Dr. Eulade Rugengamanzi

Abstract Background The incidence of Hodgkin's lymphoma (HL) in people living with HIV (PLWHA) and on HAART is approximately 20–30 times higher than in HIV-negative individuals. Most patients with HIV-HL present at an advanced stage (III-IV) have 'B' symptoms and extranodal involvement. The natural history and risk stratification of HIV-HL has undergone a significant change as a result of HAART's rollout. This study investigated the differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania during the HAART era. Methodology This hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher’s exact tests were used to compare proportions. The student t-test was used to compare means. To determine factors that predict survival, we used the log-rank test to analyze the variables in univariate analysis. A Cox regression model was used to analyze the significant factors from univariate analysis in multivariate analysis. Results Eighty-three patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of > 30 years (73.9%), while most of the non-HIV-HL patients had an age of ≤ 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00). Conclusion The prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for ≤ 10 months, or with a low CD4 count below 200 cells/mm3. Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels.

Background: Cancer care involves disclosing difficult information, making treatment decisions, and advance care planning. Communication practices and preferences are strongly influenced by sociocultural context. This scoping review aims to identify, map, and appraise the available evidence on clinical communication in cancer care in Africa and recommend priorities for future work. Methods: A search strategy was developed to identify studies conducted in Africa with a primary focus on patient-clinician communication in cancer care and performed in PubMed, Embase, Web of Science, CINAHL, African Index Medicus, and PsycINFO. Two reviewers independently screened titles and abstracts, full texts, and cited references. Study characteristics were analyzed using descriptive statistics and content anal- ysis. Critical appraisal was performed using the Mixed Methods Appraisal Tool. Results: Our search yielded 58 articles from 19 countries. Study designs were quantitative survey (53%), qualitative (38%), non-randomized experimental (5%), and mixed methods (3%), with no randomized trials. Populations included patients with cancer (n = 25), doctors (n = 24), nurses (n = 16), family/caregivers (n = 16), and/or others. Seven studies (12%) focused on pediatrics. Most studies (60%) focused on clinicians’ disclosure of information, often framed as “breaking bad news” or “truth-telling.” The remainder focused on information preferences (14%), advance care planning (10%), illness understanding (5%), shared decision making (5%), and communication training (3%). Critical appraisal demonstrated higher quality among qualitative than quantitative studies. Conclusions: Future work should explore underexamined research areas such as patient-centered communication, translate observational findings into intervention development and testing, implement communication skills training, and evaluate outcomes related to communication in cancer care in Africa.

Cancer genetic data from Sub-Saharan African (SSA) are limited. Patients with female breast (fBC), male breast (mBC), and prostate cancer (PC) in Rwanda underwent germline genetic testing and counseling. Demographic and disease-specific information was collected. A multi-cancer gene panel was used to identify germline Pathogenic Variants (PV) and Variants of Uncertain Significance (VUS). 400 patients (201 with BC and 199 with PC) were consented and recruited to the study. Data was available for 342 patients: 180 with BC (175 women and 5 men) and 162 men with PC. PV were observed in 18.3% fBC, 4.3% PC, and 20% mBC. BRCA2 was the most common PV. Among non-PV carriers, 65% had ≥1 VUS: 31.8% in PC and 33.6% in BC (female and male). Our findings highlight the need for germline genetic testing and counseling in cancer management in SSA.

PURPOSE Cancer continues to be a significant public health concern. Sub-Saharan Africa (SSA) struggles with a lack of proper infrastructure and adequate cancer care workforce. This has led to some countries relying on referrals of cancer care to countries with higher income levels. In some instances, patients refer themselves. Some countries have made it their goal to attract patients from other countries, a term that has been referred to as medical tourism. In this article, we explore the current status of oncology-related medical tourism in SSA. METHODS This was a cross-sectional study. The study participants included oncologists, surgeons, and any other physicians who take care of patients with cancer. A predesigned questionnaire was distributed through African Organization for Research and Training in Cancer member mailing list and through study team personal contacts and social media. RESULTS A total of 52 participants from 17 African countries with a 1.6:2 male to female ratio responded to the survey. Most (55.8%) of the respondents were from Eastern African countries. The majority (92%) of study participants reported that they knew patients who referred themselves abroad, whereas 75% referred patients abroad, and the most common (94%) referral destination was India. The most common (93%) reason for referral was perception of a higher quality of care in foreign health institutions. CONCLUSION The findings suggest the need to improve local health care systems including building trust of the system among general population. The study highlights potential financial toxicity, and it adds to the current emphasis on return of investment on homegrown workforce and cancer treatment infrastructure.