The MUHAS-UCSF Esophageal Cancer Research Team is co-lead by Dr. Katherine Van Loon (second from left) and Dr. Elia Mmbaga (second from right).
In September, Katherine Van Loon, MD, MPH
, assistant professor in hematology/oncology and director of the HDFCCC Global Cancer Program
, led a group of UCSF faculty and trainees to Tanzania to meet with stakeholders at the Muhimbili University of Health and Allied Sciences (MUHAS) and Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. Below, Van Loon talks about the trip, and UCSF residents offer their thoughts on this unique opportunity.
Q.What was the purpose of the trip and what did the team do there?
Dr. Katherine Van Loon heads the Global Cancer Program at the UCSF Helen Diller Family Comprehensive Cancer Center.
One of the amazing things I have discovered about global cancer work at UCSF is the diversity and breadth of our faculty. Before the Global Cancer Program even existed, our faculty were already engaged in innovative and impressive international cancer collaborations around the world, but most were working individually and with minimal institutional support. As a program, we have identified a strong impetus to deepen our relationships with key partner sites through the establishment of multi-disciplinary collaborations.
The Global Cancer Program proposed to convene relevant stakeholders from Muhimbili University of Health and Allied Sciences, Ocean Road Cancer Institute, Muhimbili National Hospital, and UCSF for a symposium in Dar es Salaam, Tanzania to discuss opportunities to expand our cancer-focused collaborations through education and mentoring, research, and capacity-building. Through this visit, the primary aim of the group that travelled from UCSF was to listen to Tanzanian priorities in cancer control and to explore opportunities for an expanded engagement with UCSF and the Global Cancer Program.
Q. Talk about the partnership between Muhimbili National Hospital and UCSF?
Radiology department tour by Dr. F. Lwakatare.
UCSF and MUHAS have a longstanding collaborative partnership. The partnership started in 2005 with the Academic Learning Project (ALP) which was funded by the Bill & Melinda Gates Foundation to develop, implement, and document strategies to enhance the contributions of African academic institutions in building their national health workforce and improving health outcomes. The ALP has been regarded as a great success by stakeholders at MUHAS and UCSF and has also been internationally recognized. The partnership between MUHAS and UCSF has continued to develop since then with activities in several areas, including emergency medicine, surgery, orthopaedics, and cancer.
Q. What are you colleagues there facing in terms of incidence, mortality, treatment setting, and resources?
Africa is facing an unprecedented growth in cancer burden and is inadequately prepared to meet this public health challenge. While HIV, TB, and malaria have dominated the global health agenda for the past few decades, over one million people are projected to die of cancer in Africa by 2020. Many have dismissed cancer as an insurmountable challenge in a low-resource setting. However, I think we are at a poignant moment in history, where we must begin to tackle this challenge with a strategic and incremental approach – much as was done with the HIV/AIDS pandemic.
Tanzania estimates that it sees approximately 44,000 new cancer patients per year. Currently, demands for cancer care at the national referral center, Ocean Road Cancer Institute, far exceed available services, and the number of new cases are steadily increasing. The most common cancers in sub-Saharan Africa are also some of the most treatable, including breast, cervical, and prostate cancer. However, most patients present with cancers at very advanced stage due to a variety of issues including low cancer awareness, stigma, and challenges with access to care. Cancer prevention, early detection, and palliative care services in Tanzania are not well developed.
Delegates from UCSF:
Linda Abramovitz, RN, MSN, BMTCN
Ron Balassanian, MD
Stella Bialous, RN, DrPH
Geoffrey Buckle, MD
Hueylan Chern, MD
Amie Lee, MD
Dianna Ng, MD
Deirdre Olynick, PhD, MBA
Sujay Sheth, MD, MBA
Katherine Van Loon, MD, MPH
Melody Xu, MD
Q. What are the needs there? How is the work of the HDFCCC Global Cancer Program team helping?
I think one of the most striking needs is for mentoring in research. MUHAS is a unique institution in sub-Saharan Africa in that the academic culture truly celebrates and prioritizes research. Similar to the culture at UCSF, the most highly-regarded faculty are those who are accomplished in clinical care, education, and research. These individuals are extraordinary, however, and there are very few people with expertise in specific to cancer research that can serve as mentors in this area.
I firmly believe that by partnering to train and mentor a cadre of investigators in Tanzania who are capable of performing high-quality research focused on cancer, we are investing in the future leaders in cancer care for the entire East African region.
Q. Talk about the progress the team at Muhimbili has made?
Over the past several years, Dr. Elia Mmbaga and I have co-lead a collaboration focused on investigating the determinants of the disproportionately high incidence of esophageal cancer along the eastern corridor of Africa. We have been co-investigators on two grants from the National Cancer Institute, focused on the etiology of esophageal cancer in Tanzania.
This collaboration now spans multiple disciplines, including biostatistical, epidemiologic, genetic, genomic, virologic, and laboratory studies. More recently, efforts have expanded to include capacity-building efforts related to surgical and endoscopic treatments and palliation for patients with advanced disease. Along with the NCI and IARC, UCSF, and MUHAS are founding members in the African Esophageal Cancer Consortium.
Thoughts from UCSF Residents
Our trip to Tanzania was brief but certainly had a profound and important impact on my vision for my career. For me, this trip has opened up many doors to the career I've long envisioned at the crossroads of oncology and global health. As I look ahead to next steps with fellowship training and beyond, I look forward to building on these opportunities and continuing to work to improve cancer care in this context, as well as other resource-limited settings.
Geoffrey Buckle, MD MPH
Internal Medicine Resident, R3
When I started residency, it was not clear how or when I would have an opportunity to merge my passions for global health and radiation oncology. I had the privilege to meet many inspiring Tanzanian faculty, residents, and staff who were as excited about collaborating as I was! We are actively developing ideas, including a project to create a decision-making aid for palliative radiation in esophageal cancer. I aim to return to Tanzania in the spring. I hope that this will become a foundation upon which we may carry out long term commitments in radiation oncology patient care, research, and education.
Melody Xu, MD,
Resident Physician, UCSF Department of Radiation Oncology
Q. Did the UCSF team initiate any new programs, protocols, etc.?
One of the most exciting results of our week there was the Global Cancer Program’s announcement of a new request for applications for research projects focused on cancer in Tanzania. Projects must be led by a Tanzanian investigator but require a collaborative approach and a mentorship team that will include at least one UCSF faculty member. Our intention is to support pilot studies that will provide early career investigators with the experience and mentoring to conceptualize a project, write a competitive grant application, successfully execute a study, and publish a manuscript.
Q. Talk about something that happened there that inspired team and reaffirmed your commitment to the GCP’s mission.
I think all UCSF delegates were amazed (and possibly surprised) by the genuine enthusiasm around our visit. We were all very touched by the openness and honesty of our Tanzanian colleagues about the challenges they are facing. I think this reflects two things. First, there is a true sense of urgency around the burden from cancer that Tanzania is facing. Second, there is a very strong foundation of partnership that exists between MUHAS and UCSF. The interactions were truly genuine, and we all left with a sense of the magnitude of the need for an expanded collaboration focused on cancer between our two institutions.
Q. Talk a little about what's next.
There’s so much to do! Our pathologists, Drs. Ron Balassanian and Dianna Ng, are leading capacity-building efforts to improve the utilization of fine needle aspiration as a tool for improving turn-around times for cancer diagnoses in Tanzania. Along with Dr. Amie Lee from Radiology, they lead a three-day workshop on ultrasound-guided fine needle aspiration in September.
One of the MUHAS pathology residents, Dr. Asteria Kimbambo, is here at UCSF this month for an observership in cytopathology and rapid-onsite diagnosis. Dr. Ng and Dr. Vuhahula are also leading a very innovative research project to validate the use of the GeneXpert machine using fine needle aspiration specimens for point-of-care testing to determine the hormonal status of breast cancers in low-resource settings.
We are partnering with Dr. Mwaiselage and oncologists at Ocean Road to provide expert review for development of their first iteration of resource-stratified, national cancer treatment protocols, and I will likely be calling on many of the clinical faculty within HDFCCC to assist with this. Looking forward, I hope we will be able to establish additional bi-directional clinical electives and research training opportunities for UCSF and MUHAS trainees.
Q & A with Dr. Elia Mmbaga, Senior Lecturer in the Department of Epidemiology and Director of Strategic Planning at MUHAS
Q: What do you think was most significant about the recent visit from UCSF and faculty and trainees?
A: Similar to other training and research institutions in the country and region, MUHAS has trained, researched and practiced extensively on infectious disease. However, the current epidemiological transition in the burden of disease from infectious to non-communicable diseases (NCDs) has created a growing need to focus on NCD research and training. The MUHAS-UCSF Cancer Collaboration is the only cancer/NCD group at the University. The successes realized by this group over the years have created a demand for expanded collaboration with UCSF. MUHAS faculty and residents were therefore highly enthusiastic about the UCSF faculty visit, with anticipation of initiating collaborative research, training.
Read more about the UCSF Global Cancer Program