Hutchinson Center receives USAID grant to build a cancer clinic and medical-training facility in Africa

Building on the strengths of two institutions separated by nearly 9,000 miles over two continents - both renowned in their work in the fight against cancer - the United States Agency for International Development has awarded a $500,000 grant to Fred Hutchinson Cancer Research Center to aid in the construction of the first American cancer clinic and medical-training facility in Africa.

"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 Hutchinson Center physician-scientist Corey Casper, M.D., M.P.H., scientific co-director of the Uganda Program on Cancer and Infectious Diseases, a research effort begun in 2004 between the Hutchinson Center and the Uganda Cancer Institute, the country's sole cancer clinic. The institute is located at Makerere University Medical School on the campus of Mulago Hospital in Kampala, the nation's capital.

The main goals of the collaboration, co-led by Jackson Orem, M.B.Ch.B., M.Med., director of the Uganda Cancer Institute, are to:

• better understand the link between infectious disease and cancer;
• improve access and delivery of clinical care to patients with infection-related cancers in the U.S. and Uganda; and
• train the next generation of American and Ugandan physicians and scientists to combat infection-associated cancers at home and abroad.

"Up to one-quarter of the world's cancers are attributable to chronic infections," Casper explained. "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."

Casper and colleagues hope that this joint effort between the Hutchinson 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.

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, said Casper, an assistant member of the Hutchinson Center's Vaccine and Infectious Disease Institute, one of the nation's largest infectious disease research groups.

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.

While the grant from USAID's American Schools and Hospitals Abroad program will contribute significantly to the construction of a new outpatient cancer clinic and training facility, additional federal and private funding is being sought to complete the $1.4 million project and to construct an adjacent clinical and laboratory research building, said Banks Warden, executive director of the Hutchinson Center's Vaccine and Infectious Disease Institute.

"We will soon launch a campaign to see if other foundations and individuals are interested in supporting this effort. It is a wonderful opportunity for a foundation or individual to come forward with a major gift to support global health," Warden said.

Support for the project to date has come from several sources, from initial funding provided by the Hutchinson Center and the Doris Duke Charitable Foundation to satellite grants from the National Institutes of Health and, most recently, the USAID funding.

Securing this federal grant would not have been possible without broad support from the Washington congressional delegation, Warden said. "We are deeply indebted to our senators and representatives who got behind our efforts 100 percent," he said.

A letter of support signed by the congressional members stated: "Cancer is all too common in East Africa, with the number of new cases diagnosed annually approximating the number of deaths. With these infrastructure improvements, cancer treatment for Ugandans will dramatically improve. In addition, the collaboration ... will allow for important questions about the biology of infectious-disease related cancers to be answered. Solutions discovered will be applicable globally."

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. The renovation will include the construction of an inpatient facility. The Hutchinson Center has also committed $400,000 to construct new laboratory space for molecular diagnostics. The master plan for these renovation and construction projects was provided by facilities planning and construction staff at the Hutchinson Center.

Ultimately, the provision of new facilities for inpatient and outpatient cancer care, education and research will allow the Seattle/Uganda collaboration to:

• provide first-rate cancer care in Uganda - a country of more than 30 million with one of the highest cancer rates in the world - and improve survival from most common cancers from 10 percent to 90 percent, saving an estimated 6,000 lives each year;
• study the intersection between infections and cancer by promoting cutting-edge research aimed at pathophysiology, prevention, diagnosis and treatment of infection-related cancers in Africa; and
• improve the quality of medical education in oncology and increase the number of cancer specialists in Africa seven-fold (there are currently just two practicing full-time oncologists in Uganda).

One of the biggest benefits the Hutchinson Center is bringing to Uganda is a training program to address the country's lack of cancer specialists. Two Ugandan physician-scientists have already spent year-long fellowships at the Hutchinson Center; five more will be trained in the next three years. There are also plans to expand the training program to include other medical professionals, such as nurses and pharmacologists, Casper said.

The Hutchinson Center also 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," Casper said, "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.

The collaborative effort is also an opportunity for the Hutchinson Center to help mobilize humanitarian aid in this East African nation, where proper nutrition and medical care is scarce and where the families of patients are responsible for all nonmedical care, including food.

"Having a healthy population is essential for the fabric and stability of the nation," Casper said. "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."