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Background: Cervical cancer screening rates in Zambia have remained low for women 25 - 59 years old despite efforts to raise awareness among women using different communication platforms. The mHealth for cervical cancer used mass messaging and was implemented to complement already existing interventions aimed at increasing knowledge levels and the number of women accessing screening services. Methods: A concurrent mixed methods design was used. Quantitative data was collected using telephone interviews with both women and men to whom text messages on cervical cancer screening had been sent. The qualitative data was collected using focus group discussions and key informant interviews, and focused on the implementation process as well as the perceptions and experiences of the users. Qualitative data was analyzed using thematic analysis while quantitative data was analyzed using descriptive statistics (proportions). Results: From the 990 (473 men and 517 women) participants sampled in the survey, only 46% of the women and 34% of men had received the short message services (SMSs). The SMSs resulted into 14% (72) of women going for screening for the first time, and 4% (22) for follow-up screening, totaling 18% (94). The intervention was described as appropriate because it resulted in more awareness about cervical cancer; and the frequency, time of day of transmission, the language and content of the SMSs were perceived good. The challenges experienced include low number of SMSs successfully delivered to the target population (50%), and the high cost of transmission. Conclusion: Despite the challenges experienced, the mCervical cancer intervention showed moderate effectiveness in reaching women and encouraging them to go for first time and follow-up screening.

ObjectiveTo describe the health system, socioeconomic and clinical factors that influence access to and outcomes of care for prostate cancer (PC) in Uganda.DesignQualitative Delphi techniqueSettingGovernment and private-not-for-profit hospitalsMethodsWe applied a two-stage modified Delphi technique to identify the consensus view across cancer experts. In the first round, experts received a questionnaire containing 22 statements drawn from a systematic review of the literature focusing on identifying the reason for the delay in accessing cancer care. Round 2 comprised 18 statements considered the greatest priority from round 1.ResultsWe found that the top five research priority areas arise from challenges including: (i) lack of Diagnostic services - Ultrasound, laboratory tests, and biopsy facilities; (ii) High costs of services e.g., surgery, radiotherapy, hormone therapy are unaffordable to most patients, (iii) Lack of critical surgical supplies and essential/critical medicines, (iv) Lack of awareness of cancer as a disease and low recognition of symptoms, (v) Low Healthcare literacy. The lack of critical surgical supplies, high costs of diagnostic investigations and treatments were ranked highest in order of importance in round one. Round two of the survey also revealed lack of diagnostic services, unavailability of critical medicines, lack of radiotherapy options, high costs of treatments and lack of critical surgical supplies as the top priorities.ConclusionThese research priority areas ought to be addressed in future research to improve prompt prostate cancer diagnosis and care in Uganda. There is need to improve the supply of high-quality affordable anticancer medicines provided timely to prostate cancer patients so as to improve the survivorship from the cancer.Article SummaryStrengths and limitations of this studyThis is a novel Delphi study exploring research priorities for prostate cancer research in Uganda from various stakeholders in cancer care.The study was informed by a recent systematic review which provided insight into the statements explored in the Delphi technique.Participants were recruited from various clinical, government aided and private settings and geographical locations giving representativeness of the participants.A limitation to this study was the low response rates in round 1 and round 2 as most stakeholders were not familiar with the Delphi technique, or how it works.

ObjectivesLate presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA.DesignSystematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool.Data sourcesPubMed and Embase, for publications from January 1995 to March 2021.Eligibility criteriaInclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. Exclusion criteria: paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways).Data extraction and synthesisTwo reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes.Results57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines.ConclusionsRobust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.

In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.