AORTIC 2015

Dr Ghosh talks to ecancertv at AORTIC 2015 about the MD Anderson's Africa Initiative which focuses on training and educating doctors, nurses and clinicians from Africa using their multidisciplinary approach. She talks about their activities working with institutions in Zambia and Mozambique and says that they have also learned from African healthcare professionals about the specificities of the cancer management challenge in Africa and the ways they have approached it.

Dr Onyeka talks to ecancertv at AORTIC 2015 about the importance of every African oncologist to be able to administer basic palliative care, early on in the diagnosis to improve quality of life. As well as pain management, she notes the spiritual and psychological importance of culturally sensitive palliative care. For example, she highlights the issue of religion leading people to believe that they have been punished or cursed. She also notes the logistical issues in people getting to hospitals and the importance of drawing on the structure of extended family to help patients.

Dr Rudd talks to ecancertv at AORTIC 2015 about the cervical cancer situation in Malawi, including screening, the HPV vaccine, and treatment options. She argues that the main barriers are a lack of awareness and lack of infrastructure. She emphasises prevention as the most important way forward and notes the important role that the government will have in putting this on the agenda.

Dr Munishi talks to ecancertv at AORTIC 2015 about the correlation between the temperature of your tea or coffee and the occurrence of oesophageal cancer. In particular, he has been looking at the situation in Moshi, where he is from, whereby the custom is to boil the water, milk and sugar together in a pot and drink it very quickly whilst it is still extremely hot.

Dr Gospodarowicz talks to ecancertv at AORTIC 2015 about the task force that has been established to improve access to radiotherapy in low and middle income countries. She says that currently the focus in Africa has been on tobacco control, vaccination, and palliative care because their health sysems are ill equipped to adequately treat cancer, especially with radiotherapy. There are thirty countries in Africa that have no access to radiotherapy at all, and even those who do have so few facilities that two year waiting lists are common, she says. For the amount of work involved in obtaining facilities, training, and implementation, she says 20 years is a realistic timeframe. Radiotherapy is important because it can be used to extend surival when used optimally. She argues that certain measures, such as improving efficiency, can help reduce the running costs of equipment, and that although the initial outlay of funds is significant, it will pay off in the long run. Governments and international organisations should work together to meet these goals, she says, and there is an important role for mentoring and e-learning.

Dr Bogler talks to ecancertv at AORTIC 2015 about the work of the Global Academic Program (GAP) at the MD Anderson Cancer Center. The programme helps train healthcare providers globally. He says that although there have been many gains in cancer research, the benefits are unevenly distributed. In Africa, the focus of GAP has been on capacity building and they have partnered with various organisations and institutions such as the UICC. Efforts in Africa should be focussed on tobacco controls, screening for HPV and breast cancer, the HPV vaccine, and better access to radiotherapy. He explains how through on-site workshops, collaboratively produced educational materials, treatment guidelines and telementoring, GAP has been able to help.

Dr Mbatani talks to ecancertv at AORTIC 2015 about the difficulties facing cervical cancer-related screening programmes in Africa. She describes the situation of the PAP smear test as being less than ideal because due to a lack of lab technicians in Africa and difficulty getting the samples to the lab, it takes a month for a woman to get the results. Furthermore, she explains how it is often hard to get the results successfully communicated back to the person who has been tested. The method which involves the visual inspection of the cervix using iodine is better, as the diagnosis and treatment (if applicable) can be given at the time of the test. However, this method requires training which is often lacking and tends to result in over-treatment, she says. She argues that the most reliable method of screening is the HPV test but that it needs to come down in price before it can be implemented in Africa.

Dr Mutebi talks to ecancertv at AORTIC 2015 about surgical oncology services in Sub-Saharan Africa. She outlines the practical steps that can be taken, in terms of physical and human resources, to combat the surgical deficit. Eighty percent of cancer patients are going to require surgical intervention, she says, meaning many more surgeons are required in Sub-Saharan Africa. Encouraging governments to invest in their health systems is crucial, she says. Establishing networks and multidisciplinary medical communities will also be a necessary step. She notes the importance of surgeons within Africa acting as catalysts for change by undertaking advocacy roles and says that Centres of Excellence must be identified from which surgical expertise can be developed. Finally, she demonstrates the way these approaches have worked in the breast clinic where she works.

Dr Ramondetta talks to ecancertv at AORTIC 2015 about global inequities in cancer care and the insight she has gained by learning about the creative approaches to cancer care taken in Africa. She discusses things such as 'telementoring' which enable the exchange of skills across borders, and the harnessing of the private sector which has seen companies deliver drugs and vaccines along with their regular deliveries. Ultimately though, she argues that governments need to take cancer care more seriously. Noting how successful Rwanda has been in vaccinating over 90 percent of its girls, she says it is "totally unacceptable" for governments to not implement HPV vaccination programmes. She explains how cost is not the only issue surrounding the HPV vaccine, citing the fact that only 30 to 40 percent of girls in the US have been vaccinated due to confusion, uneven access, and lack of education and understanding on sexual health. Furthermore, governments need to recognise that it is "totally unacceptable to not have a radiation facility within your country", she says.

Dr Ramondetta talks to ecancertv at AORTIC 2015 about global inequities in cancer care and the insight she has gained by learning about the creative approaches to cancer care taken in Africa. She discusses things such as 'telementoring' which enable the exchange of skills across borders, and the harnessing of the private sector which has seen companies deliver drugs and vaccines along with their regular deliveries. Ultimately though, she argues that governments need to take cancer care more seriously. Noting how successful Rwanda has been in vaccinating over 90 percent of its girls, she says it is "totally unacceptable" for governments to not implement HPV vaccination programmes. She explains how cost is not the only issue surrounding the HPV vaccine, citing the fact that only 30 to 40 percent of girls in the US have been vaccinated due to confusion, uneven access, and lack of education and understanding on sexual health. Furthermore, governments need to recognise that it is "totally unacceptable to not have a radiation facility within your country", she says.

Dr Charaka talks to ecancertv at AORTIC 2015 about breast cancer screening in Morocco. She says that breast cancer is the biggest cancer in Morocco for women in terms of incidence and mortality. She explains how, in 2010, a collaboration of organisations worked together to develop a breast cancer screening programme in Morocco since it had only been offered by private companies prior to that. Though the scheme is going well, a lack of education and understanding has led to a low participation rate in screening vis-à-vis other countries. This, she says, will need to be addressed going forward.

Prof Snyman talks to ecancertv at AORTIC 2015 about the use of sentinel lymph node detection to diagnose uterine cancers such as endometrial and cervical. He highlights the problem of HIV, tuberculosis and pelvic inflammatory disease in Africa and its negative impact on the accuracy of sentinel lymph node detection.

Dr Odedina talks to ecancertv at AORTIC 2015 about the work of the African Organisation for Research and Training in Cancer (AORTIC) Education and Training Plan. The needs of African healthcare providers were assessed with a survey. Once the needs have been identified, the resources necessary to meet this needs will be assessed with a second survey, she explains.

Dr Dreyer talks to ecancertv at AORTIC 2015 about fertility-sparing surgery in early-detected cervical cancer. She says that, unfortunately in Africa, the majority of cervical cancer is detected at a late-stage. Loss of fertility can have a big impact on women in Africa as it can ruin their chances of obtaining or keeping a husband, she explains. This leads to a woman being unable to meet her basic needs. Surgeons need to be educated about fertility-sparing (uterus retaining) surgery so that they can use it wherever possible, she says.

Dr Luyirika talks to ecancertv at AORTIC 2015 about the measures that need to be taken to improve cancer patients' access to palliative care. He says that palliative care needs to be part of the medical curriculum and that more resources need to be committed to education, noting the importance of the African Union and regional bodies in Africa in working together towards this goal.

Dr Odedina talks to ecancertv at AORTIC 2015 about the importance of the AORTIC Advocacy Program. The Advocacy Program was initiated in 2011 and involves training people to be advocates who can educate and raise awareness on cancer throughout Africa. In 2013, the Master Advocates Program was initiated, which involves advocates from around the world providing their insight and skills to train others. Since conferences are only every two or three years, she notes an important aspect of the scheme which involves advocates who have undergone three years of training and mentoring training 100 people themselves over the next three years. This means that people don't have to wait for the next conference to receive training. Cancer survivors in particular are encouraged to be advocates as they are "the true face of cancer", she says. Furthermore, she speaks of the Cancer Control Plan which was also established by AORTIC in 2013, to address the problem of many countries not having a plan in place.

Dr Kampani talks to ecancertv at AORTIC 2015 about 'telepathology' in Africa. Telepahology involves experts from different countries being able to analyse slides from under the microscope via the internet. This is extremely useful in countries were expertise in pathology are more scarce. Dr Kampani talks with particular reference to his experience in Malawi, working with the University of Carolina in the USA.

Dr Baskies talks to ecancertv at AORTIC 2015 about breast cancer in Africa. He says it is the biggest cancer effecting women in Africa and it is normally detected once it has already metastasised. He talks about the work that the American Cancer Society and WHO are doing to improve the situation but also notes the crucial role of governments. Finally, he discusses prevention, saying that tobacco use is the main issue that needs to be addressed and that fifty percent of all deaths worldwide could be prevented if governments committed to "doing what's right".

Dr Armando talks to ecancertv at AORTIC 2015 about the results from the cancer registry of the National Oncology Centre of Luanda, Angola. The majority of patients in Africa are diagnosed at an advanced stage, he says. In particular, he explains how there is a high proportion of girls diagnosed below the age of 50 with breast cancer in Angola. He discusses how screening methods and policies need to be changed so that cancer is detected earlier.

Prof Elzawawy talks to ecancertv at AORTIC 2015 about the development of a roadmap for cancer control in Africa. He stresses the importance of a multidisciplinary approach which looks at integrating pathology, palliative care, immunotherapy etc. This is, of course, a huge undertaking which involves the input of many organisations. He speaks with particular reference to the Lalla Salma Foundation in Morocco which is a good example, he says, of a local foundation with international connections that can help achieve a lot both regionally and internationally.

Prof Ginsburg talks to ecancertv at AORTIC 2015 about the different ways in which health equity in cancer can be promoted across Africa, with a particular focus on female cancers and the important role of women in administering care and lobbying policy makers. She also describes a session on breast cancer and the barriers to screening. She explains how training is more important than equipment that people don't know how to use. Though her work has been looking at palliative care in under-resourced rural areas, she also mentions the important work of Dr Mary Gospodarowicz in making sure that every government invests in radiotherapy facilities.

She explains how people are working together to promote cross-border and intracontinental capacity building in research and training in Africa. She argues the need to move away from a Europe and US based support system and draw on already existing capacity in the continent. She also notes the importance of expanding that capacity to places previously unreached. In particular, she notes the facilities and expertise in South Africa and its role as a hub of education from which people can draw knowledge and take it back to their country. Where there was a divergence was in the fears surrounding death, but she argues that this was related to socioeconomic status rather than race. This information can inform which aspects of awareness raising need to be focussed on, she says.

Dr Rayne talks to ecancertv at AORTIC 2015 about breast reconstruction surgery. She found that there were less complications and less costs involved in a direct to implant reconstruction for mastectomy which doesn't make use of acellular dermal matrices. This is great news for the public sector, she says.

Dr Rayne talks to ecancertv at AORTIC 2015 about tamoxifen adherence in South Africa. She says that, alarmingly, two thirds of women said they had considered stopping taking their tamoxifen when surveyed. Women cited both side effects and transport issues among others, she says. She argues that the benefits of the drug - namely protection against relapse - need to be properly communicated to patients to encourage them to maintain the tamoxifen regimen.

She says that the majority of fears were to do with treatment and side effects and that this was true across different ethnic and socio-economic groups. Surprisingly, she says, fears of being unable to commit to treatment due to cost or conflicts with work or family responsibilities featured low on the list. Where there was a divergence was in the fears surrounding death, but she argues that this was related to socioeconomic status rather than race. This information can inform which aspects of awareness raising need to be focussed on, she says.

Prof Rochord talks to ecancertv at AORTIC 2015 about the establishing of a population based cancer registry in Kasumi, Kenya. She discusses some of the challenges they have faced and the reasons why cancer registries are so important. The cancer registry informs where resources should be concentrated in terms of treatment and prevention, she explains. Registry capacity-building in Kenya is being helped by the National Cancer Institute in the US and has support from the Kenyan government, she says.

Dr Sankaranarayanan talks to ecancertv at AORTIC 2015 about cervical cancer prevention with the HPV vaccine. He says that HPV vaccination is one of the easiest vaccination programmes to scale up. Screening is also important, he says, but requires the simultaneous enhancement of the healthcare infrastructure to work properly. Vaccinating 10 - 14 year old girls with the HPV vaccine and screening women in their 30s will be the best strategy for decreasing cervical cancer mortality in Africa, he says. He also explains about how the cost of the HPV vaccine can be cushioned by applying for help from the Gavi Vaccine Alliance. Furthermore, he argues that Africa could learn from countries such as Latin America who are able to purchase the HPV vaccine at a reduced rate by buying in bulk. African countries could form a consortium to make collective purchases.

Dr Sankaranarayanan talks to ecancertv at AORTIC 2015 about the importance of cancer registries in informing and evaluating cancer control plans. He talks about his work looking at breast cancer incidence and the ways cancer registries have improved prevention, detection and treatment. He also highlights the case of the HIV AIDS-related cancer, Kaposi's Sarcoma, which rapidly climbed in Uganda along with the HIV epidemic, but declined just as rapidly, he says, because of cancer registries. The registry informed awareness-raising campaigns and the administering of antiretroviral medicine which controlled the spread of HIV.

Dr Jalloh talks to ecancertv at AORTIC 2015 about the perspective of PSA-based active surveillance of prostate cancer in Africa and developing countries. Active surveillance is one of the treatment modalities of prostate cancer.

Dr Botteghi talks to ecancertv at AORTIC 2015 about the work of the Association Vittorio Tison's work in telepathology in Tanzania. Telepathology enables the live diagnosis of diagnostic images as well as document sharing and the transfer of skills. This addresses the lack of medical pathologists in the country, he says. He explains the ways in which the initiative will be expanded in the future, including the adding of more sites.

Dr Imane Maane talks to ecancertv at AORTIC 2015 about a lack of accurate prostate cancer screening facilities in Africa and Morocco in particular. She argues for the PCA3 test to be implemented in Africa in combination with AMACR quantificationas it is cheap and effective.

Dr Kantelhardt talks to ecancertv at AORTIC 2015 about the findings of the cancer registry in Ethiopia and the benefits and difficulties of establishing a cancer registry. They have found that breast is the number one cancer effecting women and colorectal is the number one cancer effecting men. She says that colorectal cancer is not as prominent in other African countries so this is a good example of how important it is to understand the particular situation of each country. She says that it isn't enough to just establish a cancer registry - the task needs to be successfully handed over to governments to keep it going for long-term benefits.

Dr Baker talks to ecancertv at AORTIC 2015 about the telementoring scheme, Project ECHO (Extension for Community Healthcare Outcomes). Though the scheme originates in the USA, they have since teamed up with many institutions in Africa and elsewhere. People are mentored by experts via video conferencing. The scheme is free and relies on two key factors, she says - enthusiasm and an internet connection.

Dr Merriman talks to ecancertv at AORTIC 2015 about the importance of pain management in palliative care. She outlines the history of palliative care and pain relief in Africa. The stress on addiction, she says, has been very damaging as people who need morphine haven't had access to it in many African countries. She explains that the price of oral affordable morphine in Uganda has gone up due to health and safety concerns but still remains cheap, safe, and effective. We need to better educate undergraduates training to be doctors on the importance of pain control, she argues, as doctors inform government policy.