Colorectal cancer research priorities in Uganda: perspectives from local key experts and stakeholders.

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]