Building a Foundation for Multidisciplinary Hepatocellular Carcinoma Care in Tanzania: Implementation of a Liver Tumor Board in Sub-Saharan Africa

Jeanine Justiniano¹Ally Mwanga²Eric Mbuguje²Seif Wibonela²Nashivai Kivuyo²Daniel Kitua²Larry Akoko²Mustafa Al-Qaraghli¹Cameron Gaskill^1*

• ¹UC Davis Medical Center, Sacramento, United States
• ²Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

ABSTRACT Background In sub-Saharan Africa (SSA), cancer is the fifth leading cause of death among adults with an estimated 40,464 new cancer cases and 26,945 cancer related deaths each year. Hepatocellular Carcinoma (HCC) is the predominant type of liver cancer in Africa. Pathogenesis is driven by high rates of hepatitis, untreated cirrhosis, and limited access to screening and treatment. Less than 1% of patients with HCC receive treatment in SSA. To improve liver cancer treatment such as HCC, Muhimbili University of Health and Allied Science (MUHAS) recently established the Tanzania Liver Cancer Group who identified the need for a Multidisciplinary Liver Tumor Board (MLTB) that performs guideline-concordant evaluations and care coordination for liver cancer patients referred to MUHAS. Methodology This is a descriptive analysis of implementation effort for weekly in-person and virtual MLTB meetings held at a quaternary care center in Tanzania. MLTB members from a variety of subspecialties involved in oncology care submit patient cases for review. A consensus recommendation is then communicated to the departments involved, and the presenting physician proceeds with implementing the recommendations. This was designed to promote maximum engagement among medical specialties and international collaborators. Results Over 16 months, forty-nine meetings were conducted, and a total of 266 patients were reviewed. The tumor board included surgeons, interventional radiologists, hepatologists, gastroenterologists, oncologists, and pathologists along with international participation from five countries. The MLTB led to the development of a national referral pathway and a secure registry platform. Conclusion Developing the first MLTB in Tanzania has come with its challenges, however this pilot implementation demonstrated the feasibility and sustainability of multidisciplinary approach to liver cancer care in Tanzania. Future work will evaluate patient-level outcomes and measure the impact of MLTB recommendations on the management and survival of patients.