Scientific Outputs

Diagnosis and Management of Kaposi Sarcoma-Associated Herpesvirus Inflammatory Cytokine Syndrome in Resource-Constrained Settings: A Case Report and an Adapted Case Definition

December 2024 Kaposi sarcoma-associated herpes virus (KSHV), also known as human herpes virus 8 (HHV-8), is the primary etiologic cause of Kaposi sarcoma (KS) and KSHV Inflammatory Cytokine Syndrome (KICS). Patients with KICS demonstrate symptoms of systemic inflammation, high KSHV viral load, elevation of inflammatory markers, and increased mortality. Management requires rapid diagnosis, treatment of … Read more

Tumor-Associated Edema in Children with Kaposi Sarcoma: 14 Years’ Experience at Kamuzu Central Hospital, Lilongwe, Malawi.

November 2024 Background/Objectives: Kaposi sarcoma (KS) is a common lymphatic endothelial cancer among children with and without HIV in central and eastern Africa. Despite its clinical heterogeneity, its various clinical phenotypes are often grouped together in staging and treatment algorithms. Patients with KS tumor-associated edema, referring to hard, non-pitting lesions which often lead to chronic … Read more

Aetiology, susceptibility and outcomes of fever in patients receiving chemotherapy in Malawi: a prospective study

October 2024 Objectives: To evaluate causes of fever, including resistance patterns, in patients undergoing cancer treatment in Malawi. Methods: In this prospective cohort study, enrolled patients undergoing chemotherapy at Kamuzu Central Hospital in Lilongwe, Malawi were given a thermometer. If a temperature of ≥38°C was recorded, they were instructed to return for hospitalization, standardized fever … Read more

Transcriptome profiling of pediatric extracranial solid tumors and lymphomas enables rapid low-cost diagnostic classification

August 2024 Approximately 80% of pediatric tumors occur in low- and middle-income countries (LMIC), where diagnostic tools essential for treatment decisions are often unavailable or incomplete. Development of cost-effective molecular diagnostics will help bridge the cancer diagnostic gap and ultimately improve pediatric cancer outcomes in LMIC settings. We investigated the feasibility of using nanopore whole … Read more

HIV and prior exposure to antiretroviral therapy alter tumour composition and tumour: T-cell associations in diffuse large B-cell lymphoma.

May 2024 Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of lymphoma worldwide, accounting for up to 40% of new non-Hodgkin Lymphoma (NHL) globally. People living with HIV are up to 17 times more likely to develop NHL, and as such, DLBCL is the leading cause of cancer death in this high-risk population. … Read more

Letters to the Editor Low Rates of Side Effects in Paclitaxel Chemotherapy for Kaposi Sarcoma and Feasibility of Treatment in Outpatient ART Clinic Settings in Malawi.

May 2024 Kaposi sarcoma (KS), caused by human herpes virus 8,1 is the most common cancer in HIV-infected individuals. Immunosuppression is an important risk factor of KS development and before antiretroviral therapy (ART) treatment became widely available in a large proportion of people living with HIV developed KS.2 In 2020, KS was ranked as the … Read more

HIV infection and ART exposure affect tumor TCR repertoire of diffuse large B cell lymphoma

May 2024 The most common subtype of lymphoma globally, diffuse large B cell lymphoma (DLBCL), is a leading cause of cancer death in people with HIV. The restructuring of the T cell compartment because of HIV infection and antiretroviral therapy (ART) may have implications for modern treatment selection, but current understanding of these dynamic interactions … Read more

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

May 2024 Background: The World Health Organization recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a … Read more

. Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort study

March 2024 Background: ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi. Methods: We report a prospective observational cohort of HL (aged ≥ 15) from a single, tertiary … Read more

Addressing the Intersectional Stigma of Kaposi Sarcoma and HIV: A Call to Action

February 2024 Epidemic Kaposi sarcoma (KS), also called AIDS-related KS, is one of the most commonly diagnosed cancers in people living with HIV (PLWH). In Malawi, KS is the leading cancer overall, accounting for 34% of all malignancies recorded in the national registry.1 Although the incidence of KS has substantially declined since the widespread adoption … Read more

Experiences of women participating in a human papillomavirus-based screen-triage-and treat strategy for cervical cancer prevention in Malawi

February 2024 Objective: To explore the experiences of Malawian women who underwent a human papillomavirus (HPV)-based screen-triage-treat algorithm for cervical cancer (CxCa) prevention. This algorithm included GeneXpert® HPV testing of self-collected vaginal samples, visual inspection with acetic acid (VIA) and colposcopy for HPV-positive women, and thermal ablation of ablation-eligible women. Method: In-depth interviews were conducted … Read more

Update on pathology laboratory development and research in advancing regional cancer care in Malawi

January 2024 The pathology laboratory at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi was established in 2011. We published our initial experiences in laboratory development and telepathology in 2013 and 2016, respectively. The purpose of this paper is to provide an update on our work by highlighting the positive role laboratory development has played in … Read more

Kusankha Pamodzi: Health Care Decision-Making Preferences Among Patients with Cancer in Malawi.

April 2023 BACKGROUND Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients. METHODS In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making. RESULTS Most participants (70%, n = 35) preferred to engage … Read more

Pediatric HIV+ Kaposi sarcoma exhibits clinical, virological, and molecular features different from the adult disease

November 2023 BACKGROUND Kaposi sarcoma (KS) is among the most common childhood cancers in Eastern and Central Africa. Pediatric KS has a distinctive clinical presentation compared with adult KS, which includes a tendency for primary lymph node involvement, a considerable proportion of patients lacking cutaneous lesions, and a potential for fulminant disease. The molecular mechanisms … Read more

Breast Cancer Germline Genetic Counseling and Testing for Populations of African Heritage Globally: A Scoping Review on Research, Practice, and Bioethical Considerations.

September 2023 PURPOSE Despite the disproportionately high risk of breast cancer among women of African heritage, little is known about the facilitators and barriers to implementing germline genetic testing and counseling (GT/C). METHODS This scoping review followed guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Published manuscripts … Read more

Survival After Diagnosis of Esophageal Squamous Cell Carcinoma in Malawi.

September 2023 PURPOSE Esophageal cancer (EC) is the second most common cancer in Malawi, with esophageal squamous cell carcinoma (ESCC) representing >90% of all ECs. Despite significant morbidity and mortality, little is known about disease outcomes. In this study, we assess survival after ESCC diagnosis in Malawi. METHODS We report on ESCC cases enrolled in … Read more

Eliminating cervical cancer as a global public health problem requires equitable action

December 2023 “We need action to reduce inequities in vaccination, screening, and treatment in order to prevent cervical cancer and make elimination a reality everywhere—not just in high income countries, write Lisa Rahangdale and colleagues” Full Paper

Evaluating the Knowledge Change Before and After Continuing Cancer Education in Malawian Nurses

October 2023 Malawi has a high cancer incidence and mortality. Efforts to train and educate oncology nurses have been identified as an area of need. This study evaluates the educational needs of oncology nurses in Malawi and the effects of a virtual cancer education program on improving the knowledge of cancer epidemiology, treatment, and nursing … Read more

Cancer-Related Stigma in Malawi: Narratives of Cancer Survivors

February 2023 PURPOSE Stigma is an impediment across the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life. The goal of this study was to qualitatively examine the drivers, manifestations, and impacts of cancer-related stigma among individuals who received cancer treatment in Malawi, and to identify … Read more

Characterizing HIV status documentation among cancer patients at regional cancer centers in Malawi, Zimbabwe, and South Africa

October 2023 INTRODUCTION In East and Southern Africa, people with HIV (PWH) experience worse cancer-related outcomes and are at higher risk of developing certain cancers. Siloed care delivery pathways pose a substantial barrier to co-management of HIV and cancer care delivery. METHODS We conducted cross-sectional studies of adult cancer patients at public radiotherapy and oncology … Read more

Results from Two HPV-Based Cervical Cancer Screening-Family Planning Integration Models in Malawi: A Cluster Randomized Trial

May 2023 We conducted a cluster randomized trial of two models for integrating HPV self-collection into family-planning (FP) services at 16 health facilities in Malawi between March 2020–December 2021. Model 1 involved providing only clinic-based HPV self-collection, whereas Model 2 included both clinic-based and community-based HPV self-collection. An endline household survey was performed in sampled … Read more

Case Report: Multicentric Castleman Disease as a Manifestation of Immune Reconstitution Inflammatory Syndrome in Malawi

December 2022 INTRODUCTION Multicentric Castleman disease (MCD) is a lymphoproliferative disorder characterized by systemic inflammation, lymphadenopathy, and cytopenias. MCD caused by Kaposi sarcoma herpesvirus (MCD-KSHV) frequently arises in the context of HIV. It can be associated with immune reconstitution inflammatory syndrome (IRIS), but MCD-IRIS is rarely reported in sub-Saharan Africa (SSA) where HIV and KSHV … Read more

Tobacco and Other Risk Factors for Esophageal Squamous Cell Carcinoma in Lilongwe Malawi: Results from The Lilongwe Esophageal Cancer Case: Control Study

June 2022 OBJECTIVE Esophageal cancer is the second commonest cancer in Malawi, and 95% of all cases are esophageal squamous cell carcinoma (ESCC). Very little is known about the epidemiology of ESCC in Malawi including risk factors. The main objective of the study was to evaluate and describe risk factors of ESCC in Malawi. METHODS … Read more

African Esophageal Cancer Consortium (AfrECC). Treatment Outcomes of Esophageal Cancer in Eastern Africa: Protocol of a Multi-Center, Prospective, Observational, Open Cohort Study

January 2022 BACKGROUND Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with … Read more

An International Report on Bacterial Communities in Esophageal Squamous Cell Carcinoma

Dec 2022 The incidence of esophageal squamous cell carcinoma (ESCC) is disproportionately high in the eastern corridor of Africa and parts of Asia. Emerging research has identified a potential association between poor oral health and ESCC. One possible link between poor oral health and ESCC involves the alteration of the microbiome. We performed an integrated … Read more

Spatial Distribution of Incident Pediatric Burkitt Lymphoma in Central and Northern Malawi and Association with Malaria Prevalence

June 2022 PURPOSE Burkitt lymphoma (BL) accounts for 90% of pediatric lymphomas in sub-Saharan Africa. Plasmodium falciparum (Pf) malaria is considered an etiological factor of BL. We describe the geographic distribution of pediatric BL in Malawi and association with malaria prevalence (PfPR). We also examine the influence of travel time to cancer referral center as … Read more

Characteristics and Outcomes of Acute Lymphoblastic Leukemia in Adolescents and Young Adults in Malawi

June 2022 PURPOSE There are limited data on treatment and outcomes for acute lymphoblastic leukemia (ALL) among adolescents and young adults in sub-Saharan Africa. We describe a prospective observational cohort in Malawi. METHODS Patients age 15-39 years with newly diagnosed ALL at Kamuzu Central Hospital, Malawi, were enrolled from 2013 to 2019; follow-up was censored … Read more

Comparison of Baseline Lymphoma and HIV Characteristics in Malawi Before and After Implementation of Universal Antiretroviral Therapy

Sep 2022 Access to antiretroviral therapy (ART) led to epidemiological changes in human immunodeficiency virus (HIV) associated lymphoma in high-income countries such as reductions in diffuse large B-cell lymphoma (DLBCL) and stable or increased Hodgkin lymphoma (HL) and Burkitt lymphoma (BL). In 2016, Malawi implemented a universal ART (UART) policy, expanding ART eligibility to all … Read more

The Role of Telepathology in Improving Cancer Diagnostic and Research Capacity in Sub-Saharan Africa

October 2022 Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. … Read more

Cancer Care Cost-Effectiveness in Low-Income and Middle-Income Countries: Time to Shift the Burden of Proof

August 2022 Kaposi sarcoma is one of the most common cancers in sub-Saharan Africa and is associated with substantial morbidity and mortality.1 Kaposi sarcoma is caused by the Kaposi’s sarcoma herpesvirus. Although Kaposi sarcoma was recognised in endemic form before the HIV epidemic, HIV has driven an epidemic, AIDS-associated form of the disease.2 Given the … Read more

Prevalence of Traditional, Complementary, and Alternative Medicine (TCAM) Among Adult Cancer Patients in Malawi

April 2022 PURPOSE The objective of this study is to document the prevalence of traditional, complementary, and alternative medicine (TCAM) use by adult cancer patients at a national teaching hospital in Malawi. We aim to document the products/therapies used, the reason for use, as well as patient-reported satisfaction with TCAM practitioners and modalities. METHODS We … Read more

Quality of Life Among Patients with Cancer and Their Family Caregivers in the Sub-Saharan Region: A Systematic Review of Quantitative Studies

March 2022 Guided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus … Read more

A Novel Cervical Cancer Screen-Triage-Treat Demonstration Project with HPV Self-Testing and Thermal Ablation for Women In Malawi: Protocol for a Single-Arm Prospective Trial

April 2022 Cervical cancer is the leading cause of cancer mortality among Malawian women, despite being preventable through screening and preventive therapy. In 2004, Malawi implemented a national screening program, using visual inspection with acetic acid (VIA) and cryotherapy, but its success has been limited due to equipment and human resources challenges. Since the development … Read more

Assessing Community Health Workers’ Time Allocation for a Cervical Cancer Screening and Treatment Intervention in Malawi: A Time and Motion Study

September 2023 BACKGROUND Community health workers (CHWs) are essential field-based personnel and increasingly used to deliver priority interventions to achieve universal health coverage. Existing literature allude to the potential for detrimental effects of multi-tasking CHWs. This study objective was to assess the impact of integrating cervical cancer screening and prevention therapy (CCSPT) with family planning … Read more

Perceptions of Cervical Cancer and Motivation for Screening Among Women in Rural Lilongwe, Malawi: A Qualitative Study

February 2022 INTRODUCTION Cervical cancer is the leading cause of cancer death among women in Malawi. Low awareness of cervical cancer and negative perceptions of screening can prevent women from participating in preventative strategies. We sought to explore perceptions and motivations for screening among women who participated in a cervical cancer screen-and-treat pilot study in … Read more

Tobacco and other risk factors for esophageal squamous cell carcinoma in Lilongwe Malawi: Results from the Lilongwe esophageal Cancer case: Control Study

Esophageal cancer is the second commonest cancer in Malawi, and 95% of all cases are esophageal squamous cell carcinoma (ESCC). Very little is known about the epidemiology of ESCC in Malawi including risk factors. The main objective of the study was to evaluate and describe risk factors of ESCC in Malawi. We conducted a case-control … Read more

Implementation and Evaluation of Educational Videos to Improve Cancer Knowledge and Patient Empowerment

February 17 2022 PURPOSE Low health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi. METHODS We developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, … Read more

Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy

January 2021-The eastern corridor of Africa is affected by a high burden of esophageal cancer (EC), with > 90% of patients presenting with advanced disease. Self-expanding metal stents (SEMS) have been previously reported as safe and effective for palliation of malignant dysphagia in resource-limited settings; however, access is limited throughout Eastern Africa. In response to … Read more

Safety and efficacy of rituximab in patients with diffuse large B-cell lymphoma in Malawi: a prospective, single-arm, non-randomised phase 1/2 clinical trial

July 2021- There are no clinical trials involving patients with diffuse large B-cell lymphoma (DLBCL) in sub-Saharan Africa since antiretroviral therapy (ART) for HIV became widely available in this region. We aimed to establish the safety and efficacy of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with DLBCL in Malawi. This prospective, … Read more

Comparison of best supportive care, CHOP, or R-CHOP for treatment of diffuse large B-cell lymphoma in Malawi: a cost-effectiveness analysis

July 2021- Cost-effectiveness data for cancer treatment are needed from sub-Saharan Africa, where diffuse large B-cell lymphoma (DLBCL) is a common, curable cancer. In high-income countries, the standard of care for DLBCL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemoimmunotherapy. Rituximab is often not available in sub-Saharan Africa due to perceived unaffordability, and treatment … Read more

Feasibility of upfront mobile money transfers for transportation reimbursement to promote retention among patients receiving lymphoma treatment in Malawi

May 2021-Cancer outcomes in sub-Saharan Africa (SSA) remain suboptimal, in part due to poor patient retention. Many patients travel long distances to receive care, and transportation costs are often prohibitively expensive. These are well-known and established causes of delayed treatment and care abandonment in Malawi and across SSA. We sent visit reminder texts and offered … Read more

Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains

August 2021- Patient-reported outcomes (PROs) that assess health-related quality of life (HRQoL) are increasingly important components of cancer care and research that are infrequently used in sub-Saharan Africa (SSA). We administered the Chichewa Pediatric Patient-Reported Outcome Measurement Information System Pediatric (PROMIS)-25 at diagnosis, active treatment, and follow-up among pediatric lymphoma patients in Lilongwe, Malawi. Mean … Read more

Epidemiology of haematological malignancies in people living with HIV

August 2020- SERIES: People living with HIV or AIDS are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. Data on the risk of multiple myeloma or leukaemia are inconsistent and of low quality but the risk does not seem to be increased. Specific haematological malignancies occur in different contexts of age, … Read more

Improving outcomes for non-Hodgkin lymphoma in Sub-Saharan Africa: where to start?

March 2020- COMMENTARY: As governments in sub-Saharan Africa (SSA) expand access to effective antiretroviral therapy (ART) for HIV-infected patients, cancer is becoming an increasingly important cause of preventable death in the region. According to the Global Burden of Disease study, cancer is now the second leading cause of death worldwide, and, despite decreases in cancer … Read more

Identifying Transcriptional Profiles and Evaluating Prognostic Biomarkers of HIV-associated Diffuse Large B-cell Lymphoma From Malawi

February 2020-This study provides among the first molecular characterizations of DLBCL from SSA, demonstrates marked gene expression differences by HIV status, and identifies genomic and immunophenotypic characteristics that can inform future basic and clinical investigations.

Outcomes and Prognostic Factors for Malawian Women with Breast Cancer

April 2020 – Breast cancer incidence in sub-Saharan Africa is increasing, and the region has the highest age-standardized breast cancer mortality rate worldwide. In a setting where breast cancer data are limited, our findings indicate that late stage presentation, HER2-enriched and triple-negative subtypes, and HIV coinfection were associated with mortality and were more prevalent in … Read more

Modified EPOCH for High-Risk Non-Hodgkin Lymphoma in Sub-Saharan Africa

January 2020 – Aggressive NHL is among the most common cancers in SSA where CHOP is the standard treatment and outcomes are poor. We treated patients with a modified EPOCH regimen with moderate outcomes. Results indicate that this regimen was feasible and effective in a small cohort and suggest EPOCH with setting-appropriate modifications may be … Read more

High pretreatment plasma EBV DNA level is a poor prognostic marker in HIV-associated, EBV-negative DLBCL

November 2019 – Although plasma EBV DNA measurement has established prognostic utility in EBV‐driven lymphomas, findings from this study suggest that EBV reactivation in nontumor cells is a poor prognostic finding even in HIV‐positive patients with convincingly EBV‐negative DLBCL.

Facilitators and Barriers to Traditional Medicine Use Among Malawian Cancer Patients

October 2019 – Increasing access to conventional cancer treatment in low-income countries is an important public health initiative to address the global burden of cancer. Our findings indicate that cancer patients in our cohort rely on a pragmatic and experience-based treatment selection process and provide insights to the various factors that influence T&CM use among cancer … Read more

Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi

July 2019 – Cost analysis of treating diffuse large B-cell lymphoma (DLBCL) in Malawi indicates that per-patient cost of first-line treatment of DLBCL in Malawi is low relative to high-income countries, suggesting that investments in fixed-duration, curative-intent DLBCL treatment may be attractive in sub-Saharan Africa.

Global Oncology

June 2019 – This article highlights the important role of cancer care and research outside the United States, particularly in low- and middle-income countries, in furthering innovative solutions for cancer that can be applied worldwide.

Epidemiological and Histopathological Profile of Malignant Melanoma in Malawi

April 2019 – Studies on malignant melanoma have largely focused on Caucasian populations with very limited data on the disease in black Africans. This retrospective study characterizes melanoma cases in Lilongwe, Malawi and demonstrates that malignant melanoma occurs in black Malawians and may be an under-appreciated malignancy.

Prospective Study of Burkitt Lymphoma Treatment in Adolescents and Adults in Malawi

February 2019 – Although Burkitt lymphoma (BL) is common in sub-Saharan Africa (SSA) and highly curable in high-income countries, there are few prospective nonpediatric BL studies from SSA and no regional standard of care. This study represents one of the best characterized prospective cohorts of nonpediatric BL in SSA.

Rosai-Dorfman Disease in Malawi

December 2018 – We present the case report of an HIV‐negative female adolescent with Rosai-Dorfman disease, a rare lymphoproliferative disease with limited cases reported in sub‐Saharan Africa.

Mature Outcomes and Prognostic Indices in DLBCL in Malawi

December 2018- Outcomes for diffuse large B-cell lymphoma (DLBCL) in sub-Saharan Africa are poorly described. We report mature data from one of the first prospective SSA cohorts and propose a setting-appropriate prognostic model.

High Cancer Burden Among ART Users in Malawi

December 2018- In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users. We link cases from the population-based cancer registry with EMRs supporting ART delivery in Malawi’s two largest HIV cohorts, Lighthouse Trust and Queen Elizabeth Central Hospital to identify cancer burden.

HIV-Associated Multicentric Castleman Disease In Malawi

November 2018-  Despite high burden of Kaposi sarcoma and HIV, multicentric Castleman disease is rarely reported in SSA. To supplement previous reports on MCD cases in Malawi, we describe a larger cohort of MCD patients with longer follow-up.

A Tailored Approach to Building Specialized Surgical Oncology Capacity in Malawi

November 2018 – We report on early experiences and outcomes of making life-saving surgical treatment for cervical cancer available for the first time as a routine clinical service in Malawi.

Ending Tribalism in Global Oncology

October 2018- Dr. Satish Gopal urges the global health community to prioritize meaningful multilateral partnerships in order to improve the coordination of patient care and research.

‘Discovering’ primary effusion lymphoma in Malawi

September 2018- Although HIV and HHV8 are highly prevalent in SSA, there are scarce reports of primary effusion lymphoma (PEL) from the region, likely reflecting underdiagnosis. This article describes the two recently confirmed cases of extracavitary PEL in Malawi.  

Treating Burkitt Lymphoma in Children and AYA in Sub-Saharan Africa

July 2018- Although highly effective, high-intensity cytotoxic treatments for Burkitt lymphoma are available in resource-rich settings, these therapies are usually not feasible in SSA, and lower-intensity continuous infusion approaches are impractical. We review current treatment approaches in SSA and discuss options for risk stratification and individualize therapy.

Plasmablastic lymphoma in Malawi

June 2018- Despite high prevalence of HIV in SSA, descriptions of Plasmablastic lymphoma (PBL) are scare.  In one of the first clinical descriptions of PBL, we report on characteristics, treatment, and outcomes of 12 pathologically confirmed PBL cases in Lilongwe.

Dissecting Heterogeneous Outcomes for Paediatric Burkitt Lymphoma in Malawi after Anthracycline-Based Treatment

June 2018 – We discuss our experience in relation to others’ major contributions to paediatric Burkitt lymphoma care in sub-Saharan Africa. We believe that sharing of heterogeneous regional experience is valuable for rigorous examination, and look forward to on-going collaborative efforts to define best approaches for this disease, which we are actively pursuing with many … Read more

Translation, Psychometric Validation, and Baseline Results of the PROMIS-25 measures

June 2018- Efforts to translate and culturally validate patient-reported health-related quality of life measures are scarce in SSA are scarce. This study translates the PROMIS-25 to Chichewa and assesses its validity and reliability in our setting.

Frequent HIV and Young Age Among Individuals With Diverse Cancers

June 2018- We report the epidemiology of patients with cancer recorded by a hospital-based cancer registry at Kamuzu Central Hospital, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory.

Guidelines for sub-Saharan Africa: a Call for Evidence

April 2018- Cancer care in resource-limited settings is radically different from cancer care in resource-rich settings. Drs. Painschab and Gopal comment on the urgent need for region-specific data and clinical trials to address the rising cancer burden in SSA.

Practical Successes in Telepathology Experiences in Africa

March 2018 – We report on how, despite limitations and challenges, real-time telepathology conferences have had a dramatic impact on diagnostic accuracy for direct patient care and have supported successful implementation of clinical trials in our setting.

Risk Factors and Reasons for Treatment Abandonment Among Children with Lymphoma

March 2018- We examined risk factors and reasons for treatment abandonment among Malawian children with lymphoma, the most common pediatric cancer in SSA. 

Lymphoma and Pathology in Sub-Saharan Africa: Current Approaches and Future Directions

March 2018 – The care of patients with lymphoma relies heavily on accurate tissue diagnosis and classification. Lymphoma burden is increasing in sub-Saharan Africa, but diagnostic pathology services are still limited. This article summarizes lymphoma epidemiology, current diagnostic capacity, and obstacles and opportunities for improving practice in the region.

CD4 Count and HIV RNA Trends for HIV-Associated Lymphoproliferative Disorders in Malawi

October 2017 – Given scarce data from sub-Saharan Africa, we describe CD4 count and HIV RNA trends over time among patients with HIV-positive lymphoproliferative disorders in Malawi.

Global Health: What’s in It for Us?

October 2017- In this essay, Dr. Satish Gopal addresses why he provides cancer care and conducts research in Malawi, and how global health efforts benefit the United States and human health more broadly.

Extranodal Natural Killer/T-cell Lymphoma in Malawi

September 2017- Our experience with these patients highlights that ENKTCL does indeed occur in SSA, increases familiarity with ENKTCL among clinicians and pathologists throughout the region, and emphasizes the need for better diagnosis and treatment for this neglected population.

Salvage Chemotherapy for Adults with Relapsed or Refractory Lymphoma

August 2017 – Lymphoma is highly associated with HIV in sub-Saharan Africa and contributes to worse outcomes relative to resource-rich settings. This study describes 21 patients with relapse or refractory lymphoma who were prospectively treated with salvage chemotherapy in Malawi.

Cancer Trials in sub-Saharan Africa

July 2017- Dr. Gopal proposes a potential resource-tailored framework for cancer clinical trials and for aligning care and research in SSA.

Beyond Endemic Burkitt Lymphoma: Navigating Challenges of Differentiating Childhood Lymphoma Diagnoses Amid Limitations in Pathology Resources in Lilongwe, Malawi

June 2017 Abstract Background.  Although Burkitt lymphoma (BL) is the most common childhood lymphoma in sub-Saharan Africa, Hodgkin lymphoma (HL) and other non-Hodgkin lymphomas occur. Diagnosing non-jaw mass presentations is challenging with limited pathology resources. Procedure.  We retrospectively analyzed 114 pediatric lymphomas in Lilongwe, Malawi, from December 2011 to June 2013 and compared clinical versus … Read more

International Cancer Seminars: Esophageal Squamous Cell Carcinoma

June 2017 – An international workshop aimed at examining the state of current science regarding esophageal squamous cell carcinoma. These discussions highlight a series of difficult questions which are recommended to inform and prioritize future research efforts. 

Navigating Challenges of Differentiating Childhood Lymphoma Diagnoses Amid Limited Pathology Resources in Malawi

June 2017 – Although Burkitt lymphoma (BL) is the most common childhood lymphoma in sub-Saharan Africa, Hodgkin lymphoma (HL) and other non-Hodgkin lymphomas occur. We found that lymphomas other than Burkitt accounted for 35% of childhood lymphoma diagnoses. Although over-reliance on clinical diagnosis for BL was a limitation, confidence in non-BL diagnoses improved with time … Read more

Risk Factors for Common Cancers at Kamuzu Central Hospital in Malawi

June 2017 – In light of limited data regarding risk factors for different cancers in Malawi, we assessed risk factors for and epidemiologic patterns of common cancers among patients treated at Kamuzu Central Hospital. We found that age, smoking, and HIV are important risk factors for the 3 commonest cancer types (oesophageal, KS, and cervical), … Read more

HPV in Head and Neck Squamous Cell Carcinoma: A descriptive study

June 2017- We describe the etiologic contribution of human papillomavirus (HPV) in head and neck squamous cell carcinoma (HNSCC), a common cancer in our setting. 

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi

April, 2017 – Breast cancer is very common in Sub-Sahara Africa, but many misconceptions about it make early detections and treatment difficult. This study looks at what misconceptions exist and what barriers need to be addressed.