Prioritisation of research topics for head and neck cancer in Africa – Report of the International Collaboration On Improving Cancer outcomes in low and middle income countries – ICOnIC Africa

Introduction
Over the past two decades, the burden of cancer in low and middle income countries (LMICs) has increased steadily1,2. However many LMICs have limited access to the full array of cancer treatments: 70% of developing countries having no access to radiotherapy at all, and 98% of patients in low income countries have no access to timely, safe affordable surgery3–5. As a result, at least 66% of people diagnosed with cancer in LMICs die from their disease, in contrast to less that 50% in high income countries (HICs)6. The burden of disease in LMICs is further heightened by constrained access to allied health services and palliative care expertise. In LMICs, where resources are already very stretched, delivery of research, addressing the specific problems these countries encounter, is consequently limited.

The International Collaboration On Improving Cancer outcomes in low and middle income countries - Africa (ICOnIC Africa) was established to help identify and develop research to address the most pressing research needs in cancer management in Africa. The Collaboration comprises front-line stakeholders in cancer care in Africa, including clinicians, patient advocacy groups, training organisations, higher education institutes, and policy makers across 14 African countries, along with two universities and professional bodies in the UK (Table 1).


Head and neck cancer (HNC) in Africa is the first cancer site to be studied by the collaboration, as it was deemed to be a good model for a cancer that is relatively common in Africa and results in considerable burden to the patient. It affects all population groups, especially those with socioeconomic deprivation, and results in considerable disease burden to the patient and is relatively common in Africa. Detailed data are difficult to obtain, as many countries’ population level incidence data is not collected or is over a decade old7,8. In South Africa, where the data quality is highest, the total incidence of HNC (when including all its component subsites) makes it is the 3rd most common cancer in men, and 6th most common in women9. The majority of HNC in LMICs present with advanced disease10, and due to its anatomical site and treatments, HNC poses one of the highest functional deficits of any cancer11; it therefore represents a considerable unmet need in Africa.

To improve cancer management outcomes in Africa, it is important to utilise interventions that have been shown to be effective in that setting. To facilitate the generation of this evidence, we undertook this study to identify and prioritise the most important research questions addressing the areas of greatest unmet need relating to head and neck cancer management across Africa.