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CGH Supports 8 New Supplemental Projects Studying COVID-19 and Cancer in LMICs

, by Allison Frank, Elise M. Garton, MSc., Paul C. Pearlman, Ph.D.

coronavirus under the microscope

The Center for Global Health is excited to announce eight new administrative supplement awards studying the impact of COVID-19 on global cancer prevention and control submitted in response to a Notice of Special Interest (NOSI). The COVID-19 pandemic has challenged the capacity of health systems, making access to cancer detection, diagnosis, and treatment services difficult or impossible. This has impacted cancer prevention, diagnosis, and treatment services worldwide and is anticipated to result in increased cancer incidence and mortality over the next several years. This administrative supplement funding opportunity was designed to support NCI-funded investigators who have existing research grants in low- and middle-income countries (LMICs) to leverage those partnerships to conduct research on the pandemic’s impact on cancer prevention, diagnosis, treatment, and outcomes. Research objectives for this opportunity were: 

(1)    Studies that contribute to understanding the impact of COVID-19 on global cancer prevention and control, including the direct effects of COVID-19 in cancer patients or the indirect health, economic, and sociocultural impacts of the pandemic across the cancer continuum.

(2)    Studies that generate an evidence base necessary to mitigate the effects of this and future pandemics on persons with cancer, at risk for cancer, undergoing treatment for cancer, or in remission.

The projects supported through this initiative include the following:

Dr. Scott Dryden-Peterson, from Brigham and Women's Hospital, has partnered with Dr. Mompati Mmalane at the Botswana Harvard AIDS Institute, Dr. Memory Fadziso Bvochora-Nsingo at the Gaborone Private Hospital and Dr. Tlotlo Ralefala and Dr. Peter Vuylsteke at the University of Botswana to investigate COVID-19-related cervical cancer treatment interruptions and the role of neoadjuvant chemotherapy. The radiotherapy unit in Botswana experienced prolonged downtimes due to COVID-19-related border restrictions preventing routine service and repair. Limited and disrupted access to radiotherapy is a significant issue in many LMICs and the option to temporize with carboplatin/paclitaxel chemotherapy, while appearing favorable, has only been sparsely studied. The inability of women to access healthcare due to COVID-19 travel restrictions created a need to better study the impact of such treatment delays, neoadjuvant chemotherapy, and HIV on disease progression and treatment outcomes.

Dr. Miriam Cremer, from Cleveland Clinic Lerner College of Medicine, has partnered with Dr. Rachel Masch and Dr. Karla Alfaro at Basic Health International in San Salvador, El Salvador to evaluate a cervical cancer result delivery method based on text messaging. In El Salvador, approximately 40% of screen-negative women and 20% of screen-positive women for human papillomavirus (HPV) do not receive screening results. Moreover, the ongoing pandemic has significantly interrupted screening services and result delivery. Building on previous Ministry of Health investment in a mobile phone based COVID-19 diagnostic result delivery tool, investigators will pilot a telemedicine intervention to communicate screening results using an analogous automated texting service and embed it in a patient database created in collaboration with the Ministry of Health to improve communication of screening results and adherence to follow-up. This study is also embedded in a trial looking at a procedure to destroy abnormal cervical tissue, so the text messaging can bring more women into the trial and potentially increase the reach of cervical cancer treatment services to screen-positive women. 

Dr. Charles Wood, from the University of Nebraska Lincoln, and Dr. Owen Ngalamika at Cancer Diseases Hospital, Adult & Emergency Hospital, University Teaching Hospitals/University of Zambia, will investigate the potential synergistic effects of human immunodeficiency virus (HIV) and prior exposure to other infections in cancer patients on COVID-19. The investigators also seek to predict the efficacy of adenovirus-vector based SARS-CoV-2 vaccines by analyzing the immune responses against prior viral infections   . Investigators hypothesize that COVID-19 patients with prior exposure to other infectious diseases will have a more tempered COVID-19 course, but cancer and HIV infection in COVID-19 patients will lead to less effective immune responses in controlling SARS-CoV-2. 

Dr. Surbhi Grover, from the University of Pennsylvania, has partnered with Dr. Lisa Bazzett-Matabele and Dr. Peter Vuylsteke from the University of Botswana, to investigate how the pandemic impacted cervical cancer care and how different delivery approaches may have shaped outcomes for patients in Botswana. Leveraging an existing cohort of over 1,000 women receiving treatment for advanced cervical cancer in Botswana, investigators will quantitatively evaluate patterns of treatment initiation and completion for cervical cancer during the pandemic, qualitatively assess contextual determinants (e.g., patient fear, social distancing policies, shifts to telemedicine) contributing to experiences and timeliness of care, and identify intervention strategies to target these contextual determinants. 

Dr. Kasisomayajula Viswanath, from Dana-Farber Cancer Institute, has partnered with Dr. Himanshu Gupte from the Nortam Sekhsaria Foundation in Mumbai, India to conduct a survey to explore impacts of COVID-19 on health service delivery and help-seeking, cancer communication, and mental and social wellbeing as well as examine the impact of these factors on tobacco use. This study will address the dearth of knowledge on the impact of COVID-19 on low socioeconomic position (SEP) individuals in India, particularly on how the pandemic may be associated with changes to their health service engagement and other health behaviors, and mental and social wellbeing, and how these factors may impact tobacco use.  

Dr. Ann M. Moormann, from the University of Massachusetts Medical School in Worcester, has partnered with Dr. John Ong'echa at Kenya Medical Research Institute and Dr. Festus Njuguna at Moi Teaching and Referring Hospital to investigate the impact of the COVID-19 pandemic on Kenyan children diagnosed with endemic Burkitt lymphoma (eBL) in the context of an ongoing etiologic study on the impact of malaria in shaping immunity to the Epstein Barr virus. The studies will assess how the COVID-19 public health measures put into place in Kenya have impacted healthcare access for timely eBL diagnoses and eBL cancer survivorship, as well as SARS-CoV-2 epidemiology. SARS-CoV-2 molecular testing will be carried out to compare variants that infect cancer patients compared to healthy age-matched controls, which may have implications for vaccine efficacy. Moreover, if children have been infected with SARS-CoV-2, it will be included as a cofactor in analyses evaluating immune regulation in the parent study.

Dr. Steven D. Leach, from Dartmouth College, has partnered with Dr. Suyapa Bejarano at Liga Contra el Cancer in San Pedro Sula, Honduras to assess radiotherapy innovations that were put in place to address the challenges in delivering care imposed by the pandemic. The project proposes to leverage an existing partnership between Norris Cotton Cancer Center and oncology professionals in Latin America and the Caribbean to evaluate so-called “frugal innovations” for safety, efficiency, quality, feasibility, acceptability, and potential potency; and to assess adaptability for use in future pandemics or other public health emergencies. Investigators will conduct a participatory action research study to assess the interventions used across the region. The iterative approach proposed for this study will yield interventions suitable for deployment during future health systems disruptions. 

Dr. Edus Warren and Dr. Warren Phipps, from Fred Hutchinson Cancer Research Center, have partnered with Dr. Jackson Orem and Dr. Innocent Mutyaba from the Uganda Cancer Institute to study the impact of SARS-CoV-2 infection on the profile of immune cells in Kaposi’s sarcoma (KS) tumors for HIV+ and HIV- adults and to evaluate the effects of the SARS-CoV-2 pandemic on access to cancer and HIV care. This supplement may provide data on transcriptional differences in the composition of immune cells in HIV+ and HIV- KS patients that are also infected with SARS-CoV-2. Additionally, previous studies have shown that KS patients were presenting late and had advanced disease; this study may provide some additional insights into reasons for late presentation during pandemic conditions.


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