PHILADELPHIA-For more than two decades, experts at Penn Medicine have worked hand in hand with local partners to improve health care and outcomes in the sub-Saharan African nation of Botswana. Now, a new $3.5 million grant from the National Cancer Institute (NCI) will help further that work by addressing one of Botswana's most serious health challenges: cervical cancer.
"We are honored to be a part of this funding initiative that extends the huge impact that years of partnership in Botswana has had on improving care for cervical cancer patients," said Surbhi Grover, MD, an associate professor of Radiation Oncology and the director of global radiation oncology at the Hospital of University of Pennsylvania. Grover co-leads the grant with Katharine Rendle, PhD, an assistant professor of Family Medicine and Community Health in the Perelman School of Medicine at the University of Pennsylvania.
Penn Radiation Oncology has been working with colleagues in Botswana since 2011, with Grover leading efforts in cervical cancer care since 2014 when she moved full time to Botswana. "This grant provides the opportunity for our clinical and research teams at Penn and the University of Botswana to test innovative strategies that can directly improve the lives of women diagnosed with cervical cancer in Botswana," said Rendle, who is also deputy director for research at the Penn Center for Cancer Care Innovation (PC3I).
Cervical cancer is the leading cause of cancer death for females in Botswana and is the most common cancer among younger women between the ages of 15 to 44, according to 2021 data from HPV Information Centre. In fact, the age-standardized mortality rate for cervical cancer is 10 times higher in Botswana (20.1 per 100,000) than in the United States (2.1 per 100,000) according to 2020 Globocan estimates.
Grover says this is due in large part to the nation's high prevalence of HIV, which substantially increases cervical cancer risk. Botswana has the third-highest rate of HIV prevalence in the world, with about 20 percent of its population of people aged 15 to 64 living with HIV, according to data from the Botswana AIDS Impact Survey published in 2022.
When there isn't coordination between laboratories, patients, and clinics, there can be catastrophic delays in diagnosis and treatment.
"Sometimes when I see a patient, I realize their biopsy occurred months or even years ago. There is no alert system whereby the lab can notify the referring facility when cancer is diagnosed," Grover said. "Furthermore, there is often no link between patients and the cancer clinic. This lack of communication and support is what this grant aims to address. This is the first step in our larger aim to improve outcomes of women with cervical cancer across the globe."
As part of the NCI-funded project, researchers will identify communication and support strategies, such as text messages or phone-based patient navigation, that are best equipped to close gaps in the care continuum.
"We will test strategies that aim to shorten the gap from diagnosis to initiation of potentially life-saving treatments for all patients with cervical cancer," Rendle said. "Our goal is to do so in the most cost-effective and efficient way, reducing burden on the health system."
Since 2001, Penn has worked through the Botswana-UPenn Partnership (BUP) to improve health in Botswana. What began as a response to the burgeoning HIV/AIDS crisis has evolved into a wide-ranging health initiative focusing significantly on oncology over the last decade with support from Penn's department of Radiation Oncology and Center for Global Health. BUP works closely with Botswana's Ministry of Health, the University of Botswana, and other partners to care for patients, and develop initiatives advancing cancer education, research, and capacity.
The team hopes that the study's findings could ultimately be applied to care strategies for other cancer, in Botswana and in other countries facing similar barriers. "This project is reflective of Penn Medicine's commitment to ensuring patients around the globe receive high-quality cancer care," Rendle said. "By collaborating with and learning from leaders in Botswana and other countries, we aim to implement clinical solutions that are sustainable over time and directly responsive to the needs and priorities of our global partners."
