With Covid-19 impacting cancer patients across Africa and globally, innovative forms of rapid communication that can reach multi-lingual audiences are necessary. For the Union for International Cancer Control (UICC)-sponsored World Cancer Day 2021, the Walther Center in Global Palliative Care & Supportive Oncology at Indiana University launched a novel text-based Whiteboard video to convey the benefits of quality palliative care for cancer services in Low and Middle Income Countries (LMICs) and globally.

Objectives: (1) Provide an easily accessible visual product for clear communication of global disparities in access to essential medicines for cancer pain; (2) address the specific topics of palliative care, advocacy as well as psycho-oncology themes.

Methods: a series of 5 team-based strategy sessions were held to develop key messaging to integrate UICC’s World Cancer Day sub-topic on 'equity in access to cancer services' with a specific focus on palliative care. These strategy sessions included subject matter experts to address the following aims:
a) Identification of misconceptions around palliative care, specifically addressing disparities in essential medicines for cancer pain.
b) Development of a key message: Palliative Care is always a priority, with substantiating facts such as: 70% of people around the world don't have access to standard clinical interventions for cancer.
c) Engagement in an iterative process to refine visuals and pace of graphics to captivate a general audience, in addition to clinical cadres and policy makers.

Results: The Whiteboard product was produced over 3 weeks. Following launch, it received over 1,200 organic views on social media platforms, namely: Twitter, YouTube and Facebook. The Whiteboard has recently been translated to French and Arabic, increasing opportunities for dissemination across African countries.

Conclusions: With African health care systems struggling to maintain cancer care services amidst the Covid-19 response, clear communication around palliative care’s offerings is of essence. Leveraging a cost-effective software for text-based motion graphics can facilitate messaging that is both appealing and accessible to multi-lingual African audiences through social media dissemination.
Link to 1.5 minute whiteboard: https://www.youtube.com/watch?v=fMv-ySLuO6Y

INTRODUCTION: There is a need for cancer-focused clinical trials in low-middle income countries (LMIC). Clinical studies from high-income countries (HIC) are not always relevant to cancer care in LMIC, as LMIC populations have lifestyles and health care systems distinct from those in HIC. As such, building clinical research nurse (CRN) capacity to provide specific skills to conduct clinical trials in LMIC is imperative and essential to effective clinical research, timely treatments, and symptom management. An emerging role, CRNs play a vital tripartite role in research enterprise, serving as an expert nursing care giver, member of scientific team conducting the study, and research participants' advocate throughout the study. However, to date there have been few nurses in sub-Saharan Africa (SSA) trained in this specialty.
The purpose of this study is to explore the knowledge, attitudes, and practices of CRNs practicing at Obafemi Awolowo University Teaching Hospital and Aga Khan Hospital in Nairobi, Kenya to inform future training initiatives.
METHODS: To understand how nurses conceptualize their role, we engaged CRNs in an autoethnography, a qualitative approach that includes focus group discussion and self-documentation techniques. CRNs respond to researcher prompts on a WhatsApp discussion thread, encouraging reflection on research activities, emerging challenges, and new learnings. Participants engage in monthly focus groups via videoconference using semi-structured guide. Text from discussions are iteratively coded using a thematic analysis approach.
RESULTS: The study is ongoing; themes from monthly discussions will be presented as well as key learnings related to long-distance qualitative research, including adaptions in response to the COVID-19 pandemic.
CONCLUSION: Clinical research nursing is an innovative and emerging role for oncology nurses in SSA. Building CRN capacity provides specific skills to conduct clinical trials in SSA is imperative and essential to effective clinical research, timely treatments, and symptom management.

There is a need for cancer-focused clinical trials in low-middle income countries (LMIC). Clinical research differs between between high income countries (HIC) and may not be relevant to cancer care in LMIC; since LMIC populations have lifestyles and health care systems distinctly different from HIC populations. Therefore, building clinical research nurses (CRN) capacity to provide specific skills to conduct clinical trials in LMIC is imperative and essential for effective clinical research, timely treatments, and symptom management. The CRN role has become a nursing specialty practice and to date there have been few nurses in sub-Saharan Africa (SSA) involved with this specialty. This study explores the knowledge, attitudes, and practices of CRNs practicing in Obafemi Awolowo University Teaching Hospital (Nigeria) and Aga Khan Hospital (Kenya). We engaged CRNs in an auto-ethnography, qualitative study that includes focus groups discussion and self-documentation techniques. We use WhatsApp discussion boards and meet regularly using a semi-structured guide. Text discussions are iteratively coded using thematic analysis. The study is ongoing but we will present the state of the research completed thus far; along with the adaptations in response to COVID-19 pandemic. Clinical research nurses are in an innovative and emerging role for oncology nurses in SSA. Building this nursing specialty practice provides specific skills to conduct clinical trials in SSA where it is imperative and essential for effective clinical trials, timely treatments, and symptom management.

Background: Globally, 21 million children need pediatric palliative care (PPC) services yet these services have not been prioritized. Among the low- and middle-income countries, they are only available in few institutions or are not integrated into the health care systems. In Uganda most of the children with cancer present in late stages where cure may not be possible, this calls for palliative care at the time of diagnosis to help manage the symptoms in a less aggressive manner while keeping dignity for the child. The range of PPC services provided at the facilities are still wanting and low compared to the WHO minimum essential package of PPC services.

Aim: To develop an integrated network of children-centered PC services in Mulago hematology-oncology based on an interdisciplinary approach which is sensitive to the child’s and family’s wishes regarding treatment throughout the course of illness.

Methods: This quality improvement project will run for up to 6 months. The team includes the clinical care team at Mulago (PHO) and collaborators. Services being provided initially focus on end-of-life and bereavement support guided by the WHO (2018) essential package of PPC services. These are aimed at offering relief from physical, psychosocial and spiritual suffering. Activities include home visits, availing IEC materials like assessment tools, training personnel, offering internal and external support supervision and mentorship, generation of data base of children in palliative care, a needs assessment to ascertain the level of need for PPC and the appropriate model of care delivery and perioding monitoring and evaluation of the interventions.

Activities status: Between December 2020 and to date, 37 patients requiring end of life and bereavement support have been reached, of which 17 have died. Of the 17 that have died, 14 families have received bereavement support: In total, 53 phone calls with 25 of these being bereavement follow ups have been made. Four home reviews and 16 hospital reviews have been done too.

Utility: Findings will enable development of an integrated network of children-centered PPC services in Mulago hematology oncology based on an interdisciplinary approach which is sensitive to the child’s and family’s wishes regarding treatment and choice of care setting throughout the course of illness. The program may also promote continuity of the link nurse (provider) program given its demonstrated effectiveness.

OBJECTIVE:
Radiotherapy (RT) is a crucial component of comprehensive cancer care, but there are large global gaps in access. Within Ghana, a West African country with a population of 31 million people, there are only 3 RT centres with 5 external-beam (EBRT) and 2 high-dose rate (HDR) brachytherapy (BT) machines located in 2 cities in the south. This study aims to describe the gaps in RT capacity and geographic accessibility.

METHODS:
A retrospective review of data from all RT centres in Ghana was done to determine the number of RT courses, EBRT fractions, and BT insertions delivered annually between 2018-2020. The additional RT capacity required for optimal utilization was estimated from GLOBOCAN 2020 cancer registry data and the Collaboration for Cancer Outcomes Research and Evaluation radiotherapy utilization rate (RUR) model for all cancers. Geospatial modeling was used to calculate the distances that patients currently need to travel to access RT, and how access would be improved with new RT centres strategically located throughout the country.

RESULTS:
In 2020, Ghana delivered 1,794 RT courses and 34,624 EBRT fractions for all cancers, and performed 497 HDR BT insertions for cervical cancer (the 2nd most common cancer in the country). Based on a RUR of 48%, an additional 9,730 RT courses, 188,948 EBRT fractions and 4,538 HDR BT insertions are required. This translates to 5 additional RT centers, each with 4 EBRT units and 1 HDR BT afterloader.

Based on the current capacity and distribution of RT centres, patients have a median one-way travel distance from their regional capital to the nearest RT centre of 157 km, with 54% of patients traveling less than 100 km, 15% traveling 100-150 km, 9% traveling 150-200 km, and 22% traveling more than 200 km. The North East, Upper East, and Upper West regions have the longest travel distances of 424 km, 533 km, and 439 km, respectively. Establishing a third RT centre in Tamale in northern Ghana would decrease median one-way travel distance from their regional capital to the nearest RT to 145.5 km, and the proportion of the population with a travel distance of over 200 km to 4%. Optimization of the location of other new centres is needed to further reduce the travel distances.

CONCLUSIONS:
Ghana has a major national deficit of RT capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution can improve RT accessibility.

Radiotherapy (RT) is a crucial component of comprehensive cancer care, but there are large global gaps in access. Ghana, with a population of 31 million has only 3 RT centres with 5 EBRT and 2 HDR brachytherapy (BT) machines located in 2 cities in the south. This study aimed to describe the gaps in RT capacity and geographic accessibility.

A retrospective review of data from all RT centres in Ghana was done to determine the number of RT courses, and BT insertions delivered annually between 2020. The additional RT capacity required for optimal utilization was estimated from GLOBOCAN 2020 cancer registry data and the Collaboration for Cancer Outcomes Research and Evaluation radiotherapy utilization rate (RUR) model for all cancers. Geospatial modeling was used to calculate the distances that patients needed to travel to access RT, and how access would be improved with new RT centres strategically located throughout the country.

In 2020, Ghana delivered 1,794 RT courses for all cancers, and performed 497 HDR BT insertions for cervical cancer. Based on a RUR of 48%, additional 9,730 RT courses, and 4,538 HDR BT insertions were required. This translates to 5 additional RT centers, each with 4 EBRT units and 1 HDR BT afterloader.

The median one-way travel distance from their regional capital to the nearest RT centre of 198 km. Patients in the northern half had the longest travel distances.Establishing a third RT centre in Tamale in northern Ghana would decrease median one-way travel distance from their regional capital to the nearest RT to 154 km. Optimization of the location of other new centres is needed to further reduce the travel distances.

Ghana has a major national deficit of RT capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution can improve RT accessibility.

OBJECTIVE: In 2017, the World Health Organization urged member states to develop and implement national cancer control plans (NCCPs) and to anticipate and promote cancer survivor follow-up care. This study analyzes the inclusion of cancer survivorship-focused objectives in NCCPs in Africa to support regional stakeholders in advancing cancer survivorship care in Africa.

METHODS: As part of a 2018 Union for International Cancer Control global review, NCCPs were accessed via the International Cancer Control Partnership portal and directly from Ministries of Health and reviewed by a group of international, independent experts according to 111 measures. For this study, 12 of these measures were identified as relevant to survivorship care and this subset of data was extracted for NCCPs of African countries. Nine new or updated NCCPs published between 2018 and 2021 were also reviewed for these 12 objectives using associated search terms.

RESULTS: A total of 24 of 54 African countries have an active or recently expired NCCP, and 9 had a current plan in 2021. The 24 plans contained reference to between 2 and 12 survivorship-focused objectives, with a median of 5. The objectives most often included related to acknowledgement of primary care’s role in cancer care (n = 21), provision of psycho-social or spiritual support (n = 20), and primary care training in cancer (n = 19), while those least often included related to long-term care protocols (n = 1), patient navigation (n = 2), and financial protection (n = 4).

CONCLUSIONS: Survivorship-focused objectives in NCCPs may influence development of guidelines, appropriation of resources, and provision of care to support cancer patients, survivors, and caregivers. This study serves as a baseline analysis of survivorship-focused objectives in NCCPs in Africa and identifies gaps to inform further research, grant portfolio analyses, and efforts to strengthen survivorship care in the region.