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Legason ID, Ogwang MD, Chamba C, Mkwizu E, El Mouden C, Mwinula H, Chirande L, Schuh A, Chiwanga F. A protocol to clinically evaluate liquid biopsies as a tool to speed up diagnosis of children and young adults with aggressive infection-related lymphoma in East Africa "(AI-REAL)". BMC Cancer 2022; 22:484. [PMID: 35501771 PMCID: PMC9059110 DOI: 10.1186/s12885-022-09553-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background The capacity for invasive tissue biopsies followed by histopathology diagnosis in sub-Saharan Africa is severely limited. Consequently, many cancer patients are diagnosed late and outcomes are poor. Here, we propose to evaluate circulating tumour (ct) DNA analysis (“liquid biopsy”), a less invasive and faster approach to diagnose endemic EBV-driven lymphomas (EBVL) in East Africa. Methods We will evaluate the clinical utility of an already validated ctDNA test prospectively in a head-to-head comparison against histopathology. The primary endpoint is the time from presentation to the specialist centre to a final diagnosis of EBV- Lymphoma. Secondary endpoints include the sensitivity and specificity of liquid biopsy and health economic benefits over histopathology. One hundred forty-six patients will be recruited over 18 months. Patients will be eligible if they are 3–30 years of age and have provided written consent or assent as per IRB guidelines. Tissue and venous blood samples will be processed as per established protocols. Clinical data will be captured securely and in real-time into a REDCap database. The time from presentation to diagnosis will be documented. The sensitivity and specificity of the methods can be estimated within 5% error margin with 95% confidence level using 73 cases and 73 controls. Health-economic assessment will include micro-costing of ctDNA test and histopathology. All results will be reviewed in a multidisciplinary tumour board. Discussion The study evaluates the clinical utility of ctDNA in improving the speed of diagnostic pathways for EBVL in sub-Saharan Africa. Our results would provide proof-of-principle that ctDNA can be used as a diagnostic tool in areas without access to regular pathology, that transfer of the tool is feasible, and that it leads to an earlier and faster diagnosis. The potential clinical and economic impact of this proposal is thus significant. If successful, this study will provide appropriate, and cost-effective diagnostic tools that will promote earlier diagnosis of EBVL and potentially other cancers in countries with restricted healthcare resources. Trial registration Pan African Clinical Trials Registry: PACTR202204822312651, registered on 14th-April-2022.
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Affiliation(s)
- Ismail D Legason
- AI-REAL Study, St Mary's Hospital Lacor, Gulu& African Field Epidemiology Network, 180, Gulu-Uganda. African Field Epidemiology Network, 12874, Kampala, Uganda.
| | - Martin D Ogwang
- AI-REAL Study, St Mary's Hospital Lacor, Gulu& African Field Epidemiology Network, 180, Gulu-Uganda. African Field Epidemiology Network, 12874, Kampala, Uganda
| | - Clara Chamba
- AI-REAL Study, Muhimbili University of Health and Allied Sciences, Dar es Salam, Tanzania
| | - Elifuraha Mkwizu
- AI-REAL Study, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Claire El Mouden
- AI-REAL Study, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Hadija Mwinula
- Molecular Diagnostic Center, Department of Oncology, University of Oxford, Oxford, UK
| | - Lulu Chirande
- AI-REAL Study, Muhimbili University of Health and Allied Sciences, Dar es Salam, Tanzania
| | - Anna Schuh
- AI-REAL Study, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Faraja Chiwanga
- AI-REAL Study, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Shamley D, Ezeani A, Okoye I. Oncology Clinical Trials in Africa: Partnering for Quality. JCO Glob Oncol 2021; 7:572-576. [PMID: 33886365 PMCID: PMC8651154 DOI: 10.1200/jgo.19.00315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Oncology clinical trials are requisite for testing the safety and effectiveness of promising treatments and deciphering new knowledge into concrete benefits for patients. They present opportunities to innovate promising, novel cancer remedies. A dearth of local evidence to guide cancer treatment in Africans is creating an increased interest in oncology clinical trials to improve patient care. This is primarily because of limitations in pathology, surgery, medical oncology, radiation, and palliation that are leading to worse cancer outcomes on the continent. Investment in oversight of Human Research Ethics committees and Medicines Regulatory Authorities in Africa has improved the potential for many countries to host clinical trials. However, the distribution of cancer trials remains poor across the continent, resulting in inadequate treatment options for patients with cancer. There are some initiatives aimed at developing research capacity to host trials in Africa. However, there is now a need to establish strategic partnerships whose aim should be to achieve harmonized, accredited Clinical Trials Units capable of running trials to meet Good Clinical Practice standards. This article discusses what has been achieved and proposes a model for quality oversight of Clinical Trials Units in Africa.
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Affiliation(s)
- Delva Shamley
- Clinical Research Centre, University of Cape Town, Cape Town, South Africa
| | - Adaora Ezeani
- University of Florida, College of Pharmacy, Gainesville, FL
| | - Ifeoma Okoye
- College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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Cassell A, Yunusa B, Manobah B, Wambo D. Management guidelines of penile cancer- a contemporary review of sub-Saharan Africa. Infect Agent Cancer 2020; 15:26. [PMID: 32377231 PMCID: PMC7195778 DOI: 10.1186/s13027-020-00293-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Penile cancer is a rare malignancy with prevalence higher in areas of high Human Papilloma Virus (HPV) such as Africa, Asia and South America. In middle- and low-income countries where circumcision is not routinely practiced, the rate of penile cancer could be ten times higher. MAIN BODY OF THE ABSTRACT A literature review was conducted from 1992 to 2019 using PubMed, Google Scholar, African Journal Online and Google with inclusion of 27 publications with emphasis on the Sub-Saharan literature. Findings revealed that most men with penile cancer in Sub-Saharan Africa (SSA) present with locally advanced to advanced disease with devastating consequences. The option of penile sparing procedure is reduced with most treatment option directed to mutilating surgeries. The lack of appropriate chemotherapy and radiotherapy worsens the prognosis in the region. SHORT CONCLUSION Human Papilloma Virus (HPV) vaccination may not be cost-effective for most regions in SSA. Therefore, early childhood circumcision might be the best advocated alternative for prevention.
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Affiliation(s)
- Ayun Cassell
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
- Department of Surgery, Liberia College of Physicians and Surgeons, University of Liberia, Monrovia, Liberia
| | - Bashir Yunusa
- Department of Surgery, Liberia College of Physicians and Surgeons, University of Liberia, Monrovia, Liberia
| | - Burgess Manobah
- Department of Surgery, Liberia College of Physicians and Surgeons, University of Liberia, Monrovia, Liberia
| | - Desire Wambo
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
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Muliira JK, Kizza IB. The other untold burden of cancer in sub-Saharan Africa: Anxiety and depressive symptoms among family caregivers of adult cancer patients. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ebogo-Belobo JT, Kagoué Simeni LA, Mbassa Nnouma G, Lawan Loubou M, Abamé I, Tchuisseu Hapi A, Dooh Ngalle S, Hemerode Mbock S, Mpondi Ngole Etame M, Atenguena Okobalemba E. Incidence of cancer in people living with HIV and prognostic value of current CD4 . Bull Cancer 2018; 106:201-205. [PMID: 30502923 DOI: 10.1016/j.bulcan.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/20/2018] [Accepted: 11/01/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although Sub-Saharan Africa accounts for 71% of the people living with Human Immunodeficiency Virus (HIV) worldwide and Cameroon accounts for about 2% of them, the role of HIV-induced immunodeficiency and exposure to Antiretroviral Therapy (ART) in the occurrence of cancers in Cameroon has scarcely been examined. The aim of our study was to determine the incidence of cancers in HIV patients and to determine the role of CD4+cell count in the onset of cancers. METHODS A retrospective cohort study was carried out from medical records of people confirmed to be HIV-positive from 01 July 2003 to 30 April 2013. Potential risk factors were studied by Cox proportional hazards model. RESULTS A total of 1768 patients were included in the analysis and 53 cases of cancer were diagnosed with an incidence rate of 7.4 per 1000 person-year of follow-up (95% CI; 5.4-9.4 per 1000 person-years of follow-up). Immunosuppression and exposure to ART were identified as factors associated with the occurrence of cancers in this population. Current CD4+cell count was the most important risk factor for cancer. Risk of cancer ranged from 15.51 (95% CI; 5.45-44.1; P<0.001) for a CD4+ cell count<50 cells/mm3 to 2.87 (95% CI; 1.14-7.2; P=0.025) for a CD4+ level between 350-499 cells/mm3. CONCLUSION Our study showed that the incidence rate of cancers is high among HIV patients in Cameroon. This incidence seems to correlate positively with the latest CD4+cell count and negatively with initiation of antiretroviral treatment.
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Affiliation(s)
- Jean-Thierry Ebogo-Belobo
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon; Institute of Medical Research and Medicinal Plant Study, PB 13033, Yaoundé, Cameroon.
| | - Luc-Aimé Kagoué Simeni
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon
| | - Gregoire Mbassa Nnouma
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon
| | | | - Idrissa Abamé
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon
| | - Aurelie Tchuisseu Hapi
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon
| | - Sabine Dooh Ngalle
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon
| | - Sorelle Hemerode Mbock
- School of Health Sciences, Unite of Microbiology-immunology, Central African Catholic University, PB 11628, Yaounde, Cameroon
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Family caregivers for adult cancer patients: knowledge and self-efficacy for pain management in a resource-limited setting. Support Care Cancer 2018; 27:2265-2274. [PMID: 30327878 DOI: 10.1007/s00520-018-4504-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Adult cancer patients (ACPs) in resource-limited settings disproportionately suffer from inadequate pain control despite advancements in pain management. Family caregivers (FCGs) can support optimal pain control for ACPs in these settings if they are knowledgeable and confident about the needed care. However, the status of FCGs' knowledge and self-efficacy (SE) for pain management in developing countries is not well established. PURPOSE To assess the FCGs' knowledge and SE levels for pain management among ACPs while at home in a resource-limited setting. METHODS Using a questionnaire that comprised a Family Pain Questionnaire and Chronic Pain Self-efficacy Scale, data were collected from 284 FCGs of ACPs receiving care from two cancer care centres. RESULTS The FCGs had moderate knowledge (mean = 41.70 ± 14.1) and SE (mean = 795.95 ± 301.3) levels for pain management at home for ACPs. Majority of the FCGs had low knowledge (52.1%), but expressed higher SE (52.5%). Poor self-rated health among FCGs was significantly associated with low knowledge levels (OR = 1.75; 95% CI 1.024-2.978, p = 0.041). SE was significantly associated with perceiving a low impact of caregiving on health (OR = 1.55; 95% CI 1.074-2.239, p = 0.019), hours of caregiving per week (OR = 0.52; 95% CI 0.315-0.854; p = 0.01) and receiving organisational support (OR = 0.388; 95% CI 0.222-0.679; p = 0.001). CONCLUSION The results show a need for deliberate interventions to enhance FCG knowledge and SE for pain management at home as one of the ways of improving cancer pain management in resource-limited settings.
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Rifkin RF, Potgieter M, Ramond J, Cowan DA. Ancient oncogenesis, infection and human evolution. Evol Appl 2017; 10:949-964. [PMID: 29151852 PMCID: PMC5680625 DOI: 10.1111/eva.12497] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/22/2017] [Indexed: 12/27/2022] Open
Abstract
The recent discovery that malignant neoplastic lesions date back nearly 2 million years ago not only highlights the antiquity of cancer in the human lineage, but also provides remarkable insight into ancestral hominin disease pathology. Using these Early Pleistocene examples as a point of departure, we emphasize the prominent role of viral and bacterial pathogens in oncogenesis and evaluate the impact of pathogens on human evolutionary processes in Africa. In the Shakespearean vernacular "what's past is prologue," we highlight the significance of novel information derived from ancient pathogenic DNA. In particular, and given the temporal depth of human occupation in sub-Saharan Africa, it is emphasized that the region is ideally positioned to play a strategic role in the discovery of ancient pathogenic drivers of not only human mortality, but also human evolution. Ancient African pathogen genome data can provide novel revelations concerning human-pathogen coevolutionary processes, and such knowledge is essential for forecasting the ways in which emerging zoonotic and increasingly transmissible diseases might influence human demography and longevity in the future.
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Affiliation(s)
- Riaan F. Rifkin
- Center for Microbial Ecology and Genomics (CMEG)Department of GeneticsUniversity of PretoriaHatfieldSouth Africa
| | - Marnie Potgieter
- Center for Microbial Ecology and Genomics (CMEG)Department of GeneticsUniversity of PretoriaHatfieldSouth Africa
| | - Jean‐Baptiste Ramond
- Center for Microbial Ecology and Genomics (CMEG)Department of GeneticsUniversity of PretoriaHatfieldSouth Africa
| | - Don A. Cowan
- Center for Microbial Ecology and Genomics (CMEG)Department of GeneticsUniversity of PretoriaHatfieldSouth Africa
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Odutola M, Jedy-Agba EE, Dareng EO, Oga EA, Igbinoba F, Otu T, Ezeome E, Hassan R, Adebamowo CA. Burden of Cancers Attributable to Infectious Agents in Nigeria: 2012-2014. Front Oncol 2016; 6:216. [PMID: 27822455 PMCID: PMC5075533 DOI: 10.3389/fonc.2016.00216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/28/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In Nigeria, like many other developing countries, infections remain a leading cause of morbidity and mortality. While there are data on the incidence of different cancers in Nigeria, there has been no study of cancers attributable to infections. This study was carried out to determine the burden of cancers attributable to infections using data from two population-based cancer registries (PBCRs) in Nigeria. Methods We obtained data on cancers associated with EBV, human papillomavirus (HPV), hepatitis B and C, HIV, HHV8, Helicobacter pylori, and Schistosoma spp. from the databases of Abuja and Enugu cancer registries in Nigeria. We used population-attributable fraction for infections-associated cancers in developing countries that are based on prevalence data and relative risk estimates from previous studies. Results The PBCRs reported 4,336 incident cancer cases [age standardized incidence rate (ASR) 113.9 per 100,000] from 2012 to 2014, of which 1,627 (37.5%) were in males and 2,709 (62.5%) were in females. Some 1,030 (23.8%) of these cancers were associated with infections (ASR 44.4 per 100,000), while 951 (22.0%) were attributable to infections (ASR 41.6 per 100,000). Cancers of the cervix (n = 392, ASR 28.3 per 100,000) and liver (n = 145, ASR 3.4 per 100,000); and non-Hodgkin’s lymphoma (n = 110, ASR 2.5 per 100,000) were the commonest infections-associated cancers overall. The commonest infectious agents associated with cancers in this population were HPV, EBV, hepatitis B and C, HIV, and HHV8. Conclusion Our results suggest that 23.8% of incident cancer cases in this population were associated with infections, while 22.0% were attributable to infections. The infections attributable cancers are potentially preventable with strategies, such as vaccination, risk factor modification, or anti-infective treatment.
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Affiliation(s)
| | - Elima E Jedy-Agba
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , London , UK
| | - Eileen O Dareng
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge , Cambridge , UK
| | | | | | - Theresa Otu
- University of Abuja Teaching Hospital Gwagwalada , Gwagwalada , Nigeria
| | - Emmanuel Ezeome
- University of Nigeria Teaching Hospital Enugu , Enugu , Nigeria
| | | | - Clement A Adebamowo
- Institute of Human Virology, Abuja, Nigeria; Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Downing J, Leng M, Grant L. Implementing a Palliative Care Nurse Leadership Fellowship Program in Uganda. Oncol Nurs Forum 2016; 43:395-8. [DOI: 10.1188/16.onf.395-398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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