CIRGO Initiative Blazes Trail in Global Health

Expanding the number of highly trained surgical oncologists in Tanzania and strengthening cancer data systems in Kenya are tangible results of $480,000 in grants distributed last year to eight projects in Africa.

The grants, funded by the Bristol Myers Squibb Company, were distributed by a consortium of oncology organizations known as the Coalition for Implementation Research in Global Oncology, or CIRGO.  ASCP is a founding member of this coalition of predominantly global oncology organizations working together to improve the coordination of cancer care systems in low- and middle-income countries, particularly in Africa. The key to the coalition’s initiative is to provide healthcare solutions that can be adapted to the local context. Different solutions and approaches are studied, adapted to fit specific needs, and recorded, a process known as implementation science research. Over time, the collective research provides tools to implement and measure that adaptation in order to prove its effectiveness and impact.

Through the grants, each of the projects received $60,000 to develop country-specific initiatives focusing on early detection of breast cancer, improving access to cancer testing and diagnostic services for people living in rural communities, and strengthening cancer registries, reporting and data quality. A cancer registry is a system of recording the number of reported cancers and types of cancers in an identified area. Registries are important to help provide guidance about the most prevalent cancers in a certain area, what sort of diagnostics and treatments are relevant in that area, and the types of research that should be conducted. They are important to establish and maintain because some low- and middle-income countries do not have well established registries. Some of the CIRGO projects that address strengthening registries and the quality of data collected are critical to the work that subsequently take place in these countries to address cancer.  

Here is a look at some of those projects and their results:

1.   Training Surgical Oncologists in Tanzania

The burden of cancer is very high in Tanzania, which has few highly trained surgical oncologists to address cancer patients’ needs. The nation has a limited number of operating rooms and trainers, making it difficult to expand the surgical oncology workforce.

To address this situation, the project team led by Dr. Godfrey Sama Philipo, MD, conducted a needs assessment during the past year. They learned that while Muhimbili University of Health and Allied Sciences (MUHAS) has established training in clinical oncology, it has few training opportunities in surgical oncology. Leaders also learned Tanzania has no structured curriculum for surgical training. So, they studied an existing laboratory-based, surgical training curriculum from another country and created a curriculum that could be adapted to meet the unique needs in Tanzania. They then developed a plan to implement this curriculum, while considering any challenges that might arise. The plan was put in place in collaboration with key stakeholders from the MUHAS Department of Surgery. A space was identified at MUHAS that could be renovated into a surgical laboratory space. Project leaders also identified trainers and faculty who would provide instruction to undergraduate students in the Doctor of Medicine Program, as well as general surgery residents. Dr. Philipo has registered for a PhD program in order to gain expertise in implementation science and translate knowledge into practice and improved patient care. 

As a next step, the project leaders will launch the training programs and design tools to evaluate the effectiveness of the training.

2.   Strengthening cancer data systems in Eldoret, Kenya

The aim of this project was to increase coverage of population-based cancer registration by collecting cancer data from six health facilities in Uasin Gishu County that previously had not been obtained. (Uasin Gishu County is one of the 47 counties of Kenya, with the city of Eldoret as its largest population center.) Cancer registries provide a census of cancer cases and provide critical data to monitor incidence, identify patterns, and evaluate the effectiveness of prevention programs.

Another goal of the project was to improve the quality of cancer registry data through data collection from both rural and urban health facilities, to produce a five-year, population-based report for cancer incidence in Uasin Gishu, and to disseminate those findings to stakeholders. Over the past year, the data collection has more than doubled, from 43 percent to 88 percent. An increase in the quality of data has been observed, owing to increased coverage of data sources in the study population. Currently, 85 percent of sources have been covered.

Project leaders found that one of the challenges was the difficulty obtaining enough staff during the COVID-19 pandemic to carry out all aspects of this initiative. Only registered, mainstream hospital staff received priority for the COVID-19 vaccination. The project leaders have now requested their hospital management include the four new staff members for this project in the next round of COVID-19 vaccinations.

The project organizers have also organized refresher training for staff to improve their knowledge of procedures.

To underscore, the importance of this initiative is to improve coordination of cancer care which includes addressing the lack of population-wide cancer incidence data that exists in many LMIC countries. Hence, CIRGO projects like this one contribute to an improved understanding of the types of cancers that are prevalent in these countries, which ultimately helps better inform the overall diagnosis and treatment of cancers.

3.   Improving access to cancer tissue diagnosis for remote hospitals in Sub-Saharan Africa: The experience of a rural cancer center in Rwanda

The aim of this project at Butaro Hospital, under the leadership of Dr. Deo Ruhangaza, was as follows:

·      Describe the current situation of how samples are transported from remote hospitals to the Butaro Cancer of Excellence (BCCOE) and how pathology results are communicated back to those hospitals from 2015-2020

·      Determine the turnaround time for samples from remote hospitals

·      Create an electronic sample tracking system (online request form completion, tracking of samples, upload of results in the system with possible access by remote clinicians)

·      Evaluate the impact of the new electronic sample tracking system on the turn-around time

·      Review the retrospective data collection to describe the current situation on how samples are transported from remote hospitals, how feedback from the BCCOE to remote hospitals is conducted and the review the turn-around time for samples. Data were abstracted from pathology documents at the BCCOE, from Partners in Health documentation, and electronic medical record systems. Almost 95 percent of the sample size was covered.

·      Create an electronic sample tracking system 

·      Train clinicians from remote hospitals on the use of the software, as well as on pathology sample preparation

Challenges

·      COVID-19 restrictions caused a delay in the retrospective data collection. While the data collection was only done from the hospital pathology archive, only a few staff members were allowed to work from these sites.  

·      Preparation of the above-mentioned training sessions were affected by restrictions on in-person meetings due to COVID-19 precautions.  

·      The time needed to hire staff, and to learn and create the technology for external users to use electronic medical records, coupled with the delay in the provision of high-speed internet to sites, as required for the technical upgrade, delayed the overall completion of electronic tracking tool development.

Future Efforts

·      Finalize the retrospective data by retrieving remaining variables from the oncology electronic medical record

·      Begin prospective data collection. The electronic platform will be used to track the progress of pathology samples, and the turn-around time will be compared before and after the usage of the tool.

·      Data analysis and report writing for dissemination

Additionally, three of the grant recipients featured in this article have been invited to present their findings at the World Cancer Congress in Geneva, Switzerland, in October 2022. The World Cancer Congress, held every two years, is organized by the Union for International Cancer Control and brings together several thousand participants from more than 130 countries to discuss challenges and opportunities in the fight against cancer worldwide.  

CIRGO has been a trailblazer in global health, with its focus on implementation science to expand capacity of resources and workforce in low and middle income countries. Larry Shulman, MD, MACP, FASCO, Director of the Center for Global Cancer Medicine at the Abramson Cancer Center, University of Pennsylvania, has been central in the planning and founding of CIRGO. 

“CIRGO has been a great collaboration of multiple stakeholders invested in advancing global cancer medicine,” says Dr. Shulman. “The initial grants from CIRGO to strengthen data infrastructure to support critical implementation science efforts has been important beyond words. These are essential first steps in advancing the development of effective and safe cancer care delivery in resource-constrained settings. Additional funding will support the continuation of these efforts and ultimate success.”