The National Comprehensive Cancer Network® (NCCN®) aims to define and improve high-quality, high-value cancer care in Sub-Saharan Africa.
Sub-Saharan Africa’s cancer burden is significant and growing: in 2012, there were an estimated 626,400 new cases and 447,700 cancer deaths. Based on population aging alone, annual cancer deaths are projected to increase dramatically by 2030 to 984,000. Cancer here is characterized by late diagnosis, limited access to treatment and poor patient outcomes. Due to high levels of stigma surrounding cancer, a lack of symptom awareness, limited access to diagnostic services and poorly functioning referral systems, more than 80% of patients seeking treatment are already in the advanced stages of the disease – fewer than 10% receive pain relief, chemotherapy or radiotherapy. As a result, cancer is twice as lethal in Sub-Saharan Africa as it is in the US; although common cancers, such as cervical and breast cancer are quite treatable in the early stages, the five-year survival rate for women with breast cancer in The Gambia is only 12% (compared with 90% in the US).
Cancer care in Sub-Saharan Africa is marred by limited availability of basic treatment. While access to the latest biomedical advancements may be idealistic, the disparity in access to basic cancer care is unacceptable and reversible.
To combat this, the NCCN collaborated with the African Cancer Coalition, adapt the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) to create the NCCN Harmonized Guidelines™ for Sub-Saharan Africa. The collaboration also includes the American Cancer Society (ACS) and the Clinton Health Access Initiative (CHAI).
The NCCN Harmonized Guidelines™ offer two tiers of treatment recommendations: representing both the optimal care that these countries aspire to provide and pragmatic approaches that provide effective treatment options for resource-constrained settings.. The different versions provide specific recommendations depending on access to resources like radiation equipment or laparoscopic surgical tools.
The African Cancer Coalition comprises oncologists from Sub-Saharan Africa who are working together to improve access to high-quality cancer treatment. Co-chaired by Honourable Minister Isaac Adewole, Nigeria’s health minister, and Dr. Jackson Orem, Director of the Uganda Cancer Institute, the Coalition has 80+ members from 13 countries that are home to 55% of the cancer cases in Sub-Saharan Africa. We are joining forces to strengthen clinical guidelines, training, and technical collaboration to ensure that all people with cancer get access to effective, affordable treatment.
“This extraordinary collaboration between African oncology experts and NCCN will make it easier for oncologists to access up-to-date clinical guidance and ensure the highest standard of care for their patients,” said Meg O’Brien, PhD, managing director of Global Cancer Treatment at the American Cancer Society. “The NCCN Harmonized Guidelines empower patients and providers to focus on what is practical, achievable, and effective at present, while providing a template for future improvements and advances.”
“This collaboration provides an opportunity to bring together leading African oncology experts and NCCN experts to develop clinical guidance that ensures our patients get access to the highest quality cancer care possible,” said Jackson Orem, MD, executive director, Uganda Cancer Institute and co-chair of the African Cancer Coalition.
CHAI is working closely with NCCN and ACS to support the harmonization process and is engaging the Africa Cancer Coalition more broadly around access to medicines. Additional NCCN Harmonized Guidelines™ for Sub-Saharan Africa will be released in 2019, including Soft Tissue/Bone Sarcomas, Hodgkin Lymphoma, Anal Cancer, Gallbladder Cancer, Cholangiocarcinoma, Central Nervous System Cancers, and remaining Head and Neck Cancers.
In November 2017, Dr. Carlson participated in the presentation of the NCCN Harmonized Guidelines™ for Sub-Saharan Africa at a standing-room-only session during the African Organisation for Research & Training in Cancer (AORTIC) meeting in Kigali, Rwanda. Hundreds of medical professionals from across Africa, and elsewhere, converged to learn about this new resource, based on the NCCN Guidelines, and co-created with the African Cancer Coalition (ACC). Local experts rightfully took clear ownership of the materials, which present an array of options for cancer care targeted for various resource levels. The enthusiastic crowd members had a key question after the presentations: how can I get involved?
The New York Times has published an article about this collaboration: “As Cancer Tears Through Africa, Drug Makers Draw Up a Battle Plan”