As the 3rd leading cause of death in Kenya, cancer places an increasing burden on the country’s healthcare resources. In 2020, The Christie NHS Foundation Trust and The University of Manchester signed Memoranda of Understanding with Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) and Ministry of Health, Kenya to develop a long-term equitable partnership that seeks to improve cancer outcomes within Kenya and East Africa.
This government interest and backing provides the perfect backdrop for initiating our NIHR Group between Kenya and Manchester. This partnership brings together researchers from a variety of scientific and clinical backgrounds to focus on the early detection of lethal squamous cell carcinoma of the oesophagus (OSCC). It is the third most common cancer and the most lethal (99% of patients die from their disease within 5 years) due to patients being diagnosed too late when they have advanced, incurable disease. OSCC needs better early detection strategies to diagnose cancers at a much earlier stage whereby 40-50% of Kenyan patients could potentially be cured with surgery. However, there are obstacles to quickly introduce this early detection programme. The majority of Kenyans (~75%) live in rural areas with very low incomes, many of which are cut off from cancer care. There are also marked differences in the number of OSCC cases between different Kenyan counties, and even between East, West and South Africa. We do not know all the factors that lead to these different rates of OSCC presentation, but they could include late recognition of symptoms by the patient and general practitioner, social stigma of a cancer diagnosis, different access to healthcare, lifestyle and genetic factors or other environmental and exposure factors. We will overcome these research obstructions and develop interventions to improve OSCC early detection. By pairing expertise within our joint NIHR GACD Group, we seek to address the problem of OSCC early detection through the following AIMs:
• AIM 1: Co-develop best engagement and research practices for OSCC detection amongst local health leads and their communities;
• AIM 2: Co-create a KUTRRH “Hub and Spoke” model whereby mobile units address cancer detection directly within rural communities and sends back clinical and imaging digital data and biological specimens to KUTRRH. It uses telemedicine to communicate regularly to rural settings and to Manchester collaborating clinicians;
• AIM 3: Increase the capability for pathology high-throughput analysis of the extra specimens associated with increased early detection. Also to partner with world leading genetics experts to discover mutations in the OSCC tumour DNA that might explain why a cancer came to be in certain Kenyans – to describe how best to detect them or one day, to prevent them entirely. We will work with local community partners and the Kenyan Network of Cancer Organisations (KENCO) to optimise a national Cancer Early Detection network to support research on OSCC and all cancers. Success in this first 3-year project could lead to further success in long-term goals in which we can show improved survival and quality of life in patients with OSCC, which will in turn decrease family separation or fragmentation due to treatment or worse, death. We see this as a way to improve Kenyan and East African healthcare for all cancers and success in this grant would lead to future larger applications
