Strengthening Capacity for Prostate Cancer Early Diagnosis in West Africa Amidst the COVID-19 Pandemic: A Realist Approach to Rethinking and Operationalizing the World Health Organization 2017 Guide to Cancer Early Diagnosis

Abstract

Two years after SARS-CoV-2 (COVID-19) was declared a global public health emergency, the restoration, at least, to the pre-pandemic level of early diagnostic services for prostate cancer has remained enormously challenging for many health systems, worldwide. This is particularly true of West Africa as the region grapples also with the broader impacts of changing demographics and overly stretched healthcare systems. With the lingering COVID-19 crisis, it is likely that the current trend of late prostate cancer diagnosis in the region will worsen with a concomitant increase in the burden of the disease. There is, therefore, a compelling need for innovative and evidence-based solutions to deescalate the current situation and forestall the collapse of existing structures supporting early prostate cancer diagnosis in the region. In this viewpoint, we make a case for the operationalization of the World Health Organization (WHO) guide to early cancer diagnosis to strengthen the capacity for early prostate cancer diagnosis in West Africa using a realist approach, drawing on participatory health research and evidence-based co-creation. Ultimately, we demonstrate the potential for developing COVID-19 responsive and context-specific models to optimize patient navigation/journey along the essential steps of the World Health Organization guide to early cancer diagnosis.

Strategies to enhance the approach to prostate cancer screening of South African black men in the Free State: a Delphi study

“… 39 This study focused on PCa screening; thus, the experts might have viewed patient navigators as irrelevant in the context of this study. Some authorities view traditional leaders as essential in promoting PCa screening awareness in the community; 40 it is unclear why there was no consensus on the inclusion of this item as a strategy for promoting PCa health education.…”

The effect of unusual presentation on delayed diagnosis of prostate cancer: a case series

“…He was initially managed for uraemic encephalopathy, and dialysis was started. An abdominal ultrasound scan showed bilateral hydronephrosis with echogenic parenchyma and a prostate volume of 81cm 3 . Patient was referred to the urologist where a PSA was done which was 11,251 ng/ml (0-4 ng/ml), and pelvic and lumbosacral X-ray images done showed osteoblastic lesions.…”

“…A lack of knowledge of prostate cancer and its symptoms contributes to delayed presentation and diagnostic delays by healthcare providers [3]. According to the World Health Organisation (WHO) guidelines for early cancer detection, the importance of creating awareness and improving access to healthcare as well as providing early clinical diagnosis, staging and early referral for treatment is key to tackling the increasing burden of prostate cancer, especially in our part of the world [14].…”

“…Early diagnosis is key for curing prostate cancer [ 1 ]. Unfortunately, approximately 33–50% of patients in a resource-constrained setting present with classical advanced disease symptoms in sub-Saharan Africa [ 2 , 3 ]. This high percentage of late-stage patients may be attributed to a lack of access to or poor knowledge of early screening.…”

The impact of the COVID-19 pandemic on cancer care including innovations implemented in Sub-Saharan Africa: A systematic review

“…While a majority of the countries experienced suspension of screening and preventive services, some countries were able to continue routine services, even during lockdown periods. In most of Western and Central Africa, prostate cancer awareness programmes were suspended [33]. In Cameroon, cervical cancer screening services were also suspended [10,55].…”