In Kenya, 4,400 people die from oesophageal cancer every year, and 99.3% of those diagnosed will die from the disease. The problem is that patients and general practitioners recognise symptoms too late, so most people already have incurable, advanced cancer by the time they are diagnosed. This research group will test whether a “hub and spoke” model—where five pilot counties send patient data to a central hub at Kenyatta University Teaching, Referral and Research Hospital, and receive standardised care protocols in return—can catch the disease earlier. The team will also co-develop community engagement strategies to improve referral rates to local endoscopy units, and build pathology capacity to study the unique biology of Kenyan oesophageal cancer. If the model works, it could create a blueprint for early detection networks across East Africa, shifting the focus from treating incurable late-stage disease to intercepting it earlier. The project is not fundamental science; it is a practical, implementation-focused effort to redesign how cancer care is delivered in a resource-limited setting.
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The Kenyan Ministry of Health is committed to reducing the incidence of cancer with a systematic and coordinated approach. Early diagnosis and accurate staging are key for optimising treatment and outcomes. Successful breast and cervical cancer screening programmes have been launched within a new National Cancer Control Strategy. To further improve cancer outcomes in Kenya and East Africa, the Ministry of Health, Kenya have reached out to and signed Memoranda of Understanding with The Christie NHS Trust and University of Manchester in January 2020. At the direction of President Kenyatta, a long-term partnership was subsequently established with Kenyatta University Teaching, Referral and Research Hospital (KUTRRH).In Kenya, oesophageal squamous cell carcinoma (OSCC) is the third most common cancer with the highest mortality of all cancers at 4400 deaths per year and a case fatality rate of 99.3%. This is thought to be due to late recognition of symptoms by the patient and general practitioner, with consequential delays in diagnosis and inevitable presentation as incurable, advanced disease. Kenyan healthcare researchers tasked Manchester researchers to understand the unique needs of the Kenyan oncology ecosystem and effectively partner with them to decrease OSCC mortality. This NIHR Research Group application supports this joint partnership using early detection of OSCC as a research exemplar. There remain key outstanding questions for our joint research programme: How can local engagement be optimised to refer individuals with symptoms to local endoscopy units within their counties? What is the feasibility of setting up and running early diagnostic centres associated with health centres in 5 pilot counties? What is the feasibility of developing an integrated cancer network for diagnosis and treatment of OSCC via telemedicine between the 5 counties, KUTRRH and the Manchester Oesophageal Cancer Centre? What is the feasibility of developing an integrated clinical outcomes platform between KUTRRH and the 5 counties for patients with OSCC? What can mutational signatures tell us about the aetiology of Kenyan versus Western OSCC and inform future detection-interception studies? In addressing these questions, we hypothesise that improved engagement and pipelines towards OSCC early detection and increased OSCC biological knowledge will lead to a step change in OSCC prevention, interception and treatment; all these will be bespoke to Kenyan and East African populations. Our new NIHR GACD Group will drive 3 AIMs to address this hypothesis and will be delivered over a 3 year grant period with a unique paired expert approach to both scientific co-creation and NIHR Group Governance: AIM 1: Co-develop enhanced community engagement strategies to establish equipollent partnerships and improve county-level access to cancer early detection services for OSCC. AIM 2: Co-create a research-based digital ‘hub and spoke outcomes unit’ with inward OSCC clinical data from counties to KUTRRH hub and outward harmonised OSCC care protocols to distant spoke counties. AIM 3: Co-build a pathologist and pathology capacity to support early detection programmes and inform on bespoke Kenyan cancer biology relevant to future prevention studies. Success in these AIMs will be evaluated using a Rapid Cycle Evaluation Framework (Plan>Do>Study>Act), which will allow the use of mixed methodologies to inform in real time and capture the nuances of the evolving project.
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