Childhood cancer is underdiagnosed and often presents at an advanced stage in Sub-Saharan Africa, but consistent improvements in oncologic care over the past 2 decades have increased diagnosis and treatment of African children with cancer. For many solid tumors, curative treatment is only possible when surgical excision follows oncologic principles. As such, there is an increasing need for expertise in pediatric surgical oncology (PSO). Expansion of pediatric surgery fellowship training programs over the past decade, in response to severe shortages in almost all African countries, is often without the opportunity to receive robust and specific PSO training. Given that 40% of the world’s children will live in Africa by 2050, we are at a critical juncture to improve care and education for coming generations of surgeons and patients.
I am a trainee member of the organizing group for a course called TOSCA - teaching oncology surgery for children in Africa. Modelled after similar courses for North American trainees, the TOSCA curriculum has been adapted to focus on topics and training that African surgeons felt were lacking. The goals of this course are to teach and reinforce PSO principles, particularly relating to cancer care in resource-limited settings. This will include didactic course material, case-based discussions, and mock tumor board with African pediatric oncology participation. Approximately one-third of the sessions will be case discussions with active learner participation. The course will cover the major pediatric cancer types as well as general topics such as aspects of chemotherapy and radiation therapy relevant for surgeons. The teaching faculty will be pediatric surgical oncologists drawn from Africa, and from high resource settings with experience working in Africa.
There are two populations that will benefit from this course: children in Africa affected by cancer, and the surgeons treating them.
This course is intended for pediatric surgery trainees in their final stages of training, reaching surgeons from across sub-Saharan Africa. These trainees will ultimately be responsible for the surgical treatment of children with cancer across the continent of Africa. TOSCA will equip them with clinically useful knowledge to improve the care they can provide their future patients. In addition to the direct clinical learning, the format of the course is designed to foster mentorship and community-building. We anticipate this will allow a young faculty to contact global experts with difficult cases or questions. For African pediatric surgeons who want to develop particular expertise or research in oncology, it may allow them to find the mentorship and sponsorship they need to succeed.
Many or most of these trainees work in settings with limited resources and expertise in the area of PSO. Financial limitations impact the care they can provide, but also their ability to interface with experts and with the surgical community at large by attending regional and international conferences. This course is being held in conjunction with the SIOP Africa meeting in Lagos in April, with the goal of reducing the barrier to entry associated with travel costs. Our team is also soliciting funding from institutional donors with the hope that these funds can support the operational costs of the course and allow us to fund the attendance of trainees who would otherwise be unable to afford the trip. As a US-based member of the organizing team (although currently on a temporary fellowship in Malawi), I am applying for the Doximity Foundation grant to fund my attendance in hopes that our other funding can be used to pay for the trainees attending the course.
There are drastic disparities in outcomes for children with cancer in Africa compared to children with the same conditions in high-income countries like the United States. There are multiple reasons for these disparities, including insufficient health workforce and resources to provide the highest standard of care. While some of these factors may be beyond the reach of an individual surgeon to address or improve, pediatric surgeons play a crucial role in the diagnosis and treatment of pediatric cancers. The quality of their training directly impacts their ability to provide the best chance of curative treatment for their patients, and these surgeons believe they would benefit from additional training in the area of PSO. Our expectation is that providing this training, both directly and through the facilitation of building relationships between early career surgeons and subject matter experts, will lead to improvement in surgical cancer care for African children and ultimately to better outcomes and greater survival.
With funding to support the attendance of trainees across Africa, and the goal to make this a recurring course to continue to reach future classes of pediatric surgery trainees, TOSCA aims to make a lasting impact on the survival of children with cancer in Africa.
This past April, I had the privilege of helping organize the TOSCA (Teaching Oncology Surgery for Children in Africa) course in Lagos, Nigeria — a two-day intensive training program held just before the biennial SIOP Africa meeting.
TOSCA was created to address a specific and urgent gap. Childhood cancer in Sub-Saharan Africa is often diagnosed late, yet curative treatment for many solid tumors depends on surgery performed according to sound oncologic principles. Pediatric surgery fellowship programs across the continent have expanded rapidly in response to severe workforce shortages, but most trainees graduate without dedicated instruction in pediatric surgical oncology. With projections that 40% of the world's children will live in Africa by 2050, closing this training gap now felt urgent rather than aspirational.
With a team of experienced pediatric surgeons from around the world, including local partners, we built a curriculum around the needs of African trainees and important principles of pediatric surgical oncology. About a third of the course was dedicated to case-based discussion and a mock tumor board, deliberately designed so trainees weren't just listening but actively working through real decision-making. Shared meals with faculty each morning and evening turned out to matter just as much as the sessions themselves — conversations over breakfast and dinner were where many of the real mentoring relationships took root.
The response exceeded what we'd hoped for. We were able to sponsor 50 trainees from 15 countries across East and West Africa to attend at no cost, and course evaluations showed a 15% increase in core knowledge among participants. More telling than the numbers, though, was watching a room of pediatric surgery trainees and consultants new to practice participate in lively discussion around the material and applying it to their specific context and available resources.
This course is one of the more meaningful things I've been part of professionally. Watching colleagues who train under enormous resource constraints leave with both a concrete clinical framework and a network of colleagues and experts they can reach out to when the need arises was a rewarding culmination of months of work by the organizing committee and course faculty. Thank you again to the Doximity Foundation for making my participation possible. We are already planning how to sustain and expand the course for future SIOP Africa meetings, so that more pediatric surgeons in training across Africa can eventually take part.
