Globally, there are approximately 1.8 million new cases of lung cancer per year. Lung Cancer accounts for highest cancer-related mortality globally. Despite this, many African countries lack information regarding the epidemiology of lung cancer and its control. There is also the compounding heavy burden of comorbidities in Sub-Saharan Africa, including HIV and TB. This is the first proposal of a collaboration between 4 African countries on lung cancer across the continent. We propose to develop a lung cancer control program in the specified regions of the four participating countries with emphasis on improvement of access to early diagnostics and addressing the barriers to optimal outcomes.
This is a multinational study covering four countries in sub-Saharan Africa.
The goal of the Multinational Lung Cancer Control Program (MLCCP) is to improve access to early diagnostic services for lung cancer by addressing the barriers of cancer care through working with communities and the Ministries of Health in the identified regions in the four countries with a potential for scale-up.
Lung cancer is the most common cancer worldwide, and disproportionately affects developing countries where over 58% of cases occur. This however is in sharp contrast with low incidence rates of lung cancers reported in (7.7 per 100,000 in men and 2.6 per 100,000 in women, respectively) (Ferlay et al., 2015). This apparently low burden of lung cancers in the context of critical lack of accurate data, likely reflects enormous underestimations of the true burden, considering the high prevalence in the African setting of some major risk factors for lung cancer (Sigel et al., 2012; Yu et al., 2011) such as pulmonary tuberculosis (WHO, 2016) and HIV infection (UNAIDS, 2016). Indeed, most African countries lack nationwide or regional population-based cancer registries, and have no reliable source of mortality data (Ferlay et al., 2015; Joubert et al., 2012). The epidemiology of lung cancer is largely unknown in Africa, reflecting until recently, the low priority given to cancer and non-communicable diseases (NCDs) research in this setting. In most African settings, there is low cancer awareness, uncoordinated or absent screening services, late cancer diagnoses, when therapeutic solutions, where available, are less likely to be effective (Nanguzgambo et al., 2011). In addition, cultural beliefs in these settings influence health seeking behavior, with patients with warning signs and those with clinical signs suggestive of cancer or diagnosed with cancer resorting to alternative medicine either preferentially, or in parallel with modern medicine (Nanguzgambo et al., 2011). For example, the number of lung cancer cases reported from 2 of the collaborating centers (Eldoret in Kenya and Mwanza in Tanzania), over the preceding period was extremely small, for Eldoret-Kenya only 53 cases 2011-2014 and for Mwanza 69 cases over 5 years. All these factors have contributed to lack of a true burden estimation in this region, which this program will address.
This is the first project of this nature in the country. The project will span three years and will involve a mix of interventions and evaluations (2 years for SA). The overall methodological approach is one of pragmatic studies. Pragmatic studies, as opposed to explanatory trials, seek to answer a research question in the context of usual clinical practice, without requiring extraordinary additional changes. They have the advantages of being easier to conduct in real-world conditions, and they apply the research question to generalized populations as opposed to explanatory trials, where the intervention is applied in optimal conditions, to highly selected and controlled population (Ford and Norrie, 2016, Patsopoulos 2011).
The scope of the overall multinational project covers the following;
- Assessing the readiness of the health system to prevent and control lung cancers
- Identify pathways of care of lung cancer
- Identify the enablers to achieving earlier diagnosis
- Strengthen hospital-based cancer surveillance/ registries