1. Engagement: Co-develop enhanced community engagement strategies to establish equipollent partnerships and improve county-level access to cancer early detection services for OSCC. 2. Digital Transformation: Co-create a research-based digital 'hub and spoke outcomes unit' with inward OSCC clinical data from counties to KUTRRH hub and outward harmonised OSCC care protocols to distant spoke counties. 3. Molecular Pathology and Biology: Co-build a pathologist and pathology capacity to support early detection programmes and inform on bespoke Kenyan cancer biology relevant to future prevention studies. 4. In year 3, submit an application to become an NIHR Global Health Research Unit.

Cancer care is an increasing burden on the limited health resources in Kenya and improved early detection could decrease both mortality and complex treatment costs. The Christie NHS Foundation Trust and The University of Manchester have signed Memoranda of Understanding to support a long-term partnership with Kenyatta University Teaching, Referral and Research Hospital and Ministry of Health, Kenya to improve cancer outcomes with a specific focus on early detection within Kenya and East Africa. This programme of work supports a joint partnership to improve early detection of oesophageal squamous cell carcinoma (OSCC). In Kenya, OSCC is the 3rd most common cancer with the highest mortality of all cancers at 4400 deaths per year. Although present-day therapeutic interventions of surgery, chemotherapy and radiotherapy can positively influence disease prognosis, OSCC remains a highly lethal disease in Kenya with 99% case fatality rate due to late recognition of symptoms by the patient and general practitioner and advanced disease presentation. OSCC therefore needs better early detection strategies to diagnose cancers at a much earlier stage whereby 40-50% of Kenyan patients could potentially be cured with surgery. Potentially influenced by a combination of genetics, lifestyle, socio-economic and environmental factors, striking variations in incidence and survival exist across geographic confines whereby Western and Central Kenya have the highest OSCC incidence. Cancer survival also varies as a function of geography within Greater Manchester (GM) with great variation in the proportion of GM’s cancer patients that present with late-stage disease across different locales and poor survival. The similarities in needs of Nairobi and Manchester to reach out to at-a-distance and socially deprived communities allows for reciprocal learning and research co-creation. This includes an unmet need to use African-specific genomics to improve our understanding of OSCC carcinogenesis to offer bespoke cancer aetiologic information to aid long-term prevention strategies. The latter approach is currently blocked by the preponderance of non-African genomic OSCC data in which risk factors may differ in the Western world. Our programme of work will benefit from engaging with a range of communities and stakeholders across the clinical cancer care ecosystem in Kenya. Partnering with and complementing the work of key local patient and community partners such as the Kenyan Network of Cancer Organisations will help to reduce the stigma associated with cancer, and inform best future joint actions through a Kenyan lens. This programme will lead to the earlier reporting and understanding of symptoms leading to better treatment and enhanced survivorship. Together, with the personnel and infrastructure build for research diagnostics and pathology at KUTRRH, this will start important stepchanges needed to embed a system-wide and research-driven earlier detection programme for all cancers. This project sets out an initial and systematic approach to understand and engage the communities we seek to support, with long-term goals for improving cancer care. With strong partners, there is clear succession planning to enable sustainable success beyond this 3-year grant.