Enhancing cancer management through IT // by Dr. Bitange Ndemo, former Permanent Secretary Ministry of ICT // Business Daily Africa

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Summary

  • At least 80 per cent of women will contract HPV in their lifetime.
  • 85 per cent who develop cancer die in developing countries.
  • Taxing broadband and IT accessories such as smart phones is increasingly becoming counterproductive.
  • There is mounting evidence that IT improves the lives of people and thereby would lead to the achievement of the SDGs.

Cervical cancer is the number one cause of death among Kenyan women. According to the World Health Organisation’s (WHO) 2016 Factsheet titled, Human Papillomavirus (HPV) and Cervical Cancer, most cervical cancers are caused by HPV.

At least 80 per cent of women will contract HPV in their lifetime. Of those who develop cancer, 85 per cent will die in developing countries. Unlike advanced countries that have well-established population-wide cervical cancer early detection programmes, developing countries lack the necessary infrastructure due to limited resources.
However, information technology (IT), has now brought new hope to significantly accelerate and simplify the screening approaches in less affluent and more remote parts of the world.

Collaboration between SAP’s Design and Co-Innovation Centre, Heidelberg University Hospital in Germany and the Moi Teaching and Referral Hospital, developed a digitised screening solution as part of the Emerging Technologies in Cervical Cancer Screening (ETiCCS) project in Eldoret.

It is a process that begins at a local clinic, followed by data being codified before it is uploaded into the cloud. The project started with a series of ‘Design Thinking’ workshops at the AppHaus Heidelberg (Germany) to optimize the cumbersome manual and paper-based process. A mobile solution connected to the cloud that also runs offline if no Internet is available, was the natural outcome of these workshops.

It connects the silos in the end-to-end screening process – from study recruitment, to data collection, to examination to remote data access to track the study’s progress from Kenya and Germany.

This was one of a kind solution, which African Media Agency reported early this month as having won an award in 2016 for improving lives according to user-centred design principles.

The next step for ETiCCS, SAP Business Trends, says, “is to bring the solution closer to patients by eliminating the need for women to travel long hours to a health centre. The project plans to offer a self-sampling test in larger, more rural areas with an ultimate goal to screen eligible women across the entire country. The project also envisions the adoption of smartphones to further simplify the process and provide full mobility.”

The process would be better if the internet was accessible and affordable in rural Kenya. It is no longer a secret that improving the lives of African people requires improved universal broadband infrastructure that is affordable, flexible policy and regulatory environment.

Taxing broadband and IT accessories such as smart phones is increasingly becoming counterproductive when new technologies like Internet of Things (IoT) and Big Data analytics are promising to comprehensively assist developing countries to leapfrog decades of dependence and backwardness.

It is possible that in the coming days the motivation from ETiCCS and collaboration with other cancer studies, we can build predictive models that would provide an even more robust solution to humanity.

There is need to break other national silos in research to bring together findings from other studies.

For example, a recent study by researchers from Kenya Medical Research Institute (Kemri), Britain’s Queen Mary University and Oxford University came up with striking conclusions linking the occurrence of cancer (including cervical cancer) in Nairobi to the tribal origin of afflicted people.

With such knowledge, it is therefore possible to develop some predictive model to target those whose infections are most likely to lead to cancer and provide targeted awareness programmes. More importantly, the studies could point to new unexplored areas that could lead to an eventual cure for cancer.

The Nairobi study could very well suggest that environment if not genetics plays in some way into the causes of cancer.

If new research points elsewhere then WHO’s suggestion of risk factors for HPV persistence and development of cervical cancer may put into question. These risk factors include early first sexual intercourse, multiple sexual partners, tobacco use and immunity suppression.

There is mounting evidence that IT improves the lives of people and thereby would lead to the achievement of the SDGs.

Developing countries like Kenya, therefore, must strive towards universal connectivity that enables access to ICTs. IT as demonstrated in the ETiCCS case has the power of doing that which we couldn’t do before. There is a greater need now than ever before to collaborate, leverage IT, build capacity and change the lives of people.

The writer is an associate professor at the University of Nairobi’s School of Business

First SAP mobile Cloud cervical cancer machine unveiled in Kenya // Dr. Gilbert Saggia, SAP East Africa Managing Director

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BizNis Africa // February 2nd, 2017

SAP’s Design and Co-Innovation Center together with Heidelberg University Hospital has optimized a cervical cancer screening test that combines applied medical research with the power of innovative SAP cloud technology to improve quality of life amongst women in Africa.

Cervical cancer is the second most common cause of death for women worldwide and ranks number on in Kenya. Although it is easily preventable, most eligible women have never been screened and have no access to healthcare resources. The cervical cancer screening test was piloted during a one-year study, and was tested on a total of 800 women at the Moi Teaching and Referral Hospital in Eldoret, Kenya.At the UN Sustainable Development Summit 2015, 193 world leaders gathered to adopt 17 Sustainable Development Goals aimed at protecting the planet and ensuring prosperity for all by 2030. Projects like ETiCCS proof SAP’s mission how technology can effectively transform the healthcare industry and help medical professionals to address cancer diagnosis and treatment in fragile infrastructures which directly supports the UN’s top 3 goal of Good Health & Well-Being.“This is a special award for SAP as it reinforces our vision and commitment to help the world run better and improve people’s lives, while supporting the 17 sustainable development goals of the United Nations (UN). The screening technology is the first to combine applied medical research with the power of cutting edge cloud technology and user-centered design principles for cervical cancer. SAP is very excited about this achievement as we continue to uncover the underlying challenges of cancer screening in Africa and other emerging countries,” comments Dr Gilbert Saggia, SAP East Africa Managing Director.The screening in Kenya is ongoing and the plan is to include countrywide self-sampling and IoT scenarios (lab equipment integration), pattern recognition, deep learning, remote diagnostics support and validation. “SAP is looking for additional strategic partners with a passion for improving people’s lives and strengthening Africa’s healthcare systems. The aim for SAP East Africa is to collaborate towards a global 2030 vision for user-centered design and cloud technology to improve cancer screening and further uncover the underlying challenges of cancer screening in emerging countries,” adds Dr. Saggia.

With the help of technology such as SAP HANA Cloud Platform the user centered solution runs on a single platform across multiple roles which enables seamless communication between all parties, even in very remote areas and environments with unstable Internet connectivity. Thanks to role-specific data entry the solution is easy to use and access to patient data and test results are immediately available to the local hospital and to Heidelberg University Hospital in Germany.

Through the use of the technology, medical staff have now reduced paperwork meaning no duplication or opportunities for human error to affect test results. The medical records are safely stored in the cloud providing instant access to results. This enables labs to accelerate the screening process and empower medical staff through improved quality control embedded in the screening process. Real-time access to data and reporting, fully compliant with data privacy and security requirements, means labs can make informed diagnoses regardless of location or region.

“This project is another milestone in SAP`s attempt to address the challenge of adequately screening for and treating cancer. It is not only about building great software to help the world run better, but also creating a positive impact in society and improving people’s lives,” adds Dr Saggia.

The project stands to transform healthcare screening services by combining user-centered design with on-site user research that enables healthcare professionals to uncover critical patient insights and adapt the solution to other screening processes and field research.

ETiCCS’ vision is to support the fight against cancer in fragile infrastructures. The solution sets new standards for bringing applied medical research to Africa, powered by the SAP HANA Cloud Platform. SAP Design projects such as these undoubtedly positions SAP in the lead with regards to design and innovation to influence the medical community. With this solution, hundreds of women in Kenya now have access to screening for cervical cancer during the first pilot phase.

“Through the ETiCCS program, we were able to complement applied medical research around biomarkers with the power of cutting edge cloud technology to bring co-innovation to Africa in a way which really helps to improve people’s lives,” Prof Magnus von Knebel Doeberitz, Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital Medical Director.

Currently all personal records are kept in Kenya – only pseudonyms data is uploaded through the SAP mobile solution. The mobile solution creates a number based on the pseudonyms data and links to the patient test results. However, the mapping between the generated number and patient is done on site by a medical professional. The app will be made available through SAP to other interested countries in Africa as a custom development solution.

German academics tackle cervical cancer in Africa with SAP HANA

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By Jessica Twentyman, November 20, 2015

Almost nine out of ten cervical cancer deaths worldwide occur in the developing world. Researchers from the University of Heidelberg are rolling out screening to women most at risk.

Screen Shot 2015-11-19 at 15.33.11In the developed world, regular screening, early detection and rapid treatment have led to positive long-term outcomes for women diagnosed with cervical cancer. In the developing world, the disease is still a killer.

In Western Europe or Australia/New Zealand, for example, for every 100,000 women diagnosed with the disease, fewer than two will die from it, according to figures from the UN’s World Health Organisation (WHO). In East Africa, it’s closer to 30 (27.6). There, few women will ever be screened. For many of those diagnosed, treatment comes to late.

In fact, almost nine out of ten (87%) of cervical cancer deaths occur in less developed regions. And since the disease is particularly prevalent in women in their thirties, many victims leave dependent children behind. Of the twenty countries worldwide with the highest incidence of the disease, sixteen are in Africa, says the World Cancer Research Fund International.

But the screening processes that have proved so successful in the developed world, based on annual or three-yearly Pap smear tests, are difficult to implement elsewhere, explains Dr Magnus von Knebel Doeberitz, a professor of molecular oncology and microbiology at the University of Heidelberg in Germany. There are considerable costs involved, he explains, not least to train pathology technicians in the cytology skills needed to analyse Pap smear test results.

Although this test has undoubtedly saved the lives of many millions of women in the developed world, it has its weaknesses, among them ‘false positive’ findings, sometimes leading to unnecessary biopsies, and more seriously, ‘false negative’ findings, where malignant cell changes go undetected. So, in the developed world, skilled analysis and repeat testing of women is still required.

In Africa, by contrast, the infrastructure challenges involved in getting women to regular screenings, let alone to make subsequent repeat visits and undergo treatment, are immense. Paper-based medical record systems only slow responses down further.

A few years ago, his research work in molecular biology led Dr von Knebel-Doeberitz to develop a technology that makes Pap smear tests more accurate, by highlighting cells particularly liable to become cancerous when exposed to the HPV virus responsible for cervical cancer. He later spun this off as a company, MTM Technologies, that was acquired by Swiss pharmaceutical giant Roche in 2011. He says:

So my personal dream has always been to implement these tests in Africa, because that’s where the real suffering happens.

In the absence of a commercially viable market in Africa, however, it’s been difficult to bring that dream to fruition – until a few of his investors came forward with backing for a trial of the test in that region. And even then, there was still the hurdle to cross of making screening available to women, especially those in rural areas, and tracking and communicating their results.

Enter HANA

It’s at this point a friend of Dr von Knebel-Doeberitz comes into the picture, who is an employee of SAP:

He suggested SAP could help us in this respect. We could establish a system using cloud-based technology, available through mobile phones, to transmit information to patients, physicians and local healthcare workers in the villages.

The initial focus of Dr von Knebel-Doeberitz’s Emerging Technologies in Cervical Cancer Screening (ETiCCS) project is currently a one-year study involving 800 women, delivered by the Moi Teaching and Referral Hospital in Eldoret, Kenya and funded by the German Federal Ministry of Education and Research. Much of the technology involved was provided for free by SAP and Intel. Roche, meanwhile, has provided the test kits.

Dr von Knebel-Doeberitz and his team worked with staff at the Design & Co-Innovation Centre team at SAP’s AppHaus Heidelberg centre, to design a mobile app that would work for the project, based on the company’s HANA Cloud Platform. This is designed to accelerate study recruitment and provision of cancer test results. SAP has produced a video showing the app at work.

All patient data entered locally, along with test results, can be monitored remotely by staff at the Heidelberg University Hospital and, to ensure that the solution works in areas with patchy Internet connectivity, the local part of the tablet-based app can run in offline mode and be synchronised to the cloud via an Internet ‘dongle’ several times a day. Says Dr von Knebel-Doeberitz:

It’s slowly developing, but we need more public interest. We hope we can get more funding because, right now, we have enough for about two years, but after that, we’re not sure. What we do know is that we would like to be rolling out this kind of screening on a broader basis to other countries too, such as Tanzania.

We need to show industry that there’s a market here for them. Without that, it would be incredibly naive to imagine that big pharmaceutical companies will get involved. But with the help of SAP, we’re now able to give them a glimpse of that market – and get better outcomes for patients and their families, too.

Krebsvorsorge in Kenia: Neues Screening-Konzept erreicht Frauen zuhause

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Universitätsklinikum Heidelberg, Deutsches Krebsforschungszentrum (DKFZ) und SAP starten Testphase zur Früherkennung von Gebärmutterhalskrebs in Kenia / Gemeinsam entwickelte Software, neues Konzept und leicht auszuwertender Test erlauben flächendeckendes Screening in medizinisch unterversorgten Ländern

Gebärmutterhalskrebs ist in vielen Ländern Afrikas kaum zu behandeln, es mangelt an Medizintechnik und entsprechend ausgebildeten Ärzten. Umso wichtiger ist die Vorsorge. Wissenschaftler des Universitätsklinikums Heidelberg und des Deutschen Krebsforschunsgzentrums (DKFZ) haben gemeinsam mit IT-Spezialisten der SAP SE ein auf die Verhältnisse vor Ort zugeschnittenes Konzept entwickelt: Eine von SAP entwickelte Software und das Internet – in Afrika über das Mobilfunknetz verfügbar – sowie ein leicht auszuwertender Test erlauben ein flächendeckendes Screening auch in wenig erschlossenen Gebieten. Krankenschwestern besuchen die Frauen in ihren Dörfern, nehmen Abstriche der Gebärmutterschleimhaut und verschicken die Proben an ein Zentrallabor. Die für die Patientenakten erhobenen Daten werden auf einer speziellen Cloud Plattform gespeichert. Hier hinterlegt das Zentrallabor auch die Testergebnisse, so dass die Krankenschwestern vor Ort die Frauen zeitnah informieren können. Das Projekt ist nun im Rahmen einer Studie in Zusammenarbeit mit dem Moi Teaching and Referral Hospital in Eldoret, Kenia, gestartet worden.

“Wir möchten mit diesem gemeinsamen Projekt Unternehmen der Gesundheitsbranche zeigen, dass es sich lohnen kann, in Gesundheitsprojekte in ärmeren Ländern zu investieren. Es gibt dort einen enormen Bedarf z.B. an innovativen Vorsorge-Programmen”, erläutert Dr. Miriam Reuschenbach, Klinischen Kooperationseinheit Angewandte Tumorbiologie des Pathologischen Instituts am Universitätsklinikum Heidelberg und am DKFZ: Sie ist die Projektleiterin einer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Pilotmaßnahme, aus der die Zusammenarbeit mit der SAP SE initiiert wurde.

“Nur durch die Zusammenarbeit von Wissenschaft und Wirtschaft können die Probleme vor Ort sinnvoll und nachhaltig gelöst werden”, sagt Professor Dr. Magnus von Knebel Doeberitz, Ärztlicher Direktor Abteilung Angewandte Tumorbiologie, Pathologisches Institut am Universitätsklinikum Heidelberg und Leiter der Klinischen Kooperationseinheit mit dem DKFZ. “Mit der SAP SE mit Sitz in Walldorf haben wir einen kompetenten und innovativen Partner gefunden, um trotz schwacher Infrastruktur eine lückenlose Kommunikation zwischen den Frauen, Labor, Ärzten und Krankenschwestern sicherzustellen.”

 

Krebsvorstufen in Kenia noch gut zu behandeln

Weltweit erkranken jährlich mehr als eine halbe Million Frauen an Gebärmutterhalskrebs, rund eine Viertel Million stirbt jedes Jahr daran. In den ärmeren Ländern der Welt haben Frauen mit fortgeschrittenen Krebsstadien nur selten Zugang zu einer Therapie, eine umfassende Behandlung mit Chemotherapie und Bestrahlung ist von den Krankenhäusern vor Ort kaum zu leisten. “Für die Frauen in vielen Ländern Afrikas bedeutet ein bereits in tiefere Gewebeschichten eingewachsener Tumor meist den sicheren Tod – ohne Schmerzmittel zudem einen sehr leidvollen Tod”, sagt Dr. Hermann Bussmann, Projektkoordinator des ETiCCS-Programms in der Abteilung für Angewandte Tumorbiologie. Die hohe Sterblichkeitsrate ist außerdem speziell in Entwicklungsländern ein großes sozioökonomisches Problem, da die Erkrankung häufig Mütter und Frauen im arbeitsfähigen Alter trifft. Dazu kommt, dass HIV-positive Frauen – in Kenia sind rund acht Prozent der Bevölkerung betroffen – ein erhöhtes Risiko tragen, an Gebärmutterhalskrebs zu erkranken. Programme zur Früherkennung, die auch Frauen außerhalb der Städte erreichen, könnten viele Todesfälle verhindern. Die Vorstufen des Gebärmutterhalskrebses lassen sich in der Regel auch in ärmeren Ländern gut behandeln.

Bei der Konzeption und Einführung entsprechender Screening-Programme gibt es drei große Probleme: Der bisher zuverlässigste Test auf Krebsvorstufen in der Gebärmutterschleimhaut, der auch in Deutschland zum Einsatz kommt, ist nur mit geschultem Blick auszuwerten. Andere Tests sind wenig aussagekräftig. Die Frauen leben größtenteils nicht in der Nähe einer Klinik oder eines niedergelassenen Frauenarztes. Und die wenigen Kliniken wären mit dem Zulauf im Rahmen eines routinemäßigen Screenings hoffnungslos überfordert.

 

Über Cloud Plattform erreichen Testergebnisse alle Probandinnen

Alle diese Punkte sind im Projekt ETICCS (Emerging Technologies in Cervical Cancer Screening) berücksichtigt. Zur Anwendung kommt ein Krebstest, den das Team um von Knebel Doeberitz entwickelt hat und dessen Genauigkeit in mehreren Studien belegt wurde. Ein spezielles Färbeverfahren markiert veränderte Zellen mit einem hohen Risiko, sich zu einer Krebsvorstufe weiterzuentwickeln. Das Ergebnis ist entweder positiv oder negativ, es gibt keine Zwischenstufen und keinen Spielraum für Fehlinterpretationen. Die Gewebeproben können von Krankenschwestern in den Ortschaften mit Hilfe von sterilen Einweg-Sets entnommen, sofort fixiert, codiert und anschließend an das zuständige Labor verschickt werden. Studienrelevante Daten verwalten die Krankenschwestern an Notebooks über eine spezielle Software, die das Team von SAP in enger Abstimmung mit Ärzten um Professor von Knebel Doeberitz entwickelte. Die zehn in der Studie verwendeten Notebooks sind eine Spende der Firma Intel.

Die Software lässt sich intuitiv bedienen und lädt die pseudonymisierte Patientenakte, sobald eine Internet-Verbindung hergestellt werden kann, automatisch auf die SAP HANA Cloud Plattform. Nachdem die Labormitarbeiter die Testergebnisse in dieser virtuellen Patientenakte hinterlegt haben, holt die Software sie wiederum automatisch auf die Notebooks, sobald Zugang zum Internet besteht. Auf diese Weise können die Krankenschwestern Frauen mit auffälligem Ergebnis zeitnah informieren und sie zur weiteren Abklärung an die nächste Klinik verweisen. Die Mehrbelastung der Kliniken bleibt überschaubar.

In einem nächsten Schritt wäre auch der Einbezug von Mobiltelefonen und Smartphones denkbar, die in Kenia weit verbreitet sind. Mit ihrer Hilfe könnte man die Frauen direkt über ein bevorstehendes Screening informieren, über die Erkrankung aufklären oder Testergebnisse übermitteln. “ETICCS ist ein Modell für einen wichtigen Aspekt der Gesundheitsversorgung in ärmeren Ländern. Es lässt sich problemlos auf andere Länder und auch andere Erkrankungen übertragen”, ist sich Professor von Knebel Doeberitz sicher. Die erste Projektphase wird von der in New York City ansässigen Ladenburg-Foundation gefördert.

 

Kontakt Medien

Doris Rübsam-Brodkorb
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Leiterin Ukom
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weitere Informationen

Prof. Dr. Magnus von Knebel Doeberitz
Ärztlicher Direktor Abteilung für Angewandte Tumorbiologie
Pathologisches Institut des Univ.-Klinikums und Klinische Kooperationseinheit des Deutschen Krebsforschungszentrums
Telefon: 06221-564221
E-Mail

Dr. Hermann Bussmann
Abteilung für Angewandte Tumorbiologie am
Pathologisches Institut des Univ.-Klinikums und Klinische Kooperationseinheit des Deutschen Krebsforschungszentrums
Telefon: 06221-564221
E-Mail