Fred Hutchinson Cancer Center Global Oncology’s annual report for fiscal year 2022 (July 1, 2021-June 30, 2022) provides an overview of research progress and scientific achievements, training initiatives, grants and finances, operations and the Global Oncology community. The report also provides an update on our local response to the COVID-19 pandemic.
Dear colleagues,
As another fiscal year closes, we remain humbled by the evolving COVID-19 pandemic but committed to our work. Our critical cancer and infectious disease research and training efforts are informing and transforming research, care and treatment in limited-resource settings. We acknowledge the enormous toll that the pandemic and other global events have had — and continue to have — on our research and operations, teams, partners, patients, and the world. Despite these challenges, we have been inspired by the progress we have made. Through our collaboration with the Uganda Cancer Institute, and through the commitment of our faculty and staff in Kampala (part of the Hutchinson Centre Research Institute of Uganda, HCRI-U) and our entire Global Oncology program, our research has continued to advance. Most importantly, the overall standard of care delivered to patients at the UCI has been enhanced through our collaborative research.
During FY22, we continued studies on Kaposi sarcoma, breast cancer, and lymphoma, which are among the top five cancers with the highest incidence rates in Uganda.1 We are studying the burden and management of infectious diseases among cancer patients. With our colleagues at the UCI, we continued to prioritize training initiatives, particularly through the East African Adult Hematology Oncology Fellowship Program and National Institutes of Health training grants focused on Ph.D.-level training. We look forward to expanding into new training areas. Further, the year was also a time to reflect and refine our mission and goals. We are committed to the pursuit of cancer and infectious disease research with global impact and to supporting research and clinical capacity in low-resource settings, particularly Uganda. Like many organizations, we experienced change and transitions, yet remain excited about the present and future of Global Oncology and our partnerships. We are eager to explore new opportunities through the UCI’s expansion into new satellite clinics. We also look forward to the opportunities presented by the formation of Fred Hutchinson Cancer Center, which brought together Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance into one organization that is a clinically integrated part of UW Medicine and UW Medicine’s cancer program.
“It was wonderful to see firsthand the new ground floor of the UCI-Fred Hutch Cancer Centre, which was spectacular, and more importantly, to see the inspirational work going on inside.”
In April, I had the privilege of returning to Kampala after more than two years. The progress that has been made in our research and training during these extraordinarily trying times has been remarkable.
There continues to be urgency in conducting collaborative cancer research and training with a global lens — and in translating findings into clinical care and action. By 2040, there will be an estimated 27 million new cancer cases globally — with 19.3 million new cases estimated in Africa, Latin America and the Caribbean, and Asia, or roughly 70% of all new cases, and an estimated 12.4 million cancer deaths in the same region.2 The deep inequities in cancer progress between high-income and low- and middle- income countries (LMICs) underscore the importance of this work. The National Cancer Institute’s Center for Global Health recognizes this: The center updated its five-year strategy to renew its commitment to global cancer research and control and focus its research through collaborations on technologies for global cancer control, implementation science, global cancer health disparities, cancer clinical trials in LMICs, and cancer etiology and biology.3
We are determined to advance our mission through challenging times because the call to action is urgent. On behalf of the entire HCRI-U and Global Oncology teams in Kampala and Seattle, thank you for your support and partnership that helps us move science forward and make a greater impact.
Sincerely,
Dr. Edus H. Warren, Global Oncology Program Head
1 Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, accessed [24 June 2022].
2 Ferlay J, Laversanne M, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2020). Global Cancer Observatory: Cancer Tomorrow. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/tomorrow, accessed [24 June 2022].
3 Gopal S, Sharpless NE. Cancer as a Global Health Priority. JAMA. 2021;326(9):809–810. doi:10.1001/jama.2021.12778.
We are thankful for our committed teams that are seeing through changes in leadership and programs and allowing for critical work to move forward.
Edus H. Warren, M.D., Ph.D.
Global Oncology Head; Professor, Program in Immunology, Clinical Research Division; Professor, Vaccine and Infectious Disease Division
Stuart Tenney
Senior Director of Finance and Operations, Global Oncology,
Research Administration, and Shared Resources
Warren T. Phipps, M.D., M.P.H.
Medical Director, UCI-Fred Hutch Collaboration; Associate Professor, Vaccine and Infectious Disease Division
Manoj Menon, M.D.
Associate Professor, Vaccine and Infectious Disease and Clinical Research Divisions
Global Oncology has five strategic objectives that guide us in pursuit of our mission.
During this last fiscal year, Global Oncology reflected on and refined our mission, strategic goals and objectives to a) focus on our research and training partnership with the Uganda Cancer Institute and b) explore new opportunities that would enable us to build on our research expertise.
Learn about some of our significant program metrics and other achievements during the past fiscal year.
Our research is impacting patient care in Uganda while also making valuable discoveries in the field of oncology globally.
Although the world continues to grapple with the COVID-19 pandemic and other ongoing challenges, we saw a shift in momentum related to our studies at the UCI-Fred Hutch Cancer Centre, in a large part due to our dedicated team and a decrease in COVID-19 cases in Uganda, particularly in the last two quarters of the fiscal year. Our clinical studies continued relatively smoothly, despite the pandemic. Our study teams cross-trained on all protocols to provide backup support for each study. During this time, we enrolled an increasing number of participants in our studies, particularly in the latter half of the fiscal year.
We have learned from our colleagues in Kampala that patient care quality has been enhanced through participation or enrollment in our studies, for instance, by facilitating timely diagnosis of cancers and comorbidities. In one of our studies on Kaposi sarcoma, participant visits are synchronized with the standard of care visits at the UCI. If participants have challenges with transport to the UCI, this study will support their transport. This was a critical need during COVID-19 pandemic travel restrictions, and it enabled many patients to access chemotherapy visits and other standard of care reviews regularly and in a timely way.
A few of our studies are focused on infections among cancer patients — a critical and growing area of our research portfolio. Findings from a 2022 study in The Lancet indicated that 1.2 million people died from antibiotic-resistant infections in 2019, making it a leading global cause of death.4 A study led by Dr. Margaret Lubwama on bacteremia among lymphoma patients and another study on infections in solid tumor patients, led by Dr. Elizabeth Gulleen, advocated for improved temperature monitoring among study participants at the UCI. The team supporting the bacteremia study monitors febrile episodes in lymphoma patients, and according to Constance Namirembe, HCRI-Uganda clinical research project manager:
“[The study] supports tests for blood culture and sensitivity during a febrile episode; where if an organism is identified and is suspected to be causing the fever, it informs the standard of care in real time regarding the appropriate antibiotics to be given.”
In Gulleen’s study, the temperature monitoring has increased the ability to rapidly diagnose and treat infections among UCI patients receiving chemotherapy. Participants were provided with blood cultures as well as malaria and tuberculosis testing. The study results were given to the clinical teams in real time, which helped improve their ability to prescribe the correct antimicrobials for their patients. The results of this study were presented to UCI faculty and staff at multiple clinical care conferences. According to Gulleen, “We are currently working with the UCI pharmacists and clinicians to develop infection treatment protocols based on our study results with the goal of improving patient management and decreasing infection-related mortality.” In a related study on antimicrobial stewardship, Gulleen and colleagues asked UCI clinicians about their experiences with diagnosis and treating patients with infections. The study team learned about current knowledge regarding antibiotic use and barriers to diagnosis and treating infections in their patients.
“We are using the results to build an antimicrobial stewardship program at the UCI and create educational sessions on infection management for clinicians,” Gulleen said.
Further details about these studies and our other research are below.
4 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19. PMID: 35065702; PMCID: PMC8841637. Accessed July 19, 2022.
Learn about our research led by Global Oncology faculty, fellows, and collaborators at the UCI and elsewhere.
During the fiscal year, our investigators and collaborators led several research studies at the UCI-Fred Hutch Cancer Centre. Learn more below about studies that were actively enrolling/accruing and completed studies undergoing data analysis as of the end of FY22. Also, learn about our upcoming studies in the pipeline.
Our UCI-Fred Hutch Collaboration training initiatives remain a significant focus of work with the UCI. Over the past decade, we have had multiple NIH-funded training grants (two D43 grants and one U54). Our most current five-year NIH D43 is focused on training Ugandan scientific leaders who are conducting HIV-associated malignancies (HIVAM) research with independent research funding and fostering a community of scientists and research leaders who will cultivate and train the next generation of HIVAM researchers. In FY22, various training activities through this D43 program were reactivated as pandemic restrictions eased, including Research in Progress sessions, Journal Club meetings, ongoing tumor boards and clinical case conferences continued virtually, in-person or hybrid. Another important goal of the program is to prepare trainees to pursue independent research funding through mechanisms such as the NIH K43 award, which is the NIH Fogarty Emerging Global Leader Award for early career research scientists in LMICs who hold a junior faculty position at an LMIC institution.
Three Ph.D. candidates were recently selected and supported by the current NIH D43 HIVAM training grant. These include Dr. Fadhil Geriga, associate director of Pediatric Oncology, UCI; Dr. Priscilla Namaganda, junior investigator and fellow, Adult Hematology Oncology Fellowship Program; and Dr. Solomon Kibudde, radiation oncologist at the UCI. The UCI-Fred Hutch Collaboration Ph.D. candidates supported by the previous D43 training grant included Drs. Margaret Lubwama, Innocent Mutyaba and Noleb Mugisha.
Dr. Fadhil Geriga
Associate Director of Pediatric Oncology, UCI
Dr. Priscilla Namaganda
Junior Investigator and Fellow, Adult Hematology Oncology Fellowship Program
Dr. Solomon Kibudde
Radiation Oncologist, UCI
The NIH D43 training program activities are managed by our HCRI-Ug training project manage Olive Birungi, who joined the Global Oncology program in FY22, and led by Dr. Warren Phipps, medical director, UCI-Fred Hutch Collaboration. Interested in staying up-to-date about our training activities? Please email Olive Birungi if you would like to receive our monthly Training Program newsletter.
The Adult Hematology Oncology Fellowship Program, launched in 2018 with funding from the African Development Bank to the East Africa Centre of Excellence in Oncology at the UCI, continued implementation while also navigating the COVID-19 pandemic. The program’s objectives are to provide high-quality clinical care, guide lower-level health workers, conduct research in adult hematology-oncology, and serve as mentors to the next generation of hematologists and oncologists. In FY22, UCI faculty gave six in-person lectures at the UCI-Fred Hutch Cancer Centre, while the UW and Fred Hutch faculty facilitated 29 virtual lectures by Zoom.
The fall 2020 cohort of AHO fellows, Drs. Naghib Bogere, Kenneth Kintu and Erick Were, completed their one-year ward rotations and began the second year of clinic rotations in the second quarter. The clinical competency committee met in January to prepare a report on their performance in year one. Certification of the AHO Fellowship by the Uganda Medical and Dental Practitioners Council is underway, and two external reviewers evaluated the curriculum. The newest fellow, Dr. Anne Magdalene Amata, was accepted into the AHO Fellowship in March 2022 and is pursuing the medical oncology track.
The AHO Fellowship Program is co-directed by Dr. Abrahams Omoding, Uganda Cancer Institute, and Dr. John Harlan, University of Washington. Learn more about the AHO Fellowship on Global Oncology’s website and the UCI’s website.
“I have been in this program for close to two years and will be finishing the fellowship in three months and can attest to the foundations and tireless efforts in leading and guiding us to improve the quality of care to cancer patients in Uganda and East Africa. The program is inspirational, engaging and hands-on with a diverse range of patients with different cancers. We see a different future for cancer care in Uganda because of the knowledge and experience we have acquired through the fellowship.”
— Naghib Bogere, Medical Oncology Track, Fall 2020 Cohort
“It has been a great honor to be part of the East African Adult Oncology and Hematology Fellowship Program offered by the Uganda Cancer Institute in collaboration with Fred Hutchinson Cancer Center. The East Africa Center of Excellence in Oncology has been so supportive at every step of this fellowship program … through one-on-one clinical experiences, tumor boards, joint clinical meetings and the didactic lectures. Before this program, access to cancer care has been a challenge because there are few cancer centers, yet the number of cancer patients is on the increase. This program is going to increase cancer care access to Ugandans locally through human resource development.”
— Erick Were, Medical Oncology Track, Fall 2020 Cohort
In FY22, the UCI and the Palliative Care Association of Uganda hosted the third annual conference from Sept. 23-24, 2021, with presentations by trainees including Dr. Innocent Mutyaba, Dr. Henry Ddungu, Dr. Geriga Fadhil and Dr. Noleb Mugisha. Dr. Victoria Walusansa, UCI deputy director, was also a panelist.
At IDWeek 2021 — a joint annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists — two fellows, Dr. Margaret Lubwama and Dr. Elizabeth Gulleen, presented abstracts. Their abstracts were titled, “Multidrug-Resistant Polymicrobial Gram-Negative Bacteremia in Hematologic Cancer Patients With Febrile Neutropenia at the Uganda Cancer Institute” and “Knowledge and Perceptions of Antimicrobial Resistance and Antimicrobial Stewardship Among Staff Providing Cancer Care at the Uganda Cancer Institute,” respectively. This conference was held virtually in late September and early October 2021.
Currently there are five Ugandan trainees/fellows as a principal investigator on one of our current or upcoming studies under institutional review board review. They include:
Integrating Cervical Cancer Screening in HIV Clinics and Assessing the Effect of Using a Modified Referral Protocol on Access to Cancer Services Among HIV-Positive Women in Uganda
Identifying Predictors of Kaposi Sarcoma Immune Reconstitution Inflammatory Syndrome
Treatment Response and Treatment-Related Mortality in Pediatric Patients With Acute Myeloid Leukemia at the Uganda Cancer Institute
More than 200 tumor boards were held by the UCI-Fred Hutch Collaboration, in collaboration with other invited clinicians and experts. Below is a snapshot of the eight different tumor board topics and the number of sessions held over the year.
(Note: these figures include Q2-Q4)
Beginning in FY23, the UCI-Fred Hutch Collaboration will launch a new training program, “Cancer Genomics and Genomic Data Science for East Africa,” which is a recently awarded NIH D43 grant to the Collaboration’s co-directors, Drs. Jackson Orem (UCI) and Edus H. Warren (Fred Hutch). The goal is to establish a program to train Ugandan and East African graduate students in genomics and informatics to increase the capacity for high-quality cancer research, training and clinical care in the region. The five-year award of $1.25 million (total direct cost) will be effective starting July 1, 2022. East African trainees who will be selected for this program will engage in training in Kampala, Uganda, at the UCI-Fred Hutch Cancer Centre, Makerere University in partnership with the Infectious Disease Institute, and at Fred Hutch.
The UCI-Fred Hutch Collaboration laboratory recently acquired the new Cepheid XPRESS, COV-2/FLU/RSV PLUS cartridges for testing for SARS-CoV-2, influenza and respiratory syncytial virus. The team will begin providing this service in late summer 2022. Despite the ongoing pandemic, the laboratory at the UCI-Fred Hutch Cancer Centre continued to operate successfully under the leadership of Andrea Towlerton, laboratory director, HCRI-Uganda. The lab has processed greater than 11,000 biospecimens during the fiscal year — for several active studies, SARS-CoV-2 testing, and supporting clinical care at the UCI through tumor boards and fellowship training support.
The HCRI-U laboratory team continues SARS-CoV-2 testing as part of the Ugandan Ministry of Health’s National Testing Program and operates at a <12-hour turnaround time for results. The seven-person lab team has performed nearly 4,000 tests since the program started in late 2020. Towlerton secured another donation of 2,500 tests and regents from the Beijing Genomics Institute in March 2022. The laboratory has also passed, at 100%, the OneWorld Accuracy EQA proficiency testing for SARS-CoV-2 testing.
In response to guidelines provided by the Uganda National Council for Science and Technology, we developed a risk management plan (RMP) in 2020 to ensure the safety of research participants and research teams during the ongoing COVID-19 pandemic as research activities supported by the UCI-Fred Hutch Collaboration and HCRI-Uganda resumed. The goal is to minimize transmission among research participants and staff and identify suspicious cases of COVID-19 to facilitate referral to Uganda Ministry of Health testing centers.
In May 2022, HCRI-Uganda revised the RMP to align with Uganda Ministry of Health guidelines as national statistics indicated low COVID-19 transmission rates. Like other countries around the world, the COVID-19 situation evolves quickly as new variants result in surges of COVID-19 cases; thus, the RMP may be revised to reflect the changing pandemic or if local pandemic restrictions are reactivated. Yet, as of June 2022, the updated RMP outlines standard operating procedures at the facility (e.g., masking, physical distancing, handwashing) for all staff and participants. Staff were encouraged to get vaccinated against SARS-CoV-2, and vaccines are offered at the Uganda Cancer Institute for all staff and their immediate families.
The recently completed build-out of the ground floor of the UCI-Fred Hutch Cancer Centre in Kampala in the spring of 2021 — adding approximately 3,800 square feet — has allowed the program to bring all research and administrative functions under one roof. This video highlights the new ground floor space and other key areas of the facility. This project was led by Magdalene Kintu, director, Administration and Operations, HCRI-Uganda, and Jason Barrett, operations manager, Global Oncology. The video was created by Shot by Mu in 2021.
The associate director of Fred Hutch Facilities and Engineering visited the UCI-Fred Hutch Cancer Centre twice during FY22 to optimize facilities management and equipment with a special interest in the facility’s air handling systems. As a result of these site visits, and with the hard work of the administrative and facility management teams in Kampala, the systems are now functioning optimally. The associate director will plan for annual trips to the facility, with the next one scheduled for October 2022. The associate director and a senior technical engineer plan to evaluate how to renovate the second-floor pharmacy space and will provide options to Fred Hutch leadership.
Since the last annual report, the building oversight committee (BOC) was reconstituted with some new committee members from the UCI and HCRI-Uganda assigned. The Collaboration’s executive committee (EC) tasks the BOC to provide general oversight and monitoring of the UCI-Fred Hutch Cancer Centre operations and its use. The UCI-Fred Hutch Cancer Centre facility rules, originally developed by the previous BOC and ratified by the EC in 2018, define how the UCI and Fred Hutch/HCRI-Uganda operate and maintain the facility. The BOC is required to compile an annual report of the facility’s operations and present the report with recommended operational changes to the EC. The BOC has met frequently to review their charter as well as each focus area’s (e.g., laboratory, research, administration, etc.) section of the facility rules in preparation for the development of the fiscal year 2022 report.
“In FY22, the lab team was most proud of the leadership in their commitment to support us to do more science. We were especially glad that we have the lab director on site. In this new FY, we are even more fascinated with the introduction of Nanopore sequencing.
— Lazarus Okoche, PCR lab manager, HCRI-Uganda
“It was exciting to see everyone’s face in one place after the remote policy was lifted. I remember how gratifying our first physical meeting was after a year long of virtual connection and seeing everyone looking healthy and alive. A couple of months ago we had Hootie [Edus H. Warren] visit Uganda followed by Jason [Barrett] after two years. One happy family reunited! I am excited about Shiloh’s onboard and Sumayah’s, who are great additions to the team.
“I am looking forward to a very productive next year, especially for the HR department, with an extra hand in streamlining existing processes and introducing more exciting employee engagements."
— Andrew Okot, manager, Operations and Human Resources, HCRI-Uganda
“I joined the HCRI-Uganda family on 15 April 2022 as a quality assurance assistant. I will be supporting all data quality assurance issues related to research studies conducted by HCRI-Uganda. I ensure that studies are conducted in accordance with research protocols and other applicable guidelines. I am privileged to join the HCRI-Uganda to contribute to the realization of its mission and vision by ensuring that high-quality research is conducted.”
— Enos Baghendaghe, quality assurance assistant, HCRI-Uganda
On April 25, 2022, the U.S. ambassador to Uganda, Natalie E. Brown, visited the UCI-Fred Hutch Cancer Centre. Dr. Edus H. Warren, the Global Oncology scientific director, was visiting the site and took part in the ambassador’s tour along with the UCI Executive Director Dr. Jackson Orem. Ambassador Brown shared the following Tweet after the visit.
Throughout the year, we host a global oncology seminar series to bring in diverse voices about cancer research, programs or policies from across the globe. In FY22, we were fortunate to have the following experts present at the seminar series. To learn more about this seminar series and upcoming seminars, visit our Global Oncology events webpage.
September 2021: Joyce Balagadde Kambugu, M.D., head of pediatric oncology, Uganda Cancer Institute
October 2021: Satish Gopal, M.D., Ph.D., director, Center for Global Health, National Cancer Institute
November 2021: Leeya Pinder, M.D., M.P.H., fellow, Division of Gynecologic Oncology, University of Washington & research fellow, Galloway Lab, Fred Hutch
January 2022: Solomon Kibudde, M.B.Ch.B., M.Med., radiation oncologist, Uganda Cancer Institute
February 2022: Dan Milner, M.D., M.Sc. (Epidemiology), MBA, FASCP, chief medical officer, American Society for Clinical Pathology
March 2022: Benjamin O. Anderson, M.D., FACS, medical officer, Cancer Control, World Health Organization
April 2022: Julie Gralow, M.D., FACP, FASC, executive vice president and chief medical officer, American Society of Clinical Oncology
May 2022: Doug Pyle, vice president, International Affairs, American Society of Clinical Oncology
June 2022: Clement Okello, M.B.Ch.B., M.Med., medical officer special grade/hematologist, Uganda Cancer Institute
Global Oncology has incorporated diversity, equity and inclusion, or DEI, principles into our FY22-27 five-year strategic plan. Our goal is to partner with the Fred Hutch Office of Diversity, Equity & Inclusion and/or other global programs and institutions to understand DEI in a global context for the upcoming fiscal year. Global Oncology leadership and staff have engaged in bias mitigation training through the Fred Hutch Office of Diversity, Equity & Inclusion and are committed to learning and applying these values in our work and culture.
While the world continues to respond and be nimble in the face of many challenges, cancer and other diseases remain an urgent global health priority. We have been inspired by the progress we have made, in particular, how our research is impacting the standard of care for cancer patients at the UCI. The UCI is opening satellite cancer clinics, and we are excited to learn about these sites and how we may collaborate on studies that can improve cancer care, especially locally. Breakthrough research findings should be available everywhere, equitably. We look forward to continuing our ongoing scientific training efforts with our outstanding fellows and to launching the new training program in cancer genomics. We aspire to continue these efforts and to translate findings into clinical care and action. We believe it is critical to pursue our mission and the broader mission of Fred Hutch in our everyday work.
We want to hear from you and connect with you.
Visit Global Oncology at fredhutch.org/go or or our UCI-Fred Hutch Collaboration website.
Email: globaloncology@fredhutch.org
Global Oncology
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