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The incidence of colorectal cancer (CRC) is increasing in Uganda but there is limited local research to guide policy and programming for CRC prevention and control. A stakeholder engagement workshop took place in Kampala on 19 March 2024 to identify challenges and opportunities for CRC prevention and control in Uganda. A total of 30 stakeholders with expertise in CRC primary and secondary prevention, diagnosis, treatment, palliative care as well as cancer survivors participated in the workshop. Key challenges for primary prevention included low knowledge/awareness of CRC among the general population and health workers, and rising prevalence of CRC related risk factors. Limited CRC screening, diagnostic facilities and specialists were identified as barriers to diagnosis. Treatment related challenges included limited accessibility to surgical services and drugs, late-stage presentation leading to poor treatment response, treatment abandonment and drug related toxicity. Lack of universal health coverage policies, limited community-based cancer awareness programs, and lack of national cancer registries were cited as policy and economics challenges. Opportunities to address these challenges were discussed. Our findings highlight areas for further research and prioritization to address Uganda's growing CRC burden and may be applicable to other low-resource settings. Article highlights This report summarizes key challenges and opportunities for colorectal cancer (CRC) prevention and control in Uganda as identified by local experts and stakeholders during a stakeholder engagement workshop in Kampala, Uganda. At the primary prevention level, low knowledge and awareness of CRC among both the population and health workers, and rising prevalence of CRC related risk factors were identified as key challenges. Opportunities included: utilizing district health educators to deliver CRC related information in the community, encouraging use of behavioral change interventions to promote healthier lifestyle behaviors and advancing health workers knowledge of CRC through continuous professional development. For secondary prevention and diagnosis, limited diagnostic capacity, both in terms of healthcare workforce and facilities (equipment, tests, reagents) were identified as key challenges. Opportunities included: expanding the number of trained CRC specialists and improving existing infrastructure at the tertiary levels of the healthcare system. For treatment, limited accessibility to CRC surgical services and drugs, late-stage CRC presentation leading to poor treatment response, treatment abandonment and drug related toxicity were identified as key challenges. Opportunities included: designing and implementing interventions to increase access to CRC drugs, conducting local research to understand the burden of drug toxicity and possible reasons for treatment abandonment as well as studying the feasibility of surgical camps as avenues to improve CRC surgical treatment. For economics and policy, lack of universal health coverage policies to cover/reduce costs associated with CRC screening, diagnosis and management, limited community-based cancer awareness efforts and lack of cancer registration at a national level were identified as key challenges. Opportunities included: ongoing plans to introduce universal health coverage, the possibility of piloting subsidized fee colonoscopy programs, and initiating partnerships with equipment manufacturers to increase access to screening and diagnostic tests for CRC. Addressing the identified challenges may help inform policy and contribute to CRC prevention and control in Uganda. [ABSTRACT FROM AUTHOR]

Background Experimental and clinical studies have implicated certain chemokines and angiogenic cytokines in multiple myeloma (MM) pathogenesis. To investigate whether systemic concentrations of these markers are associated with future MM risk and progression from its precursor, monoclonal gammopathy of undetermined significance (MGUS), we conducted a prospective study within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Methods We measured concentrations of 45 immunologic and pro-angiogenic markers in sera from 241 MM case patients, 441 participants with nonprogressing MGUS, and 258 MGUS-free control participants using Luminex-based multiplex assays and enzyme-linked immunosorbent assays. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. We also evaluated absolute risk of progression using weighted Kaplan-Meier estimates. All statistical tests were two-sided. Results Prediagnostic levels of six markers were statistically significantly elevated among MM case patients compared with MGUS-free control participants using a false discovery rate of 10% (EGF, HGF, Ang-2, CXCL12, CCL8, and BMP-9). Of these, three angiogenesis markers were associated with future progression from MGUS to MM: EGF (fourth vs first quartile: OR = 3.01, 95% CI = 1.61 to 5.63, P trend =.00028), HGF (OR = 2.59, 95% CI = 1.33 to 5.03, P trend =.015), and Ang-2 (OR = 2.14, 95% CI = 1.15 to 3.98, P trend =.07). A composite angiogenesis biomarker score substantially stratified risk of MGUS progression to MM beyond established risk factors for progression, particularly during the first 5 years of follow-up (areas under the curve of 0.71 and 0.64 with and without the angiogenesis marker score, respectively). Conclusions Our prospective findings provide new insights into mechanisms involved in MM development and suggest that systemic angiogenesis markers could potentially improve risk stratification models for MGUS patients. [ABSTRACT FROM AUTHOR]

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I 2  = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I 2  = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I 2  = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I 2  = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment., (© 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Alleviating symptom burden in patients with myeloproliferative neoplasms (MPNs) is imperative to achieving optimal management. Research remains to elucidate the relationship between the JAK2 V617F ( Janus kinase 2 ) mutation present in many MPN patients, and the symptomatology they experience. This retrospective study analysed data collected from MPN patients included in the Myeloproliferative Neoplasms: An In-depth Case-Control (MOSAICC) pilot study. The MPN Symptom Assessment Form was administered, and median symptom scores were compared between JAK2 V617F -positive and JAK2 V617F -negative groups. Multivariate logistic regression analysis adjusted for confounding variables. Overall, 106 MPN patients participated: 65.1% were JAK2 V617F positive, 30.2% were JAK2 V617F negative and 4.7% had an unknown status. Multivariate analysis revealed a low symptom burden for early satiety ( p  < 0.01), dizziness ( p  < 0.05), cough ( p  < 0.05) and bone pain ( p  < 0.01) in those receiving venesection alone. Interferon alpha was significantly associated ( p  < 0.05) with severe burden for 16 of the 27 symptoms. JAK2 V617F -positive females experienced a greater symptom burden than JAK2 V617F -positive males. There was no discernible relationship between the JAK2 V617F mutation and symptom burden in MPN patients, unlike the therapeutic agents investigated. Larger studies are required to validate these results and identify mechanisms of symptom development and control in MPN patients., Competing Interests: Mary Frances McMullin—BMS: advisory boards and clinical trial support; AbbVie: advisory boards and speaker bureau; CTI: advisory boards; Sierra oncology: advisory board. Ruben Mesa—Novartis/Sierra Onc/LaJolla/Pharma/Constellation: consultant; Celgene/Incyte/Abbvie/Samus/Genotech/Promedior/CTI/Constellation: research support., (© 2023 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.)