Global Oncology and Health Equity

Globally, cancer is rising rapidly. Much of the burden falls onto LMICs where more than 70 percent of cancer deaths occur. In Sub-Saharan Africa (SSA) alone, more than one million annual cancer deaths are expected to occur by the year 2040. These LMICs are ill-equipped to manage this crisis. For example, not long ago, less than a handful of trained oncologists existed in Kenya and none in the western half of the country. This, coupled with limited pathologic and radiographic services, scant supply of any chemotherapy (let alone drugs specific for cancers seen), absence of radiotherapy, oncology-trained surgeons, or palliative care made cancer care virtually non-existent.

Since 2004, AMPATH-Oncology has become a flagship of Global Oncology advancing the tripartite academic mission of education, research and clinical care. The complexity of cancer care not only demands a well-trained workforce, but one which is engaged in continuous professional development to keep up with the rapid changing nuances to biology and treatments.

AMPATH-Oncology has led the efforts at Moi University School of Medicine (MUSM) and Moi Teaching and Referral Hospital (MTRH) to provide an educational platform for the next generation of health care professionals trained for the increasing number of cancer patients.

We helped to establish the first Gynecologic-Oncology fellowship in the country, which now has 14 graduates – two of whom subsequently became department heads. We also helped to establish a pediatric oncology fellowship program at MTRH which has graduated its first two fellows, currently on staff. Additionally, recently a medical oncology fellowship has been approved by MUSOM. At MTRH, we have certificate training programs in palliative care and nursing oncology. Programs for radiation physics and surgical oncology are in planning stages.

To ensure continuous professional development, we have established a monthly virtual Global Oncology Grand Rounds, interactions with the community via Project ECHO, and we will be expanding our multidisciplinary tumor boards. Several faculty and trainees have presented research findings through publications and at national and international meetings (e.g., ASCO, AORTIC, KESHO). We have also had workshops for trainees on grant writing, manuscript preparation and mentoring.

Future Aims

Our future needs include developing a more disease-specific virtual tumor board that allows for real-time international feedback on complex cases and training for our AMPATH partners in Ghana, Nepal and Mexico. Finally, we’re concentrating on a push for extramural funding research mechanisms (i.e., Fogarty, Fullbright, YIAs and CDAs).

Whereas AMPATH and AMPATH-Oncology are guided by the principle of Leading with Care, research remains the glue that binds the relationship between the North American Consortium of Universities with MUSM and MTRH. Population, clinical, and translational research provides the contextually relevant evidence that reveals the sociologic and biologic underpinnings that inform evidence-based guidelines for Kenya and other LMICs.

Far too many men, women and children in Kenya present with advanced or Stage III/ IV cancers, where cures are rare and treatments are largely palliative. Addressing those factors in delays in diagnosis, access to proper treatment, completion of therapy, integration of palliative care are fertile grounds for investigation. These issues are the research priorities for AMPATH-Oncology.

We have been fortunate to receive grant funding from various foundations including Eli Lilly Foundation and Takeda to advance breast and cervical cancer screening. To date, more than 122,000 women have been prospectively screened with nurses and clinical officers trained not only for screening but also early treatment for women with cervical dysplasia detected by VIA (Visual Inspection with Acetic Acid). Through a U54 grant mechanism, we have determined the variations of the HPV virus over time in women differ in women with and without HIV.

Children with acute lymphoblastic leukemia and Burkitt lymphoma who present in the United States have a 90 percent cure rate. A decade ago, it was rare for a child with these malignancies in Kenya to be cured. Through efforts supported by NCI-supplement grants, we have worked with our Kenyan colleagues to dramatically decrease the early abandonment of treatment and to increase the complete remission rates and survival treated at MTRH. There is still substantial work to mirror the results found in the United States, but today more than 50 percent of children seen at MTRH have long-term survival.

Future Aims

One of our future goals is to expand our infrastructure to conduct “pragmatic” cancer clinical trials in children and adults through AMPATH and with other sub-Saharan partners. We will increase our efforts to seek extramural funding in implementation and translational research with an emphasis on contextually relevant trials in major cancers common in Kenya, such as breast, cervical, esophageal and prostate malignancies. Additionally, we will initiate research to utilize genomic and pharmacogenomic information to guide our clinical care.