NCI Center for Global Health Awards 6 Administrative Supplements in Global Survivorship Research
, by Sudha Sivaram, Dr.PH, MPH and Mishka Kohli Cira, MPH
By 2040, it is estimated that 67% of the 28 million new cancer cases and 69% of the 16 million annual cancer deaths globally will occur in LMICs. Reasons for increasing cancer burden in LMICs include population growth and aging, environmental and lifestyle changes, and increasing ability to diagnose and ascertain cancer when it occurs. Cancer treatment capacity in LMICs is also increasing, such that well-resourced cancer centers in some LMICs report 5-year cancer survival rates for breast cancer patients that are comparable to women with breast cancer living in HICs.
As the numbers of cancer survivors in LMICs increase, there is a need to understand the experience of individuals and families caring for them to improve survivorship care and support. The NCI considers an individual to be a cancer survivor from the time of diagnosis through the balance of their life. Survivors include those living with cancer and those who are free of cancer. The limited number of available descriptive studies from LMICs document several challenges faced by cancer survivors, including poor quality of life, stigma, high psychological morbidity, unaddressed needs of their caregivers, and poor translation of evidence-based strategies for secondary cancer prevention. There are also substantial barriers to treatment uptake and completion among those affected, including cost, access, and socio-behavioral factors. In addition, few interventions are focused on cancer survivors and their caregivers.
To stimulate research to understand these barriers and address the needs of cancer survivors in LMICs, the NCI issued a notice of special interest in global survivorship research in April 2021. Six administrative supplement awards were made to investigators proposing a range of research questions.
Dr. Blossom Damania, Dr. Carla Chibwesha, and colleagues from the University of North Carolina, Chapel Hill are collaborating with Dr. Hannock Tweya and investigators from the University of Malawi School of Medicine to assess patient-reported quality of life among cancer survivors. The goal of this study is to measure health-related quality of life (HRQoL) for cancer survivors with Kaposi sarcoma (KS) and lymphoma across the continuum of cancer care in Malawi.
Dr. Thanh Bui from the University of Oklahoma is collaborating with Dr. Phonepadith Xangsayarath (National Center for Laboratory and Epidemiology), Dr. Phayvanh Keopaseuth (Setthathirath Hospital), and public health officials at Lao People’s Democratic Republic to determine the efficacy of a novel mHealth intervention for smoking cessation among Lao cancer survivors and caregivers. The goal of this study is to expand a technology being developed by this team that uses a smartphone-based approach to deliver an interactive and personalized intervention for behavioral treatment and secondary prevention among cancer survivors.
Dr. Surbhi Grover and Dr. Katherine Rendle and colleagues from the University of Pennsylvania are working with Dr. Peter Vuylsteke, Dr. Lisa Bazzett-Matabele (University of Botswana), and colleagues at the Princess Marina Hospital in Botswana. The goal of this study is to quantitatively describe patterns in post-survivorship care of cervical cancer patients and examine the psychosocial impact of cervical cancer diagnosis and treatment.
Dr. Michael B. Kastan from Duke University and colleagues are working with Dr. Erica Sanga from the Bugando Medical Center in Tanzania on a project that looks at treatment effects and long-term complications among survivors of childhood cancers. The goal of this study is to describe barriers to follow-up care and establish baseline data that will help implement follow-up care guidelines and identify culturally relevant needs among this population.
Dr. Kerri Winters-Stone from Oregon Health & Science University and Dr. Pichitra Lekdamrongkul, Dr. Kanaungnit Pongthavornkamol and colleagues at Mahidol University and Siriraj Cancer Center and Hospital in Thailand will pilot test a dyadic health management strategy to promote physical activity among breast cancer survivors and their spouse care partners. The goal of this study is to assess dyadic adjustment and health among Thai couples coping with breast cancer and understand their interests and preferences for a physical activity program. Data gathered will be used to develop and pilot a culturally specific dyadic physical activity program in a sample of Thai couples.
Dr. Maureen Joffe from the University of Witwatersrand in South Africa (SA) and colleagues from Columbia University and the University of Miami are building on 10 years of research collaboration in infectious disease research, that, in 2015, established the South Africa Breast Cancer Health Outcomes (SABCHO) study. This is an extensive epidemiologic study of comorbid HIV and breast cancer among patients in sub-Saharan Africa and continues to follow a longitudinal cohort of ~ 3,500 women with newly diagnosed breast cancer (BC) at five SA academic cancer centers, 22% of whom have HIV (most on antiretroviral -ARV- treatments). The goal of this study is to determine the impact of mental health, physical symptoms, and medication beliefs on adherence to adjuvant tamoxifen among HIV-positive and HIV-negative BC survivors and explore the impact of TAM use on ARV adherence and HIV control. This project is supported by the NCI Office of HIV/AIDS Malignancy.
We anticipate that these projects will strengthen collaborations between US and LMIC investigators and support catalytic research in the emerging field of cancer survivorship in LMICs.