Uganda Cancer Institute

Cervical cancer is the fourth most common cancer among women with significant global disparities in disease burden. In lower-resource settings, where routine screening for cervical cancer is uncommon, higher incidence of advanced-stage disease contributes to increased morbidity and mortality. Understanding care delays may inform strategies to decrease overall time to treatment, and could potentially improve outcomes. We sought to characterize the cervical cancer care cascade and identify factors associated with time to care cascade completion within a Ugandan cohort. We collected sociodemographic, reproductive health and care journey data from 268 Ugandan women newly diagnosed with cervical cancer at Mulago National Referral Hospital and the Uganda Cancer Institute. We characterized time from symptoms to presentation (patient interval), time from presentation to diagnosis (diagnostic interval) and time from diagnosis to treatment (treatment interval) and estimated the influence of patient, health provider, system, and disease factors on length of each interval using survival analysis. Median patient, diagnostic and treatment intervals were 74 days (IQR 26–238), 83 days (IQR 34–229), and 34 days (IQR 18–58), respectively. Patient interval was prolonged by the belief that symptoms would resolve spontaneously (aHR 0.37, 95

Background:Blood transfusions are essential in the supportive care of patients with hematological malignancies but carry a risk of adverse reactions. Data on the incidence of transfusion reactions remain scarce in Uganda. This study evaluated the incidence of hemolytic and serologic transfusion reactions among patients with hematological malignancies at Mbarara Regional Referral Hospital and the Uganda Cancer Institute in Uganda. Materials and Methods:This prospective cohort study enrolled hospitalized patients aged ≥2 years with hematological malignancies and a history of prior red blood cell (RBC) transfusions. Participants received additional transfusions and were monitored for up to 14 days. Blood samples were collected on day 0 (transfusion day), days 7, and 14 to assess hemoglobin (Hb) levels, lactate dehydrogenase (LDH), and perform direct and indirect antiglobulin tests. Participants' medical records were also reviewed for transfusion and pregnancy histories. Repeated Measures-Analysis of Variance was used to compare mean Hb and LDH levels over time points. Results:Of the 467 participants enrolled (median age: 36.4 years, interquartile range: 27.3-46.9), 382 completed the follow-up period. A progressive increase in mean Hb levels (g/dL) was observed: 6.6 (95% confidence interval [CI]: 6.1-8.9) on day 0, 7.5 (7.3-10.1) on day 7, and 8.9 (8.4-10.6) on day 14. No acute or delayed hemolytic reactions occurred. The incidence of delayed serologic transfusion reactions (DSTRs) was 0.86 in 100 (95% CI: 0.02-1.69), while the overall RBC alloantibody prevalence was 2.4% (95% CI: 0.98-3.74). The identified alloantibodies were directed against antigens in the Rh, Kell, Lewis, and MNS group systems. Conclusion:Despite a low incidence of DSTRs, a notable prevalence of RBC alloimmunization was observed among patients with hematological malignancies. These findings underscore the need to strengthen pre-transfusion antibody testing to prevent hemolytic complications and improve transfusion outcomes in this population.

Governance is an essential component of effective national cancer control plan (NCCP) development and implementation and this study aims to describe how and the extent to which governance is defined and outlined in NCCPs. It utilizes data from a global review of 98 NCCPs in 2023 conducted by 77 experts in cancer control planning using a 95-question form that examines components of NCCP development and implementation. To assess the governance elements represented in NCCPs, we used the Health Policy Triangle (HPT) framework, categorizing questions and developing a score based on its four components: content, context, actors, and mechanisms. Strengths were identified in the adequate involvement of several actors in NCCP development and implementation, such as Ministries of Health, and in appropriate mechanisms for NCCP governance, such as information about who is responsible for plan implementation. However, the inclusion of global cancer control targets and initiatives was often lacking. Overall governance scores were poor, but some variability was observed across WHO regions and country income levels. NCCPs from countries within the WHO Regional Office for Africa and low-income countries presented the highest scores across all four components. The HPT provides a framework to assess NCCPs and may pave the way for the development of further guidance regarding the governance of NCCPs.

The global burden of neoplasms of digestive organs (NDOs) is on the rise. Various stakeholders have made significant efforts to ensure access to effective and relatively safe chemotherapy for the treatment of NDOs. However, the use of cancer chemotherapy has been associated with drug therapy problems (DTPs). These potentially compromise desired treatment outcomes. There is limited knowledge among stakeholders regarding the burden of DTPs among patients on cancer chemotherapy in Uganda. This was a cross-sectional study which enrolled 196 participants with NDOs. It was conducted at Uganda Cancer Institute (UCI), Mbarara. Data was collected using a questionnaire and checklist. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. The prevalence of DTPs was expressed as a percentage of the sample size. Factors associated with occurrence of DTPs were analyzed using logistic regression. Variables with p-values less than 0.25 at univariate analysis were subjected to multivariate analysis. Variables were considered statistically significant if p-values were less than 0.05 at 95

BACKGROUND:Radiotherapy aims to deliver a uniform dose within ± 5.0% of the prescription, while minimizing toxicity. Because treatment quality directly influences patient's treatment outcomes, error detection is critical for ensuring accuracy and safety. This study evaluated in-vivo dosimetry (IVD) as a quality assurance (QA) tool to detect treatment errors during the transition from two-dimensional radiotherapy (2DRT) with Cobalt-60 units to three-dimensional conformal radiotherapy (3DCRT) with linear accelerators. METHODS:IVD was performed for 612 treatment fields across 493 patients treated with either 2DRT or 3DCRT. A calibrated entrance diode was placed on the patient's skin to measure delivered doses, which were compared with prescribed doses at relevant depths. Deviations exceeding ± 5% were investigated, with findings discussed with oncologists to enable immediate corrective action and subsequently communicated to staff to support continuous learning. RESULTS:Ninety-two errors were identified. The most frequent causes were incorrect calculations (20.7%), procedural changes (15.2%), omission of tray/bolus in treatment time calculations (4.3%), and use of treatment times/monitor units without secondary physics verification (4.3%). Overall, 84.9% of the 612 measurements were within the ± 5% tolerance. CONCLUSIONS:IVD with a calibrated diode provides a simple and effective quality control measure for maintaining treatment accuracy. Systematic error analysis and structured staff feedback enhance awareness, strengthen safety culture, and improve patient care during technological transitions in radiotherapy.