a 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. Cancer rates are on the rise in Sub-Saharan Africa, which consists of 48 countries south of the Sahara Desert.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 recommendations 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 treatment 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 advocating 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 guidelines 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.”
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