Sub-Saharan Africa consists of 48 countries south of the Sahara Desert. The
International Agency for Research
on Cancer estimates that more than
626,000 people are diagnosed with
cancer in this region each year. Many
of these countries have limited medical
resources. For example, not all hospitals
in this region have cancer surgeons or
radiation therapy machines, and drug
treatments, including pain medication,
are scarce. As a result, cancers that can be
diagnosed at early stages in high-income
countries, like the U.S., are often not diagnosed until they are more advanced.
Seeing a need for action, the National
Comprehensive Cancer Network (NCCN)
and the African Cancer Coalition (ACC)
developed new cancer care guidelines
for the region that take into account the
context in which care is being provided.
The guidelines, released in November
2017, offer recommendations for treating
some of the most commonly diagnosed
cancers in the area: breast, prostate and
cervical cancer, B-cell lymphoma, and
the AIDS-related cancer Kaposi sarcoma.
There are also guidelines for treating pain
and providing palliative cancer care.
Wui-Jin Koh, a radiation oncologist
at the Seattle Cancer Care Alliance
who helped develop the new guidelines,
says that by taking potential economic
constraints into account, the guidelines
help doctors choose the best available
options that can still offer the chance
for a cure.
For each cancer type, the recommenda-
tions are separated into four tiers, from
basic (treatment that meets a minimum
standard of care) to the maximum NCCN
standard guidelines. The guidelines also
discuss options that can be considered in
regions where the standard-of-care treat-
ment is not available.
The standard treatment for certain types
of cervical cancer, for example, is external
radiation, chemotherapy and brachytherapy,
which delivers high, targeted doses of
radiation. If brachytherapy is not available,
the guidelines recommend chemotherapy
and standard radiation, followed by surgery.
If surgery cannot be performed, patients
should be given a targeted radiation boost.
The guidelines also take into account the
treatment needs of cervical cancer patients
who have an obstetric fistula, an injury
that can occur during prolonged labor. It
is most commonly seen in countries that
lack medical resources.
For some cancer clinics, following
the guidelines may require only a few
small changes. For others, the guidelines
will be more difficult to meet. Yet, says
oncologist Robert Carlson, the NCCN’s
chief executive officer, in those clinics
“the implementation will have bigger
impact.” Clinicians can also use the
guidelines as a starting point for advo-
cating for more resources for cancer care
from their local and national health care
ministries, he adds.
The NCCN and the ACC will meet in
April 2018 to develop additional guide-
lines for six more cancers. They will
continue to revise the current guidelines
based on feedback they receive.
“It’s amazing how challenging cancer
care is in the area,” says James Mohler, a
urologist at Roswell Park Comprehensive
Cancer Center in Buffalo, New York,
who helped develop the guidelines. “But
one should be hopeful that because of
the success that’s been had with HIV
and malaria, the same can be done with
cancer.” —CAMERON WALKER
Study Explores Familial Risk Factors for
Urothelial cancer is the most common
type of cancer of the bladder and
urinary tract. Researchers analyzed
health habits of urothelial cancer
patients in the Utah Cancer Registry
and their family members, and
Utah residents without cancer. The
results suggest there are genetic and
environmental factors, independent
of smoking, that increase risk among
urothelial patients’ family members for
urothelial and other types of cancer.
LEARN MORE IN THE ONLINE FIRS T
DEC. 8, 2017, JOURNAL OF THE
NA TIONAL CANCER INS TITU TE.
Improving Cancer Care
in Sub-Saharan Africa
NEW GUIDELINES ACCOUNT FOR LIMITED
In sub-Saharan Africa, advances in the prevention and treatment of malaria and HIV have helped people live longer. But one public health success has created another
challenge—cancer rates are on the rise.