AORTIC 2013

Dr Jimmie Holland talks to ecancer at the 2013 AORTIC meeting in Durban, South Africa about the psychosocial distress associated with a cancer diagnosis. Dr Holland discusses that the word “distress” covers several psychosocial issues that a cancer diagnosis raises, which are universal and cross cultures, ranging from physical symptoms of pain, fatigue, treatment side effects to social and spiritual distress.

President of AORTIC, Dr Isaac Adewole, discusses the newly published African Continent Cancer Plan and the overarching strategies to address cancer in Africa. The document is a targeted, 5-year plan for prostate, breast, cervix, lung and liver cancers with the ultimate goal of decreasing cancer incidence and mortality in Africa.

Dr Ahmed Elzawawy talks about the 2013 AORTIC meeting and the goals of the organisation over the next two years.

Dr James Holland, one of the co-founders of AORTIC, discusses some of the top research projects in the BIG CAT grant programme.

There is a drastic shortage of accessible knowledge and quality training programmes in Africa for comprehensive cancer control. In particular, local capacity to train and mentor practitioners within the region is not sufficient to ensure sustainable cancer control. The International Atomic Energy Agency (IAEA), through its Programme of Action for Cancer Therapy (PACT) in cooperation with its international partners in cancer control, launched, in 2010, an initiative to establish a Virtual University for Cancer Control supported by regional cancer training and mentorship networks. Susan Morgan discusses the goals and objectives of the VUCCnet at the 2013 AORTIC meeting in Durban, South Africa.

Dr Ahmed Elzawawy talks to ecancer at the 2013 AORTIC meeting about ways of implementing affordable radiotherapy to Africa.

Dr Daniela Cristina Stefan talks to ecancer at the 2013 AORTIC meeting in South Africa about the urgent need to improve the registration of cancer in children in Africa. Registries, rather, provide information that is vital to plan the services of paediatric oncology units and the collected information has the potential to assist scientific analysis, planning and research. An estimated number of new childhood cancer cases is between 46,000 and 57,000 a year, on the African continent.

Dr Chioma Asuzu talks to ecancer at the 2013 AORTIC meeting in Durban, South Africa about traditional healers in African and the need to work together with them as part of a community in order to improve a patients care. Dr Asuzu and her team assessed the use and impact of traditional and alternative medical treatment by cancer patients, its implications and explored possibilities for greater understanding and cooperation between these practitioners and their health systems with scientific medicine. The study found that 24% of the 209 participants have visited traditional or alternative healers before coming to the health facilities. 30.0% of the 50 traditional healer participants said they would talk to researchers, while 28.0% were unsure. 42.0% said that they would not assist or talk to the researchers.

Dr Gordan Vujanic talks to ecancer at the 2013 AORTIC meeting in South Africa about the pathology and treatment of nephroblastoma and how this is based on their histological diagnosis and stage. A pathologist deals with a nephrectomy specimen that is altered with pre- operative chemotherapy and has to be familiar with chemotherapy-induced changes, to assess their amount (first on gross and then on histological examination) and to follow the protocol for examining and sampling the tumour, as it is critical for accurate sub-typing and staging. Since nephroblastoma is a relatively rare tumour, pathologist’s experience is rather limited resulting in inaccuracies in diagnosis/sub-typing and staging. However, rapid central pathology review makes sure that children with renal tumours are treated appropriately.

At the 2013 AORTIC meeting in Durban, South Africa, Dr Verna Vanderpuye talks to ecancer about a recent survey on breast cancer management in Africa. Results from the survey found that more countries need access to multidisciplinary breast cancer care and that too many lack important resources such as immunohistochemistry facilities and reliable radiotherapy services. Dr Vanderpuye also talks about data highlighting the need for examination of drug control policies and the repeal of excessive restrictions that impede this most fundamental aspect of cancer pain management.

Kaposi’s Sarcoma is the most common AIDS-related malignancy in sub-Saharan Africa and is associated with the herpes virus. It is classified into six major subgroups (A-F) and subtype B and A5 predominate in Africa. The viral G protein-coupled receptor (vGPCR) is the key molecule for the initiation and maintenance of Kaposi’s Sarcoma. Dr Abera discusses a recent study that looked at the profiling of sub types of Kaposi’s Sarcoma.

The World Health Organisation recently issued recommendations on the use of a screen and treat approach using visual inspection with acetic acid (VIA) for screening and treatment with cryotherapy. These recommendations are published in the new WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Dr Broutet discusses the development and contents of the new guidelines at the 2013 AORTIC meeting.

Dr Robert Satcher discusses using eHealth modalities to develop new models for decentralising cancer care delivery. The pilot strategy's goals include extending expert-based multidisciplinary oncology patient encounters regionally and internationally, implementing integrated medical, surgical, and radiological cancer care and enrolling patients in clinical research protocols. Dr Satcher highlights that the potential benefits of establishing a comprehensive eHealth capability are numerous but most importantly include cost savings and improving patient access to quality cancer care to rural areas.

Dr Chibuike Chigbu talks to ecancer about the results from a study that investigated the impact of a new, low cost method for cervical cancer screening. During the study, the rate of cervical cancer screening improved from 0.6% to 99.1% of eligible inhabitants of participating communities. Awareness and uptake of cervical cancer screening was attributable to the community-engagement approach adopted for the study. Overall, visual inspection with acetic acid screening and immediate treatment of women testing positive with cryotherapy is an effective strategy for cervical cancer prevention in low-resource populations of southeastern Nigeria.

Chair of the scientific committee for the 2013 AORTIC, Dr Seringe Gueye, discusses some of the highlights from this year’s meeting, including prostate and breast cancer management, palliative care and working with traditional healers. Categories

Dr Margaret Fitch talks to ecancer at the 2013 AORTIC meeting in South Africa about the psyco-social care of cancer patients. Individuals diagnosed with cancer frequently experience more than a physical or biological impact from their disease and its treatment. They also cope with emotional, social, spiritual and practical consequences. Early identification of the resulting distress and the provision of appropriate interventions to reduce or ameliorate this distress are cited as a standard of high quality cancer care. In order to ensure this standard is achieved, concrete strategies are required.

Using Training modules for radical hysterectomy, consisting of pre and post-tests, power point and video presentations of the procedure, node dissection and complications including bladder, ureter and vessel injuries, a programme was developed in order to teach doctors how to perform this radical procedure. Dr Barry Rosen talks to ecancer at AORTIC 2013 in Durban, South Africa about the development of this course in Kenya and how surgery is an essential part of the treatment of stage 1 cervical cancer. In Kenya, there are very few oncologic trained surgeons. This program demonstrates a strategy to train surgeons in the surgical management of cervix cancer and provides an education model that can be applied to others cancers.

Dr Thandinkosi Madiba talks to ecancer at the 2013 AORTIC meeting in Durban, South Africa about colorectal cancer in South Africa. Colorectal cancer is amongst the top ten cancers in South Africa. The study looked at a total of 485 patients were where the average age was 62.97 14.97 years and Africans were significantly younger than all the other groups combined . The most common site in all population groups was the rectum followed by the sigmoid colon and the right colon with resection rates of 50% (African), 68% (Indian), and 69% (Coloured) and 7% (White). Staging was similar in the different population groups namely: stage I, stage II , stage III, stage IV. Amongst Africans 25% were 40 years, and the African population represented 66% of all the cases who were 40 years of age. The study found that colorectal cancer is an established disease that presents earlier among Africans and has a variable clinicopathological spectrum. Dr Madiba also discusses how affordable screening methods could reduce mortality from colorectal cancer.

Dr Ophira Ginsburg talks to ecancer at the 2013 AORTIC meeting in Durban about the use of mobile technologies in treatment of cancer patients in rural areas. Women in rural Bangladesh delay seeking care for serious breast problems until it is too late. The study examined if community health workers guided by mobile phones with special applications would be more effective than community health care workers without the phones in identifying women with serious breast problem, and encouraging them to attend for care. The study found that community health care workers guided by smart phones were more efficient and effective than control group. Community health care workers with additional training and mobile phones were superior to those with phones but without the extra training, in encouraging women with a serious breast problem to attend for proper care. Dr Ginsburg also discusses the possibility of future studies both in other countries and in other cancer types.

Dr Mary Gospodarowicz, President of the Union for International Cancer Control (UICC) , discusses accessibility to radiotherapy throughout the world and a taskforce, along with the International Atomic Energy Agency (IAEA), that has been established to evaluate and improve access. Currently, the supply of radiotherapy services falls short of demand in many parts of the world including many of high income countries. However, the shortage is so pronounced in low and middle income countries that it precludes radiotherapy from being considered as part of cancer management. Fiscal constraints and the pressure to treat as many patients as possible may lead to cost cutting initiatives which in turn may result in compromised staffing levels, limited facilities and less attention to the quality.

Palliative care in prostate cancer has become more important with an aging population and is now encompassing more than just physical pain. Metastatic prostate cancer is incurable and does cause significant morbidity, but the focus of treatment should be on improving quality of life through appropriate oncological treatment and palliative care. Dr Ali discusses how palliative care involves managing symptoms that are physical, psychological, spiritual and social and involves those close to the patient.

Dr Oliver Bogler talks to ecancer at the 2013 AORTIC meeting about MD Anderson Cancer Center's work with institutes across Africa.

Dr Mary Gospodarowicz talks to ecancer at the 2013 AORTIC meeting about the purpose of staging and how it aids the clinician in the planning of treatment, giving indication of prognosis, assisting in evaluation of the results of treatment, and supporting cancer control activities. While initial treatment recommendations are based on the clinical stage, the recommendations for adjuvant therapy are mostly determined by pathologic stage. Recording of cancer stage in hospital or population based cancer registries greatly enhances their value, in assessing the value of screening programs, informs resource allocation, evaluates compliance with treatment guidelines, compares survival trends, enhances cancer control and should be standard.