Healthcare professionals' knowledge of and compliance with the ASCO/ESMO/GLIM guidelines for the diagnosis and management of cancer cachexia (CC): the ASSIST-CC baseline findings in Uganda.

Background: More than 50% of people with advanced cancer suffer from cancer-related cachexia (CC) - a major contributor to morbidity and mortality. Despite the lack of local guidelines on CC diagnosis and management in Uganda, the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO) and the Global Leadership Initiative on Malnutrition (GLIM) developed guidelines on CC screening and management. However, the level of knowledge on CC and compliance with the available guidelines among Ugandan oncology health professionals is unknown. This study aimed to assess the level of awareness and knowledge of CC diagnosis and management and compliance with the ASCO/ESMO/GLIM guidelines on CC among healthcare professionals (HCPs) involved in the care of cancer patients. Methods: In this phase one, a self-administered structured questionnaire developed using the ASCO/ESMO and GLIM guidelines on diagnosis and management of CC was used to assess the level of awareness, and knowledge of 200 health professionals from three hospital settings on CC, and compliance with the ASCO/ESMO/GLIM guidelines on CC related core communication, barriers to communication, clinician training in communication, discussing goals of care, treatment options and meeting the needs of the underserved populations. The data were entered into Research Electronic Data Capture software analysed using STATA version 18.0 software. Results: The overall objectively correct knowledge score of CC diagnosis criteria was 67.5% (n = 135), yet there was a much lower level of awareness about ASCO/ESMO/GLIM guidelines on CC at 30% (n = 60) and only 21% (n = 42) of the HCPs have ever assessed Quality of life of CC patients. The compliance with ASCO/ESMO/GLIM guidelines on nutritional interventions for patients with CC varied across the variables markedly, ranging from 25.1% (n = 50) to 81% (n = 162) for the specific ASCO/ESMO/GLIM guidelines' recommendations. Whereas compliance with the guidelines on discussing goals of care, prognosis, treatment options and end-of-life care scored the highest in most variables, most HCPs exhibited low compliance with the discussion about patients' end-of-life preferences early in the course of incurable illness (49.8%, n = 99). There were statistically significant differences between the mean scores of only two variables among the three hospitals in compliance with ASCO/ESMO/GLIM guidelines on the provision. Conclusion: This study indicated that the overall objectively correct knowledge of CC diagnosis criteria was inadequate, with a much lower level of awareness about the ASCO/ESMO/GLIM guidelines on CC and a handful of the HCPs have ever assessed the quality of life of CC patients. Quality improvement interventions on CC diagnosis and management should prioritize improving the level of knowledge on CC, diagnostic criteria and patient-clinician communication, including discussion about patients' end-of-life care using standardised tools such as ASCO/ESMO or GLIM guidelines on CC using a multidisciplinary team approach.

Enhancing Cancer Care Through Quality Initiatives: The Uganda Cancer Institute Experience With the Quality Oncology Practice Initiative.

Cancer care in low- and middle-income countries (LMICs) faces numerous challenges, such as limited resources, infrastructure constraints, and a shortage of specialized training. To address these challenges, innovative quality improvement (QI) approaches are required. The Quality Oncology Practice Initiative (QOPI) by the ASCO provides a framework for improving care quality through evidence-based standards. This article explores how QOPI has been adapted to the local context of the Uganda Cancer Institute (UCI) and highlights the importance of aligning international best practices with local health care realities to bridge disparities in care standards. The adaptation of the QOPI program at UCI commenced with a collaborative meeting with the ASCO-QOPI team in 2020. A tailored implementation plan was developed focusing on incorporating ASCO's QOPI measures and additional metrics relevant to the Ugandan context, engaging multidisciplinary teams, and optimizing resource use by leveraging existing resources for data collection and analysis. The execution of the plan relied heavily on staff training, participatory data collection, and continuous quality improvement processes that utilized data-driven methodologies. A retrospective analysis of QOPI data of UCI from 2020 to 2023 shows significant improvements in oncology care quality, highlighted by an upward trend in QOPI assessment scores across various metrics. These reflect the journey of UCI toward aligning its oncology care practices with international standards despite facing significant challenges. UCI's experience demonstrated the feasibility and impact of implementing international QI programs in LMICs. The success demonstrates that significant improvements in cancer care quality can be achieved in resource-constrained settings through adaptability, stakeholder engagement, and strategic resource optimization. UCI's journey is a model for other LMICs seeking to raise their cancer care standards, demonstrating that QI is necessary and attainable worldwide.

Scaling up availability, accessibility, quality and equity - highlights from the 4th Uganda conference on cancer and palliative care, held in Kampala, Uganda.

The 4th Uganda Conference on Cancer and Palliative Care was held from the 14th-15th September 2023. It was run jointly by the Uganda Cancer Institute and the Palliative Care Association of Uganda, in collaboration with the Ministry of Health. The conference was held at the Speke Resort, Munyonyo and 450 participants came together for a face-to-face conference following the virtual one held in 2021. It was an opportunity for all those working in the fields of cancer and palliative care to come together, to share lessons and learn from each other, as well as celebrate 30 years since specialist palliative care came to Uganda. The conference was officially opened by the Commissioner for Non-Communicable Diseases on behalf of the Minister of Health, who reiterated the Government's commitment to reducing the burden of cancer and expanding the provision of palliative care within Uganda. Dr Tedros Adhanom Ghebresus, the Director General of the World Health Organization welcomed participants to the conference, and the Assistant Bishop of Kampala Diocese, the Right Reverend Hannington Mutebi shared his experience of living with cancer. The conference was organised into six tracks: Innovations and new technologies; Education, advocacy, policy and law; Health promotion, prevention and early detection; Family and community involvement and empowerment; Clinical care and symptom management; and, Psychological, social and spiritual care. The themes of paediatrics, vulnerable populations, service development and research were integrated throughout the tracks, and workshops were held that explored topics such as governance, access to essential medicines, national data reporting, research and education, and aging and ageism. Throughout the conference there was a sense of optimism, of resilience and a commitment to the ongoing development of cancer and palliative care services within the country.

Infection-related and lifestyle-related cancer burden in Kampala, Uganda: projection of the future cancer incidence up to 2030.

OBJECTIVES: In Uganda, infection-related cancers have made the greatest contribution to cancer burden in the past; however, burden from lifestyle-related cancers has increased recently. Using the Kampala Cancer Registry data, we projected incidence of top five cancers, namely, Kaposi sarcoma (KS), cervical, breast and prostate cancer, and non-Hodgkin's lymphoma (NHL) in Uganda. DESIGN: Trend analysis of cancer registry data. SETTING: Kampala Cancer Registry, Uganda. MAIN OUTCOME MEASURE: Cancer incidence data from 2001 to 2015 were used and projected to 2030. Population data were obtained from the Uganda Bureau of Statistics. Age-standardised incidence rates (ASRs) and their trends over the observed and projected period were calculated. Percentage change in cancer incidence was calculated to determine whether cancer incidence changes were attributable to cancer risk changes or population changes. RESULTS: It was projected that the incidence rates of KS and NHL continue to decrease by 22.6% and 37.3%, respectively. The ASR of KS was expected to decline from 29.6 per 100 000 population to 10.4, while ASR of NHL was expected to decrease from 7.6 to 3.2. In contrast, cervical, breast and prostate cancer incidence were projected to increase by 35.3%, 57.7% and 33.4%, respectively. The ASRs of cervical and breast were projected to increase up to 66.1 and 48.4 per 100 000 women. The ASR of prostate cancer was estimated to increase from 41.6 to 60.5 per 100 000 men. These changes were due to changes in risk factors and population growth. CONCLUSION: Our results suggest a rapid shift in the profile of common cancers in Uganda, reflecting a new trend emerging in low/middle-income countries. This change in cancer spectrum, from infection-related to lifestyle-related, yields another challenge to cancer control programmes in resource-limited countries. Forthcoming cancer control programmes should include a substantial focus on lifestyle-related cancers, while infectious disease control programmes should be maintained.