Background
Cancer is the third leading cause of mortality in Kenya, accounting for 7% of annual deaths. The Kenyan Ministry of Health (MOH) is committed to reducing cancer mortality, as evidenced by policies such as the National Cancer Control Strategy (2011-2016). There are many Kenyan and international organizations devoted to this task; however, coordination is lacking among stakeholders, resulting in inefficient and overlapping expenditure of resources.
Methods
The MOH and the NCI Center for Global Health collaboratively executed a two day workshop to improve coordination among government, NGO, and private organizations. Over 80 stakeholders participated from leading cancer research and control institutions in Kenya and the international sphere.
Findings
Actionable recommendations include: establishment of a nationally representative population-based cancer registry; enhanced training for community health workers, nurses, researchers, pathologists, and oncology specialists; a reconfigured referral process, including leveraging of existing resources to improve access to cancer care; and coordinated community outreach and education. The MOH is in the process of forming a Technical Working Group (TWG) and has elected a Board of Directors for the newly established Kenyan National Cancer Institute (KNCI), with both entities committed to advancing the cancer control work of the MOH.
Interpretation
This stakeholder meeting enhanced in-country networks, identified priority needs and developed actionable proposals for coordinated improvement of cancer research and control. Active, persistent follow-up by the TWG, KNCI, and other partners will be needed to turn proposals into reality and ensure that partners' investments are integrated into larger cancer control efforts prioritized by MOH.
Cancer on the African continent is quickly becoming an overt public health crisis due to an aging population and changes in lifestyle. The World Health Organization (WHO) states that a national cancer-control programme should aim to reduce cancer incidence and mortality and improve quality of life of cancer patients, through a national cancer-control plan (NCCP) that is systematic, equitable and evidence-based. Despite this, only 11 countries in Africa have a current NCCP. Participants in a US National Cancer Institute-supported, multi-year, technical assistance programme for cancer-control planning noted three main opportunities to improve how plans are created and implemented: 1) mobilisation of resources and partners for plan implementation; 2) accurate surveillance data to promote better resourcing of NCCPs; and, 3) sustainable and innovative partnership models to strengthen capacity to implement NCCPs. Most countries in the region face similar challenges in the development and implementation of an NCCP, including inadequate human, technical, and financial resources. Collaborative partnerships increase access to evidence-based cancer-control planning tools, mentoring and technical assistance, and have the potential to bridge the capacity gap and catalyse better implementation of NCCPs. Challenges can be overcome by better leveraging these opportunities to address the gaps that inhibit cancer control in Africa.
PURPOSE The objective of the Project ECHO (Extension for Community Healthcare Outcomes) for Knowledge Summaries for Comprehensive Breast Cancer Control (KSBC) was to strengthen the 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 was a collaboration between the US National Cancer Institute 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 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 case presentations, didactic presentations, and discussion. Projects spanned the care continuum and sessions addressed preplanning, assessing need/barriers, setting objectives/priorities, and implementing/evaluating. Baseline and end point surveys were used to evaluate the ECHO program. Participants identified a mentor, completed worksheets, and presented on the project status. RESULTS Fifteen project teams from 11 countries—64 participants: advocates, clinicians, policymakers, and researchers—were enrolled. Twenty-eight participants (57%) completed the baseline and end point surveys. Analysis of the data using a paired t-test indicates that the knowledge increase was statistically significant: The average knowledge gain was 0.76 ± 0.89 (95% CI, 0.44 to 1.08; P < .0001). Additional feedback on the Web-based collaborative learning model will be presented. CONCLUSION 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.
PURPOSE The National Cancer Institute (NCI)–Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations to support global cancer control. To better understand global oncology activities led by NDCCs, the NCI Center for Global Health collaborated with ASCO to conduct the 2018/2019 NCI/ASCO Global Oncology Survey of NDCCs. METHODS Seventy NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non–National Institutes of Health (NIH)-funded global oncology projects with an international collaborator led by the NDCCs. Sixty-seven NDCCs responded to the survey. Data were coded and analyzed by NCI-Center for Global Health staff. RESULTS Thirty-three NDCCs (47%) reported having a global oncology program, and 61 (87%) reported a collective total of 613 non–NIH-funded global oncology projects. Of the NDCCs with global oncology programs, 17 reported that trainees completed rotations outside the United States and the same number enrolled trainees from low- and middle-income countries (LMIC). Primary focus areas of non–NIH-funded projects were research (469 [76.5%]) and capacity building or training (197 [32.1%]). Projects included collaborators from 110 countries; 68 of these were LMIC. CONCLUSION This survey shows that there is a substantial amount of global oncology research and training conducted by NDCCs and that much of this is happening in LMIC. Trends in these data reflect those in recent literature: The field of global oncology is growing, advancing scientific knowledge, contributing to building research and training capacity in LMIC, and becoming a recognized career path. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries.
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