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Dar es Salaam, Tanzania

Background. Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion. This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary. There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. © 2010 Hanna and Kangolle; licensee BioMed Central Ltd. Source

Ngoma T.,Ocean Road Cancer Institute | Mandeli J.,Mount Sinai School of Medicine | Holland J.F.,Mount Sinai School of Medicine
International Journal of Cancer

Cancer is usually diagnosed late in rural Africa leading to incurability and abbreviated survival. Many curable cancers present on the body surface, often recognizable early by laymen as suspicious, justifying professional referral. Cancer diagnoses in two randomly chosen Tanzanian villages were compared after conventional dispensary self-referral vs. proactive visits in the home. Village navigators organized trips for professional consultation. In the control village 21% were self-referred, 20% of them were sent on as suspicious, 78% had cancer (8% in men) 0.9% of the village population. In the intervention village 99% were screened, 14% were referred for professional opinion, 93% had cancer (32% in men) 1.6% (p-<-0.01 compared with control village). In the second and third years similar activity yielded 0.5% cancer annually in the control village for a 3 year total of 1.86% whereas interventional villagers had 1.4% and 0.6% cancer for a 3 year total of 3.56% (p-<-0·001). Downstaging was recognized in the second and third years of intervention from 23 to 51 to 74% Stages I and II (p-<-0.001) but in the control village Stages I and II changed from 11% to 22% to 37% (p-=-NS). The greatest downstaging occurred in breast and cervix cancers. What's new? High cancer mortality in Africa is associated with an array of factors, including deficiencies in public education and health resources, which are likely to persist for decades to come. In the interest of effecting cancer control quickly and by economically practicable means, the authors of the present investigation in Tanzania compared routine self-referral against proactive visitation by health aides trained in the identification of suspected lesions. Significant improvement toward earlier cancer diagnosis was observed in the village where proactive visitation was implemented. Proactive referral could significantly improve the effectiveness of therapy, leading to reductions in cancer mortality in Africa. © 2014 UICC. Source

Buonaguro F.M.,Istituto Nazionale Tumori Fond. Pascale | Gueye S.N.,Cheikh Anta Diop University | Wabinga H.R.,Makerere University | Ngoma T.A.,Ocean Road Cancer Institute | And 2 more authors.
Infectious Agents and Cancer

Infectious Agents and Cancer is introducing a new section of Clinical Oncology with the main objective of stimulating debate through articles published in the section. Infectious diseases have been the major causes of morbidity and mortality in human populations, and have dominated the medical approach to clinical and public health. Successful efforts to control mortality from acute infections have paved the way for chronic, mostly indolent, infections to become major causes of morbidity. Cancer, hitherto thought to be rare in resource-limited settings, is becoming a major contributor. The changes in mortality patterns are due, in part, to diseases linked to rapid changes in lifestyle, urbanization, and pollution. These diseases include many of the non-infection associated cancers. However, there is a dearth of information about the burden, pathogenesis, and therapeutic approaches about cancer in resource-limited countries. There are also substantial other challenges, including economic, infrastructure, technology, and personnel. The Journal advocates for interactive local-global (lo-bal) efforts to generate relevant knowledge about cancer burden, pathogenesis, and therapeutic approaches using a bottom-up approach to sharpen the focus on local and global relevance of research and clinical and public practice, particularly in resource-limited countries. The section on Clinical Oncology in Infectious Agents and Cancer will harness these "lo-bal" strategies to reduce substantially the time from concept, discovery, and development and implementation of locally and globally applicable diagnostic and therapeutic technologies. © 2013 Buonaguro et al.; licensee BioMed Central Ltd. Source

Kersten E.,University of California at San Francisco | Scanlan P.,Ocean Road Cancer Institute | Scanlan P.,A+ Network | Dubois S.G.,University of California at San Francisco | Matthay K.K.,University of California at San Francisco
Pediatric Blood and Cancer

Background: In order to understand the disparity in childhood leukemia survival in low-income countries (LICs) compared to high-income countries (HICs), we evaluated the resources available at Tanzania's national pediatric oncology ward, and clinical characteristics, disease course and outcomes of children diagnosed with acute leukemia from 2008 through 2010. Procedures: A chart review and assessment of services was performed to assess childhood leukemia diagnoses, treatment, and outcomes in Tanzania at the Ocean Road Cancer Institute (ORCI) from January 1, 2008 to December 31, 2010. Results were compared to those from a 2005 evaluation that showed only one of 20 children with leukemia surviving at 1 year. Results: During the study period, 106 patients presented with leukemia, including 81 patients with acute lymphoblastic leukemia (ALL) and 25 with acute myeloid leukemia (AML). Forty-nine of 58 (84%) patients with ALL, and six of 17 (35%) with AML who received therapy and had complete data, achieved complete remission. Estimated 2-year event-free survival for all patients with ALL was 33%; for AML it was 0%. Ten patients died prior to initiation of therapy, 19 died of toxicity, and eight abandoned therapy. Conclusions: Though leukemia survival in Tanzania remains far below that in HICs, survival rates for ALL have significantly improved in recent years due to standardization of treatment regimens and better staff, though AML outcome remains dismal. Ongoing improvements in pediatric leukemia outcomes will require strategies to improve awareness and early access to treatment coupled with improvements in diagnostic capabilities, supportive care, and training. Pediatr Blood Cancer 2013;60:2047-2053. © 2013 Wiley Periodicals, Inc. Source

Makubi A.,Muhimbili University of Health and Allied Sciences | Shiyo A.,Muhimbili University of Health and Allied Sciences | Kahesa C.,Ocean Road Cancer Institute
Tanzania Journal of Health Research

Background: Despite the fact that anaemia is common worldwide, limited studies have been done in most developing countries to estimate its prevalence and factors associated with haemoglobin change in patients with cancers receiving radiotherapy. Methods: This was a descriptive cross-sectional study conducted at the Ocean Road Cancer Institute in Dar es salaam, Tanzania. All individuals with cancers who were admitted in the wards for radiation treatment from August to December 2013 were included. Information on social-clinical characteristics, cancer type and associated factors as well as haemoglobin level before and after radiation were obtained. The prevalence of anaemia was determined as a proportion and linear regression was used to determine factors associated with haemoglobin change. Results: A total of 230 study subjects were available for analysis, of whom 82% were females. The overall mean age was 50±14 years. Most of the subjects (44%) were residing in the coastal regions, 50% had never attended school and 77% had no formal employment. The overall prevalence of anaemia was 77% before and 82% after radiotherapy. Multivariate linear regression analysis revealed that history of blood transfusion (beta-coefficient= 1.193; p=0.004) was the only factor associated with absolute change in haemoglobin. Conclusion: The prevalence of anaemia was high, regardless of the cancer type. Blood transfusion appeared to have a positive change in haemoglobin following radiotherapy. Awareness should be increased to provide early detection of the condition with appropriate corrective measures. © 2016, National Institute for Medical Research. All rights reserved. Source

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