In Africa, US Cancer Guidelines Are 'Harmonized' To Locale

ORLANDO, Florida — In an effort to standardize — and hopefully improve — cancer care in Africa, the National Comprehensive Cancer Network (NCCN) has been working with a coalition of the continent's cancer centers to create treatment guidelines that fit local resources and are thus "harmonized" to the locale.

There are compelling needs for such standardized guidance in Africa, including the arrival of two scourges of the Western world — medical lawsuits and tobacco marketing — as well as an aging population with longer life expectancies, said Abubakar Bello, MD, a radiation oncologist at the National Hospital Abuja, Nigeria, which is a member of the African Cancer Coalition.

He spoke here at the National Comprehensive Cancer Network (NCCN) Annual Meeting.  

The African Cancer Coalition consists of 30 regional cancer centers in 12 sub-Saharan countries, including Ghana, Nigeria, Ethiopia, Kenya, Uganda, Burundi, Tanzania, Zambia, Zimbabwe, Malawi, Rwanda, and Botswana.

In the last 2 years, 25 NCCN guidelines, which cover about 80% of the  cancers seen in the sub-Saharan area of Africa, have been adopted by the African Cancer Coalition, according to Bello.

"It was a wonderful effort," Bello said about the collaboration.

The collaboration, which also includes other US philanthropies and cancer groups, intends on completing more guidelines in the next year, which will in turn account for an estimated 97% of incident cancers in the region.

However, Bello acknowledged that creating and implementing guidelines are two different things, in part because of the high cost of cancer drugs in Africa.

Most cancer drugs are not available locally, and must be imported on a case-by-case basis. Cancer drugs are "very expensive," said Bello, echoing complaints in the United States and other Western countries.

The cost of cancer drugs is especially prohibitive in this region of Africa, where about 75% of people live on less than $1 dollar a day, Bello explained.

Robert Carlson, MD, chief executive officer of NCCN, addressed this high-cost-of-cancer-drugs issue — in Africa — in a recent press release.

"Standardizing practices makes the medication market more predictable, which helps with negotiations to lower prices. It also allows for more regional training and collaboration, while reducing needless duplications of efforts," he said about the emerging guidelines for sub-Saharan Africa.

The NCCN Harmonized Guidelines for Sub-Saharan Africa are part of the NCCN's "rapidly expanding global program," Carlson told the NCCN annual meeting audience.

Carlson, a former medical oncologist at Stanford University in California, is  involved in the African project, having visited the continent 12 times in recent years. Multiple NCCN officials and representatives from NCCN member cancer centers have also traveled to coalition countries in recent years.

Adapting NCCN Guidelines to Africa

The harmonization of the NCCN guidelines consists of using portions of the current guidance for the United States and highlighting line items as:

  1. standard care, generally available (in Africa)

  2. advanced care, not readily available

A third category encompasses options unique to the region, which include "innovative" ways cancer patients are supported or treated locally in the absence of oncologists.

In his talk at the NCCN meeting, Bello said that cancer incidence is expected to double in Africa in the next 20 years. The most common cancers are breast, cervical, prostate, colorectal, and liver, which, in total, account for about 50% of all new cases.

Not currently a major cancer in Africa, lung cancer is expected to rise, Bello said. "Tobacco companies are now targeting sub-Saharan Africa," he commented.

Medical lawsuits are now prevalent in Africa too, Bello added. "Emergence of malpractice litigation is creating interest in documenting evidence for treatment decisions," he said.

Furthermore, life expectancy is rising in the region, he added, having increased from 48 years in past decades to about 60 years today, which makes cancer — primarily a disease of aging — more likely.

Bello and Carlson have disclosed no relevant financial relationships.

National Comprehensive Cancer Network (NCCN) Annual Meeting: Presented March 23, 2019.

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