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. 2021 Jan:7:118-126.
doi: 10.1200/GO.20.00318.

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

Beatrice P Mushi  1 , Michael M Mwachiro  2 , Geoffrey Buckle  3 , Bongani N Kaimila  4 , Gift Mulima  5 , Violet Kayamba  6 , Paul Kelly  6 , Larry Akoko  1 , Elia J Mmbaga  1 , Msiba Selekwa  1 , Yona Ringo  7 , Natalie Pritchett  8 , Russell E White  2 , Mark D Topazian  9 , David E Fleischer  10 , Sanford M Dawsey  8 , Katherine Van Loon  3
Affiliations

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

Beatrice P Mushi et al. JCO Glob Oncol. 2021 Jan.

Abstract

Purpose: 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.

Methods: In response to demand for palliative interventions for patients with dysphagia because of EC, the African Esophageal Cancer Consortium (AfrECC) partnered with the Clinton Health Access Initiative to improve access to SEMS in Eastern Africa. We undertook a stepwise implementation approach to (1) identify barriers to SEMS access, (2) conduct a market analysis, (3) select an industry partner, (4) establish regulatory and procurement processes, (5) develop endoscopic training resources, (6) create a medical device registry, and (7) establish principles of accountability.

Results: Following an evaluation of market demand and potential SEMS manufacturers, Boston Scientific Corporation announced its commitment to launch an access program to provide esophageal SEMS to patients in Tanzania, Kenya, Malawi, and Zambia at a subsidized price. Parallel regulatory and procurement processes were established in each participating country. Endoscopy training courses were designed and conducted, using the Training-of-Trainers model. A device registry was created to centralize data for quality control and to monitor channels of SEMS distribution. Principles of accountability were developed to guide the sustainability of this endeavor.

Conclusion: The AfrECC Stent Access Initiative is an example of a multisector partnership formed to provide an innovative solution to align regional needs with a supply chain for a high-priority medical device.

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Conflict of interest statement

Beatrice P. Mushi

Research Funding: Cepheid, Celgene Cancer Care Links

Michael M. Mwachiro

Consulting or Advisory Role: Boston Scientific Corporation

Geoffrey Buckle

Research Funding: Celgene Cancer Care Links

Paul Kelly

Consulting or Advisory Role: Calibr

Msiba Selekwa

Research Funding: Celgene Cancer Care Links, Cepheid

Mark D. Topazian

Stock and Other Ownership Interests: Metamodix, Inc, Intuitive Surgical, Adaptive Biotechnologies

Research Funding: Celgene, Inc

David E. Fleischer

Patents, Royalties, Other Intellectual Property: Mayo Clinic patent for invention

Katherine Van Loon

Speakers' Bureau: Physician Education Resource, LLC, Amgen

Research Funding: Celgene Cancer Care Links

No other potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Map of estimated ASRs of esophageal cancer for males and females in Africa. ASR, age-standardized incidence rate. Reprinted with permission from Globocan (2018).
FIG 2
FIG 2
A framework for the development of the African Esophageal Cancer Consortium stent access initiative. BSC, Boston Scientific Corporation; EC, esophageal cancer; SEMS, self-expanding metal stents.
See this image and copyright information in PMC

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