Introduction Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. Methodology Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009–2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. Results African countries in total published 23 679 cancer research papers over the 12-year period (2009–2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa’s contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria’s contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. Conclusions There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer.

PURPOSE: Standard treatment guidelines improve patient outcomes, including disease-specific survival, in cancer care. The African Cancer Coalition was formed in 2016 to harmonize cancer treatment guidelines for sub-Saharan Africa. METHODS: The African Cancer Coalition collaborated with the National Comprehensive Cancer Network (NCCN) and the American Cancer Society to harmonize 46 cancer treatment guidelines for use in sub-Saharan Africa. Harmonization for each guideline was completed by a group of approximately 6-10 African cancer experts from a range of specialties and with representation across resource levels. Each working group was chaired by an African oncologist and included a member of the appropriate NCCN guidelines panel. Treatment recommendations from the parent guidelines were distinguished as options that are generally available and should be considered standard care in most of the region or as highly advanced options for which cost or other resources may limit widespread availability. Additional recommendations specific to sub-Saharan Africa were added. RESULTS: The NCCN Harmonized Guidelines for sub-Saharan Africa, available for download on the NCCN website and mobile application, provide flexible recommendations appropriate for the range of resources seen in African cancer programs, from private comprehensive cancer centers to resource-constrained public hospitals. IBM (Armonk, NY) has developed a digital interface—the Cancer Guidelines Navigator—that allows oncologists to access the treatment recommendations for the first five guidelines through an interactive web-based application. CONCLUSION: Harmonized guidelines that reflect the diversity of resource levels that characterize the current state of clinical care for cancer in Africa have the potential to fill a crucial gap in efforts to standardize and improve cancer care in Africa.

PURPOSE: Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution. METHODS: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by genderize.io. World Bank classification was used to categorize the country region and income level. Odds ratios were used to describe associations between female last authorship and representation in other authorship positions. RESULTS: Although female authors were in the minority across all authorship positions, they were more under-represented in the last author position with 190 (32.1%) female, compared with 252 (41.4%) female first authors and 1,564 (38.1%) female middle authors. Female authors were most under-represented among authors from low-income countries, where they made up 21.6% of first authors and 9.1% of last authors. Of all the regions, sub-Saharan Africa and South Asia had the lowest percentage of female authors. Compared with articles with male last authors, those with female last authors had odds ratios (95% CI) of 2.2 (1.6 to 3.2) of having female first authors and 1.4 (0.9 to 2.1) of having 50% or more female middle authors. CONCLUSION: There are wide regional variations in author gender distribution in global oncology. Female authors remain markedly under-represented, especially in lower-income countries, sub-Saharan Africa, and South Asia. Future interventions should be tailored to mitigate these disparities.

PURPOSE: Local researchers must be engaged in research conducted in their populations. However, local authors from low- and middle-income countries are often under-represented in global health journals. This report aims to assess and describe the representation of authors in the Journal of Clinical Oncology Global Oncology ( JCO GO). METHODS: This retrospective cross-sectional study describes data from JCO GO articles published between October 2015 and March 2020. Data were collected on studied countries, authorship position, classified as first, middle, or last, and country of authors' institutional affiliations. Countries were then categorized on the basis of their World Bank region and income classifications. We describe aggregate authorship distribution and distribution by region and income classification. Additionally, we explore the relationships between author's country and studied country. RESULTS: Of the 608 articles identified, 420 (69.1%) studied a single country population. Although articles represented studies from all World Bank regions, the sub-Saharan Africa (SSA) region accounted for the highest number (n = 145; 34.5%). In all other regions except SSA, most of the first (66.7%-100%) and last authors (56.6%-95.2%) had primary institutional affiliations based in the same region as the studied country. However, among articles about SSA countries, SSA first authors (n = 65; 44.8%) and last authors (n = 59; 40.7%) were under-represented. In fact, there were more North American first (n = 74; 51.0%) and last authors (n = 72; 49.6%) than SSA authors. There was higher SSA representation among middle authors (n = 97; 68.8%) in studies from the region. A similar trend was also noted with the under-representation of authors from low-income compared with high-income countries. CONCLUSION: SSA authors are under-represented in global oncology articles. Concerted strategies are needed to build local capacity, promote meaningful engagement, and foster equity.

Utilization of clinical technology and mobile health (mHealth) is expanding globally. It is important to reflect on how their usage and application could translate in low- and middle-income country (LMIC) settings. With the exponential growth and advancements of mobile and wireless technologies, LMICs are prime to adapt such technologies to potentially democratize and create solutions to health-related challenges. The role of these technologies in oncology clinical trials continues to expand. The lure of mHealth promises disruptive technology that may change the way clinical trials are designed and conducted in many settings. Its applicability in the African context is currently under consideration. Although potentially of expanding benefit, the role of these technologies requires careful and nuanced evaluation of the context in which they might be applied to harness their full potential, while mitigating possible harms or preventing further deepening of disparities within populations. Moreover, technology and digital innovations are no substitute for poor referral pathways and dysfunctional health systems and can only complement or enhance definite strategies aimed at strengthening these health systems.

Breast cancer is characterized by late presentation and significant morbidity and mortality in developing countries. Breast screening aids in early detection of breast cancer. Nurses are uniquely placed to provide advocacy and screening in a resource limited environment. To assess the effectiveness of an abbreviated training program in breast cancer awareness on nurses at a tertiary hospital, in a resource constrained environment. Using a statistical tool, the Solomon Model, 79 nurses were identified and divided into experimental and control groups. An abbreviated training intervention in breast cancer awareness was administered to the experimental group. Pre and post test questionnaires and objective structured clinical examinations were used to determine nurses’ knowledge and practice skills before and after the abbreviated training intervention. Initial scores of knowledge and practice skills related to clinical breast examination were low: Mean knowledge scores of 18 out of 25 [72%] and mean practice scores of 12.5 out of 30 [41.6%]. Significant improvement was observed following the abbreviated training intervention in both knowledge and practice skills. Knowledge scores of 22 out of 25 [88%, p = < 0.001] and practice scores of 26 out of 30 [86.6%, p=0.003]. Trained nurses were able to improve their knowledge of breast cancer from fair to good knowledge. There is need to increase breast awareness, both in terms of knowledge and practice skills, in nurses as a means of improving awareness among the general population and early detection of breast cancer. An abbreviated training in breast cancer awareness can improve these skills in nurses.