Bristol Myers Squibb Foundation: Multinational Lung Cancer Control Program
Strengthen National lung cancer surveillance, lung cancer prevention, patient care pathways and survival in Tanzania
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Addressing barriers and improving access to early diagnostic services for lung cancer. Our goal is to improve access to cancer care services using lung cancer support as leverage.
The Multinational Lung Cancer Control Program (MLCCP) seeks to improve access to early diagnostic services for lung cancer by addressing the barriers of cancer care through working with communities and respective ministries of health in Eswatini, Ethiopia, Lesotho, Tanzania, Kenya and South Africa with a potential for scale-up. This program adds to the body of knowledge about lung cancer and supports the development of national policies and guidelines.
Our objects are to:
- Raise awareness on lung cancer and quantify the burden of lung cancer in Northern Tanzania.
- Raise awareness on lung cancer and quantify the burden of lung cancer in Northern Tanzania.
- Establish standardized diagnostics and pathology evaluation and reporting.
- Improve the differential diagnosis of TB and lung cancer.
- Establish a biobank for storage of the lung specimens for potential translational research.
Eswatini is a beneficiary of the three-year Multi-national Lung Cancer Control Program (MLCCP), an initiative for the African region, funded by Bristol Myers Squibb Foundation (BMSF), and in Eswatini the project is managed by URC and implemented by the Ministry of Health through Eswatini National Cancer Registry. This project commenced on the 1st of October 2017. The project is working to improve lung cancer surveillance, diagnosis, management and strengthening patient care pathways.
The goal of this project is to improve access to early diagnostic services for lung cancer by addressing the barriers to cancer care through working with the Eswatini Ministry of Health in strengthening the Eswatini National Cancer Registry. It is aimed at supporting evidence-based cancer registry, co-ordination and to establish the epidemiologic burden of lung cancer in tandem with improving Lung Cancer surveillance. The program will further build capacity of the cancer registry through continued professional development. The capacity-building and knowledge-sharing will improve Cancer Registry organizational effectiveness and maximize the beneficial impact of Lung Cancer health interventions. It employs scientifically proven strategies to improve access to health services among cancer patients along the patient care pathways. The goal of this project is to strengthen the capacity of the Eswatini National Cancer Registry initiative on lung cancer surveillance by supporting evidence-based cancer registry coordination which will help in establishing the epidemiologic burden of lung cancer. The program will also assist the Eswatini Ministry of Health to address barriers to cancer care and improve access to early diagnostic services.
Lung cancer is among the most common cancers in the world. It is estimated that about 1.8 million new cases of lung cancer occur every year, globally. Over 58% of lung cancer cases occur in developing countries, where many people living with lung cancer present to health facilities very late, making treatment and care less effective. Moreover, many African countries lack an understanding of the disease’s epidemiology, thus making it difficult to have tailored prevention strategies, which contributes to limited diagnostic and treatment facilities for lung cancer. These factors also contribute to late presentation and high mortality. Generally speaking, the true burden of lung cancer in many countries is underestimated. In Tanzania, the majority of lung cancer risk factors are present in the mining and fishing industries. The regions were mining and fishing occur are overpopulated and stressful in terms of work. Many people living in these areas are heavy smokers (people frequently have more than 14 smoking pack/year histories). The Tanzanian Lung Cancer project is part of the Multinational Lung Cancer Control Program (MLCCP) in Africa, funded by BMSF aimed at improving access to early diagnostic services, treatment and care for lung cancer. These aims will be reached by addressing the barriers to cancer care through working with communities and the Ministries of Health in Kenya, South Africa and Tanzania with the potential for scale-up into other African countries.
KwaZulu, South Africa
Aims to improve early diagnosis of lung cancer by establishing outreach screening services and establishing a lung cancer diagnostic and care center at a regional cancer care center in KwaZulu-Natal, South Africa.
Wits Health Consortium
The vision of the Lung Laboratory Centre of Research and Intervention is to address the inadequate lung cancer management in the public health system of Gauteng Province. The province has an environment of a high prevalence of tuberculosis and other serious lung diseases. Providing accurate and timely diagnosis of lung cancer may lead to improved outcomes in terms of mortality and morbidity and provide supportive care for the patients and their families from the time of diagnosis. We aim to improve lung cancer management through training in lung cancer screening, diagnosis, and management with a particular training focus on expanding palliative care resources in Southern Africa. A strong research component will support service delivery while collecting data to provide much-needed information on the epidemiology of lung cancer as well as looking at needs and challenges and providing solutions for improved health care services and targeted lung cancer screening for high-risk patients.
Specific project objectives include:
- Establishment of the Wits Centre for Respiratory Excellence (CORE): Fully staffed with electronic databases for data collection and monitoring and evaluation target indicator reports in year 1
- Research: needs analysis (challenges) by consensus, for early detection and treatment of lung cancer patient in year 2; Evaluation of minimally invasive EBUS lung cancer diagnosis & treatment impact in year 2; characterization of disease in lung cancer and other smoking-related respiratory illness in year 3, pilot of a lung cancer screening protocol for high risk patients, in year 3 & 4
- Service delivery: Expand lung cancer diagnosis, treatment management and palliative care Services (ongoing); Expand community awareness, patient navigation, support and referral services (ongoing), establish a smoking cessation clinic (year 3)
- Training: Expand clinical lung cancer and palliative care training at tertiary, secondary and primary care levels and to BMSF partner sites (ongoing)
- Lung cancer screening project: Implement a high-risk lung cancer screening program and a smoking cessation program at HJH in year 3
Lung cancer is the most common cancer worldwide, and disproportionately affects developing countries where over 58% of cases occur. This, however, is in sharp contrast with the low incidence rates of lung cancers reported in Africa. This apparently “low burden” of lung cancers in the context of critical lack of accurate data, likely reflects enormous underestimations of the true burden of the disease. Indeed, most African countries lack nationwide or regional population-based cancer registries and have no reliable source of mortality data.
In Kenya, with an average population of 47 million people, cancer ranks third as a cause of death after infectious diseases and cardiovascular diseases. It causes 7% of total national mortality every year. Although population-based data does not exist in the country, it is estimated that the annual incidence of cancer is about 40,000 cases and the annual mortality to be over 28,000. Over 60% of those affected are below the age of 70 years with 70-80% of patients diagnosed at an advanced stage.
Like many Sub-Saharan African countries Kenya is compounded with the burden of co-morbidities such as HIV and TB. It is important to note that, cultural beliefs have influenced health-seeking behaviors, where those with signs and symptoms or already diagnosed with cancer resort to alternative medicine as a preference or in parallel with modern medication. Thus, Kenya remains one of the highest disease-burden countries in Sub-Saharan Africa.
Having recognized the low cancer awareness, uncoordinated or missing screening services, late diagnosis and less effective therapeutic solutions among other challenges, the Multinational Lung Cancer Control Program (MLCCP) led by BMSF is working within selected countries in Africa namely Kenya, South Africa, the Kingdom of Eswatini and Tanzania to provide support towards improving access to early diagnostic services for lung cancer in specific regions. With no particular target group, the program aims at achieving this by addressing the barriers of lung cancer through working with communities and the ministry of health in the respective countries.
AMPATH Lung Cancer Control Program is part of the wider partnership of the MLCCP supported by BMSF. The program recognizes the need to bring all players to partner, collaborate and ensure concerted effort to mitigate against all existing barriers to lung cancer diagnosis, care, and management.
The objectives of AMPATH-MLCCP in Kenya are:
- Raise awareness and quantify the true burden of lung cancer disease in the region.
- Validate tools for screening high risk groups for lung cancer in the community
- Identify and mitigate barriers to lung cancer care and management.
- Assess the risk factors associated with lung cancer in our settings
- Establish standard diagnostic and pathology evaluation and reporting.
- Establish a Biobank for storage of specimen
Results and milestones
- 70% (801) of clients diagnosed with stage 4 lung cancer; 14.6% (167) with stage 3 and 3.8% (43) with stage 2, stage 1 and stage 0. 133 (11.6%) were unstaged/unknown.
- Most clients are now being staged, however unstaged clients increased from 117 in August 2022 to 133 in December 2022.
- The MLCCP referred lung cancer patients for treatment & 68% of all lung cancer patients were initiated on 1st line treatment [MLCCP is facilitating access to treatment]
- 53% of those initiated on treatment completed 1st line treatment
- 17.5% are currently on treatment
- 16.5% were lost to follow up [There is are still opportunities to reduce lost to follow up]
- 39% of lung cancer patients have died as most patients are diagnosed in late stages.
- Though most patients are diagnosed at late stages, 36% reported improved quality of life since they started receiving support from the MLCCP.
- Non-communicable Diseases
- People with low incomes
- Rural populations
SGDs the partnership contributes to
- 3.4: NCDs (including mental health)
- 3.8: Achieve universal health coverage
Ethiopian Ministry of Health
Ministry of Health Kenya
Ministry of Health Lesotho
Ministry of Health South Africa
Ministry of Health Eswatini
Bugando Medical Centre in Mwanza, Tanzania
Eswatini Hospice at Home – National Cancer Control Unit
Wits Health Consortium
NATIONAL UNIVERSITY OF LESOTHO - SENKATANA ONCOLOGY CLINIC
UNIVERSITY OF KWAZULU NATAL
UNIVERSITY RESEARCH COUNCIL ESWATINI
Mathiwos Wondu Ye Cancer Society (Tanzania)
Logistics and Supply Chain
TB HIV CARE/THE EASTERN CAPE COMMUNITY COLLABORATIVE CANCER INITIATIVE;
Academic Model Providing Access to Healthcare (AMPATH)
- United Republic of Tanzania
- Lung Cancer