In part through a $500,000 grant from the United States Agency for International Development (USAID), Fred Hutchinson Cancer Research Center, an NCCN Member Institution, is collaborating with the Uganda Cancer Institute to construct the first American cancer clinic and medical training facility in Africa. The focus of this collaboration is on the study and treatment of cancers related to infectious diseases. This cooperative effort is co-led by Corey Casper, MD, MPH, Director of the Uganda Program on Cancer and Infectious Disease at Fred Hutchinson Cancer Research Center and the Medical Director of Infection Control at the Seattle Cancer Care Alliance, and Jackson Orem, MBChM, MMed, Director of the Uganda Cancer Institute. Dr. Casper is also a member of the NCCN Guidelines Panel for the Prevention and Treatment of Cancer-Related Infections. The Uganda Cancer Institute is at present the only cancer clinic in Uganda and is located in Kampala, the nation's capital, at Makerere University Medical School and Mulago Hospital.
The World Health Organization estimates that chronic infectious diseases cause more than 20 percent of all cancers in the world, including liver, cervical and gastric malignancies. Infection-related cancers are more frequent and often more severe in people infected with HIV. In resource-poor Uganda, the HIV epidemic is fueling a 20,000-fold upsurge in Kaposi's sarcoma in adults and Burkitt's lymphoma in children. Both are disfiguring cancers with abysmal survival rates due to lack of access to early diagnosis and treatment.
“This is the first true collaboration between an African and a U.S. institution to attempt to reduce cancer-related suffering through collaborative medical care and training,” said Dr. Casper. “Up to one-quarter of the world's cancers are attributable to chronic infections. “Better understanding the link between infectious disease and cancer provides a unique opportunity to reduce cancer-related suffering and death in both resource-rich and resource-poor regions.”
Goals of the collaboration between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute are to better understand how infectious disease and cancer are linked, to improve access to and delivery of clinical care to patients with infection-related cancers in the United States and in Uganda, and to train the next generation of American and Ugandan physicians and scientists to combat infection-associated cancers at home and abroad.
Casper and colleagues hope that this joint effort between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute will benefit the world by identifying new infectious causes of cancer, new ways to prevent infection-associated cancers such as through the development of new vaccines, and new ways to treat such cancers with nontoxic drugs, thus avoiding the need for chemotherapy.
According to Dr. Casper, studying cancer in regions such as Uganda, where the burden of infection-related malignancies is extreme, is optimal for developing rapid and meaningful cancer treatments and diagnostics. Fred Hutchinson Cancer Research Center plans to send up to 20 of its faculty members to Uganda in the next five years as part of a faculty exchange program. Researchers in oncology, infectious disease and epidemiology will provide training in a wide variety of subjects to Ugandan clinicians and scientists. They also will have the opportunity to initiate research projects in collaboration with Ugandan researchers.
“My hope,” said Dr. Casper, “is that over the next five years we establish a first-class facility in Uganda, train a significant number of Ugandan cancer-care providers and that people who are interested in international oncology will come to the Center for the chance to work in Uganda."
Research conducted to date through the Seattle/Uganda partnership already has determined that many of the infectious diseases that cause cancer in low-resource areas are treatable at minimal costs. For example, it is estimated that 85 percent of Burkitt's lymphoma (associated with human herpesvirus 4, also known as Epstein-Barr virus), the most common cancer in children from East Africa who are on average 5 years old when afflicted, can be cured for less than $600 a case. Similarly, 75 percent of Kaposi's sarcoma (associated with human herpesvirus 8, or HHV-8), the most common cancer in East African adults, can be treated for less than $720 a case.
The Uganda Cancer Institute, established in 1967 in collaboration with the U.S. National Cancer Institute, has been the site of many landmark accomplishments, such as discovering new cancers, including Burkitt's lymphoma, and developing novel treatment regimens. Over the years, however, the institute has fallen victim to neglect attributable to periods of tumultuous national politics. Its five cinderblock buildings bear scars of the nation's troubled past. Upon completion of the new, state-of-the-art facility, the Ugandan Ministry of Health has pledged $1.8 million to renovate and repurpose the existing buildings of the cancer institute.
“Having a healthy population is essential for the fabric and stability of the nation,” said Dr. Casper. “It is the Hutchinson Center's obligation to seek the resources needed to provide care to the patients and clinical-research volunteers in Uganda. It's also the right thing to do. There can be no greater mandate in cancer research than to wage the fight by doing the right thing.”