Disparities in cancer research persist around the world. This is especially true in global health research, where high-income countries (HICs) continue to set global health priorities further creating several imbalances in how research is conducted in low and middle-income countries (LMICs). Cancer research disparities in Africa can be attributed to a vicious cycle of challenges in the research ecosystem ranging from who funds research, where research is conducted, who conducts it, what type of research is conducted and where and how it is disseminated. For example, the funding chasm between HICs and LMICs contributes to inequities and parachutism in cancer research. Breaking the current cancer research model necessitates a thorough examination of why current practices and norms exist and the identification of actionable ways to improve them. The cancer research agenda in Africa should be appropriate for the African nations and continent. Empowering African researchers and ensuring local autonomy are two critical steps in moving cancer research towards this new paradigm.

PURPOSE: Hypofractionated breast radiotherapy has been found to be equivalent to conventional fractionation in many clinical trials. Using data from the European Society for Radiotherapy and Oncology Global Impact of Radiotherapy in Oncology survey, we identified preferences for hypofractionation in breast cancer across World Bank income groups and the perceived facilitators and barriers to its use. MATERIALS AND METHODS: An international, electronic survey was administered to radiation oncologists from 2018 to 2019. Demographics, practice characteristics, preferred hypofractionation regimen for specific breast cancer scenarios, and facilitators and barriers to hypofractionation were reported and stratified by World Bank income groups. Variables associated with hypofractionation were assessed using multivariate logistic regression models. RESULTS: One thousand four hundred thirty-four physicians responded: 890 (62%) from high-income countries (HICs), 361 (25%) from upper-middle–income countries (UMICs), 183 (13%) from low- and lower-middle–income countries (LLMICs). Hypofractionation was preferred most frequently in node-negative disease after breast-conserving surgery, with the strongest preference reported in HICs (78% from HICs, 54% from UMICs, and 51% from LLMICs, P < .001). Hypofractionation for node-positive disease postmastectomy was more frequently preferred in LLMICs (28% from HICs, 15% from UMICs, and 35% from LLMICs, P < .001). Curative doses of 2.1 to < 2.5 Gy in 15-16 fractions were most frequently reported, with limited preference for ultra-hypofractionation, but significant variability in palliative dosing. In adjusted analyses, UMICs were significantly less likely than LLMICs to prefer hypofractionation across all curative clinical scenarios, whereas respondents with > 1 million population catchments and with intensity-modulated radiotherapy were more likely to prefer hypofractionation. The most frequently cited facilitators and barriers were published evidence and fear of late toxicity, respectively. CONCLUSION: Preference for hypofractionation varied for curative indications, with greater acceptance in earlier-stage disease in HICs and in later-stage disease in LLMICs. Targeted educational interventions and greater inclusivity in radiation oncology clinical trials may support greater uptake.

Background: In Zimbabwe, the hormone receptor status is not always available when patients with breast cancer are started on treatment. Aim: This study evaluated the discordance of treatment approach in such patients, with National Comprehensive Cancer Network (NCCN) guideline recommendations as the reference standard when these results are eventually available. Setting: Female patients who presented to the Parirenyatwa Central Hospital Radiotherapy and Oncology Centre with a histological diagnosis of breast cancer, managed between 1 January 2014 and 31 December 2016. Methods: Patients with breast cancer having unknown receptor status at diagnosis, and the hormone receptor status were subsequently available either clinically or the tissues were available for study-specific analysis, were eligible for the study. The level of agreement between treatments received and the NCCN recommendations if the receptor status was known was tested using Kappa statistic. Results: Patients in stage I–III received treatment that were in strong agreement with the use of chemotherapy, and endocrine treatments with agreement scores of 1 (95% CI 0.91–1) and 0.81 (95% CI 0.65–0.95), respectively; but moderate agreement with regard to the choice of chemotherapy regimen, with a score of 0.5 (95% CI 0.32–0.68). There was a median delay of 8 (range 3–27) months for the availability of receptor status. Of the 38 stage IV patients, 33 (87%) were recommended chemotherapy. Of the 38 patients, 25 (66%) had hormone driven disease. There was somewhat agreement for use of chemotherapy, choice of chemotherapy regimen and use of endocrine treatments as initial choice with agreement scores of 0.53 (95% CI 0.36,0.69), 0.18 (95% CI 0.07, 0.35) and 0.68 (95% CI 0.51,0.82) respectively. Conclusion: Treatment approaches were largely in agreement with the NCCN guidelines for patients in stage I–III. Discordance was noted in stage IV patients with under-utilisation of hormone therapy as the initial treatment when the receptor status was unknown.

Purpose: To retrospectively review the clinical outcomes of patients with metastatic breast cancer (MBCa) following liver directed ablative intent radiotherapy (RT). Methods: Demographics, disease and treatment characteristics of patients with MBCa who received liver metastasis (LM) directed ablative RT between 2004–2020 were analysed. The primary outcome was local control (LC), secondary outcomes included overall survival (OS) and progression-free survival (PFS) analyzed by univariate (UVA) and multi-variable analysis (MVA). Results: Thirty MBCa patients with 50 LM treated with 5–10 fraction RT were identified. Median follow-up was 14.6 (range 0.9–156.2) months. Class of metastatic disease was described as induced (12 patients, 40%), repeat (15 patients, 50%) and de novo (three patients, 10%). Median size of treated LM was 3.1 cm (range 1–8.8 cm) and median biologically effective dose delivered was 122 (Q1–Q3; 98–174) Gy₃. One-year LC rate was 100%. One year and two-year survival was 89% and 63%, respectively, with size of treated LM predictive of OS (HR 1.35, p = 0.023) on UVA. Patients with induced OMD had a significantly higher rate of progression (HR 4.77, p = 0.01) on UVA, trending to significance on MVA (HR 3.23, p = 0.051). Conclusions: Hypo-fractionated ablative liver RT in patients with MBCa provides safe, tolerable treatment with excellent LC.

The first Choosing Wisely Africa conference: a roadmap to value-based cancer care in Africa (16th December 2022, Senegal) Melinda Mushonga1,2, Omar Abdihamid