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Mutyaba, Innocent, Henry R. Wabinga, Jackson Orem, Corey Casper, and Warren Phipps. "Presentation and Outcomes of Childhood Cancer Patients at Uganda Cancer Institute." Global Pediatric Health 6 (January 2019): 2333794X1984974. http://dx.doi.org/10.1177/2333794x19849749.
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Introduction. Limited data suggest that children with cancer in sub-Saharan Africa have poor survival. We aimed to describe the presentation, treatment outcomes, and factors associated with survival among children with cancer managed at Uganda Cancer Institute. Methods. We retrospectively evaluated patients with childhood cancer (age ≤19 years) from Kyadondo County treated at Uganda Cancer Institute from 2006 to 2009. Cox’s regression and Kaplan-Meier methods were used to study 1-year survival. Results. Among 310 patients studied, median age was 7 years (range = 0.25-19 years), 64% were boys, and 92% had histological confirmation of cancer diagnosis. The commonest diagnoses were Burkitt lymphoma (BL, N = 87), Kaposi sarcoma (KS, N = 68), non-BL non-Hodgkin lymphoma (NHL, N = 32), acute lymphoblastic leukemia (ALL, N = 28), Wilms (N = 28), and Hodgkin disease (HD, N = 20). Advanced disease at diagnosis was common for all cancers (ranging from 45% for KS to 83% for non-BL NHL). Overall, 33.2% abandoned treatment. One-year survival was 68% for HD (95% confidence interval [CI] = 11.3-40.6), 67% for KS (95% CI = 52.1-77.9), 55% for BL (95% CI = 42-66.9), 44% for Wilms (95% CI = 22.5-63), 43% for non-BL NHL (95% CI = 23.3-61.3), and 20% for ALL (95% CI = 6.4-38.7). In univariate and multivariate analysis, anemia and thrombocytopenia were associated with mortality for several cancers. Conclusion. Survival among children with cancer in Uganda is poor. Advanced stage disease and loss to follow-up likely contribute to poor outcomes. Anemia and thrombocytopenia may augment traditional staging methods to provide better prognostic factors in Uganda and warrant further evaluation.
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Okuku, Fred, Jackson Orem, George Holoya, Chris De Boer, Cheryl L. Thompson, and Matthew M. Cooney. "Prostate Cancer Burden at the Uganda Cancer Institute." Journal of Global Oncology 2, no. 4 (August 2016): 181–85. http://dx.doi.org/10.1200/jgo.2015.001040.
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Purpose In Uganda, the incidence of prostate cancer is increasing at a rate of 5.2% annually. Data describing presentation and outcomes for patients with prostate cancer are lacking. Methods A retrospective review of medical records for men with histologically confirmed prostate cancer at the Uganda Cancer Institute (UCI) from January 1 to December 17, 2012, was performed. Results Our sample included 182 men whose mean age was 69.5 years (standard deviation, 9.0 years). Patients who presented to the UCI had lower urinary tract symptoms (73%; n = 131), bone pain (18%; n = 32), increased prostate-specific antigen (PSA; 3%; n = 5), and other symptoms (6%; n = 11). Median baseline PSA was 91.3 ng/mL (interquartile range, 19.5-311.3 ng/mL), and 51.1% of the patients (n = 92) had a PSA value above 100 ng/mL. Gleason score was 9 or 10 in 66.7% of the patients (n = 120). Ninety percent (n = 136) had stage IV disease, and metastatic sites included bone (73%; n = 102), viscera (21%; n = 29), and lymph nodes (4%; n = 5). Spinal cord compression occurred in 30.9% (n = 55), and 5.6% (n = 10) experienced a fracture. A total of 14.9% (n = 27) underwent prostatectomy, and 17.7% (n = 32) received radiotherapy. Gonadotropin-releasing hormone agonist was given to 45.3% (n = 82), 29.2% (n = 53) received diethylstilbestrol, and 26% (n = 47) underwent orchiectomy. Chemotherapy was administered to 21.6% (n = 39), and 52.5% (n = 95) received bisphosphonates. During the 12 months of study, 23.8% of the men (n = 43) died, and 54.4% (n = 98) were lost to follow-up. Conclusion UCI patients commonly present with high PSA, aggressive Gleason scores, and stage IV disease. The primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation, and a large number of patients are lost to follow-up.
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Bender Ignacio, Rachel, Matine Ghadrshenas, Daniel Low, Jackson Orem, Corey Casper, and Warren Phipps. "HIV Status and Associated Clinical Characteristics Among Adult Patients With Cancer at the Uganda Cancer Institute." Journal of Global Oncology, no. 4 (December 2018): 1–10. http://dx.doi.org/10.1200/jgo.17.00112.
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Purpose HIV increases cancer incidence and mortality. In Uganda, the HIV epidemic has led to an elevated incidence of AIDS-defining cancers (ADCs) and non–AIDS-defining cancers (NADCs). Limited information exists about how frequently HIV infection complicates the presentation and manifestations of cancer in sub-Saharan Africa. Methods We abstracted medical records from patients with cancer who were age 18 years or older who registered at the Uganda Cancer Institute from June through September 2015 to determine the burden of HIV. We used χ2 tests and generalized linear models to evaluate factors associated with HIV positivity. A sensitivity analysis estimated HIV prevalence in those untested. Results Among 1,137 patients with cancer, 23% were HIV infected, 48% were HIV negative, and 29% had no recorded HIV status. Of those with recorded HIV status, 32% were HIV positive. Forty-two percent (149 of 361 patients) with ADCs were documented as HIV infected (51% of those with documented status) compared with 14% (108 of 776 patients) of those with NADCs (21% of those with documented status). In multivariable analysis, HIV infection was associated with ADC diagnosis (adjusted prevalence ratio [aPR] compared with NADC, 2.2; 95% CI, 1.5 to 3.0), younger age (aPR, 0.9 per decade increase; 95% CI, 0.8 to 1.0), and worse performance status scores (aPR, 1.2 per point ECOG increase; 95% CI, 1.0 to 1.5). When sensitivity analysis accounted for undocumented HIV status, the expected prevalence of HIV infection was 29% (range, 23% to 32%), and almost one fourth of expected HIV cases were undiagnosed or unrecorded. Conclusion The prevalence of HIV infection among Ugandan patients with cancer is substantially higher than in the general population. Patients with cancer and HIV tend to be younger and have poorer performance status. Greater awareness of the dual burden of cancer and HIV in Uganda and universal testing of patients with cancer may improve outcomes of HIV-associated malignancies.
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Okuku, Fred Machyo, Jackson Orem, George Holoya, Christopher J. De Boer, and Matthew M. Cooney. "Prostate cancer burden at the Uganda Cancer Institute (UCI)." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 246. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.246.
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246 Background: In Uganda prostate cancer is the most common cancer and the incidence is increasing 5.2% annually. This burden is seen without screening programs in a country with limited access to cancer care. Data describing patient presentation and outcomes are lacking. Methods: Retrospective chart review for men with histologically-confirmed prostate cancer at the UCI from January 1 to December 17, 2012. Patient characteristics, treatments, and survival data were obtained. Results: There were 181 men with confirmed prostate cancer [C1] . Mean age was 69.5 (SD 9.0) with a median age of 70 (IQR: 64-75). Men presented with symptoms of lower urinary tract symptoms 73% (n=131), bone pain in 18% (n=32), elevated PSA 3% (n=5) and other causes 6% (n=11). Median baseline PSA was 91.3 ng/ml (IQR: 19.5-311.3 ng/ml) and upon presentation 51.1% (n=92) had a PSA value over 100 ng/ml. Gleason Score was 9 or 10 in 66.7% (n=120), Gleason Score 7 to 8 in 23.4% (n=44), and Gleason six or lower in 10% (n=18). Ninety percent (n=136) of patients had stage IV disease, 6.5% (n=11) were stage III, 11.9% were (n= 20) stage II, and 1 individual (0.6%) had stage I. Common sites of metastases included bone 73% (n=102), visceral metastases 21% (n=29), and lymph node involvement 4% (n=5). Spinal cord compression occurred in 30.9% (n=55) and 5.6% (n=10) experienced a fracture. A total of 14.9% (n=27) patients underwent radical prostatectomy and 17.7% (n=32) received radiotherapy. GNRH agonist was given to 45.3% (n=82) of patients, 29.2% (n=53) of men received diethylstilbestrol, and 26% (n=47) underwent bilateral orchiectomy. Chemotherapy was administered to 21.6% (n=39) and 52.5% (n=95) received bisphosphonates. During the 12 months of study 23.8% (n=43) of men experienced death and 54.4% (n=98) were lost to follow up. Conclusions: UCI patients present with significant symptoms, high PSA, and aggressive Gleason Scores. 90% present with stage IV disease and almost 33% develop spinal cord compression. Prostatectomy and radiotherapy are infrequently given and the primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation and there is a high rate of patients lost to follow up.
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Mwesige, B. "Economic Evaluation of Cancer Medicines Usage at Uganda Cancer Institute." Value in Health 19, no. 7 (November 2016): A886. http://dx.doi.org/10.1016/j.jval.2016.08.257.
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Menon, Manoj P., Anna Coghill, Innocent O. Mutyaba, Warren T. Phipps, Fred M. Okuku, John M. Harlan, Jackson Orem, and Corey Casper. "Association Between HIV Infection and Cancer Stage at Presentation at the Uganda Cancer Institute." Journal of Global Oncology, no. 4 (December 2018): 1–9. http://dx.doi.org/10.1200/jgo.17.00005.
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Purpose The HIV epidemic has contributed to the increasing incidence of cancer in sub-Saharan Africa, where most patients with cancer present at an advanced stage. However, improved access to HIV care and treatment centers in sub-Saharan Africa may facilitate earlier diagnosis of cancer among patients who are HIV positive. To test this hypothesis, we characterized the stage of cancer and evaluated the factors associated with advanced stage at presentation among patients in Uganda. Methods We conducted a retrospective analysis of adult patients with any of four specific cancers who presented for care in Kampala, Uganda, between 2003 and 2010. Demographic, clinical, and laboratory data were abstracted from the medical record, together with the outcome measure of advanced stage of disease (clinical stage III or IV). We identified measures for inclusion in a multivariate logistic regression model. Results We analyzed 731 patients with both AIDS-defining cancers (cervical [43.1%], and non-Hodgkin lymphoma [18.3%]), and non–AIDS-defining cancers (breast [30.0%] and Hodgkin lymphoma [8.6%]). Nearly 80% of all patients presented at an advanced stage and 37% had HIV infection. More than 90% of patients were symptomatic and the median duration of symptoms before presentation was 5 months. In the multivariate model, HIV-positive patients were less likely to present at an advanced stage as were patients with higher hemoglobin and fewer symptoms. Conclusion Patients with limited access to primary care may present with advanced cancer because of a delay in diagnosis. However, patients with HIV now have better access to clinical care. Use of this growing infrastructure to increase cancer screening and referral is promising and deserves continued support, because the prognosis of HIV-positive patients with advanced cancer is characterized by poor survival globally.
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Kibudde, Solomon, Bruce James Kirenga, Martin Nabwana, Fred Okuku, Victoria Walusansa, and Jackson Orem. "Clinical profile and initial treatment of non-small cell lung cancer: a retrospective cohort study at the Uganda Cancer Institute." African Health Sciences 21, no. 4 (December 14, 2021): 1739–45. http://dx.doi.org/10.4314/ahs.v21i4.30.
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Introduction: Lung cancer is a major global public health burden constituting 11.6% of all new cancer diagnoses and 18.4% of all cancer-related mortality.
Purpose: To describe the clinical profile and initial treatment of non-small cell lung cancer in Uganda.
Methods: We reviewed charts of a cohort of patients with a histologically confirmed diagnosis of non-small cell lung cancer, treated between January 2013 and November 2015 at the Uganda Cancer Institute.
Results: A total of 74 patients met the inclusion criteria. The median age was 56 years (IQR 47-70), with 16.2% below the age 45 years, and 51% were female. Only 10 percent were active smokers and the most frequent histological subtype was adenocarcinoma (71%). The majority (91.9%) had stage IV disease at diagnosis and frequent metastases to contralateral lung, liver, and bones. Twenty-seven (27) patients received platinum-based chemotherapy, while 27 patients received erlotinib, and only 4 patients received palliative thoracic radiotherapy. The median survival time was 12.4 months, and the overall response rate was 32.7%. There was no survival difference by type of systemic treatment, and on multivariate analysis, poor performance status was predictive of adverse outcomes (p < 0.001).
Conclusions: Patients with non-small cell lung cancer in Uganda frequently presented with late-stage disease at diagnosis. The majority of patients were female, never-smokers, and had predominantly adenocarcinoma subtype.
Keywords: Non-small cell lung cancer; Uganda; erlotinib; lung cancer; Uganda Cancer Institute.
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Menon, Manoj P., Nixon Niyonzima, Julie Gralow, and Jackson Orem. "Breast Cancer Clinical Trials: The Landscape at the Uganda Cancer Institute and Lessons Learned." JCO Global Oncology, no. 7 (January 2021): 127–32. http://dx.doi.org/10.1200/go.20.00185.
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The Uganda Cancer Institute, the sole national comprehensive cancer center in Uganda, has a long and rich history of clinical investigation and locally relevant cancer research. Given the increasing burden of breast cancer in Uganda and elsewhere in sub-Saharan Africa (SSA) and driven by the limited availability of immunohistochemistry (IHC), we launched a clinical trial aimed at evaluating locally available diagnostics to detect the presence of hormone receptors (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2. Preliminary data from 32 women in the diagnostic component of the study reveal high sensitivity and specificity for estrogen receptor and progesterone receptor and high specificity for human epidermal growth factor receptor 2 when comparing reverse transcriptase polymerase chain reaction with the gold standard (IHC). Innovative diagnostic and treatment strategies are required to address the burden of breast cancer that is increasing throughout SSA. Given the costs, infrastructure, and trained personnel associated with IHC, alternative testing options (including reverse transcriptase polymerase chain reaction as tested in our study) may provide an expedited and cost-effective method to determine receptor testing in breast cancer. Clinical trials conducted in the local setting are critical to determining optimal strategies for effective breast cancer management in SSA.
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Menon, Manoj P., Anna Coghill, Innocent Mutyaba, Fred Okuku, Warren Phipps, John M. Harlan, Jackson Orem, and Corey Casper. "Treatment Recommendations for Patients with NHL at the Uganda Cancer Institute." Blood 122, no. 21 (November 15, 2013): 2960. http://dx.doi.org/10.1182/blood.v122.21.2960.2960.
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Abstract Introduction It is estimated that nearly half a million people will die of cancer in sub-Saharan Africa (SSA) in 2020, and that the incidence of cancer will increase more than 40% between now and then. Unfortunately, treatment options in SSA are often hampered by a sub-optimal health care infrastructure resulting in advanced disease at presentation and the limited availability of effective, but cost prohibitive, chemotherapy. Consequently patient outcomes are typically poor and there is an unmet need to identify those cancer patients who would benefit most from the limited resources available. In resource-abundant areas, low hemoglobin [hgb], advanced disease stage, and poor patient performance status (PS) are associated with a poor prognosis and often serve to direct cancer care towards palliation instead of cure. Similarly, the international prognostic index (IPI) provides prognostic information among patients with non-Hodgkin lymphoma (NHL). However, the utility of such measures in therapeutic decision making in resource-poor areas is less studied. Here we describe characteristics of patients with a new diagnosis of NHL presenting for care in Uganda and identify factors associated with those patients recommended to receive cancer-directed therapy. Methods We conducted a retrospective analysis of all patients > 18 at the time of diagnosis of NHL between 2003 and 2010 who were residents of Kyandondo County (Uganda). Cases were identified from the Kampala Cancer Registry (KCR), a national population-based cancer registry. Patient lists from the KCR were transferred to the Uganda Cancer Institute (UCI), the nation's sole cancer center and Mulago Hospital, a university teaching hospital located in Kampala. Additionally, eligible patients who had not yet been recorded in the KCR were identified from patient records at the UCI or Mulago Hospital. Medical records were reviewed for all eligible patients. Patients determined to have a prior malignancy were excluded from this analysis. Demographic, clinical, and laboratory data were abstracted from the medical record. PS data were not routinely recorded in the medical record. The outcome measure was whether chemotherapy was recommended by clinical staff. We assessed whether demographic, clinical, and laboratory measurements were associated with the recommendation for treatment with chemotherapy. Those variable which were associated with the recommendation for chemotherapy (p <0.20) were included in the multivariate analysis. Results A total of 134 patients met our inclusion criteria. 48% of the patients were female with a median age of all patients of 40.7 years (range 19-82 years). Over half of the patients (57.5%) were HIV positive. Nearly 90% of the patients presented with stage 3 or stage 4 disease. The vast majority of patients (97.0%) reported at least 1 symptom. Fever (55.8%), a palpable mass (79.7%), and wasting (52.3%) were the most common symptoms reported at presentation. Approximately three-fourths of the patients had at least 1 comorbidity. The median baseline hgb level was 10.8 g/dl; 10% had a hgb <7g/dl. The median LDH level was elevated at 416 IU/L, however data were only obtained for 66 (49%) patients. Chemotherapy was recommended to 91.2% of the patients. In the multivariate logistic regression model, older age (p=.02), lower stage of disease (p <.001), and fewer comorbidities (p=.01) were associated with the failure to recommend for cancer-directed therapy. Conclusion Given their independent effect on response to therapy and overall survival, clinical prognostic indices are often used in resource-abundant countries to identify which patients will derive a benefit from cancer-directed therapy and which patients are better served by supportive measures. In our analysis, the recommendation for cancer-directed therapy was nearly universal. Collecting complete prospective data on IPI variables and follow-up data can validate the IPI in Uganda, allow Ugandan clinicians to determine whether such measures inform survival, and potentially optimize treatment decisions among patients with NHL. In resource-poor areas, the allocation of scarce health care resources to those patients that will be most likely to derive a meaningful benefit is imperative. Targeting therapy will not only save limited resources, it will also prevent harm in those patients unlikely to realize an effect of cancer-directed therapy. Disclosures: Casper: Janssen Research & Development: Research Funding.
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Mutyaba, Innocent, Jackson Orem, Henry Wabinga, Warren Phipps, and Corey Casper. "Access to cancer chemotherapy and predictors of early mortality for childhood cancers in Uganda." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 10070. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.10070.
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10070 Background: Although many childhood cancers respond well to chemotherapy, survival among children with cancer in sub-Saharan Africa is poor. Little is known about children’s access to specialized cancer care in SSA or factors contributing to poor early outcomes. We aimed: 1) To estimate the proportion of childhood cancer patients without access to chemotherapy in Uganda; 2) To describe 30-day survival rates and predictors of mortality post diagnosis among children with lymphoma or Kaposi sarcoma (KS), the two most common pediatric cancers in Uganda. Methods: A retrospective study of incident childhood (age< 20 years) cancers diagnosed in Kyandondo County, Uganda from 2006-2009. We compared records of the population-based Kampala Cancer Registry (KCR) and patient records at the Uganda Cancer Institute (UCI), Uganda’s sole dedicated cancer treatment center. Patient characteristics were compared using Mann-Whitney and Pearson’s chi-square tests. Kaplan-Meier method and Cox regression models were used to describe mortality. Results: Of the 658 pediatric cases recorded in the KCR, only 238 (36%) presented to UCI. Patients identified in the KCR who did not present for care were more likely to be female, diagnosed in earlier years of the study, and to have a cancer other than KS or lymphoma. Of the 177 lymphoma and KS cases at UCI, 43.7% were Burkitt lymphoma (BL), 32.5% KS, and 23.8% other lymphomas. The post diagnosis 30-day overall survival rate was 77%. In multivariate analysis, age, gender, HIV status, platelets, and stage of cancer did not impact mortality. An increased risk of death at 30 days was predicted by presence of B-symptoms (HR=10.3, p=0.05), a diagnosis of BL compared to other lymphomas (HR=14.8, p=0.007), poor performance status (Karnofsky score <70, HR=14.7, p<0.001), and anemia (HR 1.5-fold per 1g/dL decrease in hemoglobin, p=0.002). Conclusions: Childhood cancer patients in Uganda have limited access to comprehensive care. Among those presenting to the UCI, a significant proportion die before they can benefit from chemotherapy. BL diagnosis, B-symptoms, performance status and hemoglobin level may be important predictors of early mortality among childhood cancer patients in sub-Saharan Africa.
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Angucia, B. S., M. Nabwana, J. Asasira, Y. Mulumba, I. Mutyaba, and O. Jackson. "Spectrum of Primary Cancer Diagnoses Among Patients at Uganda Cancer Institute in 2015 and 2016." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 80s. http://dx.doi.org/10.1200/jgo.18.48700.
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Background: Most recent cancer registry data suggests a change in cancer occurrence in Uganda with a decrease in incidence of Kaposi sarcoma (KS) but an increase in cervical, prostate and breast cancer. Anecdotal data suggest that KS, non-Hodgkin's lymphoma and breast cancer were the most common cancers among patients at Uganda Cancer Institute (UCI) by 2006. Aim: To describe the spectrum of cancer diagnoses among new patients that presented for care at UCI over the past 2-years. Methods: We conducted a cross sectional study of patients admitted into care at UCI with a histologic or clinical diagnosis of cancer from January 2015 to December 2016. Cancer diagnoses were reported as proportions by gender and age - children (0-14 years) and adults (above 14 years). Results: Overall, 8279 new patients were registered during the study period but only 7588 (92%) were recorded in the electronic database and had information on cancer diagnosis. Of these, 53% were admitted in 2015, and 55% were females. Median age was 48 years (IQR: 34-62). Among 2997 female adults, 30% had cervical, 17% breast, 5% Kaposi sarcoma (KS), 4% leukemia and 3.9% esophageal cancer. Among 2136 male adults, 17% had KS, 12% prostate, 10% esophageal, 6% leukemia and 4% colorectal cancer. Among the 486 children, 17% had leukemia, 16.7% nephroblastoma (Wilms tumor), 15.9% Burkitt lymphoma (BL), 8% rhabdomyosarcoma, and 6% Kaposi sarcoma. Conclusion: The distribution of cancer diagnoses among patients seen at UCI reflects the population level cancer incidence with cervical, breast, KS, prostate, esophageal, and colorectal cancer in adults, and nephroblastoma in children as the leading cause of cancer related morbidity. The overrepresentation of leukemia may be due to referral bias but warrants further study. The correlation of our findings with incidence data suggests that missing information did not significantly skew our findings. However more investments are needed to improve the quality of data captured electronically.
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Kalinaki, Abubakar, Haruna Muwonge, Joyce Balagadde-Kambugu, Yusuf Mulumba, Jacob Ntende, Grace Ssali, Lydia Nakiyingi, Damalie Nakanjako, Caroline Nalukenge, and Anne M. Ampaire. "Clinical presentation and outcomes in children with retinoblastoma managed at the Uganda Cancer Institute." Journal of Cancer Epidemiology 2022 (March 8, 2022): 1–8. http://dx.doi.org/10.1155/2022/8817215.
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Background. The majority of patients with retinoblastoma, the most common intraocular cancer of childhood, are found in low-and middle-income countries (LMICs), with leukocoria being the most common initial presenting sign and indication for referral. Findings from the current study serve to augment earlier findings on the clinical presentation and outcomes of children with retinoblastoma in Uganda. Methods. This was a retrospective study in which we reviewed records of children admitted with a diagnosis of retinoblastoma at the Uganda Cancer Institute from January 2009 to February 2020. From the electronic database, using admission numbers, files were retrieved. Patient information was recorded in a data extraction tool. Results. A total of 90 retinoblastoma patients were studied, with a mean age at the first Uganda Cancer Institute (UCI) presentation of 36.7 months. There were more males (57.8%) than females, with a male to female ratio of 1.37 : 1. The majority (54.4%) had retinoblastoma treatment prior to UCI admission. The most common presenting symptoms were leukocoria (85.6%), eye reddening (64.4%), and eye swelling (63.3%). At 3 years of follow-up after index admission at UCI, 36.7% of the patients had died, 41.1% were alive, and 22.2% had been lost to follow-up. The median 3-year survival for children with retinoblastoma in our study was 2.18 years. Significant predictors of survival in the multivariate analysis were follow-up duration ( P ̲ < 0.001 ), features of metastatic spread ( P = 0.001 ), history of eye swelling ( P = 0.012 ), and bilateral enucleation ( P = 0.011 ). Conclusions. The majority of children who presented to the Uganda Cancer Institute were referred with advanced retinoblastoma, and there was a high mortality rate. Retinoblastoma management requires a multidisciplinary team that should include paediatric ophthalmologists, paediatric oncologists, ocular oncologists, radiation oncologists, and nurses.
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K., Rachel, Milton M., Godfrey Z.R., Nixon N., Jackson O., and Simon K. "Personality and Psychological Well-Being among Cancer Caregivers at the Uganda Cancer Institute and Mbarara Regional Referral Hospital." African Journal of Social Sciences and Humanities Research 5, no. 3 (July 30, 2022): 62–75. http://dx.doi.org/10.52589/ajsshr-m1oakzto.
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To assess the relationship between personality and psychological wellbeing among caregivers of patients with cancer in central and southwestern Uganda. Methods: A cross-sectional survey was conducted among adult caregivers of patients with cancer at the Uganda Cancer Institute in Kampala and at Mbarara Regional Referral Hospital in southwestern Uganda. The participants were consecutively recruited until a sample of 436 was reached. Personality was assessed using the NEO-Five Factor Inventory (NEO-FFI) after structural validation using exploratory factor analysis. On the other hand, psychological wellbeing was assessed using the General Health Questionnaire (GHQ-28). Data was analyzed using STATA version 14. The composite indices were summarized using measures of central tendency and spread. The relationship between the different subscales and the effect of personality on psychological wellbeing was assessed using multiple linear regression modelling. Results: After controlling for all the covariates, the personality domains of extroversion (P 0.0001, f statistic 4.26), neuroticism (P 0.0001, f statistic 4.31), openness (P 0.0000, f statistic 4.36) and introversion (P 0.0000, f statistic 4.31) influence psychological wellbeing of caregivers of patients with cancer. Conclusion: An individual’s personality is very crucial in cancer caregiving because it affects his/her psychological wellbeing. Therefore it is important that the caregivers’ personality disposition is considered at the beginning and during the caregiving journey.
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Asiimwe, P., P. Ebusu, and D. Olodi. "World Cancer Day As a Platform for Advocacy, Stakeholder Mobilization and Awareness Creation: The Experience of Uganda Cancer Society." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 169s. http://dx.doi.org/10.1200/jgo.18.69800.
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Background: World Cancer Day (WCD) provides a platform to raise awareness. This year Uganda's commemoration was held at the Parliamentary grounds. Aim: To bring together Uganda's stakeholders through an inclusion approach to advocate for, share information and raise awareness on cancer while recognizing efforts made and appreciating challenges faced in the fight against the epidemic. Strategy: Partnership building was key. Partners involved were; Uganda Cancer Society (UCS), Uganda Cancer Institute (UCI), Ministry of Health, World Health Organization, media, Uganda Corporate League, interreligious council, Kampala Capital City Authority, Parliament of Uganda, Uganda Police and UCS member organizations. Program process: A committee was set up and a concept developed adopting the tri-process approach; “Before - During - After” for implementation of activities. Outcomes: The digital campaign was launched using the signs for change and the #WeCanICanUg. There was high media coverage; 3 major national stations Urban TV, NBS TV and NTV UG, one regional station-CGTN Africa, as well as online platforms such as; WHO Africa Web site, UICC World Cancer Day impact report, the Grape Vine, Chimp reports, and more than 5 YouTube media uploads as per our monitoring and surveillance efforts on reach and impact. The lighting of the Queen's way clock tower attracted many passersby and media coverage. In addition there was awareness creation in select churches (6) and mosques (2) on 4th and 2nd February respectively. The WCD ceremony was attended by over 400 guests and officiated by the Speaker of Parliament who doubled as chief walker. The 7.3 km match past attracted involvement of the community along the way. The Speaker called upon the government through Ministry of Health to inject more money into training of more cancer specialists to work on cancer patients. She also stated the need to have cancer services moved closer than just the regional centers but to every district referral hospital for cancer screening and cancer treatment. She pledged Parliament's unconditional support to work with civil society in the cancer fight. The Minister of Health committed to the full operationalization of regional cancer centers by 2019. She applauded the role of civil society through Uganda Cancer Society on the advocacy efforts stating that they had already started yielding good results . The event ended with the corporate league football competitions which were aimed at promoting healthy lifestyles through physical exercise. Notably was the match between the Parliamentary team and the UCI team. The winner was given a trophy marked WCD 2018. What was learned: The role of civil society through umbrella bodies like UCS plays a crucial role in cancer control as seen during through planning, mobilization, partnership building and execution of WCD activities. Creativity and innovation is key in generating stakeholder and public interest in cancer control activities like WCD.
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Ekudo, J., D. Bwembo, and A. Agwang. "Working With the Commercial Motorists to Promote Cancer Awareness." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 127s. http://dx.doi.org/10.1200/jgo.18.56500.
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Background and context: Motorcycle transport system also known as “BodaBoda”' is one of Uganda's commonest means of transport with over 10,000 motorists ridding on the streets of Kampala on daily basis according to the statistics from Kampala City Authority. HealthAid Uganda (HAU) strategically engaged the above group in to promotion of cancer awareness, screening and blood donation for cancer patients following the lack of blood at the cancer institute for cancer patients. The process was strengthened by working in partnership with the Uganda Bodaboda Association 2010, an umbrella association that brings all the motorists together. It also included the Uganda Police Services, Ministry of Health and the private sector. Aim: To use motorists to deliver cancer education, awareness and facilitate blood donation for cancer patients in Uganda. Strategy/Tactics: The event was branded with the theme “Know your health, donate blood, save life”. It involved mobilization of the motorcycle riders through the BodaBoda 2010 association, a cancer awareness motorcycle ride across Kampala City, led by the head of traffic Uganda police as the chief rider. This was conducted along Kampala road and finally convened on the Uganda railway grounds, where the event was crowned with cancer education, screening and blood donation for the cancer patients. Program/Policy process: Community involvement and advocacy. Outcomes: There were large number of motorcycle riders 1000 who passionately turned up for the community event, high expectations to know about cancer and being able to go with cancer education materials for their families and communities. Blood bank collection team declared collecting 400 units of blood. The head, Department of Non Communicable Diseases at the Ministry of Health appreciated the efforts of HAU and pledged that the MOH will strongly work and support HAU on the initiative. The event attracted over 1500 individuals both the motorcycle riders and the community. What was learned: Using popular service groups has a high success rate in delivering cancer awareness and screening services to the least households in the community. HAU's success in this strategy was accelerated by the principle in which it focuses on working with organized groups so as to reach the households with cancer information and empower them to be able to make best choices. HAU looks further to extending the same activities to other communities of similar nature.
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Kiwanuka, Frank. "Complementary and Alternative Medicine use: Influence of Patients’ Satisfaction with Medical Treatment among Breast Cancer Patients at Uganda Cancer Institute." Advances in Bioscience and Clinical Medicine 6, no. 1 (February 13, 2018): 24. http://dx.doi.org/10.7575/aiac.abcmed.v.6n.1p.24.
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Introduction: Use of Complementary and alternative medicine (CAM) is high among cancer patients especially breast cancer patients. This study sought to evaluate Complementary and alternative medicine use in breast cancer patients and how its use is influencedby patient’s satisfaction with conventional medical treatment among breast cancer patients attending Uganda Cancer Institute. Patients and Methods: A cross-sectional study design was used in this study. Participants who were diagnosed histologically with breast cancer at Uganda Cancer Institute took part in the study. A questionnaire was developed and used to interview the participants and medical records of the respondents were also reviewed. Results: A total of 235 participants completed the study. The prevalence of CAM use was 77%. CAM therapies used included herbal medicines, prayer for health, vitamins/minerals, native healers, Chinese medicines, massage, yoga, Ayurvedic medicine, Acupuncture, reflexolog, Support group attendance, meditation, Magnetic and Bio-fieldmanipulation. Satisfaction with medical treatment was significantlyassociated with CAM use. Patients who are not satisfiedwith medical treatment were more likely to use CAM. Conclusion: There is a high number of breast cancer patients using CAM, various categories of therapies are being used and patients’ satisfaction with medical treatment triggers off a patients decision to use CAM therapies.
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Mpamani, C. J. "Determinants of visiting a referral hospital for cervical cancer screening at Uganda Cancer Institute." Annals of Oncology 30 (November 2019): ix132. http://dx.doi.org/10.1093/annonc/mdz432.005.
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Gulleen, Elizabeth, Margaret Lubwama, Alfred Komakech, Elizabeth M. Krantz, Catherine Liu, and Warren Phipps. "136. Attitudes and Practices of Antimicrobial Resistance and Antimicrobial Stewardship at the Uganda Cancer Institute." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S181—S182. http://dx.doi.org/10.1093/ofid/ofab466.338.
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Abstract Background As access to cancer treatment has increased in sub-Saharan Africa (sSA), infection-related complications are a growing concern. Little is known about infection management practices in this setting. Understanding the unique challenges to diagnosing and treating infections can inform the development of targeted strategies to improve infection management for cancer treatment programs throughout sSA. Methods We conducted a cross-sectional survey of doctors, nurses, and pharmacists at the Uganda Cancer Institute (UCI), a national cancer referral hospital in Kampala, Uganda. The 25-item survey was designed to assess staff knowledge of antimicrobial resistance and antimicrobial stewardship, investigate antibiotic decision-making practices, and identify barriers to diagnosing and treating infections. Results Of the 61 respondents, 25 (41%) were doctors, 7 (11%) were pharmacists, and 29 (48%) were nurses. In total, 98% (60/61) had heard of the term “antimicrobial resistance” and 84% (51/61) agreed that antimicrobial resistance is an important problem at UCI. Multiple factors were felt to contribute to antimicrobial resistance including the use of too many antibiotics, patient insistence on antibiotics, and poor patient adherence (Fig 1). While 72% (44/61) had heard of the term “antimicrobial stewardship”, only 25% (15/61) knew a lot about what it meant. Numerous factors were considered important to antibiotic decision-making including patient white blood cell count and severity of illness (Fig 2). Perceived barriers to infection diagnosis included the inability to obtain blood cultures and to regularly measure patient temperatures; perceived barriers to obtaining blood cultures included patient cost and availability of supplies (Fig 3). Figure 1. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute (UCI) perceive as contributing to antimicrobial resistance at the UCI. Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor does not or usually does not contribute (left of bars, main chart), occasionally or frequently contributes (right of bars, main chart), or neither contributes nor does not contribute (right of neutral chart). Figure 2. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute consider to be important when choosing antibiotics to treat infections. Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor is somewhat or very unimportant (left of bars, main chart), somewhat or very important (right of bars, main chart), or neither important nor unimportant (right of neutral chart). Figure 3. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute perceive as limiting the ability to diagnose infections and obtain blood cultures. Conclusion While most staff recognized the term “antimicrobial resistance” and identified this as a major local problem, fewer were familiar with the term “antimicrobial stewardship”. We identified numerous perceived barriers to infection diagnosis and treatment, including the ability to consistently measure temperatures and the cost of blood cultures. A multipronged approach is needed to improve staff knowledge of antimicrobial stewardship and to address the systematic barriers to infection management at UCI. Disclosures All Authors: No reported disclosures
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Okuku, Fred, Manoj Menon, Rachel Kansiime, Jason Barrett, Warren Phipps, Nixon Niyonzima, Matthew Ulrickson, Jackson Orem, and Corey Casper. "Tele-Oncology: A Joint Web-Based Clinical Conference Between the Uganda Cancer Institute and the Fred Hutch Cancer Research Center." Journal of Global Oncology 2, no. 3_suppl (June 2016): 30s—31s. http://dx.doi.org/10.1200/jgo.2016.004291.
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Abstract 47 Background: The increasing incidence of cancer in sub-Saharan Africa (SSA) has highlighted gaps in access to quality cancer care and subsequent poor outcomes. Two of the factors responsible for this disparity are the limited availability of diagnostic methods and the lack of trained oncologists. Tele-oncology, the application of web-based medical communications, has the potential to bridge the healthcare gap. Here we describe our 3-year experience linking resources between the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle, WA and the Uganda Cancer Institute (UCI) Kampala, Uganda, via a monthly conference. Methods: We created a monthly teleconference, each focused on a specific disease group, to provide a clinical treatment and research forum between the UCI and FHCRC. Guided by patients seen at the UCI, clinicians in Uganda present clinical, laboratory, and radiographic data. Case presentations and supporting documents are provided and loaded on a central site. Faculty members from the FHCRC (medical oncology, radiation oncology, surgery, pathology, and radiology, as applicable) are identified in advance and serve as discussants and assist in interpreting data, as well as provide guidance on clinical decision-making. Web conferencing is performed utilizing the Cisco WebEx platform. Results: To date, we have held 36 case conferences and have discussed the following malignancies: Leukemia (including myelodysplasia) (6), gastrointestinal (5), head/neck/lung (5), genitourinary (3), gynecologic (3), lymphoma (2), breast (2), plasma cell dyscrasia (1), soft tissue sarcoma (1), central nervous system (1) and other (5). Two conferences have focused specifically on palliative care. Two locally-relevant treatment guidelines, co-authored by colleagues from Uganda and Seattle, have been published for HIV-associated non-Hodgkin lymphoma and cutaneous T-cell lymphoma as a direct result of these conferences. Conclusions: The monthly teleconference has enhanced education, clinical practice, and collaboration between colleagues in Uganda and Seattle. Future opportunities include the initiation of a core oncology training curriculum, as well as video conferencing capabilities. Similar twinning programs between institutions in resource-rich and resource-limited countries are recommended. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Fred Okuku No relationship to disclose Manoj Menon No relationship to disclose Rachel Kansiime No relationship to disclose Jason Barrett No relationship to disclose Warren Phipps No relationship to disclose Nixon Niyonzima No relationship to disclose Matthew Ulrickson Speakers' Bureau: Incyte Jackson Orem No relationship to disclose Corey Casper Leadership: Temptime Corporation Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Glaxo Smith Kline, Temptime Corporation
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Osinde, Godfrey, Nixon Niyonzima, Vivienne Mulema, Deo Kyambadde, Yusuf Mulumba, Siraj Obayo, Ezra Anecho, et al. "Increasing access to quality anticancer medicines in low- and middle-income countries: the experience of Uganda." Future Oncology 17, no. 21 (July 2021): 2735–45. http://dx.doi.org/10.2217/fon-2021-0117.
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Cancer is one of the leading causes of death with 9.6 million deaths registered in 2018, of which 70% occur in Africa, Asia and Central and South America, the low-and middle-income countries (LMICs). The global annual expenditure on anticancer medicines increased from $96 billion in 2013 to $133 billion in 2017. This growth rate is several folds that of newly diagnosed cancer cases and therefore estimated to reach up to $200 billion by 2022. The Uganda Cancer Institute, Uganda's national referral cancer center, has increased access to cancer medicines through an efficient and cost-saving procurement system. The system has achieved cost savings of more than USD 2,000,000 on a total of 37 of 42 essential cancer medicines. This has resulted in 85.8% availability superseding the WHO's 80% target. All selected products were procured from manufacturers with stringent regulatory authority approval or a proven track record of quality products.
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D Okello, Clement, Yusuf Mulumba, Abrahams Omoding, Henry Ddungu, Kristen Welch, Cheryl L Thompson, Andrew J Cowan, Matthew M Cooney, and Jackson Orem. "Characteristics and outcomes of patients with multiple myeloma at the Uganda Cancer Institute." African Health Sciences 21, no. 1 (April 16, 2021): 67–74. http://dx.doi.org/10.4314/ahs.v21i1.11.
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Purpose: Data on multiple myeloma (MM) in sub-Sahara Africa is scarce. In Uganda, there is a progressively increasing incidence of MM over the years.
Methods: We performed a retrospective study on 217 patients with MM at the UCI using purposive sampling method. The objectives of the study were to determine the clinical characteristics, treatment outcomes, 5 year overall survival and predic- tors of survival of patients with MM at the UCI from 01 January 2008 to 31 December 2012.
Results: There were 119 (54.8%) males; the mean(SD) age of the study population at presentation was 59(12.8) years; 183(84.3%) patients presented with bone pain, and 135 (61.9%) had skeletal pathology; 186(85.3%) were HIV negative, and 152(70%) had Durie-Salmon stage III. The median overall survival was 2.5 years, (95% CI, 0.393-0.595); factors significantly associated with worse survival were Durie-Salmon stage III disease, HR=5.9, 95% CI (1.61 – 21.74; P=0.007) and LDH >225 U/L HR=3.3, 95% CI (0.57 – 5.92; P=0.029).
Conclusion: Most patients with multiple myeloma at the UCI were diagnosed at a relatively young age, presented with late stage disease and bone pain, and had a shorter survival time. Factors associated with worse survival were Durie-Salmon stage III and LDH >225 U/L.
Keywords: Multiple myeloma; Uganda cancer institute.
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Kiyange, F., V. Walusansa, G. Mandosela, H. Nzereka Kambale, E. Luyirika, and J. Orem. "The Role of South-to-South Partnerships in Developing Cancer Services in Africa." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 163s. http://dx.doi.org/10.1200/jgo.18.21200.
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Background and context: Despite being a growing public health concern in Africa, access to effective cancer treatment and pain relief is still limited in sub-Saharan Africa. The African Palliative Care Association (APCA) in collaboration with the American Cancer Society and the Ministry of Health of Swaziland have successfully implemented a South-to-South partnership which has facilitated the development and operation of a cancer unit in Mbabane National Hospital. Although the cancer burden continues to rise in Africa, many countries do not have established oncology services. They rely on cancer treatment, care and support through referral to neighboring countries or overseas, which is costly for governments and poses multiple challenges for patients and their families. Until recently, Swaziland has relied on cancer treatment and care in South Africa. This paper presents a model where the Uganda Cancer Institute (UCI) in Uganda has been facilitated to support the establishment of a cancer unit in Swaziland. Aim: The intervention aimed at providing technical assistance to the Ministry of Health of Swaziland to initiate and operate a cancer unit in Mbabane Government Hospital through a formal arrangement with the UCI. Strategy/Tactics: The planning and execution of activities was done by a tripartite of APCA, Uganda Cancer Institute a government entity and the Swazi Ministry of Health. Program/Policy process: Over a period of one year (Decemeber 2016 to December 2017) APCA, through a grant from the ACS formerly engaged the UCI to support the initiation and operation of a cancer unit in Swaziland. This was through expert exchange visits through which on-job training and mentorship was provided to a team of staff at Mbabane Government Hospital, with coordination by the Swaziland Ministry of Health. Experiential visits to Uganda were also organized for the lead pharmacist in Swaziland and a doctor to enable them set up and run a cancer unit in their country. The exchange visits provided a forum for both observation and application of knowledge and skills. Outcomes: A cancer unit was successfully established at Mbabane Government Hospital in Swaziland, which now provides services for patients, with breast cancer and expanding to include other cancers. The Swaziland Ministry of Health has been key to the success of this development and continues to identify human, financial and other resources to sustain the cancer unit. To date 69 patients have successfully undergone chemotherapy: 43 breast cancer, 22 Kaposi sarcoma, 2 colorectal cancer, 1 bladder cancer, 1 multiple myeloma. 21 health care workers were trained on cancer management; 9 doctors, 7 nurses and 5 pharmacists. What was learned: There are many opportunities for South-to-South partnership to support the establishment or improvement of cancer care. This model implemented in Swaziland can be replicated in other African countries. Documenting the model for replication in other countries is recommended.
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Ghadrshenas, Matine J., Rachel A. Bender Ignacio, Daniel H. Low, Warren Phipps, Jackson Orem, Ann Duerr, and Corey Casper. "Documentation of HIV Testing and Treatment Status Among Patients Presenting for Cancer Care in Uganda." Journal of Global Oncology 2, no. 3_suppl (June 2016): 58s. http://dx.doi.org/10.1200/jgo.2016.003756.
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Abstract 23 HIV increases the incidence and mortality of cancer; knowledge of HIV status and treatment is essential for management of patients with HIV-associated malignancies (HIVAM). In Uganda, where the prevalence of HIV infection is 7.4%, the incidence of AIDS-defining cancers (ADCs) is high, and non-AIDS defining cancers (NADCs) are increasingly common. We investigated how often cancer providers documented HIV status and clinical parameters of HIV infection among patients at the Uganda Cancer Institute (UCI). Medical records of patients aged ≥18 who registered at the UCI June - September 2015 were abstracted for demographics and cancer and HIV parameters. We calculated binomial proportions and used χ2 tests to evaluate factors associated with HIV. Among 1,130 patients in this analysis, 71% of charts documented HIV status. Of those documenting HIV status, 32% were HIV+, and 58% of HIV+ individuals had an ADC. The documented HIV prevalence in NADCs was 21%. Women were more likely to lack HIV results (RR 1.32, p=0.009); 36% of women lacked results, including 40% with cervical cancer. HIV+ patients were younger than HIV-negative patients (median age 41 vs. 49, p<0.001). 62% of HIV-infected patients had a CD4 count recorded; CD4 counts were lower among persons with ADC (median 270 cells/ml, IQR 80-460) compared with NADC (median 370, IQR 215-564), p=0.006. There was no difference in the proportion of HIV patients with ADCs and NADCs receiving ART (both 86%, p=0.45). HIV prevalence was 4.5 times higher in Ugandan cancer patients with documented status than in the general population. Though the majority of cancer patients had HIV testing performed, gaps remained in documenting HIV status, even among cancers considered AIDS-defining in HIV. This study highlights opportunities to educate cancer clinicians in Africa on the burden of HIV in cancer patients and opportunities to coordinate management of both cancer and HIV. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Matine J. Ghadrshenas No relationship to disclose Rachel A. Bender Ignacio No relationship to disclose Daniel H. Low No relationship to disclose Warren Phipps No relationship to disclose Jackson Orem No relationship to disclose Ann Duerr No relationship to disclose Corey Casper Leadership: Temptime Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Temptime Corporation, GlaxoSmithKline
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Ikara, B., P. Ebusu, N. Mugisha, and J. Orem. "Little Hands Beating Cancer: Building Resource Capacity for Cancer Control in Sub-Saharan Africa." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 125s. http://dx.doi.org/10.1200/jgo.18.22300.
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Background and context: Uganda Child Cancer Foundation (UCCF) is a nongovernmental organization that was formed in 2006, as an in-house fundraising charity for Uganda Cancer Institute (UCI). UCCF mobilizes treatment and social support for vulnerable children battling cancer and advocates for cancer control in Uganda. It is mainly managed by childhood cancer survivors/volunteers and individuals directly affected by cancer. Children Caring about Cancer (3C) program is a strategic approach through which UCCF supports children in schools to start cancer clubs which are called 3C clubs. Aim: The main aim is to create a platform through which school going children are empowered with knowledge and experiences to enable them appreciate the cancer burden and create opportunities for them to develop and implement interventions addressing the burden of cancer at their level. Strategy/Tactics: UCCF works closely with UCI in cancer control, UCI is a Uganda Ministry of Health national technical arm of government. UCCF was formed to raise awareness about cancer in the communities and public especially with the young people and also to support children with cancer, UCCF reaches high school students and teachers with cancer education and awareness through the ministry of education and school administration structures. UCCF runs a social media campaign dabbed #3ChildrenCaringAboutCancer which uses activities done by the clubs as posts targeting children, policy makers and the community. In addition, UCCF launched a national children cancer conference in 2016 as a unique platform for stakeholder engagements and for highlighting work the children are doing in cancer control. Program/Policy process: The UCCF-3C recruits and works with children in schools by establishing cancer clubs. The clubs run activities geared toward cancer awareness, patient support and community outreach/advocacy. The clubs are headed by patrons and student-led club executives. The executive is responsible for leadership and recruitment of fellow young people through a child to child process. The patrons are trained to act as mentors to the executive to support various 3C programs in school. The patrons have an interschool committee that enables them to network and plan to support the children and club needs. UCCF works with the UCI to coordinate 3C club activities, patrons, and students leaders in sustaining the clubs in schools. Outcomes: In 85 3C school clubs formed, the program has reached; 85,000 children, 3000 teachers and over 170,000 guardians. Young people have been able to contribute to cancer control in Uganda through cancer awareness, advocacy and patient support. What was learned: Children Caring about Cancer (3C) program is strategic for building resource capacity for sustainable cancer control in Uganda.
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Mika, Marissa. "Cytotoxic: notes on chemotherapy at the Lymphoma Treatment Center, Uganda Cancer Institute, Kampala." BioSocieties 14, no. 4 (November 11, 2019): 573–82. http://dx.doi.org/10.1057/s41292-019-00172-6.
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Kiwanuka, Frank, and Ronald Masaba. "Nurses’ knowledge, attitude and practices regarding pain assessment among patients with cancer at Uganda Cancer Institute." Journal of Analytical Research in Clinical Medicine 6, no. 2 (June 10, 2018): 72–79. http://dx.doi.org/10.15171/jarcm.2018.011.
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Low, Daniel H., Warren Phipps, Jackson Orem, Corey Casper, and Rachel A. Bender Ignacio. "Engagement in HIV Care and Access to Cancer Treatment Among Patients With HIV-Associated Malignancies in Uganda." Journal of Global Oncology, no. 5 (December 2019): 1–8. http://dx.doi.org/10.1200/jgo.18.00187.
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PURPOSE Health system constraints limit access to HIV and cancer treatment programs in sub-Saharan Africa. Limited access and continuity of care affect morbidity and mortality of patients with cancer and HIV. We assessed barriers in the care cascade of comorbid HIV and cancer. PATIENTS AND METHODS Structured interviews were conducted with 100 adult patients with HIV infection and new diagnoses of cancer at the Uganda Cancer Institute. Participants completed follow-up questionnaires after 1 year to assess ongoing engagement with and barriers to care. RESULTS The median time from new-onset cancer symptoms to initiation of cancer care at the Uganda Cancer Institute was 209 days (interquartile range, 113 to 384 days). Persons previously established in HIV care waited less overall to initiate cancer care ( P = .04). Patients established in HIV care experienced shorter times from initial symptoms to seeking of cancer care ( P = .02) and from seeking of care to cancer diagnosis ( P = .048). Barriers to receiving care for HIV and cancer included difficulty traveling to multiple clinics/hospitals (46%), conflicts between HIV and cancer appointments (23%), prohibitive costs (21%), and difficulty adhering to medications (15%). Reporting of any barriers to care was associated with premature discontinuation of cancer treatment ( P = .003). CONCLUSION Patients with HIV-associated malignancies reported multiple barriers to receiving care for both conditions, although knowledge of HIV status and engagement in HIV care before presentation with malignancy reduced subsequent time to the start of cancer treatment. This study provides evidence to support creation and evaluation of integrated HIV and cancer care models.
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Gordon-Maclean, C., S. Ewart, J. Orem, and C. Casper. "Research to reduce the burden of infection-related cancers conducted by the Uganda Cancer Institute/Hutchinson Center Cancer Alliance." Annals of Global Health 81, no. 1 (March 12, 2015): 90. http://dx.doi.org/10.1016/j.aogh.2015.02.710.
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Low, Daniel, Emily C. Merkel, Manoj Menon, Gary H. Lyman, Henry Ddungu, Elizabeth Namukwaya, Mhoira Leng, and Corey Casper. "Chemotherapy Use at the End of Life in Uganda." Journal of Global Oncology 3, no. 6 (December 2017): 711–19. http://dx.doi.org/10.1200/jgo.2016.007385.
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Purpose Avoiding chemotherapy during the last 30 days of life has become a goal of cancer care in the United States and Europe, yet end-of-life chemotherapy administration remains a common practice worldwide. The purpose of this study was to determine the frequency of and factors predicting end-of-life chemotherapy administration in Uganda. Methods Retrospective chart review and surveys and interviews of providers were performed at the Uganda Cancer Institute (UCI), the only comprehensive cancer center in the area, which serves a catchment area of greater than 100 million people. All adult patients at the UCI with reported cancer deaths between January 1, 2014, and August 31, 2015 were included. All UCI physicians were offered a survey, and a subset of physicians were also individually interviewed. Results Three hundred ninety-two patients (65.9%) received chemotherapy. Age less than 55 years (odds ratio [OR], 2.30; P = .004), a cancer diagnosis greater than 60 days before death (OR, 9.13; P < .001), and a presenting Eastern Cooperative Oncology Group performance status of 0 to 2 (OR, 2.47; P = .001) were associated with the administration of chemotherapy. More than 45% of patients received chemotherapy in the last 30 days of life. No clinical factors were predictive of chemotherapy use in the last 30 days of life, although doctors reported using performance status, cancer stage, and tumor chemotherapy sensitivity to determine when to administer chemotherapy. Patient expectations and a lack of outcomes data were important nonclinical factors influencing chemotherapy administration. Conclusion Chemotherapy is administered to a high proportion of patients with terminal cancer in Uganda, raising concern about efficacy. Late presentation of cancer in Uganda complicates end-of-life chemotherapy recommendations, necessitating guidelines specific to sub-Saharan Africa.
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Wampaalu, Peter B., Lars E. Eriksson, Allen Naamala, Rose C. Nabirye, and Lena Wettergren. "Experiences of patients undergoing chemotherapy - a qualitative study of adults attending Uganda Cancer Institute." African Health Sciences 16, no. 3 (October 17, 2016): 744. http://dx.doi.org/10.4314/ahs.v16i3.14.
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Orem, Jackson, Yusuf Mulumba, Sara Algeri, Rino Bellocco, Fred Wabwire Mangen, Edward Katongole Mbidde, and Elisabete Weiderpass. "Clinical characteristics, treatment and outcome of childhood Burkitt's lymphoma at the Uganda Cancer Institute." Transactions of the Royal Society of Tropical Medicine and Hygiene 105, no. 12 (December 2011): 717–26. http://dx.doi.org/10.1016/j.trstmh.2011.08.008.
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Denburg, Avram. "Cost effectiveness of treating endemic Burkitt lymphoma in Uganda." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18339-e18339. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18339.
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e18339 Background: Despite high cure rates achieved in high-income countries, outcomes for children with Burkitt lymphoma (BL) in most low- and middle-income countries (LMICs) remain suboptimal. Perceptions of high cost and resource intensity remain political barriers to the prioritization of BL and other childhood cancer treatment programs in many LMIC health systems. Little to no knowledge exists of the actual cost and cost-effectiveness of treating paediatric cancers in LMICs. To improve outcomes for children with BL, the Uganda Cancer Institute implemented a comprehensive BL treatment program in 2012. Drawing on centralized patient-level data, we undertook an economic evaluation of the program to ascertain the cost-effectiveness of BL therapy in a specific LIC setting. Methods: We compared the treatment of BL (local standard) to usual care (no care), in a cohort of 215 patients treated between 2012 and 2015. Costs included direct, indirect healthcare, and indirect patient costs. Our primary measure of effectivenesswas overall survival (OS). Patient outcomes were determined through electronic chart abstraction. The cost per DALY averted was calculated using WHO-CHOICE methodology and compared to standard definitions of cost-effectiveness. Results: The 2-year OS with treatment was 53% (95% CI, 43% to 62%). Nine percent of patients abandoned therapy. The cost per DALY averted in the treatment group was US$78. Cumulative estimate of national DALYs averted through treatment was 11,046 years, and the total national cost of treatment was US$755,216. The ratio of cost per DALY averted to per capita gross domestic product (GDP) was 0.12, reflecting a very cost-effective intervention. Conclusions: This study demonstrates that treating BL with locally tailored protocols is very cost-effective relative to per capita GDP in Uganda. Studies of this kind will furnish crucial evidence to assist policymakers prioritize the allocation of LMIC health system resources among NCDs, including childhood cancer.
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Phipps, Warren, Rachel Kansiime, Philip Stevenson, Jackson Orem, Corey Casper, and Rhoda A. Morrow. "Peer Mentoring at the Uganda Cancer Institute: A Novel Model for Career Development of Clinician-Scientists in Resource-Limited Settings." Journal of Global Oncology, no. 4 (December 2018): 1–11. http://dx.doi.org/10.1200/jgo.17.00134.
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Cancer centers are beginning to emerge in low- and middle-income countries despite having relatively few oncologists and specialists in related fields. Uganda, like many countries in sub-Saharan Africa, has a cadre of highly motivated clinician-scientists-in-training who are committed to developing the capacity for cancer care and research. However, potential local mentors for these trainees are burdened with uniquely high demands on their time for clinical care, teaching, institutional development, advocacy, and research. Facilitated peer mentoring helps to fill skills and confidence gaps and teaches mentoring skills so that trainees can learn to support one another and regularly access a more senior facilitator/role model. With an added consultant component, programs can engage limited senior faculty time to address specific training needs and to introduce junior investigators to advisors and even potential dyadic mentors. Two years after its inception, our facilitated peer mentoring career development program at the Uganda Cancer Institute in Kampala is successfully developing a new generation of researchers who, in turn, are now providing role models and mentors from within their group. This program provides a practical model for building the next generation of clinical scientists in developing countries.
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Okello, Clement D., Henry Ddungu, Abrahams Omoding, Andrea M. H. Towlerton, Heather Pitorak, Katie Maggard, Sarah Ewart, et al. "Capacity building for hematologic malignancies in Uganda: a comprehensive research, training, and care program through the Uganda Cancer Institute–Fred Hutchinson Cancer Research Center collaboration." Blood Advances 2, Supplement_1 (November 30, 2018): 8–10. http://dx.doi.org/10.1182/bloodadvances.2018gs111079.
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Saywon, Deazee M., and Pius Mulamira. "Cervical squamous cell carcinoma metastasis to the breast – A case report from Uganda Cancer Institute." Gynecologic Oncology Reports 38 (November 2021): 100892. http://dx.doi.org/10.1016/j.gore.2021.100892.
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Lubwama, Margaret, Freddie Bwanga, David Kateete, Scott Adams, Betty Namubiru, Barbara Nabiryo, Jackson Orem, and Warren Phipps. "226. Multidrug Resistant Polymicrobial Gram-negative Bacteremia in Hematologic Cancer Patients with Febrile Neutropenia at the Uganda Cancer Institute." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S220—S221. http://dx.doi.org/10.1093/ofid/ofab466.428.
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Abstract Background Bloodstream infections (BSI) are associated with significant mortality in hematologic cancer patients with febrile neutropenia. Poor clinical outcomes are associated with presence of multidrug resistant (MDR) organisms and polymicrobial infections. We sought to determine antimicrobial resistance and outcomes of polymicrobial bloodstream infections in hematologic cancer patients with febrile neutropenic episodes (FNEs) at the Uganda Cancer Institute. Methods Blood drawn from participants during an FNE (fever ≥ 37.5°C and neutrophil count ≤ 1000 cells/µL) was cultured in the BACTEC 9120 blood culture system. Bacteria from positive cultures were identified biochemically. Antimicrobial susceptibility testing was performed with the disc diffusion method. Participants were followed for 30 days from first FNE onset for death from any cause. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%). Results Six hundred and twenty-nine participants were followed for FNE. Two hundred and twenty-eight FNEs in 159 participants were observed. Of 181 FNEs with blood cultures completed, 65 (36%) had pathogenic organism isolated. A total of 74 Gram negative and 18 Gram positive bacteria were isolated. Forty-eight (74%) FNEs had monomicrobial (MBSI) and 17 (26%) had polymicrobial (PBSI) bloodstream infections. Gram negative - Gram negative (10 out of 17, 59%) was the most frequent PBSI combination (Fig 1). Up to 75% (12 out of 16) of Gram-negative PBSI were MDR. The most common organism isolated was E. coli (38% of isolates). Participants with PBSI had higher early mortality rates at 7 days compared to MBSI and negative cultures (44%, 22%, and 16% for PBSI, MBSI, and negative respectively; HR (95% CI): 3.63 (1.49, 8.86) for PBSI v. negative/MBSI cultures). Similarly, PBSI was associated with higher mortality within 30 days of FNE onset (63%, 52%, and 38% for PBSI, MBSI, and negative respectively; HR (95% CI): 2.17 (1.09, 4.32) for PBSI v. negative/MBSI) (Fig 2). Figure 1. Bar graph showing combinations for polymicrobial bloodstream infections (PBSI). GNGN: Gram-negative – Gram-negative; GNGP: Gram-negative – Gram-positive; GNO: Gram-negative – Other (fungi); GPGP: Gram-positive – Gram-positive Figure 2. Kaplan-Meier failure curves of participants with negative cultures, monomicrobial infections and polymicrobial infections Conclusion PBSI episodes were more likely to be multidrug resistant and are associated with higher mortality. Empirical therapy for patients with PBSI should consider multidrug resistant Gram-negative bacteria Disclosures All Authors: No reported disclosures
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Okunade, Kehinde, Kennedy Bashan Nkhoma, Omolola Salako, David Akeju, Bassey Ebenso, Eve Namisango, Olaitan Soyannwo, et al. "Understanding data and information needs for palliative cancer care to inform digital health intervention development in Nigeria, Uganda and Zimbabwe: protocol for a multicountry qualitative study." BMJ Open 9, no. 10 (October 2019): e032166. http://dx.doi.org/10.1136/bmjopen-2019-032166.
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IntroductionPalliative care is a clinically and cost‐effective component of cancer services in sub-Saharan Africa (SSA). Despite the significant need for palliative cancer care in SSA, coverage remains inadequate. The exploration of digital health approaches could support increases in the quality and reach of palliative cancer care services in SSA. However, there is currently a lack of any theoretical underpinning or data to understand stakeholder drivers for digital health components in this context. This project addresses this gap through engaging with key stakeholders to determine data and information needs that could be supported through digital health interventions.Methods and analysisThis is a multicountry, cross-sectional, qualitative study conducted in Nigeria, Uganda and Zimbabwe. In-depth interviews will be conducted in patients with advanced cancer (n=20), caregivers (n=15), health professionals (n=20) and policy-makers (n=10) in each of the three participating countries. Data from a total of 195 interviews will transcribed verbatim and translated into English before being imported into NVivo software for deductive framework analysis. The analysis will seek to understand the acceptability and define mechanisms of patient-level data capture and usage via digital technologies.Ethics and disseminationEthics approvals have been obtained from the Institutional Review Boards of University of Leeds (Ref: MREC 18–032), Research Council of Zimbabwe (Ref: 03507), Medical Research Council of Zimbabwe (Ref: MRCZ/A/2421), Uganda Cancer Institute (Ref: 19–2018), Uganda National Council of Science and Technology (Ref: HS325ES) and College of Medicine University of Lagos (Ref: HREC/15/04/2015). The project seeks to determine optimal mechanisms for the design and development of subsequent digital health interventions to support development, access to, and delivery of palliative cancer care in SSA. Dissemination of these findings will occur through newsletters and press releases, conference presentations, peer-reviewed journals and social media.Trial registration numberISRCTN15727711
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Katongole, Paul, Obondo J. Sande, Mulumba Yusuf, Moses Joloba, Steven J. Reynolds, and Nixon Niyonzima. "Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2015 and 2019 at the Uganda Cancer Institute." PLOS ONE 15, no. 10 (October 30, 2020): e0236458. http://dx.doi.org/10.1371/journal.pone.0236458.
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Katongole, Paul, Obondo J. Sande, Sheilla Nabweyambo, Moses Joloba, Henry Kajumbula, Samuel Kalungi, Steven J. Reynolds, et al. "IL-6 and IL-8 cytokines are associated with elevated prostate-specific antigen levels among patients with adenocarcinoma of the prostate at the Uganda Cancer Institute." Future Oncology 18, no. 6 (February 2022): 661–67. http://dx.doi.org/10.2217/fon-2021-0683.
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Background: The possible clinical application of specific cytokines and chemokines contributing to tumorigenesis and the clinical outcome of several cancers has been reported. However, less invasive and easily applicable biomarkers in prostate cancer diagnosis and prognostication are still lacking. This study assessed the levels of plasma cytokines in prostate cancer patients as potential biomarkers for noninvasive early diagnosis. Methods: The plasma levels of nine cytokines, IL-6, IL-8, IL-10, IL-1β, IL-17A, IL-2, M-CSF, IL-12 and IFN-α, were detected by Luminex© liquid array-based multiplexed immunoassays in 56 prostate cancer patients on androgen deprivation therapy and radiotherapy and 27 normal healthy controls. Results: Levels of plasma proinflammatory cytokines IL-6 and IL-8 were markedly increased in prostate cancer patients compared with controls. There was, however, no significant difference in the concentrations of all cytokines in prostate cancer patients compared with controls. Increasing levels of IL-6 and IL-8 were significantly associated with high levels of plasma prostate-specific antigen (p < 0.05). Conclusion: Proinflammatory cytokines IL-6 and IL-8 are potential biomarkers for prostate cancer pathogenesis and could serve as markers of disease progression.
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Swanson, M., M. Nakalembe, L. M. Chen, S. M. Ueda, J. Namugga, and M. J. Huchko. "Surgical candidacy among women presenting at Mulago National Referral Hospital and the Uganda Cancer Institute with new diagnoses of cervical cancer." Gynecologic Oncology 149 (June 2018): 244. http://dx.doi.org/10.1016/j.ygyno.2018.04.550.
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Okello, Clement Dove, Soheil Meshinchi, Katherine Tarlock, Edus H. Warren, Andrea M. H. Towlerton, Henry Ddungu, Yusuf Mulumba, Fadhil Geriga, Jackson Orem, and Joyce K. Balagadde. "Clinical Outcome and Treatment-Related Mortality in Patients with Acute Myeloid Leukemia Treated at the Uganda Cancer Institute." Blood 140, Supplement 1 (November 15, 2022): 8940–41. http://dx.doi.org/10.1182/blood-2022-165982.
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Kyarimpa, A. "Delivering Cost-Effective Cervical Cancer Screening Package to Women Living With Human Immunodeficiency Virus By Reproductive Health Uganda." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 146s. http://dx.doi.org/10.1200/jgo.18.77200.
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Background and context: Uganda has one of the highest cervical cancer incidences in the world. Over 80% late diagnosis compounds the challenge. It is evident that women living with human immunodeficiency virus (HIV) have a higher prevalence of precancer lesions and have limited access to cervical cancer knowledge and relevant services especially women living with HIV, who are poor and marginalized. This results in a gap for first-line defense to cervical cancer. To bridge the gap and deliver services, Reproductive Health Uganda (RHU) introduced cost-effective “see and treat”, single visit approach (SVA), using combined visual inspection with acetic acid (VIA) and cryotherapy. Aim: To promote single visit approach in cervical cancer screening program in selected HIV clinics and assess the feasibility. Strategy: • Collaborate with HIV clinics, which enroll and provide counseling and services to women living with HIV • Integrate SVA into the current services package in HIV clinics and outreaches to break geographic barriers • Train RHU and public health clinic staff to perform VIA and cryotherapy if needed • Enable SVA in public antiretroviral therapy (ART) clinics through partnerships • Awareness creation through group health education and individual counseling Program: The project implemented in three high HIV prevalence rate districts targeted women 25-49 years of age. Partnered with public ART clinics and arranged training to ensure midwives and nurses in RHU and public health facilities are able to carry out VIA and cryotherapy if needed. Announcements and appointment posters were pinned up on the facility notice board providing details of dates and service package. RHU used this opportunity to promote contraception and STIs management. Health education and counseling session were conducted. Trained peer support mothers mobilized women seek cervical cancer screening when doing HIV follow-up. Quarterly support supervision, QOC assessments and DQAs were conducted to ensure quality and reliability of results and reports. Outcomes: Acceptability of cervical cancer screening was high. The project increased general awareness among rural community members, where cancer is generally stigmatized and associated with a lot of myths. Knowledge, skills and competencies of 54 midwives to screen for and treat with cryotherapy was built. 23,713 women were screened, with average VIA positivity rate 8%-11% across project districts. 98% of cryotherapy-eligible women treated during the same visit. Referral to Ugandan cancer institute was established to ensure timely cancer therapy. Integration and acceptability of family planning increased among women attending ART clinics. What was learned: With appropriate demand creation, acceptability of SVA was good among women attending the ART clinics, SVA is cost-effective and feasible. Integration of SRH package of services helps leverage resources. Strategic partnerships are critical in strengthening public–private partnership in services provision.
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Menon, Manoj, Anna Coghill, Innocent Mutyaba, Fred Okuku, Warren Phipps, John Harlan, Jackson Orem, and Corey Casper. "Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute." PLOS ONE 13, no. 2 (February 1, 2018): e0191967. http://dx.doi.org/10.1371/journal.pone.0191967.
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Swanson, M., M. Nakalembe, L. M. Chen, S. M. Ueda, J. Namugga, and M. J. Huchko. "Addressing pain along the continuum of cervical cancer care among women ultimately presenting at mulago national referral hospital and the Uganda cancer institute." Gynecologic Oncology 154 (June 2019): 278. http://dx.doi.org/10.1016/j.ygyno.2019.04.655.
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De Boer, Christopher, Nixon Niyonzima, Jackson Orem, John Bartlett, and Yousuf Zafar. "Prognosis, diagnostic delay, and patient characteristics associated with diagnostic delay among Kaposi sarcoma (KS) patients in Uganda." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6578. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6578.
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6578 Background: The incidence and mortality of KS remain high in sub-Saharan Africa. Delaying treatment might explain poor outcomes, but no study has measured the association between delay, characteristics associated with delay, and prognosis for KS patients in low- and middle-income countries. Methods: This is a prospective, cross-sectional study conducted from June-October 2012 at the Uganda Cancer Institute (UCI) in Kampala, Uganda among HIV-infected adults with histologically confirmed KS. The aim was to measure the association between delay and overall KS stage risk at diagnosis. Standardized interviews were conducted in English or Luganda to measure delay, and medical records were abstracted to obtain KS stage at admission to UCI. Multivariable logistic regression was used to assess the relationship between diagnostic delay and poor-risk stage at diagnosis. Results: 161 patients were enrolled; 68.9% were men, mean age was 34.0 years (SD 7.7), 58.1% had income < $2 per day, and 49.4% had ≥primary education. 25.8% had been seen in an HIV clinic within 3 months, 71.6% were on antiretroviral therapy (ART), and 25.5% had visited a traditional healer prior to being seen at UCI. 45.3% delayed seeking care at UCI for ≥3 months from onset of symptoms. Among those who delayed, 35.6% waited 6 months, and 24.7% waited 12 months. The most common reasons for delay were lack of pain (47.9%), no money (31.5%), and distance to UCI (8.2%). In adjusted analysis patients who experienced diagnostic delay were more likely to have poor-risk stage compared to those who did not delay (OR 3.41, p=0.002, 95%CI: 1.46-7.45). After adjusting for patient characteristics, HIV clinic attendance, and ability to pay out-of-pocket costs, visiting a traditional healer was the only characteristic associated with greater likelihood of delay (OR 2.69, p=0.020, 95%CI: 1.17-6.17). Conclusions: Diagnostic delay was independently associated with poor-risk stage at diagnosis, and visiting a traditional healer was the only patient characteristic independently associated with delay. The relationship between traditional and Western medicine presents a critical point of intervention to improve KS outcomes in Uganda.
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Ddungu, Henry, Elizabeth M. Krantz, Warren Phipps, Sandra Naluzze, Jackson Orem, Noah Kiwanuka, Anna Wald, and Isaac Kajja. "Survey to Assess Knowledge and Reported Practices Regarding Blood Transfusion Among Cancer Physicians in Uganda." Journal of Global Oncology, no. 4 (December 2018): 1–12. http://dx.doi.org/10.1200/jgo.18.00143.
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Purpose Optimal decision making regarding blood transfusion for patients with cancer requires appropriate knowledge of transfusion medicine among physicians. We assessed blood transfusion knowledge, attitudes, and reported practices among physicians working at Uganda Cancer Institute (UCI). Materials and Methods A cross-sectional self-administered survey of UCI physicians on their knowledge, attitudes, and practices regarding blood transfusion was conducted from June to September 2014. In consultation with transfusion medicine experts, 30 questions were developed, including 10 questions for each of the following three domains: knowledge, attitudes, and practices. For the knowledge domain, we created a knowledge score equal to the number of questions correctly answered out of 10. Results Of 31 physicians approached, 90% participated. The mean knowledge score was 5.3 (median, 5.5), and 32% correctly answered at least seven of 10 questions. Almost all (96%) understood the importance of proper patient identification before transfusion and indicated identification error as the most common cause of fatal transfusion reactions. More than 60% of physicians acknowledged they lacked knowledge and needed training in transfusion medicine. Most physicians reported sometimes changing their mind about whether to provide a patient with a transfusion on the basis of opinion of colleagues and sometimes administering unnecessary transfusions because of influence from others. Conclusion Although UCI physicians have some basic knowledge in transfusion, most reported gaps in their knowledge, and all expressed a need for additional education in the basics of blood transfusion. Transfusion training and evidence-based guidelines are needed to reduce inappropriate transfusions and improve patient care. Greater understanding of peer influence in transfusion decision making is required.
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Menon, Manoj, Jackson Orem, Scott Adams, Alex Bakenga, Diana Basemera, David Kasozi, Eric Quentin Konnick, et al. "ER, PR, and HER2 expression in Ugandan breast cancer patients: An evaluation of in-country RT-PCR compared to IHC." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19009-e19009. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19009.
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e19009 Background: Breast cancer, the most common cancer in sub-Saharan Africa (SSA), is characterized by poor survival. An accurate assessment of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 receptor (HER2) status, typically via immunohistochemistry (IHC), is considered essential to provide prognostic data and guide therapeutic decision-making. However, due to inaccessible IHC services, these data are often unavailable in many parts of SSA; alternate methods need to be explored. Given the lab infrastructure developed in response to the HIV pandemic, RT-PCR testing is more readily accessible and feasible in SSA. Here we assess the potential of RT-PCR in evaluating the receptor status of women with breast cancer in Uganda. Methods: We enrolled women with a new diagnosis of invasive breast cancer at the Uganda Cancer Institute. Demographic and clinical data were obtained. A formalin-fixed paraffin embedded (FFPE) specimen was utilized for quantitative RT-PCR, using a validated assay for the detection of the ER, PR and HER2. Receptor expression levels were expressed as relative quantity (RQ) compared to housekeeping genes (CALM2). HER2 IHC results were categorized as negative (score 0 or 1+) or positive (3+); 2+ results (n=6) were excluded as FISH testing was not performed. Unstained slides were sent to the Fred Hutchinson Cancer Research Center for IHC. Receiver operating characteristic (ROC) analysis was applied to compare RT-PCR to IHC (gold standard). Results: We analyzed interim data (anticipated N=100 of an ongoing study) from 32 women aged 35 to 56 years. The majority of women (25, 78%) presented with advanced stage disease. Of the 32 cancers, 18 were ER+ (56%), 10 were PR+ (31%), 9 were HER2+ (28%) and 8 were triple negative (25%) by IHC. From ROC analysis, the AUC were 0.94, 0.95, and 0.81 for ER, PR, and HER2 respectively with high sensitivity and specificity (Table). Conclusions: Despite the tremendous need, the ability to detect the ER, PR, and HER2 via IHC in SSA is limited. Here we demonstrate the favorable test characteristics of RT-PCR when compared to IHC. Given the relatively wide accessibility of RT-PCR and endocrine therapy for breast cancer, as well as the recent inclusion of trastuzumab in the WHO’s Essential Medicines List, the results of this study have both direct diagnostic and therapeutic implications. Clinical trial information: NCT03518242 . [Table: see text]
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Okello, Clement D., Andrew W. Shih, Bridget Angucia, Noah Kiwanuka, Nancy Heddle, Jackson Orem, and Harriet Mayanja-Kizza. "Mortality and its associated factors in transfused patients at a tertiary hospital in Uganda." PLOS ONE 17, no. 9 (September 22, 2022): e0275126. http://dx.doi.org/10.1371/journal.pone.0275126.
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Blood transfusion is life-saving but sometimes also associated with morbidity and mortality. There is limited data on mortality in patients transfused with whole blood in sub-Saharan Africa. We described the 30-day all-cause mortality and its associated factors in patients transfused with whole blood to inform appropriate clinical intervention and research priorities to mitigate potential risks. A retrospective study was performed on purposively sampled patients transfused with whole blood at the Uganda Cancer Institute (UCI) and Mulago hospital in the year 2018. Two thousand twelve patients with a median (IQR) age of 39 (28–54) years were enrolled over a four month period. There were 1,107 (55%) females. Isolated HIV related anaemia (228, 11.3%), gynaecological cancers (208, 10.3%), unexplained anaemia (186, 9.2%), gastrointestinal cancers (148, 7.4%), and kidney disease (141, 7.0%) were the commonest diagnoses. Most patients were transfused with only one unit of blood (n = 1232, 61.2%). The 30 day all-cause mortality rate was 25.2%. Factors associated with mortality were isolated HIV related anaemia (HR 3.2, 95% CI, 2.3–4.4), liver disease (HR 3.0, 95% CI, 2.0–4.5), kidney disease (HR 2.2, 95% CI, 1.5–3.3; p<0.01), cardiovascular disease (HR 2.9, 95% CI, 1.6–5.4; p<0.01), respiratory disease (HR 3.0, 95% CI 1.8–4.9; p<0.01), diabetes mellitus (HR 4.1, 95% CI, 2.3–7.4; p<0.01) and sepsis (HR 6.2, 95% CI 3.7–10.4; p<0.01). Transfusion with additional blood was associated with survival (HR 0.8, 95% CI 0.7–0.9, p<0.01). In conclusion, the 30-day all-cause mortality was higher than in the general inpatients. Factors associated with mortality were isolated HIV related anaemia, kidney disease, liver disease, respiratory disease, cardiovascular disease, diabetes mellitus and sepsis. Transfusion with additional blood was associated with survival. These findings require further prospective evaluation.
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Bary, A. Derrick. "Breast Cancer Risk Perception of First Degree Female Relatives of Breast Cancer Patients Influences Their Risk Reduction Behaviors: A Pre-Study Assessment." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 23s. http://dx.doi.org/10.1200/jgo.18.55100.
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Background: Breast cancer is the second most common cancer affecting women worldwide. There is an increased risk of breast cancer among the first degree relatives. Perceived risk relates to an individual's belief about the probability or likelihood of developing some specified illness. Cancer fatalism is the belief that cancer is predetermined, beyond individual control, and necessarily fatal. Aim: To assess the self-perceived risk of breast cancer and screening and risk reduction behaviors among the first degree female relatives of breast cancer patients. Findings from this study can inform interventions to increase uptake of breast cancer screening services among relatives of breast cancer patients in low- and middle-income countries (LMICs). The results formed a baseline for designing a study on risk perception and risk reduction practices among first degree female relatives of patients diagnosed with breast cancer at Uganda Cancer Institute, Kampala, Uganda. Methods: Review of literature on risk perception and risk reduction practices of first degree relatives of breast cancer patients. We searched through various literature published in PubMed and oncology journals in HINARI published in English. All the studies were conducted among female relatives of breast cancer patients from world. All eligible papers were included in the review. The papers were carefully appraised to identify key outcomes of the studies. Results: Women were engaged in risk reduction behaviors like smoking cessation, reduction in alcohol intake, physical activity and screening for breast cancer. Women aged 54 years and below had a higher perceived lifetime risk of breast cancer (39.5%) compared with those aged ≥ 55 years (30.6%) who perceived themselves at lower risk. Levels of education have also been found key in determining an individual's perceived risk. Being unrealistically optimistic was significantly associated with high level of educational attainment while women who did not know their risk were less educated. Socioeconomic status has also been seen to influence breast cancer perceived risk. Unrealistic pessimism was frequent among women with a higher income status although a greater proportion of women who accurately perceived their 5-year risk of breast had a higher annual income. There was a significant association of the stage of breast cancer, time since diagnosis and perceived breast cancer risk among the relatives. Fatalistic beliefs about cancer prevention influenced prevention behaviors by promoting a sense of external locus of control changing beliefs about the value of specific behaviors, or reducing self-efficacy and motivation to perform prevention behaviors. Conclusion: High risk perception is associated with increase need to engage in risk reduction behaviors. Fatalism among women was the primary reason not to engage in breast cancer screening.
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Phipps, Warren T., Andrea M. H. Towlerton, David G. Coffey, Nixon Niyonzima, and Edus H. Warren. "T-Cell Receptor Sequencing of Kaposi Sarcoma Tumors to Identify Candidate Tumor-Reactive T Cells." Journal of Global Oncology 3, no. 2_suppl (April 2017): 45s. http://dx.doi.org/10.1200/jgo.2017.009761.
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Abstract 60 Background: Development of Kaposi sarcoma (KS) is strongly associated with immune dysfunction in the context of HIV infection, but little is known about T-lymphocyte responses against KS tumor cells or human herpesvirus-8, the viral cause of KS. Increasing evidence suggests that treatment response in KS is attributable in part to an antitumor immune response that is mediated by tumor-infiltrating lymphocytes (TIL). The aim of this work was to identify TIL characteristics that are associated with tumor regression in patients with KS who were treated with antiretroviral therapy and chemotherapy as well as to identify a molecular signature of response. Methods: High-throughput sequencing of the T-cell receptor β chain ( TRB) was used to define the repertoire of T cells that infiltrate up to two pretreatment and two post-treatment KS tumors and matched normal skin obtained from HIV-infected adults with KS who received care at the Uganda Cancer Institute. We compared TRB repertoire in serially collected tumors to identify TRB sequences carried in candidate tumor-reactive T cells. Results: TRB sequencing was performed on KS tumor and matched normal skin samples from 12 HIV-infected adults with KS who collectively demonstrated a range of treatment responses. Unique populations of T cells were identified in pretreatment tumors but not in normal skin in all patients, which suggested the presence of KS-specific T-cell responses. Durable complete response to treatment in one patient was associated with significant expansion of a small number of T-cell clones, one of which carried a TRB sequence that was associated with a public CD8+ Epstein-Barr virus–associated T-cell receptor. Conclusion: Understanding the immune response to KS through cellular and molecular dissection of TIL will provide important insights into KS biology and may ultimately guide new immune-based strategies to stage and treat this often-refractory cancer. Funding: Solid Tumor Translational Research Transformative Team Grant, Fred Hutchinson Cancer Research Center; National Institutes of Health/National Cancer Institute Grant No. K23-CA150931. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.