Center for Global Oncology and Health Equity

Our research efforts foster basic, translational, and population research that addresses local-regional problems that contribute to cancer disparities. For example, optimization of treatments is an imperative—complex trials with costly therapeutic interventions like many in the United States are currently not feasible in countries like Kenya.

Clinical trial networks linking low- to middle-income countries require innovative trial designs and technology that could translate to improving how clinical trials are conducted in the United States.

Research updates:

• At the 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), with our Kenyan colleagues, we presented the oral abstract “A novel approach to improve the diagnosis of pediatric cancer in Kenya via telehealth education.” 
• A large study led by Darron Brown, MD, and physicians from Kenya and Uganda is taking a long-term look at different types of HPV and the cervical cancers they cause.
• Researchers are also studying a toxin in a fungus that can grow in corn and other foods. It appears that women exposed to aphalotoxin have the same level of risk of developing liver cancer that women with HIV have, leading researchers to believe that the toxin has immunosuppressant qualities of which they were not previously aware.
• A huge concern globally is how effective COVID-19 vaccines can be in immunocompromised people. Researchers in Kenya are studying how the strength of a patient’s immune system correlates with the success of their vaccination.

Key researchs goal for 2022-25:  Expand translational cancer research portfolio in Kenya and establish a multi-national, sub-Saharan Africa clinical trials group.

Perhaps the greatest potential contribution of the center is building the next generation of scientists and physician-scientists who will embrace global oncology as a viable career path.

The AMPATH partnership has proven the important and sustainable impact of global health  activities in primary care. We are now poised to address more complex chronic diseases such as cancer, cardiovascular disease, and mental health. In Kenya and in other low- to middle-income countries,, there is a critical shortage of physicians trained to provide cancer care.

Education updates:

• Kenya’s first fellowship training in pediatric oncology and gynecologic oncology are well underway with graduates in faculty positions at Moi Teaching and Referral Hospital (MTRH).
• Moi University expects to offer medical oncology fellowships for the first time—a much-needed program that will eliminate the need for Kenyan students to travel to the United States for specialized training.
• Project ECHO (tele-education) has successfully launched programs throughout western Kenya that serve caregivers and facilitate access to care, especially for pediatric cancer patients.
• A monthly Global Oncology Grand Rounds has been initiated
• Under the direction of Gary Dunnington, MD, professor emeritus of surgery, IU School of Medicine's Department of Surgery supported a surgery team leader in Kenya In addition to supervising visiting trainees from IU, they are growing the well-trained workforce and aspire to create a full surgical oncology curriculum.

   

   

Our infrastructure team includes our partners at the Regenstrief Institute, which provides bioinformatics support to the IU Simon Comprehensive Cancer Center and Purdue University. This coordination allows us to develop more innovative and cost-effective mechanisms for research, training and care.

The center partnered with informatics experts to build a telehealth infrastructure for Moi Teaching and Referral Hospital. In addition to patient care and physician interaction, this system supports virtual meetings, allowing collaborators to make significant progress despite travel limitations.

Infrastructure updates:

• Construction is nearly complete on a second radiation bunker at the Chandaria Cancer and Chronic Diseases Centre in Eldoret, Kenya, with funding secured for equipment. Until the new radiation unit is complete, the current unit is the only facility serving the public sector in western Kenya, home to about 24 million people. More than  50 patients a day are currently being treated in this facility.

Without adequate capacity-building and infrastructure support from low- to middle-income countries to meet clinical demands long-term, there will be no lasting impact on the cancer mortality. The Center for Global Oncology and Health Equity provides evidenced-based data and the will to convene various parties to promote health policies for the prevention and treatment of cancer.

Health policy updates in Kenya:

• A series of summits led by the center, in partnership with the Kenya Ministry of Health and numerous key stakeholders in Kenya, led to the creation of the Kenya National Health Insurance Fund (NHIF) which provides funding for cancer treatments.
• In Kenya, the leading cause of cancer death is cervical cancer. Breast and prostate cancer are the second and third leading causes of death, respectively. An IU School of Medicine urologist is working with our Kenyan colleagues to develop a prostate cancer center of excellence to help address this critical need.
• Ken Cornetta, MD, is currently working with Kenyan colleagues to expand palliative care initiatives, especially among cancer patients.
• A childhood cancer, Burkitt’s Lymphoma, is curable if patients are diagnosed early and receive intervention and consistent treatment. A tele-education initiative called Project ECHO is focused on working with health care providers in Kenya to improve access to care. The strategy is working. The number of pediatric referrals is increasing, with Shoe4Africa Children’s Hospital in Eldoret now seeing more pediatric cancer patients than Riley Hospital for Children in Indiana.

Some may ask why we direct resources to Kenya when patients in Indiana face their own obstacles to cancer care. We strongly believe that doing both improves care for all.

Our center is built on the vision of a community of researchers—in North America, Kenya, and around the world—who share knowledge and ideas. A few examples include:

• Kenyan healthcare providers are skilled at screening for cancer in remote areas. We can use what they have learned to expand screening in rural Indiana.
• The escalating costs of care in the U.S. are unsustainable. In resource constrained settings like Kenya, we can identify ways to streamline the costs of treatment and the conduct of clinical trials.
• The causes of cancer are not singular. Global oncology can reveal secrets about the diverse molecular underpinnings of cancer. In this country, tobacco-associated cancers dominate our clinics. In sub-Saharan Africa, many more cancers are associated with viruses.
• The genomic diversity also has an impact on the risk for cancer, but also how we handle the drugs used to fight it. In Kenya, triple negative breast cancer is much more common than in the United States because people of African descent are at much higher risk. Understanding the mechanisms behind the health disparities in breast and other cancers will lead to more therapeutic options.