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Olatunji E, Patel S, Graef K, Joseph A, Lasebikan N, Mallum A, Chigbo C, Jaffee E, Ngwa W. Utilization of cancer immunotherapy in sub-Saharan Africa. Front Oncol 2023; 13:1266514. [PMID: 38179176 PMCID: PMC10765613 DOI: 10.3389/fonc.2023.1266514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction The Lancet Oncology Commission for sub-Saharan Africa (SSA) predicts that cancer deaths will double from 520,158 per year to more than 1 million per year by the year 2040. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy's significant therapeutic potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA. Methods A Qualtrics survey assessing the existing infrastructure and training for safe immunotherapy administration was developed and distributed online via email and WhatsApp to 3,231 healthcare providers across SSA, with a target audience of healthcare providers serving patients with cancer. The survey contained 22 questions evaluating the accessibility, use, knowledge, and training on immunotherapy in SSA. Responses were collected between January and February 2023. Microsoft Excel was used to summarize and visually present the distribution of responses as counts and proportions. Results 292 responses were included from 28 countries in SSA. 29% of all respondents indicated their clinic has easy access to cancer immunotherapy and 46% indicated their clinic currently practices it. Of clinics that practiced immunotherapy (n = 133), 12% used genomic sequencing to assess the tumor mutational burden biomarker, and 44% assessed expression of the PD-L1 biomarker prior to immunotherapy administration. 46% of all respondents were familiar with immunotherapy. 11% indicated being adequately trained to administer it. Of these (n=33), 52% indicated also being trained to manage immune-related adverse events related to immunotherapy administration. Conclusion Immunotherapy utilization and training is low in SSA and insufficient for the rising cancer burden. Increased accessibility and usage of biomarker testing to predict immunotherapy response, incorporation of immunotherapy training into continuous medical education, and increased access to immunotherapy drugs may be prerequisites for expanded utilization of immunotherapy in SSA.
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Affiliation(s)
- Elizabeth Olatunji
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, United States
| | - Adedayo Joseph
- Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital (NSIA-LUTH) Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Chinelo Chigbo
- Oncology Center, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - Elizabeth Jaffee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD, United States
| | - Wil Ngwa
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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Olatunji E, Swanson W, Patel S, Adeneye SO, Aina-Tofolari F, Avery S, Kisukari JD, Graef K, Huq S, Jeraj R, Joseph AO, Lehmann J, Li H, Mallum A, Mkhize T, Ngoma TA, Studen A, Wijesooriya K, Incrocci L, Ngwa W. Challenges and opportunities for implementing hypofractionated radiotherapy in Africa: lessons from the HypoAfrica clinical trial. Ecancermedicalscience 2023; 17:1508. [PMID: 37113724 PMCID: PMC10129374 DOI: 10.3332/ecancer.2023.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Indexed: 02/18/2023] Open
Abstract
The rising cancer incidence and mortality in sub-Saharan Africa (SSA) warrants an increased focus on adopting or developing approaches that can significantly increase access to treatment in the region. One such approach recommended by the recent Lancet Oncology Commission for sub-Saharan Africa is hypofractionated radiotherapy (HFRT), which can substantially increase access to radiotherapy by reducing the overall duration of time (in days) each person spends being treated. Here we highlight challenges in adopting such an approach identified during the implementation of the HypoAfrica clinical trial. The HypoAfrica clinical trial is a longitudinal, multicentre study exploring the feasibility of applying HFRT for prostate cancer in SSA. This study has presented an opportunity for a pragmatic assessment of potential barriers and facilitators to adopting HFRT. Our results highlight three key challenges: quality assurance, study harmonisation and machine maintenance. We describe solutions employed to resolve these challenges and opportunities for longer term solutions that can facilitate scaling-up use of HFRT in SSA in clinical care and multicentre clinical trials. This report provides a valuable reference for the utilisation of radiotherapy approaches that increase access to treatment and the conduct of high-quality large-scale/multi-centre clinical trials involving radiotherapy. Trial registration Not available yet.
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Affiliation(s)
- Elizabeth Olatunji
- Co-first authors
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
| | - William Swanson
- Co-first authors
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
| | - Samuel Olaolu Adeneye
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Funmilayo Aina-Tofolari
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Stephen Avery
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA 98121, USA
| | - Saiful Huq
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, WI 53705, USA
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana 1000, Slovenia
| | - Adedayo O Joseph
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Joerg Lehmann
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
- Institute of Medical Physics, The University of Sydney, Sydney, NSW 2006, Australia
| | - Heng Li
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa
| | - Thokozani Mkhize
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa
| | - Twalib Athumani Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam 3592, Tanzania
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, PO box 65001, Dar es Salaam, Tanzania
| | - Andrej Studen
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana 1000, Slovenia
- Jožef Stefan Institute, Ljubljana 1000, Slovenia
| | - Krishni Wijesooriya
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Luca Incrocci
- Co-senior authors
- Department of Radiotherapy, Erasmus MC, Rotterdam, Netherlands
| | - Wilfred Ngwa
- Co-senior authors
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
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Patel S, Olatunji E, Mallum A, Benjika BB, Joseph AO, Joseph S, Lasebikan N, Mahuna H, Ngoma M, Ngoma TA, Nnko G, Onwualu C, Vorster M, Ngwa W. Expanding radiotherapy access in Sub-Saharan Africa: an analysis of travel burdens and patient-related benefits of hypofractionation. Front Oncol 2023; 13:1136357. [PMID: 37143940 PMCID: PMC10151787 DOI: 10.3389/fonc.2023.1136357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The purpose of this project was to examine the travel burdens for radiotherapy patients in Nigeria, Tanzania, and South Africa, and to assess the patient-related benefits of hypofractionated radiotherapy (HFRT) for breast and prostate cancer patients in these countries. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing the adoption of HFRT in Sub-Saharan Africa (SSA) to enhance radiotherapy access in the region. Methods Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and the Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, from written records at the University of Nigeria Teaching Hospital (UNTH) Oncology Center in Enugu, Nigeria, and from phone interviews at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Google Maps was used to calculate the shortest driving distance between a patient's home address and their respective radiotherapy center. QGIS was used to map the straight-line distances to each center. Descriptive statistics were used to compare transportation costs, time expenditures, and lost wages when using HFRT versus conventionally fractionated radiotherapy (CFRT) for breast and prostate cancer. Results Patients in Nigeria (n=390) traveled a median distance of 23.1 km to NLCC and 86.7 km to UNTH, patients in Tanzania (n=23) traveled a median distance of 537.0 km to ORCI, and patients in South Africa (n=412) traveled a median distance of 18.0 km to IALCH. Estimated transportation cost savings for breast cancer patients in Lagos and Enugu were 12,895 Naira and 7,369 Naira, respectively and for prostate cancer patients were 25,329 and 14,276 Naira, respectively. Prostate cancer patients in Tanzania saved a median of 137,765 Shillings in transportation costs and 80.0 hours (includes travel, treatment, and wait times). Mean transportation cost savings for patients in South Africa were 4,777 Rand for breast cancer and 9,486 Rand for prostate cancer. Conclusion Cancer patients in SSA travel considerable distances to access radiotherapy services. HFRT decreases patient-related costs and time expenditures, which may increase radiotherapy access and alleviate the growing burden of cancer in the region.
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Affiliation(s)
- Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Saloni Patel,
| | - Elizabeth Olatunji
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | | | - Adedayo O. Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Twalib Athumani Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Godwin Nnko
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Chinelo Onwualu
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Mariza Vorster
- College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Wilfred Ngwa
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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4
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Olatunji E, Obonyo C, Wadende P, Were V, Musuva R, Lwanga C, Turner-Moss E, Pearce M, Mogo ERI, Francis O, Foley L. Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya. Nutrients 2021; 14:nu14010121. [PMID: 35010996 PMCID: PMC8747304 DOI: 10.3390/nu14010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022] Open
Abstract
The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.
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Affiliation(s)
- Elizabeth Olatunji
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
- Correspondence:
| | - Charles Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Pamela Wadende
- Faculty of Education and Human Resources, Kisii University, Kisii 40200, Kenya;
| | - Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Rosemary Musuva
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Charles Lwanga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Eleanor Turner-Moss
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Ebele R. I. Mogo
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Oliver Francis
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
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5
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Cao X, Khitun A, Na Z, Dumitrescu DG, Kubica M, Olatunji E, Slavoff SA. Comparative Proteomic Profiling of Unannotated Microproteins and Alternative Proteins in Human Cell Lines. J Proteome Res 2020; 19:3418-3426. [PMID: 32449352 DOI: 10.1021/acs.jproteome.0c00254] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ribosome profiling and mass spectrometry have revealed thousands of small and alternative open reading frames (sm/alt-ORFs) that are translated into polypeptides variously termed as microproteins and alt-proteins in mammalian cells. Some micro-/alt-proteins exhibit stress-, cell-type-, and/or tissue-specific expression; understanding this regulated expression will be critical to elucidating their functions. While differential translation has been inferred by ribosome profiling, quantitative mass spectrometry-based proteomics is needed for direct comparison of microprotein and alt-protein expression between samples and conditions. However, while label-free quantitative proteomics has been applied to detect stress-dependent expression of bacterial microproteins, this approach has not yet been demonstrated for analysis of differential expression of unannotated ORFs in the more complex human proteome. Here, we present global micro-/alt-protein quantitation in two human leukemia cell lines, K562 and MOLT4. We identify 12 unannotated proteins that are differentially expressed in these cell lines. The expression of six micro/alt-proteins from cDNA was validated biochemically, and two were found to localize to the nucleus. Thus, we demonstrate that label-free comparative proteomics enables quantitation of micro-/alt-protein expression between human cell lines. We anticipate that this workflow will enable the discovery of regulated sm/alt-ORF products across many biological conditions in human cells.
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Affiliation(s)
- Xiongwen Cao
- Department of Chemistry, Yale University, New Haven, Connecticut 06520, United States.,Chemical Biology Institute, Yale University, West Haven, Connecticut06516, United States
| | - Alexandra Khitun
- Department of Chemistry, Yale University, New Haven, Connecticut 06520, United States.,Chemical Biology Institute, Yale University, West Haven, Connecticut06516, United States
| | - Zhenkun Na
- Department of Chemistry, Yale University, New Haven, Connecticut 06520, United States.,Chemical Biology Institute, Yale University, West Haven, Connecticut06516, United States
| | - Daniel G Dumitrescu
- Department of Chemistry, Yale University, New Haven, Connecticut 06520, United States
| | - Marcelina Kubica
- Chemical Biology Institute, Yale University, West Haven, Connecticut06516, United States
| | - Elizabeth Olatunji
- Chemical Biology Institute, Yale University, West Haven, Connecticut06516, United States
| | - Sarah A Slavoff
- Department of Chemistry, Yale University, New Haven, Connecticut 06520, United States.,Chemical Biology Institute, Yale University, West Haven, Connecticut06516, United States.,Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut06529, United States
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