Registry-based systematic review maps non-pharmacological cancer trials in Africa

Cancer is a significant public health issue in low-and-middle-income countries, especially in Africa, accounting for over half a million deaths every year. While lifestyle and/or behavioral interventions such as exercise and dietary modifications are known to improve patient outcomes and quality of life, critical evidence from resource-limited settings like Africa is scanty. This review examined clinical trials on the current status and distribution of cancer-associated lifestyle and non-pharmacological clinical trials in Africa, highlighting trends, gaps, and opportunities for future research. Three trial registries (ClinicalTrials.gov, ICTRP and PACTR) were systematically searched for trials on lifestyle and non-pharmacological interventions for cancer in Africa from July 2005 to October 2024. A structured data extraction process was applied to collect information on sample characteristics and outcomes. Descriptive statistics were used to synthesize frequencies and proportions across included trials. Overall, 53 trials matching the criteria were identified. Most of the trials were in Egypt (38/53, 71.7%), Kenya (4/53, 7.5%), and Nigeria (5/53, 9.4%). Breast cancer had the highest number of conducted trials conducted (24/62, 45.3%), followed by colorectal (6/64, 11.3%), and acute lymphoblastic leukemia (4/64, 7.5%). Concerning sponsorship, most trials were sponsored by academic institutions (45/53, 84.9%), locally sponsored by institutions from within the host country (37/53, 69.8%), conducted among patients (88.7%), and cancer survivors (84.9%). Most trials involved physical activity interventions (25/53, 47.2%) and psychological interventions (10/53, 18.9%), with (32/53, 60.4%) trials completed and (13/53, 24.5%) trials ongoing. Non-pharmacological interventions for the management of cancer appear to be nascent in Africa. Oncology trials are needed to ensure the effectiveness of non-pharmaceutical/lifestyle interventions in Africa, especially sub-Saharan Africa (SSA). In the current era of precision medicine, interventions proven successful in high income countries cannot be assumed to work equally well in low-and-middle-income countries, especially in Africa, given the genetic, socioeconomic, and environmental differences.