1. MethodsAbstract Objectives Results Conclusions References 1.UNGASS 2011. UN General Assembly; Sixty-sixth session. 2.Williams, CKO, et al: Eur.J.Cancer and Clin. Oncol. 1983; 19:741-746. 3.Williams, CKO et al.: eCancer 2014, 8:396. Sub-Saharan African institutions, especially the Uganda Cancer Institute in Kampala, Uganda, led in the development of chemotherapy (CMT) for lymphoma subtypes between 1950 and 1980. Recent WHO emphasis on global non- communicable diseases indicates a need for regional HC paradigm shift in a region long inundated with communicable diseases. Expected barriers in capacity building in medical oncology there are illustrated with challenges of experimental management of Burkitt's lymphoma (BL) at the University College Hospital, Ibadan, Nigeria (UCHIN), where from 1/1984 to 12/1985, a study of tolerability and practicability of high dose cytosine arabinoside (HDAC) CMT was initiated. Included were children (chd) with a diagnosis of BL Ziegler’s Stage C or D with or without CNS involvement (CNS±), and life expectancy of at least one month, whose parents/guardians were willing to give oral consent. 60 chd were to be assigned randomly to either the standard treatment (RII) or the investigational (RI) protocol. RI was: Cyclophosphamide (CTX) 1000mg/m2 IV day 1, Vincristine (VCR) 2.0mg/m 2 IV day 1, cytosine arabinoside (AC) 50mg/m 2 q12hr x 6 doses in cycles 1 and 4, and 1000mg/m 2 q12hr x 4 doses and 50mg/m 2 q12hr x 2 doses for cycles 2 and 3 cycles q14days x 4cycles. R II was: CTX 1000mg/m 2 IV day 1, VCR 2.0mg/m 2 IV day 1, AC 50mg/m 2 q12hr x 6 doses q14days x 4 cycles. AC 50mg/m 2 was given intrathecally days 1 and 5 of each cycle. See Table for results. *MDI: Mean dose intensity. HDAC based CMT was well tolerated with more effective control of systemic and CNS disease compared to conventional CMT. Challenges encountered included ethical issues of medical research in the midst of socio-economic deprivation, technical and manpower inadequacies, unreliable drug supply leading to CMT modifications, communication, lack of compliance and unreliable accessibility to follow-up. Persistence of these problems after >2 decades signals a need for cultural change at all community levels: government, HC administration and among categories of providers.. Sub-Saharan African institutions, especially the Uganda Cancer Institute in Kampala, Uganda, led globally in the development of chemotherapy (CMT) for lymphoma subtypes between 1950 and 1980.. In spite of the long tradition, systemic cancer care has never featured significantly in the national healthcare (HC) program of any Sub Saharan African country, with no evidence of impact on cancer control in the region, probably due to several factors, including preoccupation with communicable diseases, national fiscal inadequacies etc. Recent World Health Organization (WHO) driven emphasis on non-communicable diseases (UNGASS 2011) presages a HC paradigm shift and a need for capacity building in sustainable medical oncology practices in Africa. Burkitt’s lymphoma, the most common childhood cancer in Sub Sahara Africa, has long been a model disease in the studies of etiology and systemic therapy of cancer. Given its high degree of chemosensitivity and relative easy of management (Williams et al, 1983), it could also serve as a model in capacity building in cancer management in Africa. Barriers envisaged in the process are illustrated with the challenges encountered in an experimental management of Burkitt’s lymphoma (BL) at the University College Hospital, Ibadan, Nigeria between 1984 and 1985. Printed by From 1/1984 to 12/1985, a study of tolerability and practicability of high dose cytosine arabinoside (HDAC) CMT in Nigerian children (chd) was initiated at UCHIN. The concept behind the study was to overcome the physiologic blood-brain barrier (BBB) that limits the access of therapeutic agents to the CNS “sanctuary sites” and diminishes the control of lymphoma involvement of the area, given the fact that ARA-C, when administered at a high dose, crosses BBB to lead to effective therapeutic concentration in the cerebrospinal fluid. Chd were considered eligible if they were judged accessible for follow-up, had at least cytological diagnosis of BL, presented at Ziegler’s Stage C or D with or without CNS involvement (CNS±), had a life expectancy of at least one month and their parents/guardians were willing to give oral consent to study. Sixty chd were to be assigned randomly by blind selection of pre-labeled cards to either the standard treatment (Regimen II - RII) or the investigational (Regimen I - RI) protocol. Challenges encountered included: Ethics of medical research in the midst of socio-economic deprivation Inadequacies of technical and manpower requirements Inadequacy and unreliability of drug supply resulting in study plans modifications Communication and compliance challenges Inadequacies of follow-up resulting in limits to interpretation of study outcomes Sustainability deficiencies The experience of the past indicate inadequacies in confronting cancer challenges in the African environment due to lack of capacity for sustainable action even when solutions are known. The persistence of these problems after >2 decades signals a need for cultural change at all community levels: government, HC administration and among categories of providers. The African Organisation for Research And Training In Cancer (AORTIC) (Williams et al, 2014) plans to address this problem in a workshop of stakeholders later in 2014. The plan is to invite between 30 and 100 stakeholders in the practice of systemic therapy of cancer, including physicians, nurses, pharmacists, hospital administrators and government policy makers, from all regions of Africa to participate at a workshop with a faculty of 14 experienced practitioners of systemic therapy of African descent working in and out of Africa. The aims and objectives of the workshop are consistent with Target 09 of the overarching goal and 9 targets of the World Cancer Declaration, which is to improve the education and training of healthcare professionals. (Williams et al, 1983)