The AfHNS Clinical Practice Guidelines for Oropharyngeal Cancers in Developing Countries and Limited Resource Settings tailor management according to diagnostic and therapeutic resources available to physicians and to their patients.
International guidelines for oropharyngeal cancers assume availability of cytology, p16, ultrasound, CT, MRI, high levels of surgical expertise, CO2 laser or transoral robotic surgery (TORS), reconstructive surgery, frozen section, and (chemo)radiation therapy. In developing countries these interventions are frequently not available, and follow-up may be unreliable. Management is further complicated by inclusion of P16 status in the 8th Edition of AJCC and UICC staging, thus excluding patients from being staged when testing is unavailable or unaffordable.
Without resource appropriate guidelines for oropharyngeal cancers, both resident and volunteer surgeons from developed countries have little to guide them about best practice when working in resource limited settings. This might lead to inappropriate investigations, inappropriate treatment, and may compromise patients.
The AfHNS convened a task force to enumerate resource appropriate guidelines for management of oropharyngeal cancers in poorly resourced settings. This collaboration between physicians from African and developed countries included members of the AfHNS and American colleagues. International guidelines were referenced and adapted for limited resources. Due to paucity of literature about management of oral cancers in low resource settings, much of the recommendations represents expert opinion.
Contributors to AfHNS Clinical Practice Guidelines for Oropharyngeal Cancers in Developing Countries and Limited Resource Settings were: Johan Fagan (South Africa), Julie Wetter (South Africa), Anna Konney (Ghana), Khaled Twier (Libya), Getachew Melesse (Ethiopia), Mohammed Garba (Nigeria), Innocent Kundiona (Zimbabwe), Victor Mashamba (Tanzania), Rajab Mugabo (Rwanda), Paul Onakoya (Nigeria), Patrick Noah (Malawi), Kenneth Baidoo (Ghana), Jeff Otiti (Uganda)
Johan Fagan and Julie Wetter (Co-chairs)