS>4, 84.8% were demonstrated to have malignant pathology, p<0.001. The positive predictive value is 85%.
CONCLUSION Surgeon-performed ultrasound is a useful tool with promising accuracy for the assessment of symptomatic breast disease in patients with positive clinical breast exam in a low-resource setting.

BACKGROUND TP53 plays a crucial role in preventing cancer development. Previous studies in sub-Saharan Africa (SSA) reported inconclusive findings for the association of the TP53 Arg72Pro variant with cervical cancer. We, therefore, performed a meta-analysis to precisely define the effect of TP53 Arg72Pro on cervical cancer risk in the SSA population.
METHODS A comprehensive literature search was performed in PubMed, Hinari, the Web of Science, and Google Scholar to identify suitable articles published from the year 2000 to 2018. Studies evaluating the association between TP53 Arg72Pro and cervical cancer in the SSA population were included. A fixed-effect model was used to calculate the pooled odds ratio (OR) and 95% confidence intervals (95% CIs).
RESULTS The Arg allele of TP53 Arg72Pro was associated with an increased risk of cervical cancer (OR = 1.30, 95% Cl = 1.12–1.50) compared to the Pro allele. The homozygous Arg/Arg genotype was also associated with an increased risk of cervical cancer, with corresponding ORs of 1.62 (95% CI = 1.20–2.19) and 1.74 (95% CI = 1.34–2.25) in the additive and recessive genetic models respectively. However, the Arg/Arg genotype was not associated with cervical cancer (OR = 1.20, 95% CI = 0.96–1.48) in the dominant genetic model.
CONCLUSION Our meta-analysis revealed that the Arg allele of TP53 Arg72Pro is associated with cervical cancer risk in the SSA population. More studies with larger sample sizes are needed to provide a more comprehensive conclusion.

BACKGROUND Breast cancer is the most common cancer of women worldwide. However, huge differences in the outcome of patients have been described in particular when comparing patients from industrial countries to that from sub-Saharan Africa, which have very limited treatment options. Current treatment of breast cancer are mainly surgery, chemotherapy, radiotherapy and hormonal therapy. Recently, breast cancer are also treated with T cell based immunotherapies. Since these therapies are very expensive, one has to select patients, which most probably do respond. In order to achieve this goal, analysis of the patients’ immune cell repertoire and activity was developed in a research program between the “Addis Ababa University, Ethiopia and the Martin-Luther-University Halle-Wittenberg, Germany. Therefore, a tumour bank is currently established consisting of tumour biopsies, blood from patients at different stages of disease and clinical parameters. While the biopsies will be analysed by immunohistochemistry, peripheral blood mononuclear cells will be characterized by flow cytometry. Currently, 40 samples from breast cancer patients upon their consent have been collected.
METHODS The immune cell subpopulations in blood samples prior to surgery from 6 patients with different breast cancer subtypes and from 6 healthy controls were determined using multicolour flow cytometry with a panel of > 35 distinct antibodies. This allows to distinguish between different immune cell subpopulations as well as different immune cell activities.
RESULTS Evaluation of the composition of immune cells in healthy donors and breast cancer patients demonstrated differences in the frequency of CD45RA/CD38 and PD1/LIR1 populations, which were lower in all patients’ samples when compared to controls. In contrast, the frequency of CD57+ cells was higher in patients than in healthy donors. For all other marker combinations/cell subpopulation frequencies no consistency was found to distinguish patients from control, which might be due to the low number of samples analysed. Currently, more samples were analysed in order to receive statistically significant data. In addition, these data will be correlated to the clinical outcome of these patients.
CONCLUSION Using this approach we hope to identify biomarkers, which will allow to distinguish between breast cancer patients and healthy volunteers. Further data will be presented at the meeting.

OBJECTIVE Cervical cancer (CC) is the most common female cancer in many countries of sub-Saharan Africa (SSA). We aimed to assess population-based adherence to treatment guidelines.
METHODS Our observational registry study included nine population-based cancer registries in eight countries, including Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. We drew random samples of 44-125 patients per registry diagnosed in 2010-2016. Cancer-directed therapy was abstracted from hospital records and evaluated for degree of adherence to NCCN guideline 1.2010.
PRELIMINARY RESULTS Of the 600 patients included in the study (median age: 50 years), one sixth were diagnosed with FIGO stage IV disease and one sixth received cancer-directed therapy (CDT) with curative potential, with 5% guideline-adherent, 2% minor and 9% major deviations. No CDT could be found in 22% of patients with follow-up of ≥3 months. Guideline adherence was not assessed in 45% of the patients because no information beyond registry data could be traced (32%) or because of lack of information on stage or short follow-up (13%). The largest proportion of patients with guideline-adherent CDT was observed in Nairobi (Kenya), the smallest in Maputo (Mozambique). Among selected patients with sufficient information abstracted, deviations from optimal guideline-adherent therapy showed relevant decline in survival probability.
CONCLUSIONS We found that only one in six cervical cancer patients in SSA received CDT with curative potential. One-fifth of women definitely, and possibly up to two-third of women never accessed CDT, despite presenting with curable disease. Investments into more radiotherapy facilities, procurement of chemotherapies, and surgical training could radically change the inevitably fatal future of these women.
ACKNOWLEDGEMENTS Intramural Funding from the Research Department of the American Cancer Society and Martin Luther University Halle-Wittenberg, Germany.

BACKGROUND Cancer is the 3rd leading cause of morbidity and mortality with 7% of deaths per year after infectious and cardiovascular diseases in Kenya. In 2018, there was an estimated 40,000 new cancer cases and 28,500 cancer deaths. This study sought to evaluate the available health programs in Kenyan media and the frequency of running cancer topics on these health programs.
METHOD Structured interview questionnaires were used to collect data. The collected data included; availability of health programs produced, cancer topics in the health programs, frequency of cancer topics, when the topics were aired, length of time on air and print space, persons invited to disseminate the information and feedback mechanism employed for audience interaction.
RESULTS The study showed that 36% of all cancer topics selected and depicted were the three major prevalent cancers in Kenya Breast, Cervical, and prostate aired during cancer months/days. The study also found that 57% of cancer topics discussed were randomly chosen for discussion. A total of 85% health programs aired had cancer topics however this was during off peak hours (10am-5pm) for most radio and TV stations, only one TV program aired on prime time at 6pm to 10pm. The least amount of time was allocated to the Cancer prevention subject as only 5% and 28% time is allocated on exercise and nutrition respectively.
CONCLUSION Most non-communicable diseases can be diagnosed at their early onset and thereby save lives. However, for lack of knowledge many suffer through misdiagnosis in silence and in the long run reach help late. Mass media can shape the public’s opinion on cancer and offer knowledge through cancer experts and survivors if the myths surrounding cancer are to be demystified and lives saved.

Tanzania is a low to middle income sub-Saharan African country which endures significant adverse impact from HIV-1 and HPV-associated malignancies.  To investigate the influence of HIV upon HPV-dependent cervical dysplasia in women from urban and rural areas of Tanzania, we designed a multi-site cross-sectional cervical screening study.  We chose rural catchment clinics in Bagamoyo and Chalinze, and an urban site, Dar es Salaam.
METHODS We implemented a low-cost multiplex PCR assay to detect 14 high-risk and 2 low-risk HPVs. The assay performance was evaluated by determination of intra‐laboratory reproducibility, sensitivity, and specificity, by comparison with the widely accepted and validated HPV. My09/My11 amplification and hybridization assay. Pap smears were performed and cervical cytobrush samples were collected for HPV genotyping. Pap smears were read in quadruplicate by readers blinded to HIV status and patient demographic data. Blood samples were collected for HIV status confirmation and CD4+ T-cell counts. All HPV genotype, cytopathology, and HIV status data were compared to patient demographic factors. We report our analyses of 1046 patients out of our target of 1400.   
REULTS The overall concordance between the multiplex and line blot hybridization assays was 99% (per sample) with a κ value equal to 0.95; and 96.49% (per detection event) with a κ value of 0.92. Interobserver reproducibility of the assay per sample was 95.76% with κ of 0.91. We found variation in HIV positive rates across the cohort; ORCI: 12.5%, Bagamoyo: 16% and Chalinze: 25%. HPV16 was the most common HPV genotype, at about 16% in Bagamoyo and Chalinze. The HIV positive group showed a significant expansion of HPV genotype diversity and cytopathology compared to the HIV negative group. We found that multiple HPV genotype infections were associated with a higher probability of abnormal cytopathology, when compared to HPV negative (OR= 2.7). Participants from Dar es Salaam showed the highest prevalence of any HPV infection and the greatest cytopathology. The rural sites exhibited a greater proportion of HPV naïve and normal cytopathology than the urban site, but also higher rates of multiple HPV infections. Higher rates of multiple HPV infections are influenced by HIV. Coinfection with four or five different HPV genotypes significantly increases the rate of HSIL among HIV positive cases.
CONCLUSIONS HIV is associated with greater HPV genotype diversity, greater numbers of HPV coinfections and higher grades of cytopathology.

OBJECTIVE To examine the test performance of careHPV, Hybrid Capture2 (HC2) and visual inspection with acetic acid (VIA) for detection of cytologically diagnosed high-grade cervical lesions or cancer (HSIL+).
METHOD It was a cross sectional study involving women attending routine cervical cancer screening at Ocean Road Cancer Institute (ORCI) and Kilimanjaro Christian Medical Center (KCMC). We enrolled 4080 women (25-60 years) in the study. The women were interviewed on lifestyle habits, and tested for HIV. A cervical specimen for careHPV testing (performed at ORCI and KCMC), and a liquid-based cervical cytology sample for HPV DNA detection using HC2 (performed at Tuebingen University Hospital, Germany) and for cytology assessment (performed at Vejle Hospital, Denmark) were obtained at a gynecological examination. Subsequently, VIA was performed. With cytology as gold standard, the sensitivity and specificity of careHPV, HC2, and VIA for detection of HSIL+ were calculated.
RESULTS Altogether, 22.7% had a positive careHPV test, 19.2% had positive HC2 test, and 6.1% had a positive VIA test. The sensitivity/specificity was 87.4%/79.6% for careHPV and 91.1%/83.7%, for HC2. VIA showed a low sensitivity of 31.1% but a high specificity (94.6%) for detection of HSIL+. The sensitivity of careHPV, HC2 and VIA was higher among younger women, and among HIV positive women. VIA triage of careHPV positive women improved specificity, but sensitivity dropped to 27%.
CONCLUSION Our results confirm the low sensitivity of VIA for detection of HSIL+ and further document that careHPV test is promising as a primary screening method for cervical-cancer prevention in low-resource regions. A suitable triage test has to be identified.

A Histiocitose de células de langerhans (HCL) é uma doença hematológica rara, caracterizada por distúrbio do sistema reticuloendotelial com proliferação células apresentadoras de antígenos detríticas, associada a reação imunológica ou a um processo neoplásico. Embora não conhecida a etiologia, a maioria dos casos são reportados em pacientes em idade pediátrica e sexo masculino. As manifestações da doença são variadas descrevendo-se lesões ósseas 80%, pele 50%, linfonodos 33% e outros órgãos 20% dos casos. A detecção precoce é difícil pelo facto de não ter uma apresentação clínica específica, e depende da comprovação histopatológica de presença de histiócitos, e imunohistoquímico com a expressão do antígeno de superfície CD1a e a expressão citoplasmática e nuclear da proteína S100. O tratamento inicial é com Quimioterapia e em alguns casos é indicado o tratamento com Radioterapia. O objetivo deste trabalho é Relatar 2 casos de jovens, do sexo feminino, com idades 19 e 23 anos, ambas seronegativas para HIV, tratadas inicialmente como casos de mal de Pott, devido a apresentação clínica de linfadenopatia seguida de paraplegia e a alta incidência local de tuberculose, correlacionar a hipótese infeciosa com etiopatogenia da doença.
MATERIAL E METODOLOGIA Relato de caso, Revisão de literatura, Analise descritiva. A importância deste relato, deve-se ao facto de a Histiocitose ser uma doença de ocorrência rara sobretudo em mulheres, em idade jovem, ambas com a mesma proveniência geográfica (Província de Inhambane). Devido a epidemiologia da tuberculose no País, muitos doentes com quadros semelhantes são submetidos a tratamento específico mesmo sem confirmação laboratorial da presença bacteriana. São necessárias mais evidências de casos para melhorar a conduta nestes doentes, recomendamos mais estudos em doentes com quadro semelhante provenientes de Inhambane.

OBJECTIVE South Africa implemented its first urban population-based cancer registry in 2017. We present cancer incidence rates in the first year of active cancer surveillance in Ekurhuleni district, Gauteng province, South Africa.
METHODS The 2017 cancer incidence data was collected through active surveillance in both public and private health facilities in Ekurhuleni district. In addition, we used two passive data sources; pathology reports from the National Cancer Registry and electronic reports from the South African Oncology Consortium. Crude and age standardised rates (ASR) were calculated, stratified by gender and race.
RESULTS In 2017, cancer cases reported were 1414 and 1957 in men and women respectively. Cancers occurred in 2090 (62.0%) black Africans, 1135 (33.7%) Caucasians, 58 (1.7%) Coloureds, 50 (1.5%) people of Indian/Asian origin and race was not specified in 38 (1.1%) people. Leading cancers in men were prostate (ASR 30.63 per 100 000), colorectal (ASR 6.42), lung (ASR 4.39), non-Hodgkin lymphoma (ASR 3.23) and Kaposi’s sarcoma (ASR 2.81). In women, the most common cancers were breast (ASR 33.83 per 100 000), cervix (ASR 25.62), colorectal (ASR 7.05), uterus (ASR 6.01) and lung (ASR 4.72).
CONCLUSIONS The leading cancers in Ekurhuleni district reflect a mixed cancer burden consistent with the economic and racial diversity of South Africa. This comprises cancers (such as breast, prostate, colorectal and lung) of importance in high human development index (HDI) countries as well as infection-related cancers such as cervix and Kaposi’s sarcoma which are prominent in low HDI countries. Cancer control policies in South Africa need to target both westernization (lifestyle, dietary and hormonal) and poverty related (infection-related) cancer risk factors.

OBJECTIVE Cancer cases are rising globally with most cases projected to occur in low-middle income countries. With the growing number of facilities providing chemotherapy services, there is a need to build capacity for both health care workers and support staff on how to safely manage chemotherapeutic agents. This project equipped health care professionals in chemotherapy centres with the requisite knowledge and skills to safely deliver chemotherapeutic agents and manage side effects. The project also equipped public hospitals with the required Personal Protective Equipments (PPEs).
METHODS The National Cancer Institute of Kenya convened a multi-institutional steering committee with representation from public, private and faith-based hospitals, academic institutions and civil society organizations. This was further broken down into curriculum and standard operating procedures (SOPs) development subcommittees. The American Cancer Society supported initial training and the committees subsequently developed a locally-contextual based curriculum and training materials. Two national Trainer-of-Trainers (ToTs) sessions and two cascaded trainings were conducted during the initial phase.
RESULTS Sixteen master trainers formulated the local curriculum and developed training materials. They also facilitated ToT training. A total of 107 health care workers were trained; 53(49%) trained as ToTs. Among the trainees, 59(55%) were nurses, 17(16%) were medical officers/clinical officers and 31(29%) were pharmacists/pharmaceutical technologists. Majority (59%) of the trainees were drawn from public hospitals.
CONCLUSIONS Countries need to establish local training experts to promote safe handling and delivery of chemotherapeutic agents. Public private partnerships can be effective in building the human resource capacity for cancer care in Kenya by leveraging existing local expertise across all

INTRODUCTION High quality data and effective data quality assessment are necessary for accurately evaluating the impact of data reporting and measuring disease outcomes. Data collection, data processing, reporting and data storage constitute the data flow process that need to be assessed for overall data quality and integrity.
OBJECTIVE To identify gaps and corrective action points in all dimensions of data quality.
METHODS The assessment was based on five dimensions of data quality: (a) Validity, (b) Reliability, (c) Timeliness, (d) Precision and (e) Integrity. To achieve this, the AMPATH Multinational Lung Cancer Control Program staff, together with an independent reviewer, conducted the following five phases: (1) examination and understanding of the data flow process along the cascade of care; (2) Validation of hard copy data collection tools as well as the database (Point of Care System). (3) Data verification using source documents (patient charts, training participant’s list and awareness activity attendance); (4) Conducting community visit and (5) completing the data quality check list.
RESULTS The results of validity showed whereas the quality of data was excellent at the central AMPATH, supervision, verification of data and support were the main gaps identified at the community level affecting quality of data. In addition, unavailability of standard operating procedures (SOP) to correct known data errors were the gaps identified in data processes within the Point of Care System used in clinical care at that level. The need to strengthen physical files security at the main hospital, having distant back-up servers and independent end of project phase evaluation were the gaps identified to assess integrity. Solutions included allocating resources (training and support) for Data Quality Assessment, establishing standards and guidelines, and changing organizational culture. Based on the assessment relative to the five standards, the overall conclusion regarding the quality of the data was rated acceptable.
CONCLUSION Several barriers affecting Data Quality Assessment and reporting were identified. Integrating the Clinical team, community core team, information technology team, M&E and data management team towards systematic DQA would overcome these gaps. Understanding gaps and solutions to DQA reporting is paramount to establishing trust within the data flow process, data reporting, data analysis and publication. Future research and clinical studies should conduct routine checks to have quality data

BACKGROUND Increasingly, evidence is emerging from developing countries like Kenya on the burden of loss to follow-up (LTFU)from care after a positive cervical cancer screening/diagnosis. This has been shown to negatively impact cervical cancer management. Unfortunately little or no information exists on the subject in the western Kenya. This study is designed to determine the proportion, predictors and reasons for defaulting from follow-up care after positive cervical cancer screen using visual inspection using acetic acid (VIA).
METHODOLOGY We conducted a prospective study of women, who presented for cervical cancer screening at Chulaimbo and Webuye sub county hospitals and screened positive by VIA. A 2-3 weeks appointment was then set for review by a gynae-oncologist. A total of 100 women, scheduled for review, were recruited in the study and followed between August 2016 and May, 2017. LTFU was defined as failure to keep scheduled appointment or being unreachable for 3 consecutive months and failure to confirm that a woman sought for care in another health facility. Descriptive statistics were used to summarize data and the Cox proportional hazards model to determine factors associated with LTFU.
RESULTS The age range was 21-77 years, with a mean of 44.45 years (STD=12). Thirty nine percent 39% of the women defaulted from scheduled follow-up appointment of which 25(64%) were LTFU. Univariate cox regression was conducted for HIV cases (HR=2.7, p-value=0.021), clinic revisits (HR=2.6, p-value=0.026), married (HR=0.63, p-value=0.237) and previously screened women (HR=1.67, p-value=0.198). Increased risk of LTFU was observed for HIV cases (HR=2.4, p-value=0.04) and revisits (HR=7.5,p-value=0.014) in a multivariable model.
CONCLUSION LTFU affects cervical cancer management due to several factors some of which are beyond the control of the women. 25% of women with cervical dysplasia are LTFU before treatment; HIV-infected women were at higher risk of being lost to follow-up, main reasons associated with LTFU include lack of fare, Myths and receiving traditional treatment.

BACKGROUND Kaposi’s sarcoma is the commonest HIV/AIDS associated malignancy and most of the disease burden is found in Sub Sahara Africa. Pegylated liposomal doxorubicin has been proven to be efficacious in patients with advanced Kaposi’s sarcoma (KS) even in those who failed prior chemotherapy.
OBJECTIVE To describe the characteristics of the patients with recurrent Kaposi’s Sarcoma and their treatment outcomes.
METHODS This is a descriptive retrospective study involving patients with recurrent Kaposi’s sarcoma in Moi Teaching and Referral Hospital from March 2018 to February 2019. We included only adult patients, confirmed cases of KS by histology, have failed at least 1 chemotherapy regimen and have received at least 6 cycles of pegylated liposomal doxorubicin as the current treatment. Their demographic data, presenting manifestations, viral load, CD4 counts and Eastern Cooperative Oncology Group (ECOG) performance were collected and analysed.
RESULTS Between March 2018 and February 2019, there were a total of 60 adult patients with recurrent Kaposi’s sarcoma but 40 with complete data. Sixty five percent (26) were male, 12.5% (5) were sero-negative and the median age was 35 (28-73). At baseline, ninety percent (36) patients presented with both cutaneous manifestations with lymphedema while 10% (4) had cutaneous manifestations only. Ninety percent (36) patients had a baseline performance status of ECOG 0 and 1 and 10% (4) had ECOG 2. After 6 cycles of chemotherapy the CD4 counts and performance status of the patients improved significantly (p value=0.020 and p value=0.001) respectively while there were no improvements in viral load (p value=0.62)
CONCLUSION The most common presentation of patients with recurrent Kaposi’s sarcoma were cutaneous manifestations with lymphedema and majority of the patients had both clinical and CD4 count improvement after treatment with pegylated liposomal doxorubicin.

OBJECTIVE Cervical cancer is the fourth most common cancer globally. East Africa has an estimated Age Standardized Rate (ASR) of 40.1 per 100,000 women. In Kenya, cervical cancer is the leading cause of cancer deaths among women. Nine women die daily from the disease, even though it is preventable through HPV vaccination, and screening for early detection coupled with timely treatment of pre-cancerous lesions in women. The aim of the literature review was to get an in-depth understanding of existing research about knowledge, attitudes, practices and beliefs regarding HPV vaccination and screening in Kenya, and to identify potential gaps in the existing body of knowledge.
METHODS Published and unpublished literature on cervical cancer in Kenya was reviewed and organized under emerging themes. Electronic databases PubMed, Medline, Scopus, Cochrane Library, Science Direct, Embase as well as Google Scholar were searched for primary studies. The online database search generated 92 published articles. 47 remained after duplicates were removed. These articles were assessed for eligibility and 11 of them were excluded as they addressed cervical cancer treatment and not prevention. A total of 36 articles were included for final review.
RESULTS: The literature review observed that despite a high incidence of cervical cancer in Kenya:
- Less than 15 % of eligible women have ever been screened and only 3.5 % of these are screened every 3 years,
- The national screening program implementation has been inconsistent,
- There exists social, economic, religious, cultural, and health systems barriers to accepting cervical cancer prevention through HPV vaccination and screening.
CONCLUSIONS The barriers to HPV vaccination and screening are amenable to change through advocacy, education and visible endorsement of prevention methods by the government. Improvement in screening and HPV vaccination uptake can be achieved through a well-planned and funded strategic communication and mobilization plan. Messages need to be targeted to specific audience's while being culturally sensitive. Community leaders need to be brought on board to help communicate the goals and benefits of HPV vaccination and address concerns about vaccine safety.
OUTCOMES Using these learnings, the team was able to craft a strategic behaviour change communications and cervical cancer platform (STOP Cervical Cancer Initiative) which is an annual advocacy platform that can be utilized across Africa in response to the call by WHO, to Eliminate Cervical Cancer.

OBJECTIVE Research about breast and cervical cancer in Africa has focused on patient-related and health system-related barriers to screening, early detection, diagnosis, and treatment; cancer stage at diagnosis and treatment outcomes; HPV vaccine implementation; integration of cervical cancer into HIV programming; screen and treat programs for cervical cancer, and early treatment programs for breast cancer. We describe research priorities of participants of the 2019 Women’s Empowerment Cancer Advocacy (WE CAN) Summit in Johannesburg, South Africa.
METHODS Participants filled out surveys that included an open-ended question about what cancer-related research question they would like to be addressed in their community. Answers were analysed for prevailing themes.
RESULTS Forty-two participants filled out surveys. Most were female (90.5%), with a median age of 48.5 (range 28-70). Education included school (9.5%), some university (33.3%), graduate degree (40.5%), nursing or MPH (9.5%), MD or social work (2.5%). Participants identified as cancer survivors (52.4%), advocates (54.8%), NGO (50.0%), researchers (4.9%), and clinicians (11.9%). Thirty-six (85.8%) answered the question about research priorities, with the following most common suggested topics: how to address barriers to care (21.6%), cervical cancer/HPV vaccination (21.6%), culture/religion and stigma in cancer care (16.2%), needs of survivors (13.5%), evidence-based patient navigation (8.1%), impact of cancer campaigns (8.1%), needs of patients with metastatic cancer (5.4%), and impact of sexuality on patient needs (5.4%).
CONCLUSIONS The African Organization for Research and Advocacy in Cancer best practices in research advocacy include continuous assessment of priorities of cancer patients and partnership with scientists. We found that research priorities of patient advocates and survivors focus on addressing patient needs, quality of life, and access to care. Following the principle "Nothing for us without us", research questions deemed relevant by patient advocates and survivors should be taken into account when setting national and regional research priorities related to cancer care.

Biobanks, which facilitate the collection and storage of research-ready, high-quality biological specimens and associated data, play a key role in scientific research on disease prevention, screening, and treatment. In contrast to the situation in high-income countries where support might be committed for the longer-term, biobank infrastructures and related guidelines and protocols are much less developed in LMICs. This constitutes a serious barrier to high-quality scientific research projects in LMICs. In line with IARC’s and WHO’s mission in contributing to worldwide cancer research, and in collaboration with the US National Cancer Institute - Centre for Global Health (NCI-CGH) and other international partners, a biobank network (BCNet) was set up as an opportunity for LMIC to work together in a coordinated and effective manner and jointly address the shortfalls in biobanking infrastructure and other shared challenges, including ethical, legal and social issues. The network will facilitate the sharing of resources and the development of joint projects, strengthening the competitiveness of the LMIC biobanks in applying for international funding. The founding members include 30 representatives from 16 LMICs. Membership is not exclusive and is open to other LMIC biobank institutions that are willing and able to work together for common interest and agree with the principles and practices endorsed by the BCNet governance

High quality biological and environmental specimens are critical research tools in developing targeted therapies and precision medicine. The research environment has evolved from research conducted in a single investigator’s lab to multiinstitutional, multi-national collaborative efforts with widespread sharing of specimens and genetic data. This points to a need for promoting high quality technical standards for repositories and addressing the specific and challenging ethical, legal, social, and harmonization issues associated with specimen sharing on a global level. ISBER promotes consistent, high quality standards, ethical principles, and innovation in specimen banking by uniting the global community. ISBER’s Best Practices for Repositories (Best Practices) reflects the collective experience of its members and provides repository professionals with a comprehensive tool to guide them in all their repository activities.

The fourth edition of the ISBER Best Practices builds on the foundation established in previous editions produced by ISBER’s Education and Training Committee. The Best Practices focuses on the establishment and day-to-day management of a repository and is applicable to repositories that manage either human or envirobio origin material. For the fourth edition, great effort was made to seek input from the diverse ISBER membership for contributions and to prevent any national / federal or regional biases. Working groups were formed to work on the expansion and revision of Best Practices with the goal of including new areas of interest to the repository community and to present a more international perspective to reflect the growing global diversity of the ISBER membership. ISBER, in collaboration with the Society of Cryobiology, has produced an addendum to the fourth edition of the Best Practices which focusesd on the liquid nitrogenbased cryogenic storage of samples. This addendum addresses a long-standing need for the biobanking and cryobiology community and reflects the high degree of scientific collaboration possible between these two societies. Both documents are available for download from the ISBER website (https://www.isber.org/bestpractices).

BACKGROUND AND AIM In 2016 the University of Cape Town together with Radiation Oncology in SA identified the need to integrate palliative care in the oncology curriculum at an intermediate level. In collaboration with CANSA, a 12-module curriculum was introduced at five teaching hospitals. The aim of this research was to evaluate the impact of a 1-year Palliative Care course within the oncology registrar program in South Africa. This was a prospective evaluation of an intervention using a mixed mode approach.
METHODOLOGY Blended learning was developed to train and support students (n=32) and facilitators (n=5) across 5 universities. Evaluations forms were electronically collected to determine students' reactions to course materials. Pre and post-MCQ's were used to review knowledge. Focus group discussions were used to explore reactions, change in knowledge and skills and integration of PC. Case studies from Oncology Portfolios will be evaluated to determine the application and integration of skills in their oncology practice.
RESULTS The first objective of this research was to determine the reaction of oncology registrars and their supervisors to a PC course. There was an overwhelmingly positive reaction towards the course. Concerns like the feasibility and appropriateness of the course and material were found unsubstantiated. PC training in oncology is feasible and the topics addressed were appropriate. The second objective was to determine the change in knowledge and skills in PC. The MCQ demonstrated a change in knowledge and skills in symptom management. The poor MCQ results can be ascribed to poor sequencing of the questions. The focus group discussions demonstrated change in knowledge and skills in especially communication skills and pain and symptom management. The focus groups also indicated that the students’ approach to PC changed by indicating that they are able to integrate the principles of PC and see PC as an essential component of oncology. The third objective was to determine the application of PC knowledge and skills. The registrars felt the course made oncology ‘more fluid’ and addressed topics that formed part of their work.
CONCLUSION This research demonstrated that PC training is an essential component in Oncology Training in the South African setting. PC forms part of the daily practice of oncologist and a structured curriculum enable clinicians to practice using an evidence-based approach. Supervisors of the oncology training program and registrars are confident that the training of 12 modules across one year is feasible and appropriate.

OBJECTIVE To use inverse probability of censoring weights (IPCW) to address loss to follow-up (LTFU) in Malawi, a major contributor to biased cancer survival estimates in sub-Saharan Africa (SSA).
METHODS We estimated overall survival (OS) among incident cancer cases who were HIV+ and newly initiated on antiretroviral therapy (ART) between 2000 and 2010 in Malawi. HIV+ cancer patients were identified by probabilistically linking two large HIV cohorts to the national cancer registry, and follow-up data were captured from the HIV cohorts. We used unadjusted risk ratios (RR) to assess associations between patient characteristics and LTFU. LTFU was defined as missed clinic appointment with unsuccessful tracing for ≥180 days. OS was estimated using unweighted and weighted methods. Variables in the weighted method included age, sex, WHO stage for HIV, and cohort type. Sensitivity analysis using best- and worst-case scenarios was applied to evaluate the robustness of our estimates.
RESULTS Among 883 cases, median age at cancer diagnosis was 35 years (IQR: 30-41), and most common cancers were Kaposi sarcoma (89%) and cervical cancer (5%). Median follow-up time was 5 years (IQR: 1-6), and 257(29%) cases met the LTFU definition. Male gender (RR: 1.69, CI: 1.37-2.07) and HIV stage 4 (RR: 2.24, CI: 1.74-2.89) were associated with increased risk of LTFU. Both weighted and unweighted 2-year OS were 91%. Sensitivity analysis estimated best and worst case 2-year OS at 91% and 83%, respectively.
CONCLUSION IPCW method failed to significantly correct for bias due to LTFU, resulting in consistently overestimated survival among HIV+ cancer patients in Malawi. This is likely due to limited covariate availability in routinely collected cohort data to generate appropriate censoring weights. In SSA, where comprehensive patient tracing among LTFU groups can be impractical, intensive tracing of representative samples of LTFU patients is likely necessary to accurately estimate survival.

OBJECTIVE Despite the possibility of remission when diagnosed and treated early, most HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa is diagnosed too late for available treatment to be effective. We sought to explore the events from patients’ first recognition of skin lesions until time of KS diagnosis.
METHODS Via rapid case ascertainment, we evaluated consecutive HIV-infected adults newly diagnosed with KS at three community-based health care networks in Kenya and Uganda. Cases were identified from outpatient, inpatient, and laboratory searches. Guided by Andersen’s model of health services use, we documented when patients first noticed suspicious skin lesions and subsequent events until KS diagnosis including persons consulted, time durations, opinions received, and interventions pursued.
RESULTS We identified 242 participants with newly diagnosed KS in whom median age was 35 years, 33% were women, and 44% had only primary education. Most (94%) had advanced extent of KS (ACTG stage T1). Participants first sought help a median of 1 month after noticing suspicious lesions (interquartile range (IQR): 1 week to 2 months; absolute range: 1 day to 72 months). They consulted a median of 2 biomedical providers (IQR: 1 to 3; absolute range 1 to 4) over a median of 4 different visits (IQR: 3 to 6; absolute range 1 to 12) prior to KS diagnosis. Only 15% received a KS diagnosis from the first provider consulted. Attribution to witchcraft, use of Traditional Providers, and self-treatment were common. Median time from first lesion identification to KS diagnosis was 2 months (IQR: 1 to 5; absolute range 1 day to 84 months).
CONCLUSION In a representative sample of HIV-infected adults newly diagnosed with KS, we observed delays to KS diagnosis attributable to both patients and health care providers. Interventions to promote early KS diagnosis should target both the public and the health care system.

OBJETIVO As neoplasias malignas estão a aumentar em Angola. O Globocan estima que em Angola em 2018 podem ter ocorrido cerca de 15949 novos casos e que em 2040 ocorrerão 21 433 novos casos. O peso das doenças oncológicas nos doentes admitidos e tratados no hospital Principal das Forças Armadas Angolanas (HMPFAA), militares e familiares, já é significativo. Assim, é imperioso a organização de uma Unidade de Oncologia neste hospital. Um programa de formação de quadros com competências em Oncologia foi implementado.
MÉTODOS Foi realizado um curso de oncologia básica que envolveu internos de especialidade do último ano ou recém-especialistas de cirurgia, medicina interna e gastroenterologia do HMPFAA, no sentido de identificar os potenciais membros da Unidade de Oncologia. Os médicos seleccionados cumprirão um programa de pós-graduação em oncologia em hospitais de referência de Portugal. Após cumprirem com sucesso o programa, poderão adquirir a subespecialidade em oncologia (das especialidades de origem) após avaliação pelos colégios de especialidade, em Angola.
RESULTADOS Dos 32 participantes no curso de oncologia básica que ocorreu em 2018 foram seleccionados 15 médicos (7 de cirurgia geral, um gastroenterologista e 7 de medicina interna). Em estes médicos, em 2019 iniciaram um programa de formação de 24 meses. Foi previamente definido as actividades potenciais que cada um irá desenvolver na unidade de Oncologia do HMPFAA. Realizarão anualmente essas actividades com supervisão, em Angola, durante 15 dias. Os restantes membros da equipa multidisciplinar terão formação semelhante.
CONCLUSÕES O HMPFAA, com base num programa global que se inicia durante o período pré-graduado, em Angola, selecciona os profissionais de saúde que integrarão a Unidade de Oncologia e organiza a sua formação com base em “fellowships” em oncologia que ocorrem em Hospitais oncológicos de referência

OBJECTIVE Cancer treatment, such as cytotoxic drugs (CTX), needs specific knowledge, training, facilities and resources. African Lusophone Countries (ALC), namely Angola, Mozambique, and Cape Verde decided to develop a specific program to build oncology pharmacies and train their staff. The aim is to report the experience of training in these 3 countries.
METHODS A program design was conducted by trainers of the Portuguese Institute of Oncology, Porto, Portugal, into 4 modules namely (theoretical, practical, local trainer’s course and audit). In order to evaluate output and outcomes were administered pre and post train program assessment which rated the knowledge across the modules. Learning Methods included: face to face training, workshops, simulations, discussions and reflected-oriented activities. Training provided was tailored to the needs of the individuals after considerations as job functions, previous level of education and specific responsibilities relating to CTX and according to international guidelines. Initially, local trainees were identified with the collaboration of local health authorities and from local pharmacy team and also nurses that already were involved in CTX preparation. During the training, it was also identified the future local trainers and facilities were optimized.
RESULTS In Angola and Cape Verde the 3 first modules were already completed. In Angola and Cape Verde Oncology Pharmacy Units started up and compound CTX in accordance with best practice after this training. Mozambique: a new Pharmacy Unit is in construction and formation still ongoing.
CONCLUSIONS This methodology of training has been proven to be effective. The aims of the training program were perceived and implemented. Thus, investment in training staff, in local trainers, equipment and facilities are required. Continuous teaching and monitoring are essential.

OBJECTIVO A taxa de incidência das doenças oncológicas está a aumentar em Moçambique pelo que é fundamental preparar recursos e adquirir competências para que os cuidados sejam de qualidade.
METODOLOGIA Durante 2016 e 2017 foram inquiridos os profissionais do Hospital Central de Maputo (HCM) envolvidos nos cuidados oncológicos. Os questionários e fontes de informação utilizados foram: Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey, PSAC-Surgery e The Cancer Units Assessment Checklist for low- or middle-income African countries, entrevistas, artigos, documentos e visitas. Estes dados foram avaliados no sentido de se conhecer a realidade estabelecer um programa de ação.
RESULTADOS Este estudo revelou que os tumores mais prevalentes no HCM com tratamento cirúrgico são: o cancro do esófago, mama e colorectal. O HCM tem os requisitos mínimos necessários para o tratamento de doenças oncológicas. Funciona desde 2016 consultas multidisciplinares para os tumores da mama e ginecológicos e mais recentemente do esófago. As dificuldades encontradas foram a inexistência de radioterapia e de cuidados paliativos. Verificou-se que é necessário melhorar a preparação em oncologia cirúrgica, a organização dos protocolos clínicos (multidisciplinares) e reforçar a qualidade do hospital dia oncológico e preparação dos citotóxicos. Há necessidade de organizar uma unidade de oncologia cirúrgica no HCM com meios, abordagem multidisciplinar, responsável pela formação nesta área e que audite os seus resultados. O conhecimento em oncologia deve ser melhorado em todos os profisionais envolvidos nos cuidados oncológicos pelo que a optimização das acções formação em oncologia em curso é fundamental.
CONCLUSÃO Impõe-se construir o currículum e iniciar o programa de formação em oncologia cirúrgica bem como o programa de oncológica básica nos cursos de saúde. É necessário melhorar a coordenação das intervenções formativas de oncologia, em curso e criar formalmente a subespecialidade de oncologia cirúrgica.

As the world moves on to more sophisticated technology in treatment planning and radiation delivery, LMICs that seek to improve their service delivery must engage in human capacity development of all the key personnel involved in the delivery of safe and effective radiation services. The key work force include radiation oncologists, medical physicists and therapy Radiographers. Updating the knowledge base and skills set of individual specialties sequentially may compromise the expected competence in radiation delivery and ultimately increase radiation risk to the staff and patients as well as worsen disharmony amongst staff.
OBJECTIVE The purpose of this report is to describe the development, implementation and evaluation of a multidisciplinary, interactive and simulation enhanced course on migration from 2D to 3D Radiotherapy in Nigeria by AORTIC and ARCON.
METHODS The development of the course content was guided by a qualitative needs assessment survey of key opinion leaders in radiation Oncology, Medical physics and Therapy Radiographers. The course used a blended learning simulation enhanced training programme with breakout sessions of the specialties to allow for more in depth shared experiences with the resource persons. Participants completed a web-based course evaluation at the end of the course.
RESULTS A total of 66 participants attended the course however only 48 completed the web-based evaluation survey. 40% were attending radiation oncologist and 17% residents in training. 23% were medical physicists and 20% radiation therapy radiographers. 100% agreed course content was relevant and new while 96% agreed that the use of simulation was beneficial. 92% would strongly recommend the course to their colleagues. 97% agreed that the course on imaging for target volume and organ at risk determination was important. 90% strongly agree that the course would change their practice and 97% would want the course to be an annual event.
CONCLUSION We successfully completed a 2-day course involving Radiation oncologist Medical Physicists and therapy radiographers on 2D to 3D Radiotherapy migration. Effectiveness of training methods and materials used, relevance of training content, knowledge, attitude and skills gained by the participants were assessed and found to be satisfactory. Participants felt the multidisciplinary approach fostered mutual respect for each discipline and resolved to continue to work as a team for the good of the patient. Safety concerns were important to all specialties. The type of collaboration between AORTIC and ARCON was also well appreciated.

OBJECTIVE Outreach cervical cancer screening is one of many innovations to overcome challenges of cervical cancer screening in low resource settings. It may actually be the only opportunity some hard to reach communities in low resource settings will have to be screened. To better understand the performance of outreach cervical screening services within the context of low resources settings, we reviewed outcome of a cancer screening outreach program in Kebbi state.
METHODOLOGY The planning and execution of medical outreach program for free cancer screening in a low resource setting was review and a follow-up analysis of screen positive participants was conducted to determine their experiences and challenges in accessing post screening follow-up services.
RESULT A total of 231 women were screened for both breast and cervical cancer during the 3-day free screening period, out of which 21(9%) women had positive screening for either cervical cancer, breast cancer or both. Amongst those with positive screening result, 16(76%) women have positive cervical screening, 3(1%) of which have positive screening for both breast and cervical findings. Only 11 of 21(52%) could be contacted for follow-up. Amongst those contacted only 1 (9%) had a follow-up diagnostic evaluation and another 1 (9%) was reported to have died of breast cancer. Majority 9/11(82%) did not have evaluation for their positive screen result hence the screening was effort in futility.
CONCLUSION Cervical cancer screening without adequate post screening plan for treatment of both pre-invasive and invasive lesions will not impact on the burden of the disease. Further study to understand barriers to accessing post screening services might help in better planning.

OBJECTIVE To report psychometrics of an instrument to assess Quality of Life (QoL) in a Pan-African pilot study of men enrolled in an on-going study of prostate cancer (PrCa) [U01CA184374, Rebbeck, PI].
METHODS Participating centres (n=7) contacted a random sample of cases enrolled in the multi-centre parent study. The pilot instrument included 22 items selected from measures of QoL widely used in health research in the United States (i.e., SF-12; FACT-P, version 4). Consultation with African-based co-investigators informed initial item stems and structured response sets. Items assessed self-reported general health, physical and emotional barriers to daily activities, pain, anxiety, depression, fatigue, as well as known symptoms of PrCa. All data were collected via face-to-face interviews at participating centres. Item answers were based on respondents’ recollection of the 4-week period preceding their interview date. Principal component analysis (PCA) was used to explore the factor structure of items comprising the pilot instrument. Internal consistency of items loading on each factor was assessed by Cronbach’s Alpha and by content validity. Multi-item scale scores were computed by summing valid responses to items found to load on each identified factor. For the purpose of comparison, all scale scores were standardized (Mean=0, sd=1). Pearson correlations were computed to assess inferred associations among QoL scale scores and indicators of morbidity and self-reported general health.
RESULTS A total of N=65 cases were successfully contacted (by phone), consented, and interviewed. An initial PCA with all 22 QoL items indicated that 5 items were of bad quality, loading on multiple factors and/or showing poor internal consistency. After removal of these items, PCA was rerun and revealed four robust factors: Daily Activity (4 items; Alpha=.90); Urological Problems (3 items; Alpha=.74); Pain and Discomfort (3 items; Alpha=.77), and Mood (3 items; Alpha=.79). Total variance explained by the final PCA was 81%. While there were no statistically significant associations with indicators of morbidity (i.e., recent PSA level, stage, time since PrCa dx, age at PrCa dx), scale scores were related to self-reported general health in a pattern that supported expected patterns of convergent and divergent validity.
CONCLUSION Despite limited sample size, preliminary psychometrics of an instrument to assess QoL in a Pan-African pilot study of men living with PrCa are promising. Psychometrically problematic items (n=5 of 22) asked respondents about their ‘comfort,’ ‘energy,’ and ‘stamina.’ Future work will revisit the framing and utility of these dimensions of QoL in African cancer populations.

INTRODUCTION The cosmetic use of bleaching products is common among women in sub-Saharan Africa, with a prevalence of 67% in certain urban areas. The main products used are highly potent corticosteroids such as clobetasol propionate and hydroquinone. The skin diseases associated with this practice are various and often severe, and the most commonly reported are cellulitis, dermatophyte infections, scabies, acne, eczema, irritant dermatitis and dyschromia including exogenous ochronosis. In 2002 H. Addo in Accra, Ghana reported the first case of squamous cell carcinoma (SCC) associated with skin bleaching in a 58 old year woman. In 2010, we reported the first cases of SCC associated with this practice in Dakar, Senegal. Since this date the number of registered cases continues to increase. In 2009, the International Agency for Research on Cancer (IARC), the WHO's specialized agency, classified exposure to UV-emitting tanning devices as carcinogenic to humans. African health professionals must mobilize for the recognition of depigmenting products as carcinogens for effective prevention.
METHODS A retrospective study of cases collected between August 2005 and April 2019 in three dermatological units in Senegal is carried out. We included all the patients who consulted for cutaneous squamous cell carcinoma associated with VCD. Socio-demographic, clinical, cosmetological, paraclinical and therapeutic data were collected.
RESULTS Seventeen patients aged 53.75 years on average were included. The hydroquinone and clobetasol propionate combination was used in 15 patients. The average duration of practice of VCD was 20.3 years and the consultation time after tumour discovery was 6.75 months. No pre-neoplastic dermatosis was observed in our patients. The clinical appearance of the tumour was variable: ulcero-budding (n = 9), ulcerated (n = 6) or nodular (n = 2). The lesions were localized: face (n = 1), neck (n = 9), back (n = 4), breast (n = 2) and leg (n = 1) on lichenoid lesions or exogenous ochronosis. The most common histopathological appearance was the infiltrating type; there were two cases of carcinoma in situ. The evolution was favourable in the majority of the patients after a surgical resection.
CONCLUSION From 2005 to 2019, seventeen cases of SCC associated with VCD are reported in Senegal. It is urgent to challenge the health authorities of sub-Saharan African states for appropriate measures to prevent this scourge. It’s time to act!

OBJECTIVE Breast cancer incidence is rising in Nigeria, and one major barrier to care is the lack of affordable and appropriate breast cancer diagnosis by ultrasound (US)-guided biopsy. The lack of comprehensive training programs limits the availability of US guided biopsies in LMICs. The emergence of mobile health (mHealth) US devices may offer a low-cost solution for training. The objective of this research was to understand ultrasound usage and training needs among radiologists in Nigeria, to inform the development of an mHealth-based US-guided biopsy training program.
METHODS Focus groups were conducted with radiologists who attended the 6th Annual African Research Group for Oncology Symposium. Focus groups were divided based on geographic area. Radiologists took part in a day long training with the mobile US device, after which they completed a voluntary technology usage and usability survey, adapted from existing instruments.
RESULTS Focus groups were conducted with radiologists working in the southwest (n=11) southeast (n=5) and northern (n=5) regions of Nigeria. Barriers to performing US-guided procedures included clinician training, equipment functionality, cost, and access to consumables. Participants expressed that a mobile US device would increase screening in rural sites, reducing patient need to travel. There was strong interest in a US-guided biopsy training program focused specifically on breast cancer. Across groups, individuals voiced a preference for a “train the trainer” learning format that combines in-person didactics with independent modules. Usability (n=16) surveys indicated that most participants found the mobile US device easy to learn after first use.
CONCLUSION Feedback from Nigerian radiologists identified a need and acceptability towards mHealth-based US-guided biopsies, which will be used to inform the development of a comprehensive training program.

OBJECTIVE The aim of this study is to determine the frequency of double hit lymphomas (DHL) from Diffuse large B cell lymphoma (DLBCL) cases diagnosed in 2017.
METHODOLOGY DLBCL cases diagnosed in 2017 were retrospectively reviewed. The cases with fluorescent in situ hybridisation (FISH) results for MYC, BCL2 and BCL6 were used to determine the frequency of DHL.
RESULTS We identified 74 cases of DLBCL which were seen in the year 2017. The majority of the cases (75 %) were under the age of 49 yrs. Of the cases with known HIV status, most were HIV positive (92.5%). More than half (62%) of the cases were of GCB origin compared to 38% who were of non-GCB origin. FISH analysis for MYC, BCL2 and BCL6 translocation status was submitted for 17 of these cases. Ten cases were negative for any translocations (10/17, 58.82%). Four were positive for MYC translocation only (4/17, 23.53%). One case was positive for BCL6 translocation only (1/17, 5.88%). One of these cases was positive for MYC and BCL6 translocations (1/17, 5.88%). None of the cases exhibited translocations involving BCL2.
CONCLUSIONS The frequency of Double hit lymphoma cases from DLBCL is comparable to global statistics. The most frequent translocations in our DHL population are those involving MYC and BCL6.

OBJECTIVE Cervical premalignant lesions are precursors of cervical cancer. It is the fourth most common cancer in women. It is a major cause of deaths in low- and middle-income countries. Effectiveness of screening, rates of persistence following treatment and factors driving these in African have not been well documented. The current study aimed to examine the factors associated with persistent cervical premalignant lesions after treatment at Kilimanjaro Christian Medical Centre, Tanzania.
METHODS This was a hospital-based analytical cross-sectional study among women who participated in “screen and treat” program between 2008 and 2015 at the Kilimanjaro Christian Medical Centre. Multivariable logistic regression model was used to determine factors associated with the persistence of premalignant lesions.
RESULTS A total of 21, 253 women were screened. Of these, 902 (4.2%) were positive for premalignant lesions. Among those who were positive, 337 clients were treated with LEEP or cryotherapy and 235 returned after a year. About a quarter (24.7%) of the women who returned after one year were HIV-positive, 18.3% were HIV-negative while more than half (57.0%) had unknown HIV status. Persistence occurred in 19.6 % of the women who returned. The persistence was higher among HIV positive as compared to the negative counter parts (20.7 % vs. 18.6 %, respectively). Women who had big lesions had 4-fold (OR = 4.3, 95% CI: 1.1 - 16.2) higher odds of persistent cervical premalignant lesion as compared to those who had small lesions.
CONCLUSIONS We found a high proportion of persistent lesions one year after treatment. This was common among women with a big lesion. Our findings suggest a need for efforts to address this high rate of persistence including screening for Human Papilloma Virus. In addition, colposcopy and cytological grading before initiating the treatment is warranted.

OBJECTIVES Non-Hodgkin lymphoma is a lymphoproliferative disorder that accounts for 4.1% of new cancer cases and 3.7% of cancer deaths in South Africa. The most common subtype in adults is Diffuse Large B-Cell Lymphoma (DLBCL). The aim of this study is to document the clinical characteristics, treatment responses and outcomes of DLBCL patients at Tygerberg Hospital. Secondary objectives are to correlate HIV status with treatment response and survival.
METHODS A retrospective review of all DLBCL patients presenting to the Haematology unit at Tygerberg Hospital (January 2014-December 2018). Data was analysed using Stata version 15.
RESULTS There were 88 DLBCL patients in the study period with a female predominance of 1:0.8 and 47(53%) females. Median age was 47 years (range 15-86). Forty-nine (59%) had B-symptoms, 65(74%) had extranodal involvement, 24(28%) had bulky disease and 69(88%) had raised lactate dehydrogenase. Forty-six (53%) were HIV positive, 44(96%) were on combination Antiretroviral Therapy (cART), median CD4 count was 244 cells/μL (IQR 108-331) and 18(55%) had HIV viral load <20copies/mL. HIV positive patients were younger than HIV negative patients (40 vs 54, p<0.000). Sixty-nine had molecular subtype, 32(46%) had GCB and 37(54%) had ABC. Forty received CHOP(cyclophosphamide, doxorubicin, vincristine and prednisolone), of which 22(58%) were HIV positive while 18 received R-CHOP(Rituximab-CHOP), of which 5(28%) were HIV positive. Forty-three (91%) developed severe neutropenia. Treatment response was assessed in 56 patients, 31(55%) had Complete Remission (CR) and 14(25%) had Progressive disease. At the end of the study, 35(40%) were alive, 34(39%) were dead and 19(21) were lost to follow up. Overall survival (OS) was measured as time-to-death in months and the incidence rate was 3/100 person-months. The rate of death was higher in HIV positive patients compared to HIV negative patients (4/100 person-months vs 2/100 person-months, p value=0.01). The median OS was 28 months and 5 (6%) had a relapse.
CONCLUSION CR rates were better than patients in Johannesburg, which could be due to the lower HIV prevalence of DLBCL in this study (81% vs 53%). Studies have shown HIV positive patients to have similar survival to HIV negative patients due to high cART use, however in this study, despite high cART use, HIV positive patients had a higher incidence of death. Compared to resource-rich countries, DLBCL median OS is low at Tygerberg hospital. There is need for better management and possibly prospective studies looking at prognostic factors of DLBCL lymphoma to yield more significant results.

INTRODUCTION Low breast awareness and late presentation are continuing challenges to prevention and control of breast cancer in Ethiopia. Documenting community members’ perception about the benefits and barriers to breast awareness is vital to achieve maximum benefit of the practice. Hence, this study explores community members’ perception on breast awarenessinthe rural town of Butajira, Ethiopia
METHODS A community based descriptive study was conducted using a qualitative approach toexplore community members’ perception of breast awareness in the rural town of Butajira. In-depth interviews and focus group discussions were held to explore women’s perception towards breast self-awareness and a thematic analysis was performed to summarize key findings.
RESULTS The barriersto breast screening were lack of awareness about the practice in general and its benefits, and a negative general perception about the prognosis of breast cancer. We did not identify any taboo or cultural fears to participate in a breast screening program. Participants expressed a perception of breast cancer is the “deadliest” disease, and they had a positive view toward the benefit of breast cancer screening. They stated breast cancer screening would also help them know more about their general wellness and health. Participants expressed willingness to receive breast cancer care if diagnosed. Financial hardship was identified as a significant anticipated barrier to care, as transportation and treatment costs can be high.
CONCLUSION Lack of awareness of breast cancer screening are major barriers for women in rural Ethiopia. To enhance the effectiveness of screening programs, public awareness about the benefits of early diagnosis should be raised and efforts to decrease the financial burden of medical care and transportation should be investigated.

OBJECTIVE Women treated for cervical precancer have up to 30% higher risk of developing cervical cancer than women in the general population. An essential part of cervical cancer secondary prevention is following-up of women who screen positive and/or are treated for precancerous lesions. The essence of follow-up is to identify and retreat any recurrent/persistent lesions. The objective of this study was to examine the predictors for follow-up among women with cervical precancer in Cameroon.
METHODS After receiving institutional review board approval, we conducted a retrospective chart review of 755 women in Cameroon who screened positive for cervical precancer in 2013. The women were followed-up for five years, through 2018.
RESULTS Of the 755 women, 422 (55.9%) received same-day treatment/biopsy or returned for treatment/biopsy. A total of 333(44.1%) were lost to follow-up immediately after their diagnosis. Of those who returned for treatment at a later date, the lesions of 160(37.9%) women were found to have regressed spontaneously. Of the 344 treated, 180(42.7%) had same-day treatment/biopsy and 164 (47.7%) were treated/biopsied after the initial visit. Women 30-39 were more likely to show-up for treatment than women less than 30 (OR=1.62, p=0.01, 95%CI 1.12-2.34) and women 40-49 were even more likely to show-up than women less than 30 (OR=2.19, p=0.001, 95%CI 1.38-3.49). For post-treatment follow-up, 205(59.6%) had no follow-up, 93(26.6%) had one follow-up, 46(13.1%) had two or more follow-ups. Women aged 40-49 were 2 times more likely to be adherent than non-adherent to recommended follow-up compared to women aged less than 30 (RRR=2.96, p=0.037, 95%CI 1.07-8.23). Women aged 50 and above were 12 times more likely to adhere to post-treatment follow-up than women less than age 30 (OR=13.23, p=0.044, 95%CI 1.07-163.91).
CONCLUSION Age was the most statistically significant predictor to follow-up among women with cervical precancer in Cameroon.

INTRODUÇÃO A Leucemia Mielóide Crónica (LMC) é uma doença mieloproliferativa que representa 15-20% de todos os casos de leucemia, com incidência anual de 1 a 1,5 casos por 100.000 indivíduos e prevalência de cerca de 1 por 17.000. É uma doença normalmente trifásica, incluindo uma fase crónica, acelerada e blástica. A LMC caracteriza-se pela presença do Cromossoma de Filadélfia, uma anomalía resultante de uma translocação equilibrada entre os cromossomas 9 e 22 (t(9;22) (q34;q11.2)).
OBJECTIVO Caracterizar uma população com diagnóstico de LMC.
MÉTODOS Estudo retrospectivo de 108 doentes. Diagnóstico de LMC entre Janeiro de 2012 - Dezembro de 2018.
RESULTADOS Idade média no diagnóstico: 43 anos (17-80); 29% dos doentes ≥50 anos. 69% doentes do sexo masculino (75 doentes) e 31% doentes do sexo feminino (33 doentes). Valor leucocitário médio: 231.279/uL (30 -658). Em 75% isolada e 25% associada a outros sindromes mieloproliferativos. Os doentes foram todos inicialmente tratados com Hidroxiureia ou Interferon. 10 doentes (9,2%) iniciaram Imatinib e 60% destes (6 doentes) descontinuaram o tratamento por falta do mesmo. Resposta hematológica completa e molecular maior foram observadas em 50% dos doentes em fase crónica, sendo que os restantes tiveram resposta parcial. Sem registo de progressão. 12,9% (14 doentes) evoluíram para fase de aceleração e 7,4% (8 doentes) evoluíram para crise blástica (6 mielóides e 2 linfóides). Nenhum dos 8 doentes em crise blástica que foram submetidos a quimioterapia intensiva sobreviveu.
A mortalidade geral foi de 11,1% (12 doentes). Isoladamente a idade, comorbidades e disponibilidade de Imatinib influenciaram na sobrevida geral.
CONCLUSÃO Grande parte dos doentes que iniciaram Imatinib atingiram resposta terapêutica. A evolução para crise blástica apresentou caracteristicas muito agressivas que levou a alta taxa de mortalidade mesmo antes da indução. (Sem conflitos de interesse a declarar)

O vírus Herpes humano de tipo 8 (HHV-8) é o agente etiológico do Sarcoma de Kaposi. A seroprevalência global é desigual no mundo, e depende da região geográfica e da população analisada. Altas prevalências são reportadas na África Central e subsahariana, mas em Moçambique é desconhecida. Com a pandemia da Sida, foi observada uma explosão na incidência do Sarcoma de Kaposi, e este se tornou muito mais frequente em vários países africanos e em mulheres e crianças.
OBJECTIVOS Avaliar a seroprevalência da infecção HHV-8 em população assistida em centros de saúde, identificar associação entre HHV-8 e variáveis económicas, demográficas e clínicas e estabelecer Moçambique como outro país endémico.
METODOLOGIA Em 2008 foi examinada a seroprevalência do HHV-8 numa coorte de indivíduos na triagem em centros de saúde das 3 regiões de Moçambique, nomeadamente Norte (n=208), Centro (n=226) e Sul (n=318). A todos os indivíduos foi efectuado um inquérito para colheita de dados socioeconómicos, demográficos e clínicos, e seu sangue testado para os anticorpos HHV-8, usando o teste de imunofluorescência.
RESULTADOS A frequência média da seroprevalência do HHV-8 foi 21.4%, sem diferenças significativas entre as regiões Norte, Centro e Sul com 18.7%, 24.3% e 21.4% respectivamente (χ², 2.37; p = 0.305). As variáveis que foram significativamente associadas com a presença dos anticorpos HHV-8 foram o sexo, idade, nível de educação, número de irmãos e serologia para o HIV, mas estes diferiram entre as regiões. No Norte, com a excepção do número de irmãos, nenhuma associação entre a infecção HHV-8 e outras variáveis foi detectada (p>0.05). Na região Centro, a infecção pelo HHV-8 foi associada com sexo (p=0.010), o número do agregado familiar (p=0.031), e o local de atendimento (p=0.021), enquanto no Sul, associações com o número de irmãos (p=0.023), e serologia para o HIV (p=0.002), foram detectadas. Um aumento linear na média das frequências do HHV-8, de acordo com a idade, foi observado.
DISCUSSÃO Os resultados obtidos apontam Moçambique como outro país endémico para a infecção HHV-8 em África e por causa da epidemia do HIV, o acesso contínuo ao tratamento antirretroviral é fundamental para prevenir ou travar a explosão de casos de Sarcoma de Kaposi.

OBJECTIVE Greater than 80% of the world's annual deaths from cervical cancer occur in sub-Saharan African countries, like Zambia, where cervical cancer is the most common malignancy and the leading cause of cancer-related deaths. Despite the disease being highly preventable with screening and early detection, no more than 5% of women in these settings are screened. Lay perspectives of cervical cancer among women may influence proactive seeking cervical cancer prevention services. Our study sought to understand explanatory models of cervical cancer among women being treated at the Cancer Diseases Hospital (CDH) in Lusaka.
METHOD Using qualitative case study design, data was collected using in-depth personal interviews from 20 women aged between 25 to 59 years and were recorded and transcribed. Data was analysed using thematic analysis.
RESULTS Women had different perceptions of disease aetiology. Some believed it was witchcraft or from sexual intercourse with uncircumcised men. A few lacked knowledge of the cause. As a result, women sought treatment from differently, ranging from prayers, traditional healers and witchdoctors, to conventional treatment. Some of the preventive measure's women believed were; avoiding prostitution, good nutrition and male circumcision, while the majority lacked knowledge on cervical cancer prevention. Of the 20 women interviewed, only two (10%) had ever screened for cervical cancer.
CONCLUSION Women’s lay perspectives and constructions of the disease differ significantly among themselves and with clinicians. This study provided broad insights on the constructions of cervical cancer among women with the disease and revealed that women do not have correct information on the basics of cervical cancer hence will not seek screening and early detection of cervical cancer thereby leading to disease progression, costly management and poor treatment outcomes.

OBJECTIVE Whereas early detection and treatment of cancer yields good prognosis, a delay in provision of these services increases the proportion of advanced disease in cancer patients impacting on outcomes and quality of life.(1) We aimed at studying the patient timelines and elements related to obtaining referral to a cancer treatment center after the first related symptom to promote early diagnosis strategies for secondary cancer prevention.
METHODS We conducted a retrospective chart review of adult patients admitted to UCI in 2017 with any of the 4 cancer diagnoses of interest; cervix, breast, esophagus and prostate. Four key points in care were considered; First symptom, referral to UCI enrollment into UCI and initiation of treatment. Data was abstracted in relation to the patients’ path to care. Time between the key points was calculated from dates recorded in the files. T test and Anova were used to establish relationships for this objective.
RESULTS In total, 1017 cancer patients were enrolled of which 521 had complete data for the above objective. Cancers were represented as; cervix (41.7%), breast (25.9%), esophagus (20.3%) and prostate (12.1%). Seventy two percent were females, 47% of participants aged 40 -59 years. More than half of the participants 60.4% presented with advanced cancer (stage III or IV). Median time taken from first symptom to referral varied per cancer; patients with esophageal cancer presented earliest (3.9 months) with range of 1.93 – 6.56 while those with prostate cancer took more than a year (13.3 months) and range of 5.46 - 28.26 months. Overall in bivariate analysis, patients aged 60+ and those HIV negative took more time to get referred.( P=.015 and P= .009). Patient’s marital status, gender and residence area had no association with delay.
CONCLUSION There is significant delay from first identifiable symptom to getting referred to a cancer treatment center. The general population including health care providers in primary health facilities need awareness about early signs and symptoms of cancer to facilitate early diagnosis and referral.

1. Dwivedi AK, Dwivedi SN, Deo S, Shukla R, Pandey A, Dwivedi DK. An epidemiological study on delay in treatment initiation of cancer patients. Health (Irvine Calif) [Internet]. 2012;4(2):66–79. Available from: http://www.scirp.org/journal/doi.aspx?DOI=10.4236/health.2012.42012

OBJECTIVE Cancer management post treatment is usually limited to medical surveillance for relapse. This survey set out to determine if there are needs unique to cancer survivors apart from medical follow-up.
METHODS A semi-structured questionnaire was administered by a health care worker to 21 participants. 10 were parents/guardians of minors and 11 were cancer survivors. The criteria were patients who completed treatment and are in remission or on long term hormonal or targeted therapy. The questionnaire collected information on biodata, socioeconomic status, shelter and basic needs, livestock and crop farming options and challenges post treatment.
RESULTS Majority of the survivors were either unemployed or casual labourers. The employed were low income earners with a monthly salary range of 40 to 320 US dollars. The cost of treatment resulted in many of them selling assets (livestock, land) and bankrupting their businesses. It also led to loss of employment for guardians/parents who dedicated their time to caring for their unwell children. Unmet needs post treatment was reported in financial, psychosocial and continuity of care areas. Financial challenges included lack of start-up capital for businesses, unemployment, and lack of rent, school fees and groceries. Psychosocial challenges included discrimination by society, depression over body changes secondary to chemotherapy/surgery, loss of social support post treatment, infertility and poor performance of children in school. In terms of continuity of care, some did not attend clinic because of lack of funds for transportation, depletion of their insurance and ignorance about the need for regular check-up.
CONCLUSION Cancer management should include survivorship care which not only focuses on treatment but also addresses financial and psychosocial challenges to facilitate re-integration into society.

Objective: A baseline understanding of local nursing capacity is vital to identifying and prioritizing areas for improving childhood cancer care. As part of the St. Jude Global-Parirenyatwa Hospital collaboration, we developed and pilot tested a comprehensive nursing assessment process in the pediatric oncology inpatient ward in Harare, Zimbabwe.

Methods: To assess baseline clinical practice, our team used existing tools to develop a mixed method qualitative and quantitative assessment of nursing processes. In-person assessments with nurses from St. Jude Global and Parirenyatwa Hospital were conducted over six days in November 2018 and included quantitative metrics derived from chart audits and observations. Additionally, the nurse in charge was interviewed using a structured instrument from the International Society of Pediatric Oncology (SIOP) Baseline Nursing Standards survey. Assessment components were classified into five domains, inspired by The Joint Commission International Accreditation Standards (JCI): 1. Assessment of patient; 2. Care of patient; 3. Medication management and use; 4. Prevention and Control of infection; 5. Patient safety. Results were categorized according to established criteria of met, partially met or did not meet, based on how often observed nursing practices met expected measures.

Results: Based on our initial assessment, no nursing standards were fully met in the inpatient pediatric oncology ward. Using these data, hospital administration established a local nursing working group to implement quality improvement (QI) projects and education initiatives to address pediatric oncology nursing specific needs. Top priorities included positive patient identification (PPI), pain management, hand hygiene, and safe chemotherapy administration with the PPI program now already implemented.

Conclusions: Our assessment process evaluated current nursing practices and provided hospital administration with relevant data to identify and prioritize QI opportunities. Next steps include re-evaluation in Harare following implementation of planned projects and assessing reproducibility of this approach through nursing assessments at other centers in Sub-Saharan Africa.

OBJECTIVE The American Cancer Society (ACS) launched the Strengthening Organizations for a United Response to the Cancer Epidemic (SOURCE) Program in Kenya and Uganda in 2016 as part of its global civil society organizations (CSOs) strengthening initiative. ACS has supported 51 cancer organizations for their cancer control work. The present evaluation documents the results of the three years of organizational strengthening training, supportive technical assistance, and funded practicum projects. Specifically, this evaluation attempts to determine the factors that affect successful participation of CSOs in the SOURCE Program, and how learnings throughout the participation cycle affected the CSOs’ capacity for effective cancer control work.
METHODS The evaluation uses longitudinal data from organizational assessments taken at four different time points to track the progress of each participant CSO. We conducted regression analysis to identify organizational level determinants of better assessment scores using organizations’ profile data. Finally, we used the qualitative data to explain our quantitative findings.
RESULTS As expected, an organization’s age and having received organizational strengthening training and/or technical assistance in the past is positively associated with higher assessment scores at the initial assessment. But the difference fades over time - the younger CSOs caught up with older ones on assessment scores as the program progressed. The qualitative data shows that as the CSOs refresh/learn new skills, improve the use of evidence for program decisions, and establish systems and practices, their programs become more effective.
CONCLUSIONS While selecting organizations for organizational strengthening programs, multiple factors should be considered. Age of an organization is important, but it is not the sole determinant of success. Additionally, the SOURCE Program has contributed to strengthening CSOs and preparing them for more robust and coordinated cancer control work. However, a lot more remains to be done to defeat cancer in low- and middle-income countries.

OBJECTIVE The American Cancer Society (ACS) launched the Strengthening Organizations for a United Response to the Cancer Epidemic (SOURCE) Program in Kenya and Uganda in 2016 as part of its global civil society organizations (CSOs) strengthening initiative. ACS has supported 51 cancer organizations, in two cohorts, for effective cancer control work. The program has three components: 1) assessment, 2) training, and 3) technical assistance, all of which address seven domains of organizational strengthening:
1. Governance (GOV)
2. Operations and Administration (OPA)
3. Human Resources Management (HRM)
4. Financial Management (FMA)
5. Financial Sustainability (FSU)
6. Program Management (PME)
7. External Relations and Partnerships (ERP)
The present evaluation determines the extent to which the ACS support has changed the capacity of CSOs in these seven domains.
METHODS This evaluation uses longitudinal data from organizational assessments taken at multiple time points to track the progress of each participant CSO. We calculated changes in assessment scores over the period at domain, organization, and cohort levels, using the statistical package Stata. Appropriate statistical tests were conducted to see if changes in assessment scores across domains and other disaggregation levels are statistically significant.
RESULTS Cohort 1 organizations made great improvements between the first two years in the domains where they initially scored lower (OPA, HRM, FMA, and FSU). Although the initial assessment scores of Cohort 2 organizations were low on all seven domains, they made significant improvements in the second assessment, especially, in the GOV, OPA, and ERP domains. These findings are consistent with those of the qualitative data.
CONCLUSIONS This evaluation demonstrates the importance of building the capacity of a community of cancer CSOs with tailored and layered training, technical assistance, and practicum over time, informed by periodic assessment results. Such an inter-linked approach allows for sustained learning that should translate into better operations, which are a necessary for stronger programs and contribute to a more robust cancer response.

BACKGROUND Tobacco chewing and use of tobacco related products is a social norm in Tribal population in Gadchiroli district of Maharashtra state of India. The addiction consequences of this largely ignorant population are further complicated by limited access to basic health care and education.
OBJECTIVES To find the prevalence of tobacco addiction in tribal villages. Screening and Early Detection for Areca Nut and Betel Quid- Related Cancers in the tribal population. Long term objectives being health education, de-addiction and prevention of oral cancer by detecting precancer at early stage.
METHODS Tribal villages were identified in the Gadchiroli district where tribal population according to 2011 census was nearly 100%. A cross sectional data was obtained from these villages by conducting camps and population-based surveys.
RESULT 450 tribal individuals were screened out of which 349 were habituated to smokeless tobacco. 124 patients were suffering from oral pre cancer. 534 individuals from non tribal rural population were screened out of which 211 were habituated to tobacco with 116 individuals suffering from oral pre cancer. 1 patient diagnosed with advanced oral squamous cell carcinoma. High prevalence of smokeless tobacco use especially, ‘Kharra’ was observed in tribal children starting at the age of 3 yrs. Health education and advice was given for de-addiction to 560 individuals.
CONCLUSION Tobacco habits associated oral cancer is more prevalent in tribal population as compared to non-tribal rural population which warrants strong tobacco control measures.

INTRODUCTION Cervical Cancer is South Africa’s growing concern as this cancer is associated with HIV-Aids, most woman are oblivious of the high risks, especially the Millennials. A rise in South Africa with minors engaging in sexual intercourse, younger marriages, increased prostitution cases, high number of abortions, substance abuse, human trafficking and outrageous sexual behaviours.
OBJECTIVE The primary objective of a Millennials program for PinkDrive-MBTM is to create awareness of all related HIV-AIDS Cancers, focus is more women doing pap smears, knowing/ understanding at an early age the severity/impact of cervical cancer and how early detection prolongs lives. Reduce 5-year relative survival mortality rate by encouraging the Millennials to introduce healthy lifestyles, be more vigilant about their behaviours and have a greater perspective of cervical cancer.
METHOD
• Partner with HIV-AIDS organisations that offer relevant testing/counselling so that all ages, primarily Millennials receive all the required screening/testing and be HIV informed.
• As an added advantage, women with a need can receive abdominal ultra-sound and a personal communication session with the Gynaecologist.
• Patient histories, identification, relevant and treatment (pre- and post-screening) are captured for effective screening services.
RESULTS
• Introductory stages increase of Millennials testing for both Cancer and HIV-Aids, over-time to monitor drop in rate.
• Higher number of medically uninsured individuals receive pap-smears at no cost, sponsor absorbs costs.
• Partnerships focusing on best practices, successful processes and reduced waiting time on results.
CONCLUSIONS Millennials are future leaders, preserving the youth with appropriate screening opportunities in remote areas where the masses reside, builds a healthy nation and an informed individual. PinkDrive Women Mobile Unit/s are built for remote area screening and counselling, pap-smears now completed in the Mobile Unit.

OBJECTIVE Non-Hodgkin Lymphoma (NHL) are the sixth most common cancer type in sub-Saharan Africa (SSA). We aimed to assess NHL subtypes, stage and further diagnostics.
METHODS Our observational study included eleven population-based cancer registries in Benin, Congo-Brazzaville, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Namibia, Uganda and Zimbabwe. In each registry, a random sample of 8 to 86 cases diagnosed between 2011 and 2014 was selected and recorded data was amended assessing hospital records.
RESULTS A total of 529 patients were included. Additional information was traced for 60.3%. Of all NHL diagnoses, 69.0% were confirmed histopathologically, another 16.6% cytologically. For 50.1% NHL subtype was known. The largest share of NHL subtypes known was observed in Windhoek, Namibia (94.1%), the smallest in Eldoret, Kenya (16.1%). Diffuse Large B-Cell Lymphoma, Chronic Lymphatic Leukaemia and Burkitts Lymphoma were the three most common NHL subtypes (24%, 9%, 3% respectively). HIV was found positive for 18.7% and 15.8% received anti-retroviral treatment whereas HIV status remained unknown for 66.5%. Stage at diagnosis was advanced for 25.4% and unknown for 63.3%.
CONLUSIONS We found NHL subtype, stage and HIV status unknown for the majority of patients. However, according to NCCN guidelines harmonized for SSA, knowledge about these three categories is crucial. Investments in comprehensive diagnostics facilities and introduction of a standard immunohistochemistry panel may increase precision of NHL diagnostics and hence the possibility of effective treatment.
ACKNOWLEDGEMENTS Intramural funding from the Research Department of the American Cancer Society, Roland Ernst Foundation, German Academic Exchange Service, Martin-Luther-University Halle-Wittenberg and Working Group International Women´s Health of the German Society of Obstetrics and Gynaecology.

OBJECTIVE Cervical cancer is the second most common cancer among women in low and low middle income countries (LMICs). The objectives are to develop and validate video based training tool for capacity building of health services staff in cancer awareness and screening activities, to reduce the expert time involved in the training and to reduce the duration of training.
METHODS Institutional Ethics Committee approval was obtained and the trial was registered with the clinical trials registry. Video based tutorials were prepared in ten modules and three languages by Tata Memorial Hospital, Mumbai, India in co-ordination with IIT, Mumbai. The health services staff were invited for the training. The training which was for 12 weeks using standard methods was now planned for two weeks using the new technology. Practical demonstration and micro-teaching of health awareness activities, preparation of dilute acetic acid, lugol’s iodine, inserting speculums, performing VIA and VILI, identifying lesions, disinfection and sterilization procedures were combined with video based theory and demonstrations. The tablets pre-loaded with the video based tutorials were retained with the trainees during the training period.
RESULTS The fifty trainees were evaluated with theory and practical evaluation. Majority scored well in the theory exams. Out of twenty marks allocated for practical evaluation 49 (98%) scored above 10 marks. All trainees found the training to be very informative, easy to understand and felt confident to deliver cancer awareness talk and to perform VIA and VILI based screening.
CONCLUSIONS The outcome of roll out of the cancer control programme will depend on the quality of training imparted to the health services staff. A real-world issue is relieving the health services staff for longer duration for training and the availability of expert time for training. The preparation and validation of these indigenously prepared video based tutorials has opened new avenue by which the vast majority of the health services staff can be trained in relatively shorter duration. This tool will be useful in low and low medium income countries that are incorporating visual based cervical cancer screening programs.

OBJECTIVE Like in neighbouring African countries, cancer patients in Botswana present with advanced stage, leading to poor prognosis. Given resource and specialist constraints, primary care providers should target patients with the highest probability of cancer for timely referral. We compared physician assessment of cancer probability to a statistical model using clinical and demographic information collected by primary care providers in Botswana.
METHODS Primary care providers identified patients presenting with syndromes compatible with cancer in the rural Kweneng East Health District of Botswana. Cancer suspects were followed until they entered specialized care for cancer treatment (following pathology-based diagnosis), exited without cancer, or died. Data were collected through phone interviews with patients and clinicians. Predictors evaluated included age, sex, performance status, baseline cancer probability (primary clinician; low, intermediate, high), baseline cancer probability (study physician), predominant symptom (lump, bleeding, pain, or other), and HIV status. We fit predictive models using logistic regression with 10-fold cross-validation: 1) using all predictors, 2) study physician assessment alone, and 3) demographics and symptoms alone. In addition, we used LASSO regression to inform covariate selection and model fit.
RESULTS 507 cancer suspects were enrolled (April 2016 to May 2018) leading to 153 (30%) cancers (30 cervix, 29 breast). Median age was 48, 78% were women, and 31% were living with HIV. Models including all sets of predictors were able to separate cancer patients from non-cancer patients and correctly classify patients without cancer, though models 1 (c-statistic: 0.84, 95% CI: 0.81, 0.88; specificity: 0.90) and 2 (0.79, 95% CI: 0.75, 0.83, 0.92) performed better than 3 (0.74, 95% CI: 0.70, 0.79; 0.87). LASSO regression did not change results.
CONCLUSION While clinician’s assessment performed best, all predictive models demonstrated reasonably good classification ability. Next steps include developing risk scores for use by primary care providers to facilitate triage.

OBJECTIVE Cancer survivorship services (CSS) are a critical component of care yet less than 15% of Africans with survivorship needs are able to access them. The Oncopadi Cancer App is a digital cancer care navigation and resource tool aimed at improving access to CSS by equipping cancer patients with the right access to treatment, information, and coping resources. This study aims to assess the use of mobile health application as an intervention strategy in promoting access to CSS.
METHOD This study is an analysis of the findings of the Oncopadi app from 186 registered users (across 4 states in Nigeria and 2 West African Countries). Baseline data were used to assess the service utilization rates.
RESULTS The mean age for the 186 registered users was 35.1± 11.6years; the majority of the users were between 21 and 30 years (42.77%); and 172females (92.5%). About 75.4% accessed Oncopadi using a mobile phone, 23.7% used a computer and 0.9% used tablets. The uptake of CSS on Oncopadi by registered users was 97.4%. Majority 50.3% opted for chatbot instant messaging, 40.6% used the chat forums and blog services. 40 users (22.5%) opted for teleconsultation services of which 97.5% was via video and 2.5% was via audio. About 6.6% opted for deals and discounts (diagnostic and pharmaceutical requests). The majority, 41.4% (75 users) opted for at least two services provided, 39.8% opted for just one service and only about 18.7% opted for more than two services provided.
CONCLUSION This study shows that there is a relatively high demand for CSS through integrated features (chatbot, chat forums and blog) on a digital health application. By leveraging on digital technology, we can scale up access to accurate cancer information, coping resources and treatment navigation thus promoting the early presentation and better health-seeking behaviour by Africans.

INTRODUCTION Prostate cancer (PC) is the most common form of non-cutaneous cancer in men in western and developing countries (incidence 67, 9 per 100000 in South Africa). In the last decade worldwide growing evidence implicate reactive oxygen species (ROS) in the development of premalignant conditions in carcinogenesis of prostate cancer, squamous cell carcinoma of oesophagus due to Helicobacter pylori infection(incidence14,5%) and hepatocellular carcinoma by excessive intake of dietary iron (incidence 23-26%).
OBJECTIVE This study aims to demonstrate the implication of oxidative stress in the extent of DNA damage during the progression of these types of cancer.
METHODS Oxidative stress (OS) was measured by Lipid peroxides (LPO), Thiobarbituric acid reactive substances (TBARs), Isoprostane (ISO) using classical methods whereas Superoxide dismutase (SOD) and Glutathion peroxidase (GPx) activities were assessed using kits commercially available. Level of 8-hydroxy-2’-deoxy-guanosine (8-OH-dG) measuring the extent of DNA damage and that of 4-Hdroxy-2’-nonenol (4-HNE) measuring the extent of the lipid-peroxidation were evaluated by ELISA method. Prostate specific antigen (PSA) was evaluated using kits commercially available. Gleason Score was based on architectural patterns seen on H&E sections graded in well, moderate and poorly differentiated prostate cancer.
RESULTS Consistent correlation has been observed between DNA damage as indicated by the presence in situ of high levels of 8-OH-dG in biopsies, in serum/plasma and the extent of oxidative stress biomarkers in PC as evinced by the high values of PSA and Gleason score. These high values of this DNA metabolites were also observed in SCCO and HCC. The mean value of 8-OHdG (6,097/ml) in the PC test group was significantly higher (p<0.05) than that of the control group (5,327ng/ml). A moderate positive correlation (r=0.57) between the two groups was also observed. Nevertheless, conflicting correlation between 8-OHdG and Gleason score were noted.
CONCLUSION Free radicals may damage DNA molecule and overexpress some oncogenes suggesting their implication in carcinogenesis. This study has shown that 8OH-dG could be considered as one of the OS biomarkers for prostate, oesophageal and liver cancers.

OBJECTIVES The aim of the study is to describe the trends and geographical distribution of cancer prevalence in KwaZulu-Natal by conducting a three-year retrospective study at three main public hospitals (Inkosi Albert Luthuli Central hospital, Addington hospital, Grey's hospital) in KwaZulu-Natal, South Africa.
METHODS The tool used for extracting data focuses on patient socio-demographics, risk factors, diagnosis, types of investigations performed on the patient, oncology duration and types of treatment patients are given from the year 2015 till 2017. Data is captured on Research Electronic Data Capture (REDCap) and analysed using STATA. The Kulldorf and Flex spatial scan will be used to identify the cancer hotspots.
RESULTS The preliminary results from 300 analysed data of medical records out of 14 058 identified so far. The results presented that 63% of cancers were of females and 36% of males. Twenty-one percent (21%) of all new cancer cases seen in KwaZulu-Natal were from individuals within the age of 40-49 years. The majority receiving health services from the hospitals are blacks (68.33%) followed by the Asians (7.33%), whites (4.33%) and lastly Indians (0.67%). Some of the leading cancers noted in the province are HIV related Kaposi sarcoma (19.33%), cervical (11.87%), breast (10.33%), lung (6%), endometrium (5.33%), colon (5%), vulva (3.67%) and prostate (3%). Treatment plan measures that the study focused on were chemotherapy (43%) and radiotherapy (5.33%).
CONCLUSIONS The study has a misrepresentation of paediatrics and blood-related cancers due to inadequate reporting. The preliminary findings show that lung cancer is one of the top prevalent cancers seen in the province of KwaZulu-Natal. Furthermore, lung-related cancers are likely to be underreported due to generalization used by the international classification of disease (ICD-10) and commonalities it has with tuberculosis and chronic obstructive pulmonary disease (COPD). The study further anticipates higher concentration of cancer cases around the metropolitan districts where the hospitals are situated.

Infection with the Human Immunodeficiency Virus (HIV) is associated with a high incidence of B-cell lymphomas. Burkitts Lymphoma (BL) is one of the most prevalent childhood cancers in Africa, and the second most common B-cell malignancy among HIV-infected individuals. BL is also associated with EBV infection, a known oncogenic virus.
OBJECTIVE Coinfection with multiple agents is known to accelerate cancer development and this project investigates the cooperation of EBV and HIV in the development of BL.
METHODS A cell culture model is used to investigate the cooperative effect of EBV Latent Membrane Protein 1 (LMP1) and HIV-1 trans-activator of transcription (HIV-1 Tat) protein on the expression of two key lymphoma driver genes, Activation Induced cytidine Deaminase (AID), and c-MYC.
RESULTS Here we show that LMP1, a major EBV-encoded oncoprotein, significantly enhances both AID and c-MYC expression when ectopically expressed in BL cells. We further show that LMP1 enhances the activity of the AID promoter, and that it does this through an early growth response protein 1 (EGR-1) binding element. We also show that this effect is enhanced in the presence of HIV-1 Tat.
CONCLUSIONS These findings show for the first time that EBV and HIV cooperate to enhance the cancer phenotype and support a direct oncogenic role for HIV in the development of lymphoma. These results provide a potential explanation for the aggressive BL cancer phenotype observed in HIV infected individuals, even those undergoing combination antiretroviral therapy.

BACKGROUND The Papanicolaou's stain used for cervical cancer screening worldwide employs toxic-carcinogenic reagents. In the current context, contamination by PAP goes unnoticed and is dangerous for biodiversity.
METHODS We evaluate 72,901 smears within a prospective study at the San Bartolome Hospital in Lima, Peru. The Eco-Pap employs four strategies to significantly reduce the use of toxic-carcinogenic reagents: 1st) the use of Harris' progressive haematoxylin which does not require a differentiator (hydrochloric acid) or a "bluing" process (ammonia solution). 2nd) in this same stage, we develop a control system that eliminates mercury oxide water pollution, 3rd) the use of a polychromatic solution (a mixture of Orange G and EA-36), 4rd) and the direct mounting which eliminates the use of xylene’s bath for cellular clearing. The stain quality was evaluated by Bethesda system, and by the Stain Quality Index (SQI).
RESULTS Seventeen (23.7%) squamous cell carcinoma, 2 (2.7%) keratinizing squamous cell carcinoma, 45 (62.5%) carcinoma in Situ, 5 (6.9%) invasive squamous cell carcinoma, and 3 (4.1%) adenocarcinomas were diagnosed with Eco-Pap. The Eco-Pap reported a sensitivity of 99.8%, a specificity of 100%, and post-test probability of 99.5%. The global SQI were of 0.96 (ideal=1). The Eco-Pap technique in one year reduced the use of xylene to 72 litres, of HCI and NH3 to 6 litres, and of mercury oxide to 1.5gr. This method allows the creation of an ecological environment during the screening of cervical cancer, it is a tool of the Occupational Health Promotion, and it is widely important in low income countries.
CONCLUSIONS Our results demonstrate that the Eco-Pap technique offers the same staining results as those obtained by conventional staining methods used in cervical cancer screening. More importantly, the Eco-Pap test by significantly reducing the use of highly toxic-carcinogenic reagents offers a considerable value-added factor protecting the environment.

INTRODUCTION Human immunodeficiency virus (HIV) infection poses a high risk to every government worldwide. HIV-infected men who have sex with men (MSM) are at high risk for infection with the human papillomavirus virus (HPV), which is the most common sexually transmitted infection globally, and therefore in the development of anogenital cancers.
OBJECTIVE to determine the frequency of HPV and anal cytological abnormalities in HIV+ Peruvian MSM patients at Guillermo Almenara Irigoyen National Hospital (HNGAI) during 2017-2018.
MATERIAL AND METHOD A retrospective, retrospective research was conducted in the HNGAI. We used the International Code of Diseases (C22, C21.2, C24.8, C569.44) on anal dysplasia, HPV (B97.7) and HIV (B20-B24). We included HIV+ patients with or without long-term High Antiretroviral Therapy (HAART), and aged 18-68 years. We carry out a systematically search to the patient’ clinical records within the period 2017-2018. We considered viral load, CD4+ lymphocyte count, viral status and other clinical characteristics. We used the Bethesda System for cytological interpretation and Hybribio GenoArray for the HPV genotyping
Results: Our preliminary results included 35 male patients with a mean age of 36.7 ± 10 years (95%CI: 33.4 to 40.1). We reported patients with HIV status at A1 (8.6%), A2 (14.3%), A3 (11.4%), then B1 (2.9%), B2 (20%) and B3 (2.9%) %), and C1 (5.7%) and C3 (25.7%). Hence, two (2.9%) patients had an unspecified stage of infection. According to clinical characteristics, the CD4+ lymphocyte level was 377.4 ± 250 cells/ml (95% CI: 294.4 to 460.4) with a minimum count of 43 cells/ml and a maximum of 1109 cells/ml. The mean viral load was 28.2±79.5 [copies]/RNA (95% CI: 1.8 to 54.4), with a mode of 0.1 [copies]/RNA and a range of 0, 1 to 300 [copies]/RNA. We determined 12 (34.3%) patients with anal cytological abnormalities: 9 (75%) with ASCUS, 2 (16%) with HPV infection, and (18%) with AIN 1. Subclinical HPV infection was observed in 50% of the patients. All ASCUS and AIN 1 had high-risk HPV, the most frequent genotype was 16 and 32. Poly-infection was observed in 6 (20%) patients.
CONCLUSION The frequency of HPV in HIV+ Peruvian MSM was higher than that reported in the general population and was related to abnormalities in anal cytology and stage of viral infection. Prevention and control measures should be established in MSM with HPV infection to prevent progression to malignancy

INTRODUCTION Breast and cervical cancers are the leading causes of cancer related morbidity and mortality amongst women in Uganda. However, existing studies of cancer statistics have not been comprehensive on trend analysis for the two cancers. This study aims to scrutinize the burden of breast and cervical cancer using a trend analysis of incident cases from 1994 to 2014 and suggest possible directions for control programs.
METHODS Data was obtained from the Kampala cancer registry, a population-based registry in Uganda. A Join point regression analysis was performed to detect the year when significant changes occurred according to cancer site and the menopausal status. Data was stratified in 2 groups [<50 years (premenopausal) and >50 years (postmenopausal)]. Results were summarized as crude rates (CRs), age-standardized incidence rates (ASIRs) and annual percentage change (APC) values.
RESULTS From 1994 to 2014, a total of 28,040 cases (15,495 females and 12545 males) were registered. Among females 2018 had breast cancer and 3611 had cervical cancer. Squamous Cell Carcinoma (SCC) was the most registered cervical cancer subtype (49.6%) and Ductal carcinoma (19.1%) for breast. Among females with breast cancer, the crude incidence rates increased from 8.9 in 1994 to 12.1 per 100,000 persons in 2014. The ASIRs slightly increased from 13.13 to 15.5 per 100,000 persons among the premenopausal group and from 79.9 to 103.04 per 100,000 persons among the postmenopausal group. Among cervical cancer cases, there was a minimal decrease in the incidence rates from 18.8 to 17.6 per 100,000 persons. There was a significant APC decrease of -1.7% among women <50 whereas that of postmenopausal women increased annually by 0.3%.
CONCLUSION Generally, there has been an annual increase in the burden of breast and cervical cancer cases. The government should improve on control and preventive measures of the two cancers.
ACKNOWLEDGEMENTS This work was supported by the Government of Uganda - Uganda Cancer Institute under a project N0. P-Z1-IB0-24 funded by African Development Bank.

OBJECTIVE A majority of cancers present at advanced stage in Tanzania which contributes to high mortality rates. Several of these cancers are treatable if diagnosed early. The factors leading to delay in treatment in northern Tanzania are unknown. The purpose of this study was to identify the barriers to cancer treatment in adult patients with cancer.
METHODS We interviewed newly diagnosed adult patients with cancer at the cancer centre of a large referral hospital in northern Tanzania between July 2018-March 2019. The adapted survey instrument included questions to capture demographics, delay time (time between first symptoms and initial visit to the cancer centre), and specific barriers to seeking care. Hospital records were examined for diagnosis and stage. Descriptive statistics were performed with SPSS. Ethical approval and informed consent were obtained.
RESULTS A total of 145 patients were included in the analysis. Sixty-five percent were female (n=94), the median age was 53 years (IQR 43-63 years), half (n=73) received a maximum of primary level education and 43% (n=62) were self-employed. Two-thirds of patients (n=99) had a delay time of more than 3 months. Eighty percent presented with late stage cancer (stage III and IV). The most common cited barriers-to-care included: “I thought the symptoms would go away” (n=107, 74%), “I didn’t know what cancer was” (n=104, 72%), “I thought treatment would be too expensive” (n=98, 68%), “The clinic was too far away for travel” (n=85, 59%), “The pain/swelling/lump, etc. didn’t bother me” (n=82, 57%), and “I had seen or heard of other people with cancer not be cured” (n=82, 57%).
CONCLUSION The barriers to seeking cancer care in northern Tanzania were centred around lack of cancer knowledge and access to care. To help reduce these barriers, education is needed regarding cancer awareness, recognition of cancer symptoms and availability of financial assistance.

OBJECTIVE This course teaches participants the key components of successful public-private partnerships, specifically, how they can be used to expand and improve cancer outreach in the US and abroad. The program examines the essential traits of an effective public-private partnerships as well as the skills for identifying the right partnerships. We will look at how state-of-the-art leadership principles are essential to ensure success. Lastly, we will discuss how individuals and their respective organizations interested in medical outreach can develop and secure public and private funding.
METHODS Multiple cases and examples will be described including three detailed case-based examples. Dan Milner will discuss NGOS and Industry and Lotte Mulder will discuss case-based examples to provide a toolkit for leadership best practices that are effective in ensuring successful PPP’s.
RESULTS Public-Private Partnerships are pivotal in transforming organizations and long-term projects into sustainable implementation plans. Through the use of critical partnerships with public, private, and community-based networks, cancer outreach can be significantly expanded while simultaneously. Accountability is an essential element of public private partnerships. Understanding how to collaborate using win-win propositions that use sound implementation science (including the need to hold partners accountable) will help ensure successful results.
CONCLUSIONS Public-Private Partnerships (PPPs) are an integral part of conducting business and improving the health of people, and in return, their respective communities. Developing PPP’s within the sphere of medicine and cancer care capacity building is essential to improving healthcare systems throughout the world.

OBJECTIVES: Conventional chemotherapeutic approaches face obstacles such as off-target toxicity and therapy-resistance in certain cancers. Human cytolytic fusion proteins (hCFPs) are targeted therapeutic agents composed of a disease-specific humanized antibody-based ligand recombinantly fused with a conditionally apoptosis-inducing human oligopeptide. They exhibit low off-target toxicity and can overcome tumor resistance depending on the biomarker selected. The aim of this project was to generate hCFPs targeting chondroitin-sulphate proteoglycan (CSPG4), a biomarker of aggressive and treatment-resistant cancers, for the treatment of triple-negative breast cancer (TNBC). These hCFPs are designed to bind to CSPG4-positive TNBC cells and deliver cytotoxic proteins intracellularly, where they induce tumor cell death by disrupting biosynthesis (angiogenin) or mitosis (microtubule-associated protein tau or MAP tau) in a compartment-dependent manner.

METHODS: We designed recombinant hCFPs based on angiogenin and MAP tau as lead agents, as well as a CSPG4-targeting SNAP-tag fusion protein (as a fluorescent mimic for binding). All fusion proteins were expressed in a transient secretory mammalian expression system and purified from the cell culture supernatant by ion metal affinity chromatography. Binding of CSPG4(scFv)-SNAP to CSPG4-positive and -negative TNBC cell lines was validated both quantitatively (by flow cytometry) and qualitatively (by confocal microscopy).

RESULTS: Preliminary proof-of-concept data demonstrate that the CSPG4-targeting, fluorescently-labeled CSPG4(scFv)-SNAP binds effectively to CSPG4-positive TNBC cells.

CONCLUSION: While the activities of the hCFPs generated still need to be assessed, the combination of such fusion proteins with a robust companion diagnostic tool such as SNAP-tag technology represents the first step towards the effective management of African TNBC.

OBJECTIVE An important component of cancer control programs for the growing burden in sub-Saharan Africa is a population’s awareness of risk factors. Studies thereof have focused on single rather than multiple cancers and carcinogens.
METHODS During March and April 2015, we undertook a survey to assess awareness of multiple cancer risk factors and symptoms in the Kilimanjaro region, North Tanzania. General population (n=620) and attendees at HIV Care-and-Treatment Clinics (CTC) were included (n=207).
RESULTS Participants’ mean age was 43.8 (inter-quartile range 30-52) years, 58% were female. Awareness of cancer risk was highest for tobacco (90%) and alcoholic spirits (67%), but tended to be lower for infections (41% for HIV (42.2% and 41.4% for CTC and community group respectively) and 16% for HPV (16.0% and 16.6% for CTC and community group respectively), while that of mouldy maize and peanuts was 35% for both. Awareness of specific cancer signs and symptoms ranged between 70% and 90%. Awareness of alcohol and tobacco were higher in men than women (odds ratio = 1.82 (1.38, 2.40) and 3.96 (2.14, 7.31 respectively). In relation to cancer treatment, 70% preferred modern medicine and 10% preferred traditional medicine alone. 60% were not aware of any local cancer early detection services. Only 20% had ever been examined for cancer, and of those screened; CTC-group were one 1.5 times more likely to screen than community participants. Awareness did not differ by age or HIV status.
CONCLUSION There are good levels of cancer risk factor awareness for certain lifestyle related carcinogens in Tanzania, however increased awareness is needed especially for infections and cancer warning symptom both in the general and HIV-positive population, as well as some myths to be dispelled.

OBJECTIVE The training program aimed to improve survival of children with cancer by early detection of symptoms and signs and prompt referral by nurses at health centres. Over 250,000 new paediatric cancer cases are diagnosed yearly worldwide. Health care providers (mainly nurses) at Health Centres level are the children's first opportunity for correctly recognizing and responding to early signs and symptoms of childhood cancers by appropriately referring them to district hospitals but studies show that 83% of nurses did not receive training on paediatric cancers. Insufficient knowledge about the warning signs and symptoms of paediatric cancer usually leads to improper diagnosis or delay to diagnosis and hence loss of many lives of these children. After realizing that majority in our community lack information on childhood cancers, our efforts since 2017 has been concentrated on training primary healthcare providers to recognize early signs and symptoms of childhood cancers
METHODS The program is consisted of trainings in selected regions of Rwanda. The first step is a “train the trainer workshop” where volunteering medical students and doctors are trained to train the nurses and community health workers. A two day's workshop is organized subsequently in each province bringing together at least with one nurse from each selected health centre. These trained nurses go back with materials to train their colleagues. They are followed up every three months with a survey to assess how much they retain the learned knowledge and the impact made. Prior to trainings, Rwanda Children's Cancer Relief and pediatric oncologists develop training materials that include training curriculum for both the trainers and for the trainees (nurses), educational and awareness material (posters, fliers, brochures). Trained nurses are kept in RCCR database for their follow up and any case of childhood cancers they track at their health facilities.
RESULTS In 2017, the program was conducted in 4 health centres and around 90 health care providers were trained with more than 800 posters, 950 brochures and 300 flyers distributed. According to reports, the number of referrals from health centres increased and the post training showed how accurate nurses were in stating their differential diagnoses.
CONCLUSIONS Childhood cancers are curable when detected and treated early, there is a need to build strong partnerships with private and public sectors to address the challenge of early detection and late presentation at the hospital because the program of training primary healthcare providers showed a good impact.

OBJECTIVE Cervical cancer (CC) is the leading cause of mortality by cancer in Sub-saharan Africa. The human papillomavirus (HPV) infection is recognized as a necessary and sufficient cause for CC. Population-specific estimates of HPV prevalence in the Democratic Republic of Congo (DRC) is unknown. This study aims at estimating the prevalence of HPV and identifying predominant genotypes circulating in Kinshasa, DRC.
METHODS Between July 2015 and July 2017, women were invited to attend a screening program at Mont-Amba Health Centre in Kinshasa. Cervical specimens were collected using the Preservcyt® medium. HPV DNA testing was performed for all the specimen using real-time polymerase chain reaction.
RESULTS During the 2-years period, a total of 1870 woman aged 25-82 years were screened. The mean age was 46 years (± 11.4). The overall HPV prevalence was 28.2% (95% CI: 26.1-30.3). HrHPV prevalence was 24.8% (95% CI: 22.8-26.8). Women younger than 30 years had the highest overall HPV prevalence (42.2%, 95% CI: 34.7-49.9). A second peak of prevalence was observed in women aged 60 years and older. HPV68 (5.5%, 95% CI: 4.5-6.6) was the most prevalent HPV type.
CONCLUSION The distribution of HPV genotypes among women in our population was different compared to other world regions. A key finding was that HPV68 was the most prevalent HrHPV genotype. These findings highlight the need for the determination in our population of the etiologic fraction of different HPV types in invasive cervical cancers.

BACKGROUND Treatment of epidemic Kaposi sarcoma (KS) with antiretroviral therapy (ART) can be complicated by an atypical and sometimes severe clinical worsening due to KS immune reconstitution inflammatory syndrome (KS-IRIS). Diagnosis of KS-IRIS is challenging, and optimal management of KS-IRIS remains unknown. We therefore sought to describe the cumulative incidence and predictors of KS-IRIS in KS patients initiating concurrent cancer chemotherapy and ART in Kampala, Uganda.
METHODS We enrolled adult HIV-infected patients with biopsy-proven KS and followed them monthly on initiation of KS treatment. KS-IRIS diagnosis was based on worsening of KS (an increase in number/size of lesions) with a concurrent decrease of HIV VL >1 log within 12 weeks of starting ART. Kaplan-Meir and Cox regression methods were used to determine incidence and predictors of KS-IRIS.
RESULTS We enrolled 73 participants with median age 31 years (range 18-75); 76% were male and 86% had extensive KS. At baseline, median HIV VL was 5.3 log copies/mL (range 2.35 – 6.67), and CD4 T-cell count was191 cells/dL (range 3-1437). KS-IRIS cumulative incidence was 46.7% (36%-59%). In univariate analysis, KS-IRIS was associated with abnormal chest x-ray (HR=2.58 [1.04-6.4], p=0.04), and CD4 count <150cells/mL (HR=2.07 [1.05-4.07], p=0.04); there was a trend towards significance for detection of oral KSHV viremia (HR=2.9 [0.83 -10.15], p=0.09), and platelet count <200(HR=2.19 [0.94-5.09], p=0.07). In multivariate analysis, KS-IRIS was associated with a platelet count <200(HR=11.57 [2.39-55.96], p=0.02), abnormal chest x-ray (HR=7.13 [1.66-3.99), p=0.01), and detection of oral KSHV viremia (HR=5.56[1.17 – 26.23], p=0.03).
CONCLUSIONS KS-IRIS remains common even in the context of concurrent ART and cancer chemotherapy. The risk of KS-IRIS may be higher in patients with pulmonary KS, a lower platelet count, and uncontrolled KSHV replication. These factors warrant further study for their potential as biomarkers of KS-IRIS to facilitate prevention, early diagnosis and appropriate management of KS-IRIS.

OBJECTIVE A randomized controlled trial to assess safety, acceptability and efficacy of a new cordless, rechargeable, hand-held thermal ablation (TA) technique for treatment of cervical pre-cancerous lesions is underway in Lusaka, Zambia. This new technique would offer a significant advantage over and above the current TA treatment options and facilitate a more rapid scale-up of services in LMICs.
METHODS VIA screen-positive women eligible for ablative treatment are randomized to receive TA, cryotherapy or LLETZ. Side-effects, pain and client satisfaction are scored and recorded. Samples for HPV-DNA testing are collected at baseline and follow-up. Treatment efficacy is based on VIA and HPV status at 6-month follow-up. The PPV of VIA was evaluated using the histology of LLETZ specimens.
RESULTS Randomization of 750 VIA-positive women (250 in each arm) for the pilot phase was completed. The proportion reporting moderate to severe pain/cramps during treatment was lower in the TA (4.4%) than cryotherapy (12.4%) or LLETZ (6.0%) arms. Over 97% reported least pain (scores 1-3) and 98% highly satisfied (scores 7-9) with and willing to recommend the treatments. Treatment success rates assessed by repeat VIA at 6 months were 84%, 79% and 78% in the TA, cryotherapy and LLETZ arms, respectively. These rates were lower among all the treatment arms compared to that reported earlier, likely due to the high HIV positivity (52%) in the study population. When treatment success rates assessed by repeat HPV testing and VIA at 6 months, the estimates were 62%, 57% and 68%, respectively, underscoring lower 6-month HPV clearance among this high HIV prevalent population. Furthermore, baseline CIN 2/3 lesions were detected in 31% (74/237) of the women in the LLETZ arm.
CONCLUSIONS This pilot phase demonstrates the new TA device is extremely safe and highly acceptable. TA efficacy will be further confirmed at trial end.

OBJECTIVES Kaposi’s sarcoma (KS)-associated herpesvirus (KSHV) is etiologically linked to all KS forms but mechanisms underlying KS development are unclear. The high incidence of KS in HIV-1+ individuals, implicates immune dysregulation in co-infection; however, lack of in-depth characterization of KSHV immune responses in African endemic-KS makes the pathogenetic role of HIV-1 unclear. The study objective was to investigate the HIV-1 and KSHV roles in viral-nucleic-acid detection, antibody and cytokine responses in PCR confirmed epidemic-KS and endemic-KS patients, and non-cancer controls from sub-Saharan Africa.
METHODS A sample size of 200 subjects was estimated for this study. Standardized questionnaire was used to collect socio-demographic and disease information. Skin punch biopsy, 10ml blood and buccal swab specimens were collected from the subjects. KSHV viral-DNA (vDNA), total anti-KSHV antibody, KSHV-neutralizing antibody (nAb) and cytokines were quantified. ANOVA and Mann-Whitney tests were used to assess differences between groups where P-value <0.05 was considered significant.
RESULTS A total of 219 patients were recruited for the study. The mean age of the of the epKS, enKS, HIV- controls and HIV+ controls were 38.1 years, 46.7 years, 43.3 years and 38.8 years, respectively. Similarly, the mean CD4 counts in cells/µL for epKS, enKS, HIV- controls and HIV+ controls were 290, 808, 684, 447, respectively. Consistently, KSHV-vDNA was detectable in tumours but variably in plasma and PBMCs of KS patients. Consistent with elevated antibody-associated cytokines (IL-6, IL-5 and IL-10), total and nAb titers were higher in epidemic-KS and endemic-KS patients than in controls (P<0.05). Despite HIV-1 co-infection in epidemic-KS, total and nAb titers were similar between epidemic-KS and endemic-KS patients (P=0.3).
CONCLUSIONS Detection of similar antibody and cytokine responses in epidemic-KS and endemic-KS patients suggest that KSHV drives KS pathogenesis, whereas HIV-1 co-infection exacerbates and accelerates KSHV pathogenesis and KS development.

OBJECTIVE Cancer is at an increase worldwide with 14.1 million new cases per year. By 2030, over 30 million people will be affected and the burden will be more in developing countries. Oncology nurses have a major role in chemotherapy administration, although the growing number of cancer patients leads to increased workload to the nursing staff creating an environment susceptible to chemotherapy administration errors. Supporting nurses to voluntarily report chemotherapy administration errors is very crucial and improves patients’ care therefore the objective of this study was to assess nurses’ perceptions towards reporting chemotherapy administration errors and determine barriers towards reporting these errors at Uganda Cancer Institute (UCI).
METHODOLOGY This was a descriptive cross-sectional study that used quantitative methods. We purposely selected 56 nurses who directly administered chemotherapy for at least five years. Among them, a random sample of 44 nurses was selected and data collected in December 2018. The tool for data collection was a structured questionnaire that consisted of two sections; demographic data of participants and questions about chemotherapy errors with a five linkert scale.
RESULTS A total of 44 questionnaires were returned; most of the participants (68.2%) were females, 54.5% were registered nurses and 79.5% had administered chemotherapy for a period of 5-10 years. All nurses knew what a chemotherapy administration error meant and 77.3% had ever made at least an error during chemotherapy administration. 79.5% of the nurses agreed that errors affect patients in various ways, and it was important to report them however, 81.8% feared to report these errors because of consequences from reporting them. 79.5% of the participants reported fear as the major barrier towards reporting chemotherapy errors and 86.4% of the participants agreed that UCI had no adverse events report forms to chemotherapy errors, hence hindering reporting.
CONCLUSION While UCI nurses reported barriers towards reporting, it was observed that they had good perceptions towards reporting chemotherapy administration errors despite the various expected consequences towards reporting. This indicates that UCI should establish a patients’ safety committee that would set up a standardized approach for reporting chemotherapy administration errors. Risk management strategies should be embraced by conducting regular continuous education programs about proper chemotherapy administration and train chemotherapy verification nurses so as to ensure that correct chemotherapy dose is delivered to the correct patient by the correct route and at the correct time.

OBJECTIVE Lymphomas are solid tumors of the lymphatic system and are divided into Hodgkin's and non-Hodgkin lymphoma. Primary gastrointestinal lymphomas are a rare neoplasm and represent 1% to 4% of tumors of the digestive tract, and 10 to 15% of all non-Hodgkin lymphomas. We present a case of gastrointestinal non-Hodgkin lymphoma of the stomach and colon in a HIV positive patient.
METHODS 34 years old female patient, HIV positive on therapy for 7 months; very irregular taking, presented with recurrent epigastric pain ongoing for 3 months and hematemesis with one day of evolution and dizziness. Clinical laboratory tests showed her CD4 count was 405 cells/mm3, and abdominal ultrasound revealed hepatic steatosis. She underwent endoscopic exams: upper digestive endoscopy revealed oesophageal, gastric and duodenal ulcers in probable context of HIV disease; Total colonoscopy showed in the transverse and ascending colon presence of 10 mm polypoid lesions, with irregular surface; cecum mucosa with high erythematous irregular lesions, measuring 20 mm in probable HIV context
RESULTS Histopathological examination showed gastric mucosa distended by proliferation of lymphoid cells of intermediate to large size and colon mucosa extensively infiltrated by malignant neoplasm of large cells, in diffuse pattern. Immunohistochemistry study showed positivity for CD45 and CD20. A diagnosis of Non-Hodgkin lymphoma of the stomach and colon was made.
CONCLUSIONS The aim is to illustrate an unusual form of primary non-Hodgkin's lymphoma in HIV positive patient who presented distinct endoscopic findings corresponding to the same entity. This diagnostic suspicion should always be present in cases of digestive haemorrhage in immunosuppressed patients.

Cervical cancer (CC) is a multifactorial disease and it was established that the main aetiologic agent is the Human Papillomavirus (HPV). Despite the implementation of cervical uterine Pap smear (HPV) screening and vaccination to treat precancerous lesions and the early management of this disease, cervical cancer is still a public health problem. The emergence of novel cervical cancer biomarkers is promising enough to reduce the cost of prevention and improve the specific detection of high-grade cervical lesions and early-stage cervical cancer, implying an improvement in the efficacy of cervical cancer, cancer treatment management. The objective of this study will be to identify PBMC gene expression profiles and to investigate potential biomarkers through the analysis of significantly altered signaling pathways from patients with cervical cancer, cervical intraepithelial neoplasia (CIN 1) and healthy control subjects (CTR) using Illumina technology. The Illumina BeadChips were used for a complete genome-wide transcript profiling of whole blood from 31 CC patients, 27 CIN and 29 CTR. Differentially expressed genes (DEG) were identified by comparing the mean normalized expression for each gene in the different sample groups, using the Student t-test. P-values were adjusted to control the False Discovery Rate (FDR 5%). A hierarchical clustering was performed on the 3,435 significant genes and DEG at significant level between patients and the clusters generated were analyzed using Gene Ontology (GO) in String protein database to identify biological processes. Few differences were observed between CIN patients and CTR with only 129 upregulated and 130 downregulated genes in CIN patients. In contrast, 1,569 genes were overexpressed in CC patients including 1,404 and 1,303 genes respectively from the comparisons with CIN patients and CTR. We identified in CC patients compared to CTR a high expression of a spectrum of genes involved in the immunity of CC patients and a weak expression of genes related to metabolism. Microarray data were validated by RT-qPCR in a set of ten genes showing a high degree of correlation.
CONCLUSION This enrichment of genes involved in immunity overexpressed in CC patients could be related to their particular immune state regarding cervical cancer and the observation of genes related to metabolism under-expressed in CC patients could reflect the rewiring of the metabolism processes in cancer. Our study highlighted several new genes that could contribute in the identification of innovative clinical biomarkers for diagnostic procedures and therapeutic interventions.

CONTEXTO A fraca qualidade de registo de base populacional limita o conhecimento da epidemiologia do cancro na idade pediátrica em países em desenvolvimento,sendo que as leucemias agudas constituem um importante factor de morbimortalidade neste grupo etário, existe a necessidade de melhorar os registos epidemiológicos, priorizar recursos, bem como melhorar a qualidade do serviço prestado a estes pacientes. O presente estudo têm como objectivo descrever o perfil clínico epidemiológico e evolução de crianças com diagnóstico de leucemia aguda num período de 5 anos no Hospital Central de Maputo.
METODOLOGIA Foi feito estudo retrospectivo, descritivo no qual foram analisados processos clínicos de 86 pacientes admitidos no serviço de Hemato-Oncologia Pediátrica do Hospital Central de Maputo com diagnóstico de leucemia aguda no período compreendido entre 1 de janeiro de 2011 a 31 de dezembro de 2015, tendo sido avaliadas variáveis relacionadas com a idade, sexo, classificação de risco, desfecho dos casos em relação a abandono, seguimento bem como as principais causas de mortalidade.
RESULTADOS A leucemia linfocitica aguda representou cerca de 82% com uma taxa de sobrevivência de 30% e a leucemia mieloide aguda representou cerca de 18% com uma taxa de sobrevivência de 0%.
CONCLUSÃO Os resultados obtidos neste estudo demostram que a leucemia linfocitica aguda considerada o tipo mais frequente, com alta taxa de mortalidade enquanto que a leucemia mieloide aguda sem chance de sobreviver, o diagnóstico precoce, a melhoria na classificação de risco através de melhoria das técnicas de diagnóstico, a melhoria do tratamento e dos cuidados de suporte iriam aumentar as taxas de sobrevivência.

In Mozambique Kaposi’s sarcoma (KS) is the most frequent tumour in patients with HIV infection in our health facilities. The pulmonary Kaposi (PSK) involvement and pulmonary infections (PI) occurs commonly in patients with preceding mucocutaneous lesions (MCKS). The study wants identify demographics, clinic and laboratorial pattern of MCKS with and without PSK and the PI associated.
METHODS Individuals with MCKS and HIV infection admitted to HCM were recruited from 2016 until 2018. They completed a questionnaire with demographic data and medical history. Blood tests were performed to CD4 count, haemoglobin and chest X-ray, bronchoscopy, bronchoalveolar lavage for AFB smear and culture, bacterial culture, cytology and fungi. Data were analysed in Stata 13.0.
RESULTS 196 patients enrolled, 118 (60.2%) were male with age ranging from 18 to 75 years old (Median=34.00 IQR=30.0-41.0). 183 (93.4%) were on ART before KS diagnosis and in 91 (51.4%) the ART initiation was less than 1 year. The CD4 median was 160 and Hgb median 9.7 g/dl. Through bronchoscopy was identified; KS in 91 (46.4%) patients and PI in142 (72.4%)with bacterial pneumonia 60 (30.6%), pulmonary tuberculosis 37 (18.8%), pleural tuberculosis 9 (4.5%), Histoplasma capsulatum 15/47 (31.9%), pneumocystis jiroveci 12/47 (19.1%) and pneumocystis more histoplasma in 9/47 (19.0%). Main clinical symptoms were dry cough, dyspnea, weight loss and asthenia like PSK. X-Ray changes: interstitial infiltrate in 64 (32.6%), reticule nodular infiltrates in 43 (30%). 88% were in ART with CD 4 median of 136.5. The PI were associated with PSK in 68 (48%) patients. The Follow up at 3 months was achieved in 85 (60%) with 28 (19,7%) deaths.
CONCLUSIONS Half of those with MCKS presented with PKS independent of CD4 level despite ART treatment. Multiple infections were detected with clinical radiographic presentations indistinguishable from PKS. A higher mortality was observed in the patients with opportunistic infections.

OBJECTIVE Globally, lung cancer is the most common cancer and cause of cancer-related deaths, responsible for nearly one in five deaths. Many health systems in low- and middle-income countries (LMICs), including Sub-Saharan Africa have weak organizational structure, which results in delayed lead time for lung cancer patient care continuum from diagnosis to palliative care. Therefore, the aim of this study is to map evidence on the health systems issues impacting on the delays in timely lung cancer care continuum from diagnosis to palliative care in Sub-Saharan Africa.
METHODS A scoping review was performed following the method of Arksey and O’Malley. Systematic searches were performed using EBSCOhost platform, a keyword search from the following electronic databases were conducted: PubMed/MEDLINE, Google Scholar, Science Direct, World Health Organization (WHO) library, and grey literature. The screening was guided by the inclusion and exclusion criteria. The quality of the included studies was determined by Mixed Method Appraisal Tool (MMAT).
RESULTS A total of 2886 articles were screened, and 236 met the eligibility criteria for this scoping review study. Furthermore, 155 articles were also excluded following abstract screening. Eighty-one articles were selected for full-article screening by two researchers with 10 being selected for independent detailed data extraction for synthesis. These studies were also subjected to methodological quality assessment. Studies included in this review noted some health system factors responsible for the delays in timely lung cancer diagnosis, such as the long waiting times, high cost and inaccessibility of diagnostic investigations, delays due to multiple medical visits, misdiagnosis and misinterpretation of chest radiograph.
CONCLUSIONS It is important for the countries in Sub-Saharan Africa and other LMICs to strengthen their health-care systems by ensuring that they have adequate screening and diagnostic infrastructure. Furthermore, health education among health providers on lung cancer should be prioritized.

OBJECTIVE East Africa is facing a rising burden of cancer; but few clinicians are equipped to effectively conduct research in this area. The study aimed to assess Attitudes and Barriers to conducting research amongst young Oncology trainees of Master’s in Medicine (MMed) in Clinical Oncology at Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania.
METHODS A questionnaire was distributed to trainees and recent graduates of MMed Clinical Oncology Program at MUHAS. Areas that were assessed included: (1) demographic data; (2) prior research training (3) prior and current research activities; (4) attitudes towards the importance of research; and (5) supports and barriers to including research in oncology career. Descriptive statistics were used to summarize level of knowledge, attitude and research practice. Categorical variables were presented as totals and percentages. Continuous variables were presented with median values and ranges. Fisher’s exact tests were performed evaluating associations between demographic data, nationality, and rank (trainee vs. faculty), with particular attitudes and barriers. All analysis was performed with Stata statistical software version 15.
RESULTS A total of 30 individuals responded to the survey, of whom 53% were male and 70% identified as current trainees. Amongst the majority of respondents, attitudes towards research were strongly favourable. While only 42% reported receiving formal training in research-methodology, 87% reported intentions to incorporate research into their careers. The absence of protected research time and lack of access to research funding opportunities were identified by majority of respondents as critical barriers.
CONCLUSION A majority of current and recent oncology trainees in Tanzania desire to incorporate research into their careers, but most lack adequate training in research methodology and longitudinal mentorship. Thus future collaboration should focus on creation of appropriate research training curriculum and fostering an environment that catalyzes inter professional development in context-specific cancer research in East Africa.

OBJECTIVES The challenges posed by increased cancer burden in East Africa demand development of research skills and capacity to inform context-specific cancer control plans. MUHAS and ORCI are home to one of the first clinical oncology training programs in East Africa and are uniquely positioned to build capacity for cancer research. We aim to: (1) perform an assessment of training needs and establish a set of competencies that must be achieved; (2) create an inventory of training resources available in Tanzania; (3) select a training model and develop a curriculum; (4) identify and develop mentorship resources; and (5) develop strategies for scholar retention.
METHODS We employed a mixed methods approach consisting of in-depth interviews with institutional heads, and senior researchers. Current and recent trainees in the clinical oncology training program at MUHAS completed questionnaires regarding attitudes and barriers to research. Together these results will inform development of objectives for the research training program.
RESULTS Amongst 31 respondents to a survey of current and recent trainees, 87% (N=26) reported intentions to incorporate research into their careers. However, only 37% (N=11) reported receipt of formal training in research methodology. The absence of protected research time, mentorship, and access to research funding opportunities were identified as barriers. Collection of quantitative and qualitative data from additional stakeholders is ongoing; these data will be presented.
CONCLUSION Enthusiasm for cancer research in Tanzania is high, but research training and longitudinal mentorship are needed. In partnership with UCSF, we aim to train and mentor a cadre of investigators who are capable of conceptualizing, implementing, analyzing, and publishing original research focused on cancer in East Africa. Our future collaboration will focus on creation of appropriate research training curriculums and fostering an environment that catalyzes context-specific cancer research.
ACKNOWLEDGEMENTS Fogarty International Center, U.S. National Institute of Health (1D71TW011202-01).

BACKGROUND Ampath Oncology Institute, in collaboration with the International Agency for Research on Cancer/World Health Organization, conducted a 2-day biobank training course in Eldoret, Kenya on 14th and 15th January 2019. The training was developed and conducted following the expertise, biobank status and educational needs of the institution. A two-step training approach to building capacity was used and included (a) face-to-face and (b) institutional site visit.
OBJECTIVE To train Ampath Oncology Program staff with the overarching goal of providing a general overview of the key issues in establishing, maintaining and accessing a biobank as well as strengthening technical capacity for increased consideration and use of human tissue repositories.
METHODS Face-to-face training was done through lectures and discussions in-between sessions for the exchange of knowledge and experiences. Lectures focused on important areas of biobanking while discussions focused on institutional challenges and laws that govern biobanking in clinical care and research.
OUTCOME 21 participants from Ampath and Kenya Medical Research Institute attended the training including principal investigators, program managers, biobank managers, lab technicians, physicians, pathologists, immunologists and researchers. Pre-training and post-training questionnaires were issued to participants to assess the effectiveness, usefulness and impact of the training. Overall response rate was 100%. Respondents included 70.6% men and 29.4% women. For relevant analyses, results were significant at 95% confidence level. Pre-test and post-test mean average scores were 59 and 90 respectively, indicating an average score increase of 31 points after the training.
CONCLUSION The data suggested that there is a gap in knowledge on biobanking but there is willingness of Health Care Professionals in learning more about biobanking. Ampath Oncology Institute, through such partnerships and training initiatives with IARC/WHO and other willing organizations intends to change the cancer care landscape by building capacity, increasing research and improving care through biobanking.

BACKGROUND There is a huge need for capacity building at all levels of cancer control. Ampath partnered with Takeda Pharmaceuticals in a Preceptorship Program since January 2018 to accelerate the trainings in cancer control for health care professionals across all cadres.
OBJECTIVE To provide education and training support for healthcare professionals operating across the oncology continuum of care from prevention to survivorship care.
METHODS The program supports long term trainings of 1 to 4 years duration for all cadres of health care professionals by supporting tuition fees. Upon selection for training, individuals provide their study program admission letters, fee structure, identification card, and a release letter from their employer indicating that they are bonded and expected to return back to their stations upon completion of their training.
RESULTS In one year, the program has supported the training of 2 Gynecologic Oncology Fellows, 4 Clinical Oncologists, 1 Radiation Oncologist, 2 Oncology Nurses, 9 Oncology Clinical Officers, 2 undergraduate Palliative Care Specialists, and 1 Pharmacist. The mean average age of the trainees was 34 years and of the total 21 supported, 12 were male and 9 females. The individuals have been supported to undergo training in different institutions across Africa with 12 training at the Moi Teaching and Referral Hospital’s College of Health Sciences, 2 at Moi University, 2 at Alexandria University in Egypt, 1 at Stellenbosch University in South Africa, 2 at the Institute of Hospice & Palliative Care in Africa - Makerere University and 2 at Muhimbili University of Health and Allied Sciences in Tanzania. The program has also fully supported 51 healthcare professionals to attend short term, 2-30 days’ trainings in areas including Psycho-Oncology, Pediatric Oncology, Obstetrics and Gynecologic, as well as Cancer Care Electives programs. A skills lab has also been established to facilitate skills training at AMPATH. Expansion of outreach services has been initiated to more than 10 sites via Telemedicine.
CONCLUSION Partnerships with Pharma as key-stakeholders in cancer control, can help build capacity and increase access in delivering cancer care services. This represents an effective model of accelerating access to cancer care in LMIC and beyond.

BACKGROUND Cancer is a global public health problem. The malignancies of the female genital organs are major causes of morbidity and mortality. This is particularly so in the developing countries where there is poor awareness and late presentation. Hence, this study investigated the level of knowledge of gynaecological cancer risk factors and screening behaviours among childbearing age women attending outpatient clinic in some selected hospitals in Lagos state, Nigeria.
METHODS The study utilised a cross- sectional descriptive approach to elicit information from 430 randomly selected women of child bearing age, from three purposively selected hospitals in Lagos state. Self-administered questionnaire was used to gather information on each of the objective and the collected data were presented in frequencies and percentages, while the inferential statistics was analysed using Chi-square at 5% level of significance with the aid of SPSS version 20.
RESULTS Mean age was 32.9±5.9 years, 62.0% were married and 74.8% had post-secondary school education, 64.2% were nulliparous, while 32.9% had 1 - 3 children. Many (56.7%), were self-employed, 84.7% were Christians and 45.3% were receiving average monthly income of above #50,000. In addition, 58 % of the women had good knowledge of cervical cancer. Important risks factors identified were: family history (52%), multiple sexual partners, smoking (51.1%), use of contraceptives (42.9%), and infection (42.9%). However, it was observed that nuliparity (65.1%) and fatty diet (37%) were misconceived as not being risk factors. Data on screening behaviour revealed only 23.2% of the respondents claimed being screened for one of the gynaecological cancer. Main source of awareness was health professional (35.6 %). Only 19.9% of the respondents claimed having done Pap smear test, while 56.9% had done pelvic examinations and 70.9% of the respondents did ultrasound. In addition, age, income and educational were significantly related to uptake of gynaecological screening. Some of the barriers identified were cost ( 27.4%), distance (24.7%), lack of information(23.5%) and time constraint (22%) . CONCLUSION Conclusively, about half of the respondents were not aware of cancer risk factors and lacked sufficient knowledge of gynaecological cancer. Few had been screened for the gynaecological cancer. Creating more awareness on the risk factors is considered necessary in other to increase uptake. Designing intervention to circumvent the barriers could enhance uptake, reduce morbidity and mortality and increase quality of life of women of child-bearing age in the area.

OBJECTIVE with increasing cases of cancer in developing countries, strategies such as health navigation programmes that complement standard cancer care are critically important to ensuring increased survival rates. This study aims to determine the programme Fidelity (the extent to which programme was implemented as planned) and implementing staff’s experience to determine aspects of the implementation that worked and to see if it can be refined or reproduced.
METHODS purposive sampling technique was used. To determine fidelity, programme planning, implementation documents and records were evaluated using critical comparative method. Semi-structured interviews with health providers, navigators and administrative staff were conducted, transcribed, coded and analysed using manual thematic analysis to access implementers’ experience.
RESULTS Eight (8) individuals (health providers n=2, navigators=3 and administrative staff n=3) participated in the semi-structured interviews (75% female). Fidelity: The implementing team carried out most of the planned activities as outlined in the work plan, making the programme implementation somewhat successful. Thematic analysis revealed four themes: 1) a major source of health disparity is lack of knowledge and poverty. 2) The navigators are partners of the patient throughout their cancer journey and they offer health providers and the navigation centre a rare opportunity to identify and address unrecognised barriers to healthcare. 3) A multidisciplinary approach (including psychology and financial support of patients) could greatly improve outcome and 4) organizational structure, lack of knowledge of available funding by navigators contribute to systemic barriers.
CONCLUSIONS Process evaluation is only valuable to the extent it helps inform decision making on the programme implementation and future planning. The programme was implemented to plan and reproducible. This study highlights the importance of having the perspective of the implementing team during planning and evaluation. More research is needed to determine the effectiveness of the Navigation Program in improving patient outcomes in Niger State, Nigeria.

OBJECTIVE In order to achieve universal coverage, health care must therefore be acceptable to the cultural and social orientation of the community. Among the Luo of Kenya, it was believed that all diseases had cure and those that did not were as a result of non-obedience to the society rules and regulations. This belief poses a gap in explaining conditions that have no known causes like cancer. The study therefore sought to explore the perceived meaning and utilization of palliative care among the Luo to provide information and opportunities for developing tailored programmes to increasing access to these services. One objective was to explore the understanding of conditions that required palliative care, including cancer.
METHODS The study took on an Interpretive Phenomenological Analysis approach to exploring the lived and observed experiences of the Luo conditions that needed palliative care and their families. Data was collected through review of secondary data, undertaking structured interviews, key informant interviews, focus group discussions and participant observation and analysed under the thematic areas of the research questions. A total of 43 participants were interviewed.
RESULTS Every condition was perceived to have an aetiology, with no room for spontaneous cause. Chronic conditions were mostly attributed to change in lifestyle and maybe diversion from the normal societal rules. There was confusion on the causes of cancers, and limited knowledge on the disease processes and prognosis.
CONCLUSION Due to differing aetiologies for cancers, efforts should be made to discuss cancer more from the physiologic process point of view rather than by the causative factors. The causative factors are merely risk factors and people get confused and stigmatized when they or their relatives acquire cancer without explicit exposure to the highlighted risk factors.

OBJECTIVES To map place of cancer diagnosis in relation to HIV care centre in PLHIV in South Africa using a national laboratory database.
METHODS We linked HIV and cancer laboratory data from 2004-2014 using support vector machine – supervised machine-learning algorithms. We compared the province where individuals accessed their HIV care (assumed to be the province of residence) versus where they had their cancer diagnosis. We used folium leaf, branca, seaborn and matplotlib - big data mapping techniques in Python 3.6 running on jupyter notebook, to map cancer diagnosis and HIV care facilities.
RESULTS During the study period, 68,543 people with cancer also had a documented HIV positive result. The median age at cancer diagnosis was 40 (IQR, 33-49) years for the entire population with most cancers in PLHIV diagnosed in females (70.7% (n=48,572)). Gauteng and Western Cape provinces diagnosed the most cancer cases in the PLHIV at 42.4% (n=29,093) and 11.6% (n= 7,939) respectively. Of all the PLHIV cancer patients, 24.6% (n=16,864) accessed cancer diagnosis outside their province of residence with 60.7% (n=10,235) travelling to Gauteng. KwaZulu-Natal had 46.6% (n=4,107) of its PLHIV cancer patients diagnosed in Gauteng. In contrast, in the Western Cape 94.8% (n=6,522) of cancer patients had their cancer diagnosis and their HIV care within the province.
CONCLUSIONS There was poor access to cancer diagnosis in PLHIV in KZN such that nearly half of patients accessed cancer diagnosis over 500km away from their HIV diagnosis/care province. The higher retention of PLHIV with cancer in the Western Cape reflects better oncology services in the province. More effort is required to ensure equitable access to oncology services within the country to optimise cancer patient outcomes.

OBJECTIVES To implement primary HPV testing for cervical cancer screening in Maputo, Mozambique including training the local laboratory staff to perform the assay.
METHODS The CareHPV test system (Qiagen, Gaithersburg, MD, USA) was installed at the Mavalane General Hospital. This test is based in signal-amplification that allows the detection of 14 high-risk HPV types in a batch of 90 samples in limited-resource settings. Women were enrolled and a cervical sample collected by a nurse or doctor. The laboratory personnel were trained by laboratory experts from Brazil.
RESULTS Between April 2018 and January 2019, 427 women were enrolled. The local laboratory staff underwent to four one-week long training sessions to accurately perform the CareHPV test. The median age of participants was 39 years and 20.2% were HIV positive. The CareHPV test was positive in 21.8% of the cervical samples.
CONCLUSIONS Our results suggest that performing CareHPV test in resource limited areas is feasible. However, a single visit screen-and-treat strategy was not possible due to the time required to collect 90 samples plus the 4 hours CareHPV run. Intensive training was needed to perform the CareHPV test accurately and with confidence. A high HPV detection rate was noted in this population.

OBJECTIVE Uganda Cancer Society together with Uganda Cancer Institute partnered with government and other stakeholders to commemorate 2019 World Cancer Day. The global theme for 2019 which is “I AM. I WILL” explores how everyone collectively or as an individual can do their part to reduce the burden of cancer.The purpose was to increase advocacy and involve the general public along with government in raising awareness about cancer by recognizing its burden, efforts made to control it as well as the gaps that exist in fighting the epidemic.
METHOD We built collaborations within our membership and Uganda Cancer Institute fostering joint planning. The planning drew activities including lighting of the monument, screening, and physical activity. The physical activity arose from the Uganda NCD risk factor survey (2014) which showed that Ugandans have high physical inactivity especially among the urban population where 8% of adults were considered physically inactive compared to 3.5% among the rural population.
RESULTS There was increased collaboration and partnerships built among stakeholders bringing together government, civil society, media, private sector and the general public in planning and commemoration. The physical activity and screening attracted the public to join the ceremony. Media coverage included press conference, media question and answer sessions at the ceremony, and live streaming on television and radio stations. Notably, 5 articles were published in major national newspapers with Facebook page posts generating 4,100 likes, and up to 1,610 people engaged as there were also 333 tweets and retweets on twitter.
CONCLUSION The solidarity with which partners worked together both in the preparations and commemoration, including government’s commitment to create an enabling policy environment showed that together we can harness greater results in cancer control in Uganda.

BACKGROUND Endometrial Cancer (EC) is the sixth most common female cancer globally. Improved socioeconomic status and increased prevalence of obesity and low parity in South Africa (SA) may impact the EC trends in the country.
OBJECTIVE To evaluate the national trends and sociodemographic predictors of EC mortality in SA from 1997-2015.
METHODOLOGY Temporal trend analysis of EC mortality in SA was conducted using data from Statistics South Africa. National annual age standardized mortality (ASMR) rate stratified by age-group and province of usual residence was calculated. Direct standardization using segi world population was conducted. Average annual percent change (AAPC) of the observed trends was conducted using JoinPoint version 4.5.0.1 software. Provincial ASMR was geographically mapped using appropriate geocodes and ArcGIS software.
RESULTS Of the 3,955 EC deaths, about 76.4% (n=3020) were older than 60 years and the mean age at death was 66(±11) years. About 10.2% of EC deaths occurred among smokers. The national ASMR of EC increased by 3.3% annually (AAPC= 3.3%, 95% CI: 2.4- 4.3, P-value<0.00001) from 0.67/100,000 in 1997 to 1.23/100,000 in 2015. Eight of the nine provinces had increased EC mortality trends (APC range: 3.1% in Free State to 8.2% in KwaZulu-Natal) while Northern Cape had a non-significant decrease (APC= - 1.2%, P-value=0.5). Women who were ≥50 years had about four fold odds of EC mortality as compared to younger women (OR:3.98, 95% CI:3.14 – 5.03, P- value:<0.001). Compared to never married and never smoked, the odds of EC deaths decreased by 27% and 47% among divorced women (OR: 0.73, 95%CI: 0.59 – 0.89, P-value: 0.002) and smokers respectively (OR: 0.53, 95% CI: 0.43 – 0.65, P-value < 0.001).
CONCLUSION Deaths from EC increased over the studied period. This study highlights the Public Health imperative of control program for EC in developing countries with rapid epidemiological transition.

BACKGROUND Breast (BC), Cervical (CC) and ovarian (OC) cancer are leading causes of female cancer deaths in South Africa (SA). However, rapid socio-economic transformation after the commencement of multi-racial democracy in 1994 can impact the mortality trends of female gender cancers in SA. We evaluated the spatio- temporal trends of breast, cervical and ovarian cancer mortality in SA from 1997 to 2016.
METHODS A 20-year spatio-temporal trend analyses of BC, CC and OC mortality, based on data from Statistics South Africa was conducted. Join Point regression modelling was conducted to determine the trends in the annual crude (CMR) and age-standardised mortality (ASMR) rates by population/racial group, age group and province of residence. Provincial ASMR was mapped using geocodes and ARCGIC software.
RESULTS CC (n=55,317, 42.5%), BC (n= 51,435, 39.5%) and OC (11,623, 8.9%) constituted about 90.9% of breast and gynaecological cancer mortalities. Mortality (ASMR) rates increased annually by 1.6% (AAPC= 1.6%, P-value < 0.001), 1.7% (AAPC = 1.7%, P-value <0.001) and 2.0% (AAPC = 2.0, P-value <0.001) for CC, BC and OC between 2000 and 2016 and the ASMR were respectively 17.8/100,000, 13.6/100,000 and 3.5/100,000 in 2016. In 2016, Blacks (19.7/100,000) had the highest CC CMR while Asians/Indians (5.0/100,000) had the lowest CMR. All the racial groups had increased CC mortality trends (Blacks: AAPC=3.2%, Coloureds: AAPC= 3.3%, Whites: AAPC=2.9%), except the Asians/Indians (AAPC= -0.3%) with stable trends. Whites had the highest mortality rate for BC (45.9/100000) and OC (11.8/100,000) while Blacks had the least rates (breast: 11.0/100,000; ovarian: 2.7/100,000). However, Blacks had the highest annual increase in BC mortality (AAPC = 4.6%). BC was the leading cause of female cancer mortality in two South African provinces (Western Cape and Gauteng), with the highest per capita GDP, while CC was the leading cause of mortality in the other seven provinces.
CONCLUSION The increasing mortality burden of breast, cervical and ovarian cancer in SA between 2000 and 2016 were driven by different socioeconomic, ethnic and spatial characteristics. Targeted and holistic public health interventions are urgently required to improve survival rates of the major gynaecologcial cancers in SA.

OBJECTIVE Cervical cancer is the most common genital tract malignancy among women in Nigeria. Women living in slums usually have poor reproductive health knowledge and access to reproductive Health services. Mostly of low socioeconomic status, these women are at a higher risk of cervical cancer. This study assessed the knowledge, attitude and preventive practices towards cervical cancer among women living in an urban slum in Lagos, Nigeria.
Methods: This descriptive cross-sectional study was carried out among 305 women of reproductive age(15-49) in Idi-Araba, Lagos, Nigeria. Multistage sampling method was used to select respondents. Data were collected using interviewer administered questionnaires. Analysis was done with SPSS 20 software and frequency tables were made for categorical variables.
RESULTS Only 39 (12.8%) women had heard about cervical cancer. About 90% did not know any risk factors of cervical cancer. Some of the risk factors mentioned by respondents were early age at first sex (3.6%), multiple sexual partners (2.0%), infection with HPV (2.0%) and use of tobacco (0.7%). Majority of the respondents did not know about the symptoms of cervical cancer (90.8%), cervical cancer screening (92.1%) and HPV immunization (98.4%). Some of the symptoms of cervical cancer mentioned by respondents were: foul smelling vaginal discharge (5.6%), heavy vaginal bleeding (1.7%) and vaginal bleeding after intercourse (0.7%). Though most women considered themselves not susceptible to cervical cancer (64.3), majority (88.9%) were willing to undergo cervical cancer screening and 93.8% were willing to take HPV immunization or recommend the vaccine to a friend or relative. Most women however said, they will require the consent of their spouses to be screened. Only 2(0.7%) women had done a cervical cancer screening test, one at a tertiary hospital, and the other, at an outreach. None had taken HPV vaccine or immunized their eligible daughters.
CONCLUSION There is thus, need for increased cervical cancer awareness and promotion campaigns among such group of women. Women’s partners should also be targeted for health education.

OBJECTIVE Diffuse large B-cell lymphoma (DLBCL) remains the most common non-Hodgkin lymphoma subtype occurring in HIV-seropositive individuals. Factors associated with survival after AIDS-related DLBCL diagnosis are complex and inadequately described, particularly in resource-limited settings. We sought to evaluate whether tumour-associated, immunologic, virologic, or treatment-related factors are associated with survival after a diagnosis of AIDS-related DLBCL in Uganda.
METHODS We prospectively enrolled HIV-seropositive subjects referred to the Uganda Cancer Institute (UCI) with histologically confirmed DLBCL after obtaining informed consent. At enrolment, we completed a staging workup, and collected clinical data as well as blood samples for immunologic and virologic studies. Subjects received antiretroviral therapy (ART) and chemotherapy per UCI standard clinical practice and were followed-up for vital status at 6, 12, and 24 months.
RESULTS We enrolled 55 adults with HIV-associated DLBCL, of whom 60% were female. The median age was 41 years (range, 22-68). 68% had Ann Arbor stage III/IV, and 56% had intermediate-high IPI-score; 78% were ECOG 0-2. The median duration on ART at the time of enrolment was 4 years (1-19), the median CD4+ T-cell count was 243 cells/L (6-2090), and the median HIV viral load was 51 (0-4,387,274) copies/ul. 61% received CHOP-21 chemotherapy, and 51% received 4-6 cycles of chemotherapy. Of these subjects, 17% achieved a complete response, 11% achieved a partial response, 3% had stable disease, and 25% had progressive disease. The overall survival at 1 year was 25%, and mortality within the first 6 months after study enrolment was over 50% (27/49). No factors were significantly associated with survival, based on preliminary analyses to date.
CONCLUSIONS Survival outcomes of subjects with AIDS-related DLBCL in Uganda remain poor. Ongoing studies are needed to identify factors associated with survival to better understand the pathophysiology of disease and to guide staging and treatment strategies.

OBJECTIVE Our main objective was to find out the prognostic indicators for women with breast cancer below 40 years in western Kenya enrolled at Ampath Oncology.
RATIONALE Previous literature has shown the age group for breast cancer was around 50-60 years and women below 40 years have poorer outcomes. However, at Ampath Oncology the data is different, many present under 40 years. With early intervention, proper diagnostic techniques and management, women below 40 years have improved breast cancer outcomes.
METHODS Cross-sectional study for a population of patients enrolled on Breast Cancer Program at Ampath Oncology from February 2015 to 2019. An outline of our indicators were classified as age, TNM Staging, Histology typing and Hormone Receptor and data was extracted from the point of care patients’ data, analyzed and presented in graphs and tables.
RESULTS Since 2015, Ampath enrolled 91 women below 40 years diagnosed with breast cancer onto the program. The women more than 50 years were about 43 women. Good prognostic indicators were outlined as Stage 1 & 2; Grade 1 &2 cancers and estrogen positive markers and were associated with low levels of distant metastasis and higher chances of survival. A 71% 5-year overall survival was realized for breast cancer patients under 40 years with good prognostic indicators and were 65 in number out of the total 91 women. 29% (26 in number) of women had poor prognostic indicators were Stage 3&4; Grade 3&4 cancers and lack of estrogen markers. Twenty-nine percent of patients under 40 years had poor prognostic indicators and were lost to follow-up. The 5-year survival rate for the 29% of women with poor prognostic indicators was less than 10% since they had higher risks for metastasis and most were on palliative care. Community out-reach , screening programs, treatment, follow-up sponsored by Ampath including patient accommodation and follow-up visits provide a conducive environment for our patients to undergo treatment and could account for improved outcomes in good prognostic groups.
CONCLUSION Our study shows that young women make up majority of breast cancer patients in Western Kenya. Even though majority have bad prognostic features, they can be navigated to improve outcomes. We therefore advocate for early screening, diagnosis and sponsorship for women below 40 years in order to improve survival.

OBJECTIVE Cancer patients experience emotional distress including depression and anxiety which are moderated or alleviated by familial and psychosocial support interventions. Patients who receive counselling and adequate socioemotional support report less distress, improved mood and better pain management. The objectives of this study were twofold: First, the study examined the levels of psychological distress and subjective wellbeing among the patients. Two, it investigated the sources and availability of familial, psycho-social and emotional support for patients with a prediction of greater subjective wellbeing and less psychological distress among those who received more support.
METHODS A total of hundred (100) patients, within the ages of 25 to 80 (SD = 10.7) participated in the study. A mixed method approach (quantitative measures plus interviews) was used to collect data. Correlational analyses were performed on the quantitative data while thematic content analysis was used for the qualitative data.
RESULTS As predicted, there was a significant negative correlation between psychological distress and subjective wellbeing (r = -.50, p<.001). Other results showed that a significant number of patients perceived lack of support from their social networks. In addition, there was a general report of severe financial constraints for which many patients received no support from expected sources such as immediate family and faith communities. However, majority of the patients reported positive benefits from the counselling they had received.
CONCLUSION Our findings corroborate previous works that breast cancer patients in Ghana are not receiving satisfactory emotional support; a situation with potential negative impact on patients’ emotional health and physical recovery. Adequate context-specific psychosocial interventions need to be implemented to address these issues and thus facilitate greater patient wellbeing and speedy recovery.

OBJECTIVE To evaluate whether cervicitis reduces the accuracy of cervical cancer screening algorithms; using high-risk human papillomavirus (hrHPV) testing followed by visual inspection with acetic acid (VIA) or colposcopy in a cohort of women living with HIV (WLWH) in Botswana.
METHODS Prospective cohort study of WLWH in Botswana. All participants underwent hrHPV testing. All participants with positive hrHPV results underwent VIA, colposcopy, and biopsy. Histopathology was the reference standard for determination of cervicitis, pre-invasive cervical disease, and cervical cancer. Statistical analyses were calculated in SAS software including positive predictive value (PPV) and diagnostic accuracy (true positive + false positive/true positive + false positive + true negative + false negative). They were calculated to evaluate the accuracy of each cervical cancer screening algorithm based on either VIA or colposcopy and then compared between women with and without cervicitis.
RESULTS Among 300 women screened, 88 (29%) were hrHPV positive. Of those, 81 underwent visual evaluation and had histopathology results. 22 of 81 women (27%) had cervicitis and 28 of 81 women (35%) had high grade cervical intraepithelial neoplasia (CIN) defined as CIN2 or higher (CIN2+). For predicting CIN2+ in all subjects, positive hrHPV testing followed by VIA had a PPV of 39% [CI:24-55%] and a diagnostic accuracy of 52% [CI:41-63%]. PPV and diagnostic accuracy improved to 53% [CI:35-71%] and 58% [CI:44-70%] respectively when women with cervicitis were removed. Positive hrHPV testing followed by colposcopy had a PPV of 47% [CI:33-62%] and diagnostic accuracy of 61% [CI:49-71%] improving to 63% [CI:46-78%] and 71% [CI:58-82%] by excluding women with cervicitis.
CONCLUSION The accuracy of VIA and colposcopy in predicting pre-invasive cervical disease is reduced by the presence of cervicitis, even after primary hrHPV testing. Current World Health Organisation guidelines favour primary hrHPV testing as part of a two-stage screening algorithm. As the region moves towards use of hrHPV testing in the context of high prevalence of cervical infections, HIV and cervical cancer, more research is needed to understand this potential challenge for designing acceptable and effective screening programmes.

OBJECTIVE Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals due to insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries.
METHODS In its initial year, 2018, The Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of n=7 fellows for three-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants prior to arrival and upon departure; additionally, three participated in semi-structured interviews.
RESULTS Five themes emerged from the qualitative data: expectations of POETIC; differences between oncology in the USA and in SSA; positive elements of the program; areas for improvement; and potential impact. Fellows identified several elements of Western healthcare that will inform their practice: patient-centered care; clinical trials; and collaboration among medical, radiation, and surgical oncologists. From the quantitative data, feedback was primarily around logistical areas for improvement.
CONCLUSIONS POETIC was found to be feasible and valuable. The results from the pilot year justify the program’s continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future research will report on the expansion of the program and follow up with former participants.

Significant racial disparities exist in prostate cancer (PCa) incidence and mortality rates. Exploration of the basis for disparities would be enhanced by access to data and biological specimens on men of African Ancestry (AA). Unfortunately, AA men remain underrepresented in cancer biorepositories. To address this gap, we have embarked on an effort to create a state-wide biospecimen bank focused on AA men with PCa in Florida. The objective is to collect and manage patients’ data, outcome information, and biospecimens from diverse AA men who have been diagnosed with PCa in Florida. Self-identified AA PCa patients, diagnosed between 2013 and 2017, who were living in Florida at the time of diagnosis were identified through the Florida State cancer registry. Potential participants were mailed packets describing the study, with follow-up by telephone to answer questions and obtain informed consent. Interested patients were screened for eligibility and asked to complete a questionnaire, provide a saliva sample, and provide permission to obtain their tumour tissue sample. The Florida Cancer Registry reported a total of 7,960 AA PCa cases during the ascertainment period. Information packets were sent to 6,232 AA. A total of 240 were found to be ineligible mainly due to deceased or non-English speaking patients. To date, 979 have consented to participate, 1,364 declined ether by mail (n=203) or phone (=1161), 1,028 could not be located, and 2,621 have not responded to the initial information packet/phone after total of 5 attempts. This yields a participation rate of 16.3% (979/6,232). The adjusted participation rate, or the percentage of participants who consented to participate out of those who had communication with the research team, is 42% (979/2,343). Primary reasons for declining include patients stating that they are not interested (73%), or too busy (8%). A significant inverse association was found between current age and participation rate (p<0.0001) but not insurance status. Older AA PCa patients were found to be less likely to participate in the study. We observed a significant trend between treatments and participation rates. AA men who had chemo treatments were less likely to participate in the study (p<0.01). Our results demonstrate that recruiting Blacks/African-American PCa patients in the biobank study using a cancer registry is feasible, yet difficult. Despite prevailing recruitment challenges, we implemented diverse recruitment methods to increase reach. These recruitment methods helped identify additional avenues for targeting this population to increase participation and, ultimately, address cancer disparities among this population.

OBJECTIVE Data from population-based registries (PBCRs) are needed to estimate cancer patterns and trends in Mozambique.
METHODS Two PBCRs are now operational, in Beira (since 2005) and Maputo (since 2015). They collect data on all cancer cases diagnosed and/or treated in health facilities in these two cities and can calculate incidence rates based on cancers occurring in the residents of Beira district (462,000 population in 2016) and Maputo City (1,257,000 inhabitants in 2016).
RESULTS The national estimate of 25,600 new cases in the country in 2018 is based on the average of the incidence rates in the two registries. Overall, Kaposi sarcoma is the most commonly registered malignancy (27%) followed by cancers of the cervix (19%), prostate (7.5%), breast (6%) and liver (5.5%). There are some marked differences in the cancer patterns between the two cities. Incidence rates of Kaposi sarcoma in Beira are considerably higher than in Maputo, as are those of bladder cancer and cervix cancer. Conversely, the incidence of prostate cancer is higher in Maputo than in Beira, as is that of liver cancer. Although it remains high, liver cancer incidence is now much lower than 60 years ago, when the rates published in were the highest ever recorded in the Cancer Incidence in Five Continents series.
CONCLUSIONS The success of population-based registration in Beira and Maputo has allowed much better information on the national cancer profile. However, the differences in incidence between the two centres indicates that there are geographic differences in risk, and a cancer registry in Nampula, in the north of the country, is the next priority for the National Cancer Control Programme

OBJECTIVE Breast cancer incidence is increasing and low- and middle-income countries (LMIC) are being disproportionately affected. One major barrier in LMICs is the lack of breast cancer diagnosis by ultrasound (US)-guided biopsy which requires affordable US devices and comprehensive training programs to obtain successful capacity building. Mobile health (mhealth) US-devices are an affordable and sustainable solution. The gap is now the lack of an established US-guided breast biopsy-training program. Purpose of this study is to describe our competency-based mHealth US guided breast biopsy-training program for LMIC radiologists and describe a pilot study where one Nigerian radiologist was trained to perform US guided biopsies using the training program.
METHODS Describe the development of a cloud based scalable mHealth US-guided competency-based training program for LMIC with assessment metrics. The competency-based training curriculum includes (1) blended learning (combination of e-learning and instructor led), (2) simulation biopsy training on breast phantoms and (3) patient biopsy. Each competency must be successfully completed before moving on to the next.
RESULTS Portrayed through a pictorial review, we will describe our pilot study where one Nigerian Radiologist successfully completed the training program and clinically implemented mHealth US-guided breast biopsy into her practice. The Nigerian radiologist performed 50 unsupervised biopsies. Pathology was malignant for all with concordance assessment between pathology and imaging found to be 100%. There were no complications and procedure time ranged from 7-36 minutes.
CONCLUSION The significance and impact lie in: 1) establishing the critical role of tablet-based mHealth US-guided breast biopsy for early diagnosis programs in LMIC and 2) developing a competency-based US-guided training program that is scalable and sustainable. The mHealth-based curriculum is self-propagating whereby the trainee can become the trainer. This mHealth training program can also be adapted for other image-guided procedures that could impact global cancer control through diagnosis, therapeutic intervention and/or palliation.

OBJECTIVE Uganda has one of the highest incidence rates of cervical cancer in the world (47.5/100,000/year), resulting from limited screening access and weak health systems centralized in the capital. Self-collection for cervical cancer screening (SC-CCS) is a strategy to improve screening access. The objective of this study was to understand 1) women’s knowledge, preferences and barriers for SC-CCS, 2) barriers and facilitators to engagement in the current screening program and 3) health system challenges to implementation of SC-CCS.
METHODS Focus group discussions (FGDs) were administered from 4 purposively selected villages in a rural district of Mayuge, Uganda. Research assistants conducted FGDs with women’s groups in communities in Lusoga. FGDs were simultaneously translated to English by research assistants and audio recorded with permission, verbatim translated and transcribed. Data from FGDs were analyzed using thematic content analysis in Atlas TI.
RESULTS A total of 40 participants were included from 4 FGDs. Knowledge of causes and risk factors for cervical cancer were limited across participants with many comments of supernatural causes. CCS is not widely accessible despite women’s desire to be screened. Facilitators to accessing CCS and treatment include decentralized care, and community engagement and education. Barriers to accessing care included lack of transportation and knowledge, long wait times, and perception of poor quality and continuity of services when treatment is required. Challenges to the implementation of SC-CCS include: lack of human resources trained in CCS, the need for specimen transport networks from communities to laboratories, and lack of infrastructure at clinics.
CONCLUSIONS Self-collected cervical cancer screening within communities could potentially prevent the high mortality related to cervical cancer while working within the human and financial resource limitations of rural health systems. Program design must address women’s preferences and break down identified barriers to care to ensure effective use of services.

OBJECTIVE To identify primary factors affecting the use of traditional, complementary, and alternative medicine (TCAM) among cancer patients in Malawi. METHODS We conducted 2 focus groups including cancer patients >18 years of age who presented to the Kamuzu Central Hospital (KCH) in Lilongwe, Malawi for a regularly scheduled visit between January and February 2018. The focus group guide focussed on assessing local attitudes towards TCAM and conventional treatment (CT). Focus group discussions were conducted in Chichewa, recorded, and transcribed in English. We analysed the data using thematic content analysis and transcripts were coded using Dedoose (version 8.0.35). We then developed data matrices to further stratify the data and identify prominent barriers and facilitators to TCAM.
RESULTS Among 13 participants, 8 (62%) were male, 8 (62%) resided in rural areas, and median age was 35 years (range 18-61). All were receiving CT for cancer, and 11 (85%) reported TCAM use. Predominant TCAM facilitators were cultural norms, CT failure, TCAM success, and access, while TCAM failure and CT success were major TCAM barriers. Cultural norms and access were primary determinants of first-line treatment selection, which was exclusively TCAM among participants who reported using both treatment modalities for a particular illness. The success or failure of TCAM and CT largely determined decisions to continue a given treatment modality as well as future treatment selection.
CONCLUSION Despite the complex nature of the healthcare sector in Malawi, our findings demonstrate a competent, pragmatic, and experience-based treatment selection process. Cultural norms and access are important determinants of first-line treatment while treatment outcomes determine subsequent care selection. Addressing these determinants should be prioritized as cancer control programs in SSA aim to provide care to populations in the most efficient and effective manner under highly resource-constrained conditions.

OBJECTIVE To describe diagnosis, treatment, and outcomes of patients with HIV+ multicentric Castleman disease (MCD) from a prospective cohort in Malawi.
METHODS We identified Adults ≥18 years with confirmed MCD between 2013-2018 enrolled in a prospective cohort of patients with lymphoproliferative disorders in Malawi. MCD diagnosis was based on lymph node biopsy with characteristic morphology and latency-associated nuclear antigen immunohistochemistry positivity in all cases. During most of the study, first-line treatment for MCD was etoposide and second-line treatment was CVP (cyclophosphamide, vincristine, prednisone). More recently, first-line treatment was changed to CVP due to seemingly longer response durations. After August 2016, based on frequent relapses after chemotherapy, we leveraged an ongoing phase II trial of rituximab with chemotherapy for diffuse large B-cell lymphoma to petition Malawi regulatory authorities to allow compassionate use exemption for rituximab to treat relapsed MCD. Given absent laboratory capacity to measure KSHV load or inflammatory markers in real time in our setting, treatment response was defined as completion of therapy with improved subjective systemic symptoms, improved clinical adenopathy and hepatosplenomegaly, and improved hemoglobin level, compared to baseline. Kaplan-Meier methods were used to estimate overall survival (OS).
RESULTS During the study period, we identified 22 (16%) MCD patients among 137 HIV+ adults with confirmed lymphoproliferative disorders. All MCD patients presented with lymphadenopathy. No HIV- or KSHV- MCD cases were diagnosed during this period. Median age was 41 years (range 27-57), 14 (64%) were male, and 8 (36%) received empiric tuberculosis treatment before MCD diagnosis. Twenty-one (95%) were on ART, with median ART duration 53 months (range 12-179), median CD4 count 306 cells/µL (range 2-1146), and 15 patients (68%) with suppressed HIV loads. Three patients had concurrent Kaposi sarcoma, and one met diagnostic criteria for hemophagocytic lymphohistiocytosis. Of eight patients with baseline plasma KSHV loads tested in the US, all were positive with median level 4.1 log10copies/mL (range 2.7-5.2). One-year OS was 68% (95% CI 42-85%). Of nine deaths, seven were from MCD, one from an infectious treatment-related complication, and one unrelated to MCD or treatment.
CONCLUSION MCD occurs relatively frequently in Malawi, and unlike high-income countries, is uniformly associated with HIV and KSHV. MCD presents significant diagnostic and treatment challenges in Sub-Saharan Africa. Improved awareness, laboratory capacity, and treatments are needed to address this likely emerging and under-recognized problem, but rapid progress is achievable even in low-resource settings through sustained multidisciplinary collaboration.

OBJECTIVE To describe the prognostic utility of plasma Epstein-Barr Virus (EBV) measurement among patients with diffuse large B-cell lymphoma (DLBCL) in Malawi, where advanced imaging and molecular technologies for risk stratification are not typically available.
METHODS We measured plasma EBV DNA at diagnosis in a cohort of adult patients (≥ 18 years) with DLBCL in Malawi between 2013-2016. All DLBCL diagnoses were confirmed by tissue biopsy, supported by manual immunohistochemistry and a weekly clinicopathologic teleconference attended by pathologists and oncologists in the United States and Malawi. Subsequently, tissue blocks were sent to the University of North Carolina at Chapel Hill for diagnostic confirmation. First-line chemotherapy for patients with DLBCL in this cohort was CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), along with concurrent antiretroviral therapy in HIV-positive patients. All participants were followed until death, or administrative censoring on November 1, 2018, with none lost to follow-up.
RESULTS High plasma EBV DNA at diagnosis (≥ 3.0 log10 copies/mL) was associated with decreased overall survival (OS) (P = 0.048). When stratified by HIV status, the prognostic utility of baseline plasma EBV DNA level was restricted to HIV-positive patients. Unexpectedly, most HIV-positive patients with high plasma EBV DNA at diagnosis had EBV-negative lymphomas, as confirmed by multiple methods. Even in these HIV-positive patients with EBV-negative DLBCL, high plasma EBV DNA remained associated with shorter OS (P = 0.014).
CONCLUSION These results suggest that EBV reactivation in non-tumour cells is a poor prognostic finding even in HIV-positive patients with convincingly EBV-negative DLBCL, extending the potential utility of EBV measurement as a valuable and implementable prognostic marker in Sub-Saharan Africa.

Prostate cancer (PCa) remains one of the main health challenges affecting the male population and is responsible for a large proportion of cancer-related deaths across the world. Activator of G protein Signaling 3 (AGS3/GPSM1) has been reported to be responsible for modulating a plethora of cellular functions within the cell. AGS3 consist of two segments: seven tetratricopepetide repeats (TPR) and four G-protein regulatory (GPR) motifs, connected by a linker region. The aim of this study is to evaluate the effect of AGS3 expression in PCa development and progression. To that end, CRISPR/Cas9 technology was used to inhibit AGS3 expression in the mouse PCa cell line TRAMP-C1 (TRAMP-C1/AGS3-/-). AGS3 depletion increased androgen receptor (AR) but decreased CXCR4 expression, when compared to control (TRAMP-C1-vector) cells. TRAMP-C1/AGS3-/- cells displayed delay wound healing and tumour growth in anchorage-independent soft agar assay. Xenografts from TRAMP-C1/AGS3-/- cells also showed decrease tumour growth in both C57BL/6 and nude mice, relative to control cells. Interestingly, tumour lysates from TRAMP-C1/AGS3-/- xenografts showed increase P38 and ERK MAP kinase activation, when compared to control cells. Expression of AGS3 in TRAMP-C1/AGS3-/- decrease ERK activation and restore AR level. Altogether, the data indicate that depletion of AGS3 in TRAMP C1 cells delayed tumour progression via a MAPK/AR/CXCR4 axis.

Background: Young nurses avoids conversations with death and dying in children during palliative care nursing. Neverthless, it important for students to understand death and dying early in training, hence cope with difficult situation in clinical placements.
Aims: To improve knowledge of paediatric Palliative Care (PPC) and promote open and honest conversations about death and dying with young nurses.
Methods: 62 students of nursing department attended palliative care nursing module comprising chronic illness, breaking bad news, loss, bereavements and coping strategies . In addition, students had the opportunity to roleplay in different roles child, parent, nurse and friend. Before the beginning of the session, students compiled a questionnaire about their level of knowledge of PPC.
Results: Majority didnt know the defination of palliative care and important of breaking news. Half of the students (68%) had some informations about PC and the 32% of the students knew the definition of PC. As (72%) didn’t know the different between palliative care nursing and general nursing; (55%) didnt like idea of working in PCU: (45%) did avoided loss questions. Most of the students(66%) requested more accessability of information. (58%) had relatives/friends who died with chronic illness, (92%) interested in attending bearevements session: (32%) declined to be asked own death and dying: (68%)wished to attend advanced training.62% were not kin in roleplaying a sick child.
Conclusions: There is need to introduce paediatric palliative care early in training for young nurses benefits. Most of palliative care assignment need be roleplay for nurses to understand and have , confident caring for children. Results indicate lot of work needed to be done by palliative providers.

OBJECTIVE HIV-positive women in low-and middle-income countries (LMICs) have increased risk of pre-cancer and invasive cervical cancer (ICC), the 2nd common cause of cancer mortality in women in LMICs. Limited resources for cervical cancer screening justify the need for accessible and efficient screening methods. We describe cervical cancer screening results following visual inspection with acetic acid (VIA) and associated factors among HIV-positive and HIV–negative women in South-West Cameroon.
METHODS Screening (VIA, hrHPV self- and provider-collected specimens, pathology analysis), and traditional triage tests (HPV16/18/45 detection, VIA, Pap) were performed for HIV-positive and HIV-negative women aged 25-59 years receiving care in the Limbe Regional Hospital, Cameroon. Screened positive women underwent ICC diagnosis to obtain unbiased sensitivity and specificity estimates. Preliminary descriptive statistics was conducted to highlight agreement between VIA and colposcopy results and associated factors.
RESULTS We enrolled 417 HIV-positive and 279 HIV-negative participants. Mean ages were 42.2 (±7, 71) and 43.6(±8, 47) years respectively. Nearly half (45%) were married and 41% had no regular income. VIA positivity was 8.1% (8% among HIV-positives vs. 8.5% among HIV-negatives). Nearly all (96%) VIA-positives had a colposcopic impression of cervical cancer disease, while 81% of the VIA-negative, (who tested HPV-positive) were negative for the disease at colposcopy. Oral contraceptive use, recent CD4 count of ≤500 cells/µL, and tuberculosis were associated with being VIA positive (p<0.05). Logistic regression showed only CD4 count (≤500 cells/µL) was associated with VIA positivity (OR: 2.14; 95%CI: 1.09 – 4.21) among women living with HIV.
CONCLUSION This study found VIA positivity was similar by HIV status although it increased with greater immunosuppression in women with HIV. There was a strong agreement between VIA and colposcopy results. Understanding practical and effective cervical cancer screening strategies targeting women with HIV with poorer immune status in limited resource settings can improve ICC prevention.

OBJECTIVES We aim to characterize current treatment regimens at a zonal hospital in Mwanza, Tanzania to identify potential areas for interventions aimed at decreasing mortality from breast cancer (BC).
METHODS This is a retrospective review of BC cases from April 2015-January 2019. Data were extracted from 235 medical charts of women treated for BC at the Bugando Medical Center, including diagnostic reports and treatment regimen information. All data were verified with clinical notes.
RESULTS After exclusion of 71 patients with insufficient clinical information, 164 patients treated for BC were included. Mean age at presentation was 49 years (range: 22-93). Most women were post-menopausal (43%) and the majority did not have diagnostic breast imaging (67%). 130 underwent surgery as primary treatment, 68% of which were unilateral mastectomies. 103 were prescribed adjuvant chemotherapy, 79% of whom received chemotherapy. Hormone therapy was given to 38% of women, but only 3% received radiation therapy. For those with available histopathology (113), median turnaround time was 36 days (range:1-202). In terms of tumour size, 3% were <2 cm, 24% were 2-5 cm, 26% were >5 cm, and 47% were unknown. Nodal status, from axillary dissections, was positive in 38 (34%) women. 104 (92%) of the carcinomas were invasive and 9 (8%) were in situ. The majority were Elston grade III (34%), although information was unavailable for 33% of women. Of the 10 (9%) who underwent hormone receptor testing, 4 were ER-/PR-, 5 were ER+/PR+, and 1 was ER+/PR-.
CONCLUSIONS Most patients with suspected or confirmed BC receive some medical therapy, but treatment is not always based on tumour clinicopathologic characteristics and is predominantly surgical in nature, highlighting areas to address to improve BC outcomes and make best use of available resources. Further research will delve into specific chemotherapy regimens and their appropriateness based on cancer subtype.

OBJECTIVE To outline the role of cough monitors in lung cancer care.
METHODS Involvement of cough monitors within the program started in November 2017. A total of 24 cough monitors from 12 different peripheral centers were trained on identification of signs and symptoms of lung cancer based on a simplified checklist especially for clients who had been treated for pulmonary TB and with Gene x-pert negative results and/or sputum AAFBs negative. The checklist included the following; persistent cough, shortness of breath/wheezing, chest pain unexplained weight loss, bloody sputum, hoarseness of voice and difficulty in swallowing. Tools used by cough monitors include; a referral form that contains the clients’ details and the weekly log that contains clients’ contact information. Cough monitors liaise very closely with a cough monitor point person, an employee of AMPATH MLCCP who fills in a call log and contacts the clients referred. Clients who honour the referral are booked by the point person for further diagnosis by the MLCCP clinicians. Feedback which includes the diagnosis, is then given to the cough monitors on the progress of the referred clients for possible follow up.
RESULTS Since the inception of the linkage system by the program in November 2017, a total of 95 clients have been referred to the program. All the 95 clients came for further screening out of which, 27 (28.4%) were found with lung mass. Out of the 27 clients with lung masses, 9 (33.3%) were diagnosed with lung cancer. Others were diagnosed with other chronic lung conditions and care was given with back-referral to the community centers for further follow-ups.
CONCLUSION Involvement of cough monitors in the program has not only increased awareness on lung cancer within peripheral facilities but has also helped in increasing the number of patients with lung cancer who get optimal care.

OBJECTIVE Human immunodeficiency virus (HIV) infected individuals are at a higher risk of being infected with HPV and having HPV associated cancers. We determined the knowledge and awareness of HPV and HPV vaccine among women living with HIV in Lagos.
METHODS A cross-sectional survey was carried out on HIV positive women who attended the HIV clinic of a tertiary healthcare facility in Lagos from 1st February 2018-31st January 2019. Interviewer administered questionnaire was used to extract information regarding the knowledge of HPV and awareness of HPV vaccine. Microsoft Excel 2010 was used to analyze the data.
RESULTS A total of 220 women were interviewed. Their mean age was 42.3±7 years. 188 (85.6) were married. 189 (86%)had had at least secondary education. 157(71.4%) of them had been living with HIV for more than 10 years. 17 (22.3%) had children above 10yrs that were living with HIV. 148 ( 67.7%)had never heard of HPV infection and of the 72 that knew about the virus, 43 (59.7% ) didn’t know the mode of its transmission. Only 37.3% of the respondents knew HPV could cause cancer with cervical cancer being the most (70%) identified. 166 (75.6%) of them didn’t know that they were more at risk of having cervical cancer as compared to their HIV negative counterparts. Only 22.3% knew about HPV vaccine. None of the children of the women had been vaccinated against HPV. Only 2.7% of them knew that the vaccine is given to both boys and girls.
CONCLUSION The awareness and knowledge of HPV infection and HPV vaccine among HIV positive women is very low. This suggests that there is urgent need to put in interventions to increase the knowledge and awareness of this infection among this high-risk group.

BACKGROUND Breast cancer is prevalent in developed and developing regions. The prognosis is worse in low- and middle-income countries (LMICS), where women are typically diagnosed at more advanced stages. In Tanzania, approximately 80% of women are diagnosed at stage III or IV. Factors associated with Tanzanian women delay for imaging diagnostic studies after onset of breast symptoms are not known.
OBJECTIVE To evaluate factors in the delay between symptom onset and diagnostic imaging among breast cancer patients in Tanzania.
METHODS This IRB-approved qualitative study was performed at Muhimbili National Hospital in Dar es Salaam, Tanzania. Women with pathologically confirmed breast cancer diagnosis after mastectomy were purposively recruited after obtaining informed consent. In-depth interviews from a pre-designed, open-ended questionnaire were conducted. Data on demographics, time from symptom to diagnosis, use or lack of breast imaging, psychosocial factors related to delay in imaging, breast cancer knowledge and pre-conceptions, health seeking behaviour, preference for alternative treatment, and the contribution of culture and norms will be collected. The transcribed interviews will be evaluated using thematic analysis with a grounded theory approach.
RESULTS This study is actively ongoing targeting recruit 25 patients. Currently 10% of interviews are completed which show our initial recurring themes for factors in delayed imaging presentation being lack of basic knowledge about breast cancer, financial hardship, access to healthcare facility and the role of culture (religious/ministries belief, prioritizing family care) in decision making. Complete data will be compiled and analyzed, and the detailed formal analysis after complete patient recruitment and interviews will be presented at the AORTIC 2019 meeting.
CONCLUSIONS To our knowledge, this is the first study on factors involved in delayed imaging of symptomatic breast cancer in Tanzania. The long-term goal is to use this information to develop strategies to improve early imaging diagnosis of breast cancer in Tanzania.

OBJECTIVO O cancro da mama (CM) é prevalente na África Sub-Sariana, com uma taxa de mortalidade elevada e é necessário constituir equipas multidisciplinares para optimizar o seu tratamento. Avalia-se a proficiência dos cuidados a doentes com cancro da mama no Instituto Angolano de Controlo de Câncer (IACC).
MÉTODOS Coorte retrospetiva de casos de CM admitidos e/ou tratados em 2018 no IACC. Caracterização clínico-patológica da população. Em todos os casos foi efectuada avaliação anatomo-patológica no IACC. Aferida proficiência pela análise do tempo entre o diagnóstico e o início de tratamento.
RESULTADOS Incluídos 108 doentes (99% mulheres) com idade mediana de 45 anos (âmbito: 21-90). O CM (NST) invasivo foi o mais frequente (83.3%). Em 60.2% expressavam receptores de estrogénio e 38% de progesterona; 16.7% tinham sobre-expressão HER2 e 22.2% eram triplo negativo. A maioria apresentava doença localmente avançada ou metastática (estádio IIIB - 31.5%; estádio IV - 25.9%); e nenhum caso em estádio I. A quimioterapia neoadjuvante foi o tratamento primário mais realizado (35.2%), 47 doentes foram submetidos a tratamento cirúrgico (mastectomia radical modificada em 78.7% dos casos). Nenhum doente realizou radioterapia ou trastuzumab por indisponibilidade da técnica e do fármaco. A mediana de tempo entre a primeira consulta e o diagnóstico foi de 34 dias. A mediana de tempo entre o diagnóstico e a consulta de decisão terapêutica multidisciplinar (CDTMD) foi de 31 dias (âmbito: 25-37) e entre a CDTMD e o primeiro tratamento oncológico de 8 dias (âmbito: 3-13). À data de encerramento do estudo 31 doentes tinham-se perdido para o seguimento (12 antes do diagnóstico histológico; 1 antes da CDTMD; 11 antes do início e 7 durante o tratamento).
CONCLUSÃO O diagnóstico do cancro da mama em Angola é tardio, é necessário explorar formas de cuidados integrados que permitam reduzir o tempo para diagnóstico, decisão terapêutica e o início de tratamento.

RÉSUME L’objectif de cette étude était d’étudier les propriétés psychométriques d’une version dialectale Marocaine du questionnaire de la qualité de vie PR-25 (EORTC QLQ-PR25). L’étude a été menée auprès des patients du service d’oncologie du Centre Hospitalier Universitaire Ibn Rochd de Casablanca, Maroc. L’étude a porté sur des patients atteints du cancer de la prostate suivie au sein du centre Mohammed VI pour le traitement des cancers durant la période de l’étude. Un total de 82 sujets ont été inclus, dont l’âge moyen était de 69,6 ans avec un écart type de 7,9 ans. La majorité d’entre eux étaient analphabètes avec une proportion de 59,8%, les personnes issues du milieu urbain représentaient environ 60%. Une bonne fiabilité a été révélée pour la version dialectale Marocaine avec un coefficient alpha de Cronbach allant de 0,17 pour la dimension « fonction sexuelle » à 0,83 pour la dimension « symptômes urinaires ». La reproductibilité de l’échelle était bonne avec des coefficients de corrélation intra-classe allant de 0,69 pour la dimension « fonction sexuelle » à 0,87 pour la dimension « symptômes urinaires ». La version dialectale obtenue a montré une bonne fiabilité pour la dimension « symptômes urinaires » et acceptable pour les autres dimensions sauf pour « fonction sexuelle » qui n’était pas satisfaisante.

OBJECTIVE Cervical cancer is a common cause of cancer-related morbidity and mortality in developing countries. Serum folate may modify the risk through its role in DNA synthesis and methylation. The objective was to determine the association between serum folate levels and the occurrence of cervical cancer and pre-invasive disease at the Lagos University Teaching Hospital, Nigeria.
METHOD This was an analytical cross-sectional study involving three groups of participants which comprised of 50 cases with invasive cervical cancer (ICC), 25 with pre-invasive cervical cancer (CIN) and 50 controls with normal cervix. the serum folate levels of the three groups were determined and compared. The comparison between discrete baseline characteristics of the cases and controls was done with use of Pearson's Chi square test(χ₂).The mean serum folate levels of cases and controls were compared with the use of ANOVA. P-value of less than 0.05 was considered statistically significant.
RESULTS There were positive nonsignificant associations between low serum folate and the occurrence of ICC (Adjusted odds ratio 2.99, P=0.088) and CIN (Adjusted odds ratio 2.20, P=0.158).
CONCLIUSION The findings of this study showed that low serum folate is not independently associated with an increased risk of cervical cancer and pre-invasive cervical cancer. However, a robust multicentre, long-term longitudinal study will provide further evidence on the role of serum folate in the occurence of cervical cancer.

OBJECTIVE Prostate cancer (PCa) is the most commonly diagnosed cancer among men in Sub-Saharan Africa (SSA). This study aimed to characterize the diagnostic workup and the treatment patterns of PCa patients in the region.
METHODS We randomly selected 693 prostate cancer patients diagnosed between 2010 and 2015 from logbooks of 11 population-based cancer registries in 10 SSA countries (Abidjan, Addis Ababa, Bamako, Brazzaville, Bulawayo, Cotonou, Eldoret, Kampala, Maputo, Nairobi, Namibia). The register data were amended using medical records, pathology reports and/or phone calls to patients or patients’ relatives. Data collection was conducted from September 2016 to May 2018.
RESULTS Of the 693 total patients, detailed information on tumour characteristics and treatment was available for 365 of the patients (229 cases non-metastatic and 136 metastatic, median age 70). Only 11% of these patients had documentation of complete diagnostic workup (including TNM stage, Gleason Score and PSA level). Gleason score was <7, 7 and >7 for 14.0%, 12.9% and 18.4% of the patients, while for 54.8% it was not documented. PSA level at diagnosis was <10 ng/ml, 10-19 ng/ml, 20-99 ng/ml, and ≥100 ng/ml for 3.3%, 1.9%, 11.0% and 17.8% of the patients, respectively, while for 66.0% it was not documented. Of the 229 non-metastatic patients, 17.5% received curative intent therapy, 55.0% underwent different kinds of cancer-directed therapy without curative potential and 27.5% remained without cancer-directed therapy. Of the 136 metastatic patients, 59.6% received androgen deprivation therapy (ADT), 17.6% underwent different kinds of cancer-directed therapy without ADT and 22.8% remained without cancer-directed therapy.
CONCLUSIONS Under-staging and under-treatment are the reality for many PCa patients in SSA. Our findings underline the need to improve diagnostic workup and access to care in the region as recommended by the newly released harmonized NCCN guidelines for Sub-Saharan Africa.

BACKGROUND Esophageal squamous cell carcinoma (ESCC), one of the most aggressive cancers, is endemic in Sub-Saharan Africa, constituting a major health burden. It has the most divergence in cancer incidence globally, with high prevalence reported in East Asia, Southern Europe, and in East and Southern Africa. Its etiology is multifactorial, with lifestyle, environmental and genetic risk factors. Very little is known about the role of genetic factors in ESCC development and progression among African populations. The study aimed to systematically assess the evidence on genetic variants associated with ESCC in African populations.
METHODS We carried out a comprehensive search of all African published studies up to April 2019, using PubMed, Embase, Scopus and African Index Medicus databases. Quality assessment and data extraction were carried out by two investigators. The strength of the associations was measured by odds ratios and 95% confidence intervals.
RESULTS Twenty-three genetic studies on ESCC in African populations were included in the systematic review. They were carried out on Black and Admixed South African populations, as well as on Malawian, Sudanese and Kenyan populations. Most studies were candidate gene studies and included DNA sequence variants in 58 different genes. Only one study carried out whole-exome sequencing of 59 ESCC patients. Sample sizes varied from 18 to 880 cases and 88 to 939 controls. Altogether over 100 variants in 37 genes were part of 17 case-control genetic association studies to identify susceptibility loci for ESCC. In these studies 25 variants in 20 genes were reported to have a statistically significant association. In addition, eight studies investigated changes in cancer tissues and identified somatic alterations in 17 genes and evidence of loss-of-heterozygosity, copy number variation and microsatellite instability. Two genes were assessed for both genetic association and somatic mutation. We determined the linkage disequilibrium (LD) measures between the SNPs reported in the same genes, using the imputed data set from the Thousand Genomes Project and identified thirteen pairs of SNPs with r² > 0.45.
CONCLUSIONS Comprehensive large-scale studies on the genetic basis of ESCC are still lacking in Africa. Sample sizes in existing studies are too small to draw definitive conclusions about ESCC etiology. Only a small number of African populations have been analysed, and replication and validation studies are missing. The genetic etiology of ESCC in Africa is, therefore, still poorly defined.

OBJECTIVE Cervical cancer (CC) is the second most common cancer among women in Cote d’Ivoire. CC screening (CCS) program has been scaled up to all districts nationwide since 2012. This study aimed at assessing the CCS uptake among women in the general population living in Abidjan.
METHODS A cross-sectional survey was conducted from July to September 2018 in three health facilities selected through a stratified systematic random procedure. Among the 10 health districts of Abidjan, three were randomly selected, then in each district two health facilities were selected, one with a CCS unit (CCSU) and another one without CCSU. During the study period, all women aged 25 to 55 years old, visiting one the selected health facility were invited to participate. A standardized questionnaire allowing collection of Sociodemographic characteristics, knowledge on CC, personal history of CCS and barriers to CCS was administered by trained research assistants. A logistic regression procedure was used to determine factors associated with CCS uptake.
RESULTS A total of 1,158 women with a median age of 32 (IQR: [29-42]) including 648 (56%) with primary or no education level and 764 (66%) living in couple, were included. Among the participants, 786 (67.9%) had ever heard about CC, mostly women with at least secondary education level (89.0% vs 51.2%; p<0.001). Screening and HPV immunization were known as CC prevention methods by 416 (52.9%) and 167 (21.2%) participants, respectively. The proportion of CCS uptake at least once in a lifetime, was 7.5% [95% CI: 6.0-9.0]. Women with at least the secondary education level were more likely to have ever been screened compared to less educated ones (12.2% vs 3.9%; p<0.001). In multivariable analysis, age over 35 years (OR: 3.1 [1.7-5.6], p<0.001), receiving a self-considered clear information on CC (OR: 9.1 [5.0-16.7], p<0.001) and receiving information on CC during a mass campaign (OR: 4.2 [1.8-10.1], p=0.001) were positively associated with the uptake of CCS. There is no difference between health facilities with CCSU and CCS uptake (p=0.34). The main barriers to screening were lack of knowledge on CC (83.5%), negligence (14.0%) and fear of additional costs (2.6%).
CONCLUSIONS Mass awareness campaigns need to be increased with the adjunction of tailored messages based on the level of women's education to enhance the CCS coverage.

OBJECTIVES This study examines the socio-economic and demographic factors leading to delays in start of treatment in a cohort of patients attending with cervical cancer at our institution.
PATIENTS AND METHODS This is a retrospective study. Patients included are those referred for radical radiotherapy and underwent a PET-CT radiotherapy planning scan- between 2015 and 2018. Demographic data was collected from patient records including age, socio-economic group as defined by the hospital means test, residence (local versus distant), and HIV status. Date of biopsy and start date of radiotherapy were recorded. Statistical analysis included frequencies, Chi-squared tests and logistic regression models (SPSS).
RESULTS Comprehensive data was available from 243 individuals. Patients had a median age of 47 years. The median time from biopsy to start of RT was 65 days (iQR 50-86 days). The patients were of divergent socioeconomic groups with the majority (88.4%) being unemployed with no income, as expected in a public hospital setting, and 52.7% pf patients attended from the local area. HIV positive patients were significantly more likely to be unemployed (98.6% vs 66%; p=0.02). There was a trend to more HIV positive patients living in the metro areas (61.3% vs 49.7%; p=0.09). There was no difference in socio-economic status by location. The lower socio-economic group was less likely to start RT within 90 days (69.3% vs 85.2%; p=0.08). On multivariate analysis controlling for HIV status, socio-economic group and location, local patients were significantly more likely to start RT within 90 days (OR 2.3, p=0.05, CI 1.3-4.1).
CONCLUSION Patients local to the centre were more likely to be HIV positive and to commence radiotherapy within 90 days. Despite the Western Cape being a well-resourced province, this small study demonstrates that geographic challenges and socio-economic factors continue to impact access to care in Southern Africa.

RESUMO Em sua maioria os trabalhos sobre câncer de bexiga orientam sobre o tratamento e sobrevida do tipo histopatológica urotelial descrito também como carcinoma de células transicionais que corresponde à cerca de 90-95% dos casos diagnósticados na América do Norte e na Europa[2]. A prevalência reduzida nos EUA, cerca 2-5% [2] dos casos de carcinoma de células epidermoides não permite estabelecer protocolo eficaz de tratamento e seguimento de modo a determinar a sobrevida geral, sobrevida livre de progressão e qualidade de vida dos pacientes com este diagnóstico histopatógico. Como etapa ínicial pretendemos verificar a eficácia dos tratamentos instituídos em 2015 e 2016 em situação de recursos não completos e orientar para elaboração de protocolos favoráveis e com menor toxicidade tendo como prespectiva a qualidade de vida do paciente.
MATERIELS ET MÉTODOS É um estudo descritivo retrospectivo para observar a sobrevida geral dos pacientes com diagnóstico carcinoma epidermoide schistosoma haematobium relacionado, em dependência do tratamento instituído e do esquema de quimoterapia administrado que revele maior benefício com menor toxicidade. Os pacientes são coletados da base de dados do serviço de anatomia patológica, dos registos no serviço de urologia e oncologia.
RESULTADOS De 1 janeiro de 2015 à 31 de Dezembro de 2016 foram registados no Hospital Central de Maputo cerca de 125 pacientes com descrição tumor de bexiga. Destes 05 foram exluídos por apresentar laudo anatomo-patológico com dignóstico de carcinoma de células transicionais, 01 pelo diagnóstico de adenocarcinoma do reto pós RTUB por queixa de hematúria, 107 foram excluídos por não terem o comprovativo do diagnóstico histopatológico, entre estes 47,2% tem registo de diagnóstico histológico na base de dados do serviço de anatomia-patológica porém não se encontraram nos processos e na base de registo dos laudos deste serviço os comprovativos do diganóstico. 38,4% dos pacientes não foi efectuado o exame de diagnóstico. Um total 12 [9,6%] pacientes tiveram diagnóstico histológico da anatomia patológica de carcinoma epidermoide da bexiga com presença de ovos de schistosoma haematobium. 3,2% dos pacientes foram submetidas à cistectomia e neobexiga após o diagnóstico. Somente 4 pacientes foram tratados com quimioterapia dois com quimioterapia como tratamento difinitivo e dois como tratamento adjuvante. A sobrevida geral foi de 8,3% em 3 anos. Em pacientes que receberam a quimioterapia a anemia seguiu sendo a principal complicação.

OBJECTIVES Neutrophil-to-lymphocyte ratio (NLR) has prognostic value in several types of cancers. We investigated the influence of NLR in patients undergoing treatment with PD-1 checkpoint inhibitors for recurrent Non-Small Cell Lung Cancer (NSCLC).
METHODS Study CA 209-8C3, is a multicenter, non-interventional retrospective data analysis, which include patients who were previously treated for recurrent (unresectable or metastatic) NSCLC. Retrospective data was collected from 5 participating oncology centers.
RESULTS We analyzed data of 56 patients treated with nivolumab, 32 (57%) were male with a median age of 65 (46-86). Thirty-two (57%) had NSCLC specified as adenocarcinoma. Fifty (89%) patients had an ECOG performance status (PS) of 0 or 1, and 6 (11%) had an ECOG PS of 2. A ≥4 cut-off value for NLR was calculated using the receiving operating characteristic (ROC) curves. The median OS was 11 months. One and two-year survival was 45% (95% CI 32% - 58%) and 32% (95% CI 20% - 45%) respectively. Median progression-free survival (PFS) was 6 months (95% CI 4 – 8). Univariate analysis found the number of metastatic sites and a higher NLR to be associated with shorter OS. Patients with ≤2 metastatic sites had a median OS of 11.4 months and patients with >2 sites 6.10 months (HR=3.29 [95% CI 1.23-8.78], p=0.0174). Patients with NLR ≥4 at 5-weeks post treatment had a median OS of 8.13 months, with median OS not reached for patients with NLR <4 (HR=4.18, p<0.001). NLR ≥4 at 9-weeks post treatment were also significantly correlated with shorter OS (HR=4.15, p=0.001) with median OS of 7.28 months, median OS for NLR <4 not reached. In a Cox multiple regression model with age, gender, race, ECOG PS, diagnosis, smoking status and NLR at 3-, 5- and 9-weeks, NLR ≥4 at five-weeks post nivolumab was the only factor that retained significance (HR = 5.41 95% p<0.001). Clinically relevant grade ≥3 toxicities include pneumonitis (n=5), severe skin rash (n=1), colitis (n=1) and other (n=3).
CONCLUSIONS Elevated NLR is associated with a poor outcome in patients with recurrent metastatic NSCLC treated with nivolumab.

OBJECTIVES Pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC) has been proposed as a surrogate endpoint for of long-term clinical benefit, such as disease-free survival, event-free survival (EFS), and overall survival (OS) in patients (pts) with triple negative breast cancer (TNBC). The association between Ki-67, clinicopathological features, and pCR rate early in TNBC pts treated with NAC were examined.
METHODS We retrospectively analyzed data of 114 pts undergoing taxane and/or anthracycline, based NAC. Pathological complete response was defined as the complete disappearance of the invasive cancer in the breast and absence of tumor in the axillary lymph nodes.
RESULTS The pCR rate of the entire cohort was 58.77% (67 of 114). At 4 years 95% of pts who attained a pCR were disease free compared to 78% of pts who did not attain a pCR (log rank test Chi2 = 8.564, p < 0.01). At 4 years 95% of pts who had no residual disease on the primary tumor were disease free compared to 70% of pts with residual disease on the primary tumor (log rank test Chi2 = 6.842, p < 0.01); and 85% who had no residual nodal disease compared to 68% of pts with residual nodal disease (log rank test Chi2 = 6.175, p < 0.01). On univariate analysis factors associated with higher pCR included primary tumor size (T1=79% vs. T2=56% vs. T3 & T4=33%, Chi2=6.869, p<0.003), and Ki67 (≥40 % = 72% vs. <40 = 29%,Chi2=17.504 p<0.00003). ROC curve analysis determined threshold values of 40% as best cut-off values for Ki-67. Stage, menopausal status, age (≥35 vs. <35 years), ethnicity, nodal status, extra-nodal spread and lympho-vascular invasion were not associated with a higher pCR rate. In a logistic regression model Ki-67 as a continuous variable (p<0.02) retained its significance; while tumor size lost significance.
CONCLUSION High Ki67 is associated with a higher pCR rate in early TNBC pts undergoing NAC.

OBJECTIVE Prostate cancer is the most common cancer among men and its management presents an increasing demand on already strained healthcare systems in many countries. With an increasingly ageing population, recent evidence shows an increase in transperineal template biopsy of the prostate (TTBP) operations, especially as a day-case procedure [1]. As a diagnostic procedure it must be of low risk, however post-operative complications such as infection (1.1%) and bleeding (1.4%) do occur. This may result in hospitalization with associated patient morbidity and resource implications [2]. The use of antibiotics to impede surgery complications are very common. However, the emergence of organisms resistant to antibiotics is significantly increasing the risk for infection following biopsy [3]. An evaluation of the role of biomarker pathways after TTBP may provide additional knowledge to an area that has not been well established, with the aim of providing predictive markers for post-operative complications. The purpose of this study is to investigate the changes in selected biomarkers after TTBP to test the hypothesis that changes in biomarkers are associated with post-operative complications.
METHOD Wales Research Ethics Service (REC) 4 Committee has approved this study.160 patients scheduled for TTBP at the Wrexham Maelor Hospital, UK will be recruited after informed consent. Blood and urine samples will be collected pre-operatively, and at 30mins, 2hrs, 4hrs and 24hrs postoperatively. Samples will be analysed using appropriate methods for various markers of inflammation, infection, endothelial activation, haemostatic function as well as routine hematological and biochemical parameters. Patients will be monitored for postoperative infectious & bleeding complications.
CONCLUSION Findings from this study may provide an early simple blood/urine test or a panel of blood tests to predict the risk of patients developing post-operative complications and specific changes to their management could be instituted to improve patients' outcomes. This intervention could possibly have benefits for the patients through early treatment and may also offer cost benefits to healthcare providers by reducing the cost of treatments and readmissions due to postoperative complications.

REFERENCES
[1] Mottet RCN. et al. (2018). Prostate Cancer Guidelines. EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen (ISBN 978-94-92671-01-1).
[2] Wang F, et al. (2019). Complications of transperineal template-guided prostate mapping biopsy. Natl Med J China, 99(6):428-431. doi:10.3760/cma.j.issn.0376-2491.2019.06.009.
[3] Eruz ED. et al. (2017). Risk factors for infection development after transrectal prostate biopsy and the role of resistant bacteria in colonic flora. J Infect Dev Ctries, 11(2), 188-191. doi: 10.3855/jidc.7067.

Os tumores malignos da cabeça e pescoço correspondem a uma ampla variedade de neoplasias que ocorrem em diferentes estruturas da cavidade oral, faringe, cavidade nasal e laringe¹. São o sexto cancro mais comum e tem vindo a aumentar na África Sub-Sahariana, sendo problema nos cuidados de saúde. Cerca de um terço são de causa infecciosa, sendo o carcinoma de células escamosas a variante mais comum². Está descrito o HPV como o principal fator de risco para o cancro da orofaringe em doentes jovens e sem história de exposição ao álcool e tabaco³. Em África é escassa a informação sobre epidemiologia, prática clínica e prognóstico destes cancro, no entanto existem estudos que relatam o aumento da incidência dos cancros associados ao HPV³.
MATERIAL E MÉTODOS Foi feita uma revisão dos livros de registro de movimentos dos doentes admitidos no Serviço de Oncologia do HCM no período compreendido entre 2013 e 2018.
RESULTADOS E CONCLUSÕES A maioria dos doentes apresentam-se em estádios avançados, e muitos com algumas co-morbilidades particularmente o HIV / SIDA. Principais constrangimentos: a maioria dos doentes são tratados apenas com quimioterapia. Registam-se elevadas recorrências, progressão, opções terapêuticas limitadas, baixa sobrevivência, número insuficiente de cirurgiões de cabeça e pescoço, faltam próteses de reconstrução e protesistas treinados, inexistência de estudo do perfil biológico, indisponibilidade da vacinação contra o HPV e, falta de terapêutica-alvo. Principais desafios: apostar numa prevenção primária de qualidade, com vista a informar e alertar junto da população sobre os factores de risco dos tumores malignos da cabeça e pescoço, e prevenção secundária para identificar e corrigir o mais precocemente possível as lesões pré-malignas. Desafios: organizar um programa global que envolva a definição dos factores de risco dos cancros da cabeça e pescoço em Moçambique, educação das populações, melhorar o diagnóstico e boas práticas clínicas, aumentar o treino em cirúrgica oncológica, radioterapia e oncologia médica. Identificar apoios. Cremos que este programa poderá levar a uma melhor organização dos serviços de saúde num contexto de baixos recursos, o que levaria a uma melhoria dos resultados nos doentes com cancros da cabeça e pescoço.

OBJECTIVE To improve clinical outcomes of cancer patients by filling in the financial gap in cancer care in Zambia.
METHODS The Zambian Cancer Society (ZCS) is a non governmental organisation dedicated to fighting cancer along the continuum of care. Until recently, ZCS had provided non clinical social support to patients by donating food, toiletries, clothing and transport money. The society also runs a patient navigation desk at the national Cancer Diseases Hospital, which provides information to patients, cancer survivors and their care givers. In 2018, ZCS in collaboration with Oncocurae Consultancy decided to participate in clinical outcomes by fundraising for service delivery costs. Strategy: The Zambian Cancer Society engaged with technocrats in the field of oncology to understand the barriers to quality care and good outcomes for cancer patients treated at the national Cancer Diseases Hospital. Solutions within realistic budget lines were then proposed. Partners such as the Rotaract Club of Lusaka, Zambia Active Ambassadors, Zambians in the UK and many more were sensitised to these needs for fundraising. Three main areas were identified: 1. Knowledge gap in implementation of more conformal radiotherapy techniques. 2. Diagnostic costs inhibitive for patients (especially paediatric oncology and breast cancer) 3. Lack of organised preventative, screening and surveillance services at the cancer hospital.
RESULTS Activity 1: Sponsorship for radiotherapist to international congress Cost: $1,000. Return: Achieved networking and mentorship relationships with the view to enhance skills and training opportunities. Activity 2: Provision of funds to allow for timely diagnosis of disease to enable treatment. Cost: ongoing. Return: Payment for diagnostic tests and donation of contrast for imaging scans. Activity 3: Equipment for preventative, screening and surveillance clinic bought. Cost: $2,700. Return: Impending launch of preventative, screening and surveillance clinic at Cancer Diseases Hospital.
CONCLUSION The traditional role of NGOs in low resource environments has been social support. Participation of local NGOs in fundraising for clinical and research based activities improves patient care and provides an opportunity for locally generated scientific evidence. Leveraging of relationships between NGOs and goodwill sponsors can bridge financial gaps in poorly funded health care systems.

OBJECTIVE Botswana has implemented successful programs to treat HIV, but still faces attendant challenges in higher cancer rates, including longer times to diagnosis and limited treatment resources. BOTSOGO (Botswana Oncology Global Outreach) was established in 2011 as a collaboration between Massachusetts General Hospital (MGH) and Botswana Harvard AIDS Institute to improve cancer care and education in Botswana. A centralized forum was needed for specialists to come together and review cases.
METHODS The Tumour Board model, in which a multidisciplinary team meets regularly to review cases, is widely accepted as improving cancer outcomes. Beginning in February 2012, BOTSOGO implemented a monthly Tumour Board in which MGH and two oncology centers in Botswana connect via an internet conferencing platform. A recent cancer case is presented by the treating team in Gaborone, and disease experts recruited from MGH discuss recommended treatment strategies.
RESULTS We have held 69 Tumour Boards, with attendance of 70-80 in Gaborone, 10-15 at MGH and 15-20 in Francistown. Cervical cancers and lymphomas are among the most frequent cases presented. Special sessions have discussed ethical issues in oncology; research by Gaborone-based oncologists; and vaginal stenosis resulting from radiation for cervical cancer (which led to the implementation of a program to introduce the use of dilators to treat vaginal stenosis). Beginning in 2016, BOTSOGO has offered Continuing Medical Education credits through Harvard Medical School. 92.3% of attendees reported they would “definitely” recommend attending the BOTSOGO tumour board.
CONCLUSIONS The Tumour Board continues to anchor the BOTSOGO partnership, with consistently high attendance and feedback. We seek to improve the experience by selecting topics of most relevance and interest to participants, and by recruiting new partners in Botswana to present cases. The Tumour Board is recommended for other global oncology partnerships to consider as a means to develop collaborations and provide case-based education.

OBJECTIVES Mentors are role models who often guide students, trainees, and early career individuals about personal and professional development over time. However access to mentors can be challenging, including in low to middle income countries. The literature review in the last 5 years was conducted with specific focus on different approaches to mentorship, mentor-mentee roles and responsibilities and benefits, interprofessional mentorship and importance of gender and culture in mentorship.
METHODS 2013-2018 literature review was conducted in Ovid/Medline .35/589 articles served as a source of this review.
RESULTS The literature is not restricted to North American context. One of many examples of successful mentorship programs can be mentorship and coaching interventions implemented in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation’s African Health Initiative. There were improvements in quality of care and health systems. Mentorship and coaching represented an important component of HSS activities impacting positively on effective coverage, in achieving Universal Health Care. Different approaches to mentorship including the roles and the benefits for mentors and mentees, interprofessional mentorship, gender and culture will be discussed to help better understand and improve mentoring in healthcare and research. Female medical trainees and physicians and allied health providers from different ethnic groups may require modified mentoring programs that tackle ethnicity, socioeconomic factors, gender diversity and career planning in medicine and allied healthcare professions.
CONCLUSION The benefits of mentoring are not limited to the mentees, but to the mentors as well, particularly with respect to professional satisfaction and institutional recognition. Women in academia as well as ethnic minorities entering medicine and allied health professional programs face systematic local and systemic barriers to mentorship. Distance and interprofessional mentoring may contribute to substantially ameliorate these challenges in North America and Africa.

Numerous studies worldwide indicate that, women with locally advanced cervical cancer undergo High Dose Rate (HDR) brachytherapy as one of the treatment modalities, experiencing physical, psychological, social and spiritual consequences, which impact on their quality of life. In Ghana, however, little is known about such experiences as studies on that effects are limited. This study, therefore, explored the experiences of the women with locally advanced cervical cancer during HDR brachytherapy at the National Radiotherapy Oncology and Nuclear Medicine Centre of the Korle Bu Teaching Hospital. A qualitative exploratory descriptive design with purposive sampling technique was used to select 10 women who were interviewed on one-on-one basis using a semi-structured interview guide whilst being audio recorded. The qualitative data (recorded interview) was transcribed verbatim and analysed using thematic content analysis. Findings revealed that these women experienced varied physical, psychological, social and spiritual effects whilst undergoing treatment. Education, counseling, as well as orientation on brachytherapy were not adequate enough to prepare them for what to expect and these put fear and created anxiety in most of them. Having their legs strapped wide apart and being observed by all staff present added to their distress and humiliation. It is like the whole world is seeing through them. They endured severe pain as the conscious sedation was not strong enough to mitigate their suffering. These women, however, received favourable social support and spiritual comfort and hope in God. In conclusion patients should be assessed as to how much they know about brachytherapy and reinforced with education, counseling and orientation to reduce their anxiety, distress and humiliation. Pain needs to be well managed taking individual patient’s age and size into consideration and consistently assessed during the procedure and the analgesics augmented when they show signs of discomfort so that maximal effect can be achieved.

OBJECTIVE Natural products have proved their efficacy in anticancer drug development over last decades. This study was designed to investigate the in vitro and in vivo anti-leukemic effects of crude extracts from Syzygium guineense.
METHODS Aqueous, ethanol, and aqueous-ethanol crude extracts as well as fractions from ethanolic extract were screened for their anti-proliferative effects on acute and chronic myeloid leukemia cells (HL-60 and K562) using SulfoRhodamine B assay. The mechanism underlying the anti-cancer effect of active fractions was studied by flow cytometry. The Maximum tolerated dose was determined using NOD-SCID mice according to NCI guidelines. The mortality and weight loss ≥ 20% were considered as toxicity criteria. For the efficacy, the doses 100mg/kg bw and 200mg/kg bw were tested and administered orally five times per week for 4 weeks. The chemical composition of active fractions was determined by Gas Chromatography/Mass Spectroscopy
RESULTS Two out the four interesting leads exhibited GI 50 values of 1µg/mL while the GI50values of the two others were 11.8 and 18.4 µg/ml on K562 cells. Similarly, two out of the four fractions exhibited GI 50 values of 1.7 and 13.7µg/mL against HL-60 cells. We also found that fractions induced G2/M and S phase arrests and apoptosis. The levels of pro-apoptotic protein Bax and anti-apoptotic Bcl-2 studied by western blot clearly showed that the mitochondrial apoptotic pathway was triggered via up-regulation of Bax and a down-regulation of Bcl-2. The results showed no mortality and no weight loss above 20% up to 900mg/kg of body weight for fractions L4 extracted in hexane/ethyl acetate 40:60 (v:v) and L5 (extracted in hexane/ethyl acetate 60:40 (v:v) as well as the aqueous crude extract. The results of the in vivo anticancer effects showed that the fractions did not significantly inhibit the tumor growth on NOD-SCID acute myeloid leukemia xenografts while the aqueous extract significantly reduce the tumor volume after 31 days of treatment. Terpenes were suggested to be responsible of the anticancer activity.
CONCLUSION Extracts from Syzygium guineense can serve as natural source of antileukemic agents.

OBJECTIVE Survival of HIV+ adults in Uganda with diffuse large B cell lymphoma (DLBCL) is poor. We hypothesize that one-year survival after diagnosis of DLBCL in HIV+ adults will be associated with superior reconstitution of the T-cell repertoire.
METHODS We performed serial high-throughput DNA sequencing of the T-cell receptor  (TRB) and T-cell receptor  (TRA) loci in peripheral blood T-lymphocytes of HIV+ adults who presented to the Uganda Cancer Institute with confirmed DLBCL. Clinical data and blood samples were prospectively collected from subjects at study entry and after 6 and 12 months of follow-up. TRB/TRA sequencing was also performed on blood T-cells of two control populations from the US: (1) 16 HIV-seronegative adults without cancer, and (2) 30 HIV+ adults without cancer. The diversity and composition of the T-cell repertoire at 0, 6, and 12 months in the HIV+ subjects with DLBCL was inferred from the TRB/TRA sequence data, compared with that in the control groups, and analyzed for potential associations with clinical outcome.
RESULTS T-cell repertoires of HIV+ adults with DLBCL were significantly less diverse than those of HIV+ and HIV-seronegative controls, and often dominated by expanded T-cell clones. “Public” TRB and TRA sequences associated with prototypic T-cell responses to HIV and herpesviruses such as CMV and EBV were frequently identified in the HIV+ DLBCL and HIV+ control cohorts, as were semi-invariant TRA sequences associated with NK/T-cell responses to mycobacterial lipids. No significant increase in repertoire diversity was observed in the minority of HIV+ DLBCL subjects who survived to the 6- or 12-month assessments.
CONCLUSIONS Survival of HIV+ adults with DLBCL in Uganda remains poor, despite ART and chemotherapy. T-cell repertoires in these subjects contain expanded populations of T-cells associated with prototypic responses to viral and mycobacterial pathogens, suggesting that concurrent infection contributes to poor clinical outcome.

BACKGROUND Attaining high coverage for cervical cancer screening is a key to effectively combat the high burden of cervical cancer in developing countries. Social, economic, and cultural factors have been associated with participation of women in cervical cancer screening programs elsewhere. Therefore, this study aimed to identify factors associated with the participation in cervical cancer screening and reasons for refusal in Ethiopia.
METHODS A community-based randomized cluster trial was conducted at the Butajira Health and Demographic Surveillance Site (HDSS) in Ethiopia. A total of 2356 women aged 30-49 in 22 randomized clusters were invited to receive one of the two screening approaches (self-collected HPV tests or VIA). The differences between those who participated and who did not were analysed according to the socio-demographic and economic characteristics. We have inquired reasons for refusal of women who did not participate in screening in both arms.
RESULTS Out of sensitized women in both arms, 49.5% and 15.9% of women refused cervical cancer screening using VIA and HPV, respectively. In both arms, compared with women who had been screened, women who had not were living in rural area and had no formal occupation. The majority of participants, 112 (89%) and 204 (77.3%) in the HPV and VIA arm, respectively, perceived themselves to be at no risk of cervical cancer. The main reasons for refusal were being busy (72.5%), physical wellbeing (13%), and fear of misconceptions in the community (5.9%).
CONCLUSION Perceived irrelevance of screening, being busy with other tasks, and assuming no personal risk played a key role for women to withhold screening. To increase the uptake of screening at community level, a swift and convenient screening-service has to be offered to allow participation in a short time and at the doorstep. Also, behavioural changes should be aimed to resolve misconceptions related with screening.

OBJECTIVE To assess the impact of an in-country, gynecologic oncology training program in Uganda with external, international mentors.
METHODS Surveys were distributed to medical faculty and local Ugandan physicians. In-person feedback sessions with fellows, local faculty, and external mentors as well as formal evaluations of surgical and clinical skills were conducted prior to the start of a formal fellowship program, and after 6 months and 1 year.
RESULTS Two-thirds of Ugandan physician's desire skills sessions and hands-on training with international mentors. Only 17% feel that simulation and online modules are beneficial. All physicians surveyed valued surgical skills building above all other components of training including palliative care, managing chemotherapy and radiation side effects, and cervical cancer screening. Multidisciplinary care with “expert” consultation via skype and mobile messaging apps as well as in-person feedback sessions were most valued by residents and fellows. Video diaries better captured the personal impact of training on local physician rather than surveys, which required printed forms and demonstrated limited engagement (<35%).
CONCLUSIONS Successful global clinical training requires strong community partnerships, sensitivity to cultural needs, and a commitment to reciprocity. Monitoring the quality and comprehensiveness of teaching should be done frequently and consistently. Challenges remain in how to empower and assess capacity scale up in low middle income countries (LMICs), but exposing providers to intellectually stimulating experiences and focused mentorship lead to perceived positive change.

OBJECTIVES The objective of the study includes;
1. To make known the need for the roles of the oncology nurses to be expanded in the fight against cancer
2. To ensure that unmet needs of cancer patients are addressed
3. To help in the improvement of cancer patients’ quality of life.
METHOD This is a prospective study design with series of meetings coordinated with the ambulatory manager, Oncology Nursing Practitioner and primary registered nurses (RNs), and informal consultations held with all oncology staff members. Efforts was made to clearly document existing patient needs, clinic workload and processes, an exercise that took a 6-month prospective workload analysis. The analysis of focus principally was on all cancer patient populations.
RESULTS There was improvement in the management of the cancer patients. The oncology nurses were better equipped in the current oncology best practices. Advocacy and screening which was part of the scheme thought, led to more patients presenting early and fewer presenting with advanced stages. The psychosocial needs of the patients which cannot be addressed by pharmacotherapy were addressed through cognitive behavioural therapy and other psychoeducative therapies.
CONCLUSIONS Expanding the roles of the Oncology Nurses in the fight against cancer could be the next option for cancer treatment as Oncologists are much fewer when compared with the numbers of ever-increasing cancer patients especially in the low-income and middle-income countries.

OBJECTIVES The study assessed the cancer patient’s perceived adequacy of health related information communicated to them by health care professionals (HCP) on cancer diagnosis; prognosis; treatment; self care and its ability to facilitate their coping with cancer challenges.
METHOD A cross sectional descriptive survey design guided the study and convenience sampling was used to select 240 cancer patients receiving treatment at the regional oncology centre. Data was collected with a questionnaire developed by the researcher. Data analysis was done using descriptive statistics while inferential statistics was done with Fisher’s Exact test and Spearman Ranked Correlation test. All statistical calculation was done using the Statistical Package for the Social Sciences (SPSS) version 23.0 Software.
RESULT The return rate was n= 240 (100%). Majority of the respondents were females, married and within the age range of 28-67years. Most respondents’ illness had lasted for 1month to 1year. Information was not sufficient, about diagnosis, prognosis, and treatment. Although information on self-care was generally not sufficient, information on how to take medication and keeping to appointments were sufficient. Information on coping was not sufficient as well. However, respondents sex (P = 0.012 <0.05) and educational qualification (P =0.04< 0.05) differed significantly with perceived adequacy of information on diagnosis. A weak negative significant relationship was identified between respondents stage of cancer, (P = 0.029, r = -0.140) and perceived adequacy of information on diagnosis and also between stage of cancer, (P = 0.041, r = -0.13) and perceived adequacy of information on self-care. Cancer patients on stage 1 and 2 perceived the information communicated to them as sufficient more than the patients on stages 3 and 4.

OBJECTIVE The liability of breast cancer care is escalating across the globe and becoming a major public health topic in Ethiopia. A coordinated multimeric approach for diagnosis and treatment will enhance a better survival of the patients. The aim of this study was the description and feasibility of intrinsic subtyping including differential single gene expression using specimens from Ethiopian breast cancer patients.
MEHODS The present cross-sectional study was carried out in Ethiopia for histopathological as well as for RNA-based subtyping. In total 210 patients were recruited: 106 from a rural area, 104 in Addis Ababa, half from a private hospital and the other half from a public hospital in the capital. According to the St. Gallen recommendation; since 2011 the biomarkers estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 determined by immunohistochemistry (IHC) classified the specimens into five subgroups. This classification was compared to the molecular subtyping using RNA expression data derived from the nCounter platform (NanoString) and applying the PAM50 algorithm according to Parker and colleagues.
RESULTS Risk assessment by histopathological markers was higher for the patients in the rural area by similar age of diagnosis. Although differences in ER- and PR- results in the rural and urban area the combination of these receptors as hormone receptor (HR)- status led to no differences. After adding Ki-67 results to the IHC receptor status (ER, PR, HER2) more patients switched to the high-risk group. The expression profiling performed very well independently of the RNA quality with a higher rate of luminal A subtypes in the urban area (32% to 22%) and a higher rate of HER2-enriched and Basal-like tumours in the rural area (25% to 18%; 23% to 19% respectively). Overall 28% belong to the luminal A, 19% to the luminal B, 21% to the HER2-enriched, 21% to the Basal-like and 11% to the Normal subgroup.
CONCLUSIONS We describe the distribution of breast cancer subtypes in a first Ethiopian cohort using molecular RNA profiling. Similar to previous immunohistochemistry results, we found a large majority of endocrine sensitive tumours so that anti-hormone therapy should be recommended even if the HR-status is not known.

OBJECTIVO A Clínica Sagrada Esperança (CSE) é uma Instituição Pública de Saúde com gestão privada. O seu Conselho de Administração, face ao aumento de doentes oncológicos no país, decidiu criar em 2012 uma Unidade de Oncologia. Para tal, foram formados quadros, construída uma Unidade de Preparação de Quimioterapia, um Hospital de dia, um Serviço de Registo Oncológico e organizada a Consulta Multidisciplinar de Oncologia. Foi dado especial atenção aos tumores Urológicos e da Mama. Foram enquadrados na unidade os especialistas de cirurgia e realizados acordos para o tratamento com radioterapia em outras instituições. Pretende-se estudar o perfil dos doentes admitidos e tratados nesta Unidade de Oncologia em Luanda.
MÉTODOS Com base nos dados do Registo Oncológico da CSE, foi avaliado o perfil dos doentes admitidos e tratados na CSE, desde Setembro de 2012 a Fevereiro de 2019, em função da idade, género, naturalidade, localização e estádio da doença.
RESULTADOS No período estudado, foram admitidos um total de 546 doentes, dos quais, 306 (56%) eram homens e 240 (44%) mulheres. A idade mediana foi de 55 anos (mínimo 2 e máximo 97 anos). A maioria dos doentes eram naturais de Luanda (45.7%). Os 10 tumores mais frequentes foram, em ordem de frequência, a Próstata, Mama, Pele e Parte Moles, Estômago, Colo Uterino, Colo-Rectal, Pulmão, Linfoma, Fígado e Cabeça e Pescoço. Oitenta e cinco doentes (15.5%) tinham neoplasias digestivas. A maioria dos tumores eram localmente avançados no momento do diagnóstico e em 93 doentes (17%) a doença era M1. O número de novos doentes tem aumentado consecutivamente nos últimos cinco anos.
CONCLUSÕES O cancro da próstata, da mama e as neoplasias malignas digestivas, são predominantes. O diagnóstico tardio antecipa custos elevados no seu tratamento e sobrevivências diminutas.

OBJECTIVE Increasingly, evidence is emerging from developing countries like Kenya on the burden of Gynaecological cancers from care after histological findings. This has been shown to negatively impact cervical cancer management. Unfortunately little or no information exists on the subject in the western Kenya. This study is designed to assess the common gynae cancer, and stages reported late.
METHODS We conducted a retrospective analysis for women, who presented for care with histology results to our Gyn-Oncology clinic in Moi teaching and referral hospital. Descriptive statistics were used to summarize data.
RESULTS A total of 1066 women were staged, age range was 17- 88 years, with a mean of 49.9 years (STD=12). Clinical stage of cervical patients indicates 27.67 %( 285) were stage 3B, 17.28% (185) were stage 2B, compared to FIGO staging which indicates that 40% (172) were 3B and 18.84% (81) were 2B. Univariate cox regression was conducted for HIV cases (HR=2.7, p-value=0.021), education (HR=2.6, p-value=0.026), married (HR=0.63, p-value=0.237) and Health insurance cover (HR=1.67, p-value=0.198). Cervical Cancer was observed as the common type of gynecological cancer reviewed
CONCLUSIONS Cervical cancer being the most killing cancer, we recommend increase installation of radiotherapy equipment to ease treatment and reduce the late reporting of cancer in Kenya.

Patients with cervical cancer experience a variety of psychosocial effects which do affect them during treatment and through their cancer journey.
OBJECTIVES
1. To describe the psychosocial affects the patients with cervical cancer undergoing chemotherapy go through
2. Describe the interview measures taken to support these patients to cope with cancer
3. Highlight the available resources to help patients have their issues alleviated
METHOD
1. Surveys and interviews were used to obtain information from the patients
2. The participants were randomly picked.
3. Consent for participation was obtained.
RESULTS
a. Infertility: those in reproductive age were concerned whether they can have children after treatment
b. Stress: this was observed in patients who travelled long distances. Those with difficulties to pay
c. Isolation: some reported to be isolated by family members and colleagues.
d. Vomiting: some feared vomiting experience with chemotherapy
e. Depression: some reported low mood and ended up unable to bear requiring psychiatric treatment
f. Shame: some could not feel free to share their problems as they felt it shameful especially their children and relatives
g. Treatment cost: some could not afford the prescribed treatment as this made them helpless and hopeless
h. Suicide: some patients contemplated suicide.
i. Death: some felt death was iminent since they believed cancer was untreatable.
INTERVENTION
1. Counselling sessions were planned and patients attended to individually or through group discussion
2. Introduction of national hospital insurance fund is helping with treatment cost
3. Formation of support groups
4. Treatment waivers
CONCLUSION Although many patients have psychological issues, there are interventional options to help as mentioned above. This intervention helps cancer patients cope and move on with cancer journey strong.

OBJECTIVE In 2018, PEPFAR, the George W. Bush Institute and UNAIDS, refocused their partnership to support cervical cancer (CC) screening within HIV treatment sites to reach women most at risk of CC, women living with HIV (WLHIV). We assessed progress and barriers to rapid expansion of screening within this population.
METHODS Within the renewed partnership, eight PEPFAR country programs with HIV prevalence above 10% in women were funded to integrate screening and treatment of pre-invasive lesions within HIV treatment settings in Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, Zambia and Zimbabwe. Biannual screening with visual inspection with acetic acid was recommended for women aged 25-49 or per national guidelines if broader age range recommended, with one-time screening for women over age 49 not previously screened. Data tracked included number and type of screening (first, rescreen or follow up), findings, and treatment. Scale up began in Q4 of FY2018 although some sites had pre-existing programs.
RESULTS During FY2018, 108,993 WLHIV were screened; including 41,432 in the eight focus countries and 67,561 from previously established programs in Tanzania and Kenya. Of these, 99,219 (91%) screened negative, 7408 (6.8%) had abnormalities less than invasive CC (ICC), and 1788 (1.6%) were referred for suspected ICC. Treatment for pre-invasive lesions included 2,216 cryotherapy, 554 Loop Electrosurgical Excision Procedure (LEEP), and 47 thermal coagulation. Treatment of pre-invasive lesions was delayed by need for partner approval and limited referral sites for women requiring LEEP or assessment for possible ICC. Barriers to more rapid scale up included lack of space in clinics, delays in funds transfer, training and equipment acquisition, and need for development of quality assurance systems,
CONCLUSIONS Integration and rapid scale up of CC screening in HIV treatment settings are possible, but more intensive follow up is needed for women with abnormalities to receive appropriate evaluation and treatment. Expansion of LEEP providers and sites continues, and enhanced tracking systems are being developed. Evaluation of alternate screening options such as HPV testing is planned.

BACKGROUND Breast Cancer Screening Programmes have been deployed in few developing countries to aid curb increasing burden. However Breast cancer is being detected in late stage, attributed to barriers in health care. Patient navigation programmes have been associated with early detection and timely diagnosis. Despite the consistence positive effects of breast navigation programmes, there are no studies conducted to show its effect in LMIC's where the needs are enormous.
OBJECTIVES To evaluate the effect of patient navigation programme on patient return after an abnormal clinical breast cancer screening examination finding at Moi Teaching and referral Hospital, Kenya. Setting: Women Presenting for Breast Screening.
METHODS cross-sectional research design a before-and-after study was conducted on 76 patients before and after implementation of navigation programme. They were followed up for 1 month. Measures included proportional of patient return and time to return.
RESULTS The proportion of return of patients in the navigated and non-navigated group was 57.9% and 23.7% respectively (odds Ratio 2.85 at 95% confidence Interval, 0.34-24.30, p value=0.34). The mean time to return in the navigated group was 7.33 days and 8.33 days respectively (p=0.67).
CONCLUSION There was an increase in the proportion of patients who returned for follow-up following abnormal clinical breast examination finding after implementation of breast navigation programme. Patient navigation programmes to be considered in screening programmes due to its significant effect. However, a more robust study design such as randomized controlled trial can be used to confirm this apparent superiority.

BACKGROUND Breast cancer is the most common cancer in women worldwide, estimated to have caused over 508,000 deaths in 2011. Although breast cancer is thought to be a disease of the developed world almost 50% of breast cancer cases and 58% of deaths occur in low and middle income countries. Problem statement-Late diagnosis of breast cancer is common in most health institutions where 70-80% of cancer cases are diagnosed in late stages limiting their management. The status of many Kenyan women influences their health seeking behaviour especially in regard to breast cancer. The study sought to find out these factors and how they can be addressed.
OBJECTIVES To determine the characteristics of breast cancer patients attending MTRH in western Kenya, to determine the demographic characteristics of breast cancer patients, to determine the level of breast cancer awareness among women diagnosed with breast cancer, and to determine the factors that influence participation in breast cancer screening.
METHODS Cross-sectional research design was employed for the study. A total of 120 breast cancer diagnosed women were interviewed through self-administered questionnaires which comprised of closed and open-ended questions. Data was analyzed by descriptive and inferential statistics and represented on tables, Bar graphs and pie charts.
RESULTS Breast cancer affected persons from all ages, young and old. A majority (89%) of breast cancer patients sought medical attention because of presence of symptoms, felt discomfort and unusual changes. A majority (30.7%) of the respondents had stayed for a considerable length of time (1 year) with the cancer before they went to the hospital with a majority (31.7%) of the breast cancer Patients being diagnosed in stage 3 which was late. The main reason for late presentation was sighted as lack of knowledge on the symptoms of breast cancer (65.3%). The Women patients with breast cancer (81.2%) were aware of breast cancer and the main source of information being Barazas, Local radio and National television.
CONCLUSION Lack of disease awareness is the reason for late presentation. Even after the symptoms presented, many of the women still did not immediately visit the health facility but waited. Despite the awareness of breast cancer the knowledge was low and did not serve to help the women seek for immediate medical care. Awareness and education on breast cancer should be expanded to especially rural and Peri-Urban centers and campaigns mounted to increase screening uptake to improve outcomes

OBJECTIVE There are 37,000 newly diagnosed cancer cases and over 28,000 deaths yearly in Kenya, which is a Lower and Middle Income Country (LMIC). One of the main challenges faced by cancer patients is inadequate diagnostic and treatment facilities as well as shortage of specialists. In our setting, patients seeking public facilities for cancer management have the option of the two main referral hospitals in the country. They travel for long distances to access care and lack accommodation as they await treatment. AMPATH Oncology with the support of TAKEDA rented a 3 bedroom apartment to accommodate patients/guardians who await investigation and treatment as a strategy to improve on patient care.
METHODS Standard operating procedures for patient admission to the shelter were developed. A social worker was engaged for assessment of eligibility for admission. Janitors were hired to provide all housekeeping services including meal preparation.
RESULTS A total of 229 patients have been sheltered for a period of 1 year from 25th April 2018 to 16th April 2019. This comprises 67% (n=154) females and 33% (n=75) males. Adults predominant 88.2% (n=202) in comparison with pediatrics 11.8% (n=27). Breast cancer patients were the majority sheltered (43.2%), NHL (14.8%), HL (11.4%) and cervical cancer (10.9%) among the leading cancers. Patients awaiting medical results and for further medical investigation accounted for 37.1% as the major reason for admission. The longest duration stayed was 4 days and the shortest period 1 day. This has resulted in improved treatment outcomes since patients do not default their clinic appointments.
CONCLUSION Shelter provision as part of patient care can improve patient outcomes in cancer management.

BACKGROUND Oncology Outreach, a department that focuses on helping the public clearly understands cancer's impact on our daily lives is a key component of any cancer center that earns the coveted "comprehensive" designation from the National Cancer Institute. The AMPATH Oncology Institute (AOI) is engaged in an extensive, ongoing effort to provide training, education and outreach to the communities it serves to increase cancer awareness.
OBJECTIVE To highlights on how use of digital platform has improved the outreach activity services by: Centralization of patient’s information, Security of data, Easy follow-up and accountability of patients.
METHOD A Point of Care system was designed and customized for outreach activity. Breast and cervical data collection forms were integrated into the system. Key components of breast and cervical were designed to fit the outreach flow. This included Demographics collected at registration point, vitals and risk assessment collected at triage area and screening findings collected at screening exit points. The system is real time for data analytics. The system alerts for follow-up after biopsy, Pathology findings and management of patients.
RESULTS 8,088 clients were screened in the year 2018 during mass community outreach activity using digital Point of Care system. These screenings were done in 27 different sites spread across 12 counties across the Western Region in Kenya. This comprised of 26.6% (2153/8088) that were screened for breast alone, 10.3% (836/8088) screened for cervix alone and 63.0% (5099/8088) that were screened for both breast and cervix. 24 % of Males were screened for breast cancer. The mean age of clients screened was 42.4. Conclusion: Most clients were screened for both breast and cervical. Males were also involved in breast cancer screening. Key benefits of Point of Care system being real time data analytics, follow-up plan and centralization of client’s information. Other stakeholders need to come on board.

PROBLEM Radiation therapy is a cornerstone of cancer treatment. Currently, 50% of patients require radiation therapy at some stage in their cancer trajectory. However, unlike surgery and chemotherapy, radiation therapy is typically limited to large population centres because of the size and cost of the equipment required for treatment. This limitation is particularly problematic for large countries like Australia where regional and rural patients often miss out on critical care.
SOLUTION As a technology-based discipline, radiation therapy is being advanced by rapid internal and external technological innovations many led by Australia researchers. These advances, some of which our team has pioneered, include innovative patient set-up, image guidance, telemedicine and miniaturisation of equipment. Based on this we see a trend towards fewer radiotherapy treatment sessions. To solve the access and associated patient outcome problems we will combine these advances into a novel solution, ‘Radiotherapy on a Truck’ where we will bring radiation therapy to regional and rural cancer patients in Australia. Our project will deliver the mobile radiation therapy system, three docking stations in three Australian States and a demonstration of feasibility through rigorous clinical trials. It will provide a comprehensive assessment of needs and a roadmap as to how a distributed radiation therapy network would work across Australia. There is currently no system bringing radiation therapy to regional and remote areas.
The Key Benefits
• Provide access to high quality, state of the art radiation therapy services for rural and regional Australians.
• Create a solution for radiation therapy centres that temporarily lose treatment capacity (e.g. through equipment replacement)
• Create an opportunity to generate IP from integration of technology on the truck, the design of the docking stations including solar power and the e-health solutions for regional and rural locations.
• Cement Australia’s reputation as a global innovator and lead to economic return through the licensing and/or manufacture of commercial ‘radiotherapy on a truck’ cancer treatment units and generation of jobs in the manufacturing, R&D and services sectors.
Develop a model of cancer care applicable to developed and developing countries!! Can be run with iT-solarpower in satellite-connection by: 2 radiotherapist, 1 medical physicist, 1 onco-nurse, 1 truckdriver

OBJECTIVE Brachytherapy is a highly technical radiation therapy procedural skill used in standard of care treatment for gynecologic and genitourinary cancers worldwide. In Africa, cervical cancer represents the first or second most common malignancy among women, but only a handful of brachytherapy training programs exist. We aimed to develop an affordable and anatomically accurate gynecologic model for brachytherapy simulation training.
METHODS We performed literature review and sought expert opinion to combine biomedical materials engineering, computer-assisted design (CAD), 3D printing technology, anatomy, and clinical expertise in brachytherapy to design an ultrasound (US) and computed tomography (CT) compatible phantom of the female pelvis.
RESULTS Using contours from a patient with cervical cancer, we exported the anonymized structure set to develop an anatomically proportional model of the vaginal canal, cervix, and uterus. This structure set was imported into CAD and 3D printed as a negative mold in preparation for filling with US and CT compatible cast material. We next used CAD to create a urethral sphincter, rectum, and simplified female perineum. All CAD files can be readily manipulated to reflect varying anatomy and pathology in the female pelvis. Literature review revealed polyvinyl alcohol can be used as an injection mold that solidifies into an US and CT compatible human tissue mimetic through serial freeze-thaw cycles. A custom acrylic phantom designed to hold the female pelvic contents will be filled with gelatin and sealed with wax to complete the gynecologic phantom.
CONCLUSIONS We have designed an anatomically accurate gynecologic model for brachytherapy simulation training that can be affordably assembled via open access to our protocol. Our goals are to develop models for a variety of cervical cancer stages, create a male pelvis phantom for prostate brachytherapy simulation, and test its utility in a simulation training program for radiation oncology residents.

OBJECTIVE To promote early detection and treatment of cervical dysplasia in the “See & Treat” method by building a long-lasting partnership between the public and private sectors.
METHODS CureCervicalCancer (CCC), the Kisumu Medical and Education Trust (KMET), and the Kisumu County Department of Health selected public/private clinics with high catchment areas lacking cervical cancer screening. A comprehensive needs assessment was performed to identify gaps in the healthcare services provision and infrastructure. Community health volunteers (CHVs) were trained and incentivized to engage the community and increase reproductive health awareness and mobilize for service provision. Health Care Providers (HCP) from selected clinics engaged in a weeklong “See & Treat” training program, which included didactics and practicum. Trainees were ultimately evaluated through written and practical assessments. Graduating trainees returned to their respective institutions and provided cervical cancer screening to catchment area. Each institution’s screening data was collected monthly and analyzed through univariable statistics.
RESULTS Seven clinics in Kisumu County were selected; twenty-one HCP’s attended a See & Treat” training program from May 14-19, 2018. All 21 clinicians passed the written and clinical exams. Fifteen CHVs were trained and worked to increase community engagement. All 7 clinics began offering “Screen & Treat” services to patients, and a new mobile clinic was established to reach underserved patients. From 6/2018 to 3/2019, the 7 clinics and the mobile clinic reported 4,668 women screened, 191 women positive for cervical dysplasia, and of these, 149 were treated with cryotherapy.
CONCLUSIONS Our pilot collaboration between CCC, KMET, and the Kisumu County Department of Health represents the first public-private partnership of its kind in Kisumu. It has demonstrated that a collaboration promoting community engagement and optimizing the patient experience can not only successfully increase cervical cancer screening in rural communities, but also build a long-lasting sustainable healthcare infrastructure.

BACKGROUND Among non-Hodgkin lymphoma (NHL) subtypes, aggressive subtypes predominate in Sub-Saharan Africa (SSA), in part reflecting high prevalence of HIV and Epstein-Barr virus (EBV). Detailed descriptions of Burkitts Lymphoma (BL) and plasmablastic lymphoma (PBL) among adults from SSA are scarce, which are unique NHL subtypes highly associated with HIV and EBV.
METHODS We prospectively identified patients >15 years of age with pathologically confirmed BL and PBL during 2013-2018 in Malawi. Diagnoses were confirmed using immunohistochemistry, telepathology, and secondary review in the United States. Standardized chemotherapy was administered according to institutional guidelines, with concurrent antiretroviral therapy for HIV+ individuals.
RESULTS Forty-seven newly diagnosed BL and PBL participants were enrolled (35 BL, 12 PBL). Median age was 32 years (range 15-71) and 21 participants (45%) were HIV+ (15 BL, 6 PBL). Thirty participants (64%) had stage III/IV disease, and 20 (43%) had performance status >1. Among HIV+ participants, median CD4 count was 139 (range 9-605) and 13 (62%) had suppressed plasma HIV on antiretroviral therapy. Fourteen of 26 tumours tested (54%) were EBV-positive (5/13 HIV+, 9/13 HIV-). Four participants (9%) died before receiving chemotherapy. First-line chemotherapy consisted of CHOP (n = 30); EPOCH (n = 8); high-dose methotrexate-based chemotherapy (n = 4); and RCHOP (n = 1). Among 40 evaluable participants, 19 (48%) achieved a complete response. Median follow-up time was 24 months (range 3-44), and 1-year overall survival was 43% (95% confidence interval 28-57%, PBL 50%, BL 40%). Twenty-two of 28 deaths (79%) were from disease progression. More intensive chemotherapy was associated with decreased mortality compared with CHOP.
CONCLUSIONS BL and PBL are relatively common in Malawi, and highly but not uniformly associated with HIV and EBV. Most deaths were from progressive disease, and more intensive therapy was associated with better outcomes. Defining optimal approaches for these aggressive lymphomas is an urgent priority in SSA.

OBJECTIVE Aggressive non-Hodgkin lymphoma (NHL) is among the most common cancers in Sub-Saharan Africa (SSA), where CHOP is standard treatment and outcomes are poor. In SSA, resource-limited health systems, high opportunistic infection burden, and frequent comorbid HIV and/or malnutrition make administering high-intensity cytotoxic chemotherapy challenging. We hypothesized that EPOCH, a lower intensity infusional regimen, with modifications as required for local administration might be safe and effective treatment for high-risk NHL.
METHODS Between 2016 and 2018, we treated 15 newly diagnosed adult patients in Malawi with Burkitts (n=6), plasmablastic (n=8), and primary effusion lymphoma (n=1) with a modified EPOCH regimen as per the United States National Cancer Institute (NCI) protocol beginning at dose level +1 (etoposide 50 mg/m2, vincristine 0.4 mg/m2, and doxorubicin 10 mg/m2 days 1–4; prednisone 60 mg/m2 days 1–5; cyclophosphamide 750 mg/m2 day 1). Treatment cycles were administered every 21 days using peripheral venous catheters over eight hours on four successive days in clinic.
RESULTS Ten patients (67%) were male and the median age was 37 years (range 16-63). Ten (67%) were HIV+, median CD4 count was 208 cells/µL (range 9-460), and eight (80%) had suppressed HIV RNA <400 copies/mL. Patients received a median of six cycles (range 2-8) and median follow-up was 13 months (range 8-29) among patients still alive. Grade 3/4 neutropenia was observed in 26% of cycles and 60% of patients. Fourteen (93%) responded to EPOCH and ten (67%) achieved a complete response. One-year overall survival (OS) was 73% (95% CI 44-89%). Three patients (20%) died from progressive lymphoma and three (20%) from treatment-related complications.
CONCLUSIONS Modified EPOCH appeared feasible and effective in a small cohort of patients with and without HIV in Malawi. Our experience suggests infusional cytotoxic approaches, with setting-appropriate modification, may be a partial solution to improve outcomes for aggressive NHL subtypes in SSA.