Purpose: Recent developing work has demonstrated the efficacy and benefits of adopting hypofractionated radiotherapy (HFRT) for prostate cancer in low- and middle-income countries. Adopting HFRT in limited-resource countries, such as those in sub-Saharan Africa, can reduce treatment costs and increase treatment access where cancer burden is great. Before HFRT can be fully implemented, clinical trials on African populations are necessary. Clinics in these regions are significantly under-represented in radiotherapy clinical trial participation. In this work, we assess the capacity of African cancer centers to participate in radiotherapy clinical trials in terms of capability and quality assurance.
Methods: 14 African radiotherapy clinics with linear accelerators were invited to participate in a survey inquiring about past clinical trial experience, available resources, and relevant infrastructure. Survey items included experience in specific clinical trial phases, facility accreditation and documentation, specialist personnel on-site, and quality assurance methods. These reports were tabulated and compared to determine missing critical items required to participate in cancer clinical trials.
Results: Among surveyed cancer centers; 36%, 93%, 93%, and 79% of clinics have reported capability to participate in clinical trials of Phase I, II, III, and IV, respectively. Specialist on-site personnel varied greatly from 57% to 93%. Specialists included roles such as research coordinators, pathologists, and biostatisticians. All surveyed clinics reported to have computed tomography imaging.
Conclusion: While most of the surveyed clinics have the resources and accreditation for clinical trial participation, preliminary analysis shows that most sites are missing a number of specialist personnel which may be necessary for HFRT clinical trials. Additionally, only a handful of our surveyed clinics report to have Phase-I clinical trial capability. This could be due to lack of quality assurance necessary for Phase-I, lack of investment, or cultural stigma. Further investigation is required to determine the influence on the lack of Phase-I participation.