Cancer researchers must broaden the focus of their work

Cancer research in Africa has increased over the past decade, but those gains were unevenly distributed as just 13 out of 54 countries on the continent produced 90% of the research, with Egypt and South Africa contributing two-thirds of the peer-reviewed contributions about cancer, according to datasets from a recent bibliometric analysis with a focus on Sub-Saharan Africa.

In a study, ‘Cancer research across Africa: A comparative bibliometric analysis’, published in the latest issue of BMJ Global Health, a scientific journal that is indexed by Elsevier, Dr Miriam Mutebi, a consultant oncologist at Aga Khan University Hospital in Nairobi, and her 26 associates in different parts of the world, located 23,679 of Africa’s research papers on cancer after scanning the Web of Science for cancer research on the continent during the period 2009 to 2020.

“We identified cancer research papers that included articles and reviews on the Web of Science in February 2021 over 12 years, 2009-20, by means of a complex search strategy or filter that was based on scanning several hundred specialist cancer journals and title words,” said Mutebi.

In total, 16,201 of the publications that were retrieved from the database had fractional African contributions, which meant African researchers were cited as authors in one way or another, while 7,478 were entirely from non-African authors.

More research on infectious diseases

During the period under review, Egyptian researchers published 7,781 papers that represented 48% of the total African output, while their counterparts in South Africa were in second position with 2,206 papers, representing 14% of the total African output and the Tunisian cancer research group was third with 1,505 papers, or 9.3% of Africa’s output.

But, whereas, the five North African countries, Egypt (7,781), Tunisia (1,505), Morocco (1,293), Algeria (274) and Libya (66) together published 10,919 papers, representing 67% of the African output, 49 countries in Sub-Saharan Africa published just 5,281 papers, or 14% of the African output, with South African contributing 42% of the sub-region’s papers.

In addition to South Africa, countries in Sub-Saharan Africa whose researchers jointly published more than 200 papers during the 12-year period included Nigeria (997), Ethiopia (248), Kenya (233) and Ghana (213), while 19 countries in the region published fewer than 10 papers each.

According to Mutebi and her associates, cancer research in Africa accounted for 7.9% of the continent’s biomedical research, which was five times lower than that of infectious diseases.

Research outputs across Africa were found to be low in liver, throat and cervical cancers, as well as in a wide range of paediatric, or childhood, and prostate cancers.

Highlighting the problem, the study noted that childhood cancer research in Africa accounted for 388 papers, or only 1.6% of the total research output, a volume that was too small in comparison with the disease burden of cancer on African children, especially in Sub-Saharan Africa.

Collaboration dependency

But researchers noted that, whereas African cancer research appeared to be increasing, much of the funding and research structures reflected the long history of colonialism.

“Our results show that most African countries are heavily dependent on international collaboration to advance their national cancer research agenda, reflecting weak national funding for research,” stated the study.

In this regard, many of the African fractional papers were co-authored with researchers from the countries that are members of the Organisation for Economic Cooperation and Development, or OECD, while much of the funding also came from those countries.

Using the international collaboration benchmark as an indicator to mirror models of funding, priorities and governance mechanisms of cancer research in Sub-Saharan Africa, Mutebi and her associates noted that, in some countries such as Kenya and Uganda, internationally co-authored publications were more than six times more than national ones.

To understand the international collaboration in cancer research in Sub-Saharan Africa much better, researchers analysed the affiliations of the first and last authors of the international input from the region’s contributions. In scientific research publications, the first author is the person that contributes most of the work, including writing of the manuscript, while the last author is the group leader, or the person that gives most intellectual input and supervises the work.

In this context, authors based in Sub-Saharan African countries were more likely to be the first authors, as only 30% of them were last authors in the internationally co-authored papers.

According to the study, first author positions in the internationally co-authored papers were dominated by researchers from the United States, United Kingdom, Germany and France and very few co-authors from Central and Eastern Europe, Oceania or Latin America.

But there were indicators that researchers from Botswana and South Africa held more than 40% of the last author positions for their international papers, while the ratio was only about 20% for most of the other countries in Sub-Saharan Africa that held most of the first author positions.

Recommendations

In their recommendations, the researchers said there is an urgent need to increase the number of cancer specialists in Africa as, currently, the continent’s research output contributes only 1.3% to the global output.

The problem was attributed to the overall long-term under-investment in science and technology as, according to the study, African countries contribute 1.1% to the global health research and development expenditure.

In addition to addressing a low research footprint in cervical, childhood, liver, throat and prostate cancers, the researchers said there is an urgent need to prioritise clinical, care and qualitative research in order to improve outcomes for cancer patients on the continent.

Currently, cancer research in Africa is dominated by blood cancers and breast cancer, a factor that the study attributed to high civil society attention, political lobbying and funding.

The study also highlighted the need to increase cancer researchers on the continent, which are estimated to be about 48,000. Towards that goal, the study has called for re-engineering the academic structure of African cancer research institutions as the way forward to establish a culture focused on domestic priorities.

To accelerate the process, Mutebi and her associates argued there is a need for African countries to commit 10% of their gross domestic expenditure on research and development on cancer across a wide range of domains and disciplines that address national and regional needs.