Sharing oesophageal cancer lessons globally

Kenya has one of the highest incidence rates of oesophageal cancer in the world; it does not discriminate by gender, and mortality rates are high. It can progress undetected until late stage, when treatment options are very limited. Dr Suzanne Johnson, Lecturer and Programme Director for Transformative Oncology, talks about a collaboration with the Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) focused on improving oesophageal cancer survival.

Our current project seeks to better understand the biological and genetic background of squamous cell carcinoma of the oesophagus (OSCC), a cancer type that differs to the adenocarcinoma we see more frequently in the UK.

This difference has prompted an interest in the potential role of lifestyle choices, environmental and genetic factors, which may lead to the development of this cancer, and are specific to Kenya. These learnings can help to raise awareness, promote preventative measures and develop earlier detection methods, with the primary aim to reduce morbidity and mortality of future cases.

Dr Suzanne Johnson

Suzanne is a lecturer in the Division of Cancer Sciences and Division lead for Social Responsibility.

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Just like Greater Manchester, Kenya as a country does not have a homogenous population. Huge diversity in ethnicity, language and culture are apparent. This similarity allows us to draw parallels with research approaches that have been successful here in Manchester and look to apply the same principles there.

We are working with our Kenyan colleagues to build a trusted network of researchers, community health workers, clinicians, patients, and carers who will enable us to gather data about the early signs and symptoms, lifestyle choices and practices, help seeking behaviours and access to care. These insights are essential to inform future interventions and build improvement.

Kenya’s regions and counties also vary dramatically in geographical and environmental features, which adds other rich and interesting dimensions to our research.

Global health research

There are many compounding factors to performing relevant and aspirational health research, whether that’s in the UK or globally.

Often, clinical improvement cannot be measured for 10 years or more. Securing adequate funding to ensure the sustainability of any project that seeks to learn and then implement changes in behaviours, in the hope it will lead to improvements in clinical outcome, requires vision and long-term commitment.

There are also the constraints of academic rigour, historical bias or deep-rooted discrimination that need to be navigated.

It is challenging, and one size does not fit all, but by working together with the population we seek to serve, researchers can overcome many barriers and deliver fruitful and more importantly meaningful advances in their field.

Communication

Research which involves collecting information, life experiences and personal insights to disease across a population requires sensitivity. It can be very complex, as it aims to account for human diversity and its success is determined by the quality and authenticity of data that is gathered as part of the project.

Community engagement is a key feature of this, and a number of projects across Greater Manchester and beyond. The dialogue between individuals is crucial to gather what are often anecdotal insights into personal experiences of cancer and which can be so valuable when designing research.

Gaining the trust of the communities we wish to engage is pivotal and engagement relies on clear and honest communication. People’s perception of research varies and so framing the research sensitively can bring greater willingness to participate.

Pledging to support the development of those we engage with, through education or awareness, can be a positive influence and lead to co-development of resources or approaches which in turn offer ownership, belonging and sustainability.

Globalising our approaches

Manchester was the first UK university to place social responsibility as a core goal, alongside research and discovery and teaching and learning. Global influence is a key theme and aligns directly with the United Nations Sustainable Development Goals.

Using our expertise and knowledge of cancer discovery and clinical research, in collaboration with a low middle-income country such as Kenya, offers opportunities to share advances in understanding, which can directly support the improvement of outcomes for patients with cancer.

For example, in addition to bringing expertise in community engagement, this project brings expertise in cancer genomics that actively seeks to balance the deficit of understanding of the African genome. If we identify any underlying genetic signatures that are linked to an increased likelihood of developing OSCC, this can assist in future screening, treatment and education programmes, both in Kenya and elsewhere globally.

Clinically, in Greater Manchester, the Christie Hospital is the central hub for cancer care. Through the development of connections with a network of outlying care facilities, embedded within various communities, all patients with cancer across Greater Manchester have access to world-class care.

This hub and spoke model forms the basis of our approach in Kenya, with KUTRRH in Nairobi as the hub, and five diverse counties (Meru, Nyeri, Kiambu, Kisii and Nakuru) as spokes.

As part of the project, we are supporting the development of infrastructure, which will enable effective channels for communication, to ensure that each case is given the best possible treatment plan.

Reciprocal learning

There is a real opportunity with this project to broaden our understanding of the impact of movement of populations.

Working with the Kenyan diaspora in the UK enables us to monitor incidence of squamous cell carcinoma of the oesophagus in those who have migrated. That way, we can investigate whether environmental, geographical and dietary changes have influenced the disease.

In conjunction with new insights into the underlying genetic profiles, we can better advise on treatments as we move closer to precision oncology.

We may also identify specific signatures that suggest environmental triggers, which can be further explored through new screening programmes to facilitate early detection in Kenya.

We may find from our study in Kenya that because a person lives in a more urban or rural environment, or whether they have more or less arsenic in their drinking water, or change their practice of drinking hot tea, or any number of other cultural and environmental changes that happen because of the fact that they have moved locality in Kenya could inform their cancer risk, both increasing and decreasing it.

Whatever we find will ultimately benefit not only Kenyans living in Kenya, but Kenyans globally.