African head and neck fellowships: A model for a sustainable impact on head and neck cancer care in developing countries

Fagan, Johannes J.; Otiti, Jeffrey; Aswani, Joyce; Konney, Anna; Diom, Evelyne Siga; Baidoo, Kenneth; Onakoya, P A; Mugabo, Rajab M.; Noah, Patrick; Mashamba, Victor; Kundiona, Innocent; Garba, M. E.; Biadgelign, Melesse G.; Macharia, Chege; Bogale, Mesele; Koch, Wayne M.

doi:10.1002/hed.25615

Cited by 14 publications

(28 citation statements)

References 6 publications

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“…The authors concluded that high volume, specialized head and neck surgical training was possible in Africa; and that training was appropriate in terms of pathology and types of surgery. They also concluded that the fellowships had made a sustainable contribution to head and neck practice in Sub‐Saharan Africa by populating it with surgeons and teachers of head and neck surgery, by them establishing centers of excellence, by building clinical capacity, and by instituting resource appropriate management 7 . The African Head and Neck Society (AfHNS) is currently formulating an AfHNS ‐endorsed fellowship programme to increase training opportunities at more training centers in Africa.…”

Section: African Head and Neck Surgery Fellowship Trainingmentioning

confidence: 99%

“…Only about 5% of patients in Africa and 3% in South Asia have timely access to safe, affordable surgery (Figure 1). 6 Sub‐Saharan Africa has only 18 fellowship‐trained head and neck surgeons for its >1 billion people 7 …”

Section: Introductionmentioning

confidence: 99%

“…Access to cytology, histopathology, specialized radiology, operating time, safe anaesthesia and ICU beds are also limited, 7 and many poor patients cannot afford to pay out of pocket for cancer investigations and treatment. Only 24/52 African countries have radiotherapy services, and in some countries with radiation therapy facilities, patients may wait up to 46 weeks to commence treatment 8 .…”

Section: Introductionmentioning

confidence: 99%

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Africa: A window on challenges and opportunities for head and neck cancer

Fagan

2021

Laryngoscope Investig Oto

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Background Head and neck cancer occurs predominantly in the Developing World, with significant challenges relating to a high burden of disease, late presentation, and poor access to curative and palliative care. Aims This article describes challenges relating to head and neck cancer care in Sub‐Saharan Africa. Material & Methods Educational and training innovations that have been undertaken to improve access to cancer care are presented under the following headings: Open Access Educational Resources African Head and Neck Society (AfHNS); African head and neck surgery fellowship training; AfHNS Virtual Tumor Board; The AfHNS Clinical Practice Guidelines for Head & Neck Cancers in Developing Countries and Limited Resource Settings. Concerns are also raised about universally applicable cancer staging systems. Results The challenges facing African patients apply to equally to many other parts of the developing world. Discussion The challenges facing African patients apply to equally to many other parts of the developing world. Conclusions For outcomes of head and neck cancers to be improved globally, a far greater investment needs to be made in education and training to improve access to care in developing countries. To make a meaningful global impact on morbidity and mortality related to HNC, clinicians, academic institutions and professional societies in developed countries need to be sensitive to these developing world challenges and should directly engage in improving access to care through promoting open access educational resources, offering specialist and fellowship training, collaborating with appropriate research, and establishing and strengthening centers of excellence in developing countries. Level of Evidence 2c “Outcomes research”.

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Section: African Head and Neck Surgery Fellowship Trainingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Africa: A window on challenges and opportunities for head and neck cancer

Fagan

2021

Laryngoscope Investig Oto

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“…3,5,6 Given the inadequate global chemotherapy and radiotherapy capacity, 7,8 surgical care is a particularly important intervention as it is often the primary mode of diagnosis and treatment for early stage HNC. 3,5,9 However, many low- and middle-income country health systems have limited surgical capacity in part due to surgical workforce shortages and geographic maldistribution of providers, reducing the likelihood that patients receive timely surgical care. 10 In 2015, the Lancet Commission on Global Surgery (LCoGS) convened a group of experts to provide estimates on the global burden of surgical disease and to identify avenues to advance surgical system strengthening.…”

mentioning

confidence: 99%

Global Burden of Head and Neck Cancer: Economic Consequences, Health, and the Role of Surgery

Patterson

Fischman

Wasserman

et al. 2020

Otolaryngol.--head neck surg.

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Objective We aimed to describe the mortality burden and macroeconomic effects of head and neck cancer as well as delineate the role of surgical workforce in improving head and neck cancer outcomes. Study Design Statistical and economic analysis. Setting Research group. Subjects and Methods We conducted a statistical analysis on data from the World Development Indicators and the 2016 Global Burden of Disease study to describe the relationship between surgical workforce and global head and neck cancer mortality-to-incidence ratios. A value of lost output model was used to project the global macroeconomic effects of head and neck cancer. Results Significant differences in mortality-to-incidence ratios existed between Global Burden of Disease study superregions. An increase of surgical, anesthetic, and obstetric provider density by 10% significantly correlated with a reduction of 0.76% in mortality-to-incidence ratio ( P < .0001; adjusted R2 = 0.84). There will be a projected global cumulative loss of $535 billion US dollars (USD) in economic output due to head and neck cancer between 2018 and 2030. Southeast Asia, East Asia, and Oceania will suffer the greatest gross domestic product (GDP) losses at $180 billion USD, and South Asia will lose $133 billion USD. Conclusion The mortality burden of head and neck cancer is increasing and disproportionately affects those in low- and middle-income countries and regions with limited surgical workforces. This imbalance results in large and growing economic losses in countries that already face significant resource constraints. Urgent investment in the surgical workforce is necessary to ensure access to timely surgical services and reverse these negative trends.

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“…That might include the use of the WhatsApp platform by community health workers in Uganda to share cases of ear disease in their local village, 2 or the same platform used by geographically dispersed nonspecialist surgeons in the Pacific islands to discuss management of ENT pathology. The Internet can also be exploited to assist diagnosis: For instance, half of African head and neck surgeons reported that poorly developed histopathology services were an obstacle to providing care, 3 but now that histology slides can be transmitted online for diagnosis by experts in a remote location, 4 such barriers could be overcome. This has been taken further, with an entire multi-disciplinary team (MDT) available online.…”

Section: Virtual C a S E Discussionmentioning

confidence: 99%

ENT from afar: Opportunities for remote patient assessment, clinical management, teaching and learning

Bhutta

Swanepoel

Fagan

2021

Clinical Otolaryngology

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Remote communication in ENT has been expanding, spurred by the COVID‐19 pandemic. Conferences and teaching have moved online, enabling easier participation and reducing financial and environmental costs. Online multi‐disciplinary meetings have recently been instigated in Africa to discuss management of cases in head and neck cancer, or cochlear implantation, expanding access and enhancing patient care. Remote patient consultation has also seen an explosion, but existing literature suggests some caution, particularly because many patients in ENT need an examination to enable definitive diagnosis. Ongoing experience will help us to better understand how remote communication will fit into our future working lives, and also where face‐to‐face interaction may still be preferable.

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African head and neck fellowships: A model for a sustainable impact on head and neck cancer care in developing countries

Cited by 14 publications

References 6 publications

Africa: A window on challenges and opportunities for head and neck cancer

Africa: A window on challenges and opportunities for head and neck cancer

Global Burden of Head and Neck Cancer: Economic Consequences, Health, and the Role of Surgery

ENT from afar: Opportunities for remote patient assessment, clinical management, teaching and learning

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