Cancer Care and Prevention
An immediate priority of the Botswana-Rutgers Partnership for Health is to address the country’s urgent cancer care and prevention needs. The cancer mortality rate in Botswana is over 63 percent, and many patients present with advanced disease. There are minimal prevention and support services, long delays in cancer detection and diagnosis, deficiencies in the availability of cancer medications, unreliable data registries, and severe shortages in the specialty-trained workforce.
In 2019, we partnered with the University of Botswana and Botswana’s Ministry of Health to conduct a national workshop on cancer care and prevention. The workshop outcomes and recommendations were compiled in this report.
By establishing a national, comprehensive cancer care and prevention program, Botswana can save lives, prevent disease, and create a model for implementation in other African nations and developing countries around the world.
The following projects are part of our work to build this program together with Botswana:
Cancer Kitso: Oncology Workforce Training Program
Cancer Kitso is an education and training program that responds to the country’s specialty workforce needs in oncology, identified through a national cancer needs assessment. The program is designed for health care workers who care for cancer patients. The broad aim of Cancer Kitso is to improve cancer care and prevention capabilities throughout Botswana and, eventually, other countries in Africa.
Launched with support from Bristol Myers Squibb, Cancer Kitso is modeled after the KITSO AIDS Training Program, Botswana’s national training program for HIV/AIDS treatment and care that was established more than 20 years ago. The word kitso means knowledge in the local Setswana language.
A course on clinical management, launched in fall 2022, covers cancer basics, cancer screenings, treatment modalities of the common cancers, palliative care, patient navigation, and referral pathways within Botswana health systems. This course was developed primarily by local experts and adapted to local clinical settings in Botswana. It also has been introduced in Lesotho for adaptation. Additional courses are being developed to cover fundamentals for primary care providers, oncologic emergencies for hospital teams, and advanced care and treatment for specialized cancer care teams.
Ultimately, the vision is for Cancer Kitso to expand to reach other countries in Africa and include comprehensive education, knowledge exchange, and awareness resources for providers, patients, and the general public.
National Cancer Needs Assessment
The Botswana Comprehensive Cancer Care and Prevention Needs Assessment evaluated the current health system and services available for cancer across four of the nation’s hospitals that are referred to as public oncology centers. These sites are Princess Marina Hospital in Botswana’s capital city of Gaborone, Letsholathebe II Memorial Hospital in Maun, Nyangabgwe Referral Hospital in Francistown, and Sekgoma Memorial Hospital in Serowe.
This evaluation encompassed not only health facilities but also perspectives from health care providers, cancer patients and survivors, caregivers, members of the public, and local nongovernmental organizations that support cancer care and prevention programs. The evaluation was completed in 2021 and included site visits, focus groups, and questionnaires. With support from the Bristol Myers Squibb Foundation, the national cancer needs assessment also included an evaluation of cancer awareness at a population level to inform approaches for broader health campaigns throughout the country.
In 2022, a report of the assessment’s findings and recommendations was presented to the Botswana Ministry of Health and Wellness and subsequently published by the Botswana-Rutgers Partnership for Health. This report, titled A Quantitative and Qualitative Assessment of Cancer Services and Needs at the Four Public Oncology Centers within the Botswana Health System, provides key insights into awareness about cancer and its prevention, disparities in access to cancer-related services, and the difficulties of care based on different locations and types of facilities in Botswana.
Breast Cancer Research
Breast cancer is a leading cause of cancer-related deaths for women in Botswana. A lack of screening and early detection, long delays in diagnosis, and limited treatment options mean that many women present with breast cancer at advanced stages, at which point recovery is far less likely.
There is a dire need to improve timely access to breast cancer care in Botswana. Our aim is to identify and address crucial deficiencies in information and support.
Our current project, “Improving Timely Access to Care for Women with Advanced Stage Breast Cancer in Botswana,” is funded by UICC’s (Union for International Cancer Control) SPARC MBC Challenge. Through qualitative research methods, such as focus group discussions with breast cancer patients and caregivers, we are uncovering gaps in breast cancer care at the patient level, clinician level, and health system level. We also are working to understand knowledge gaps in breast cancer care and prevention among primary care practitioners. Ultimately, to improve the care received by breast cancer patients with advanced disease, we will train and implement a system of patient navigators to assist and support patients through their treatment journey.
Cancer Pathology Working Group
Pathology and laboratory medicine are critical to enabling accurate and early diagnoses of cancer, which in turn leads to improved chances of treatment and survival. However, these areas of Botswana’s health system require significant capacity building to fast-track cancer diagnoses, which currently can take months. The 28-member Botswana-Rutgers Cancer Pathology Working Group was launched in September 2020 to harness a collective commitment across Rutgers, Botswana’s Ministry of Health and Wellness, and the University of Botswana to improve pathology and laboratory medicine services for cancer throughout Botswana’s health system.
The group is currently involved in creating a digital collection of pathology cases for training purposes. Working in collaboration with the University of Botswana’s Department of Pathology, the Rutgers Cancer Institute’s biomedical informatics team is launching digital imaging capabilities for pathology slides. This will allow for a diverse spectrum of cancer biospecimens to be included as a teaching resource within a digital quiz bank. The digital imaging capabilities and quiz bank will allow for knowledge exchange between trainees at both institutions.
Global Oncology Fellowships
Since 2018, the global oncology fellowship program has provided Rutgers hematology/oncology fellows with a global oncology experience and has contributed to improving cancer care and prevention in Botswana. Rutgers Global Health Institute co-developed the fellowship program through partnerships with Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, the University of Botswana, and Princess Marina Hospital in Gaborone, Botswana.
Each year, two fellows participate in a yearlong program that includes a one-month research elective in Botswana. They gain exposure to the realities of cancer care in the country; provide mentorship to junior medical officers, residents, and hospital staff; and conduct research. Projects have included gathering and analyzing data on chemotherapy utilization and stockouts, developing cancer care guidelines, and creating oncology staff protocols.