News and Events

On 4 February 2020, His Excellency President Paul Kagame inaugurated the official opening of the Rwanda Cancer Centre (RCC) at Rwanda Military Hospital (RMH) in Kanombe. Constructed by UNTEC, a French company, and funded by the Government of Rwanda, the Global Fund, and the CDC: Centers for Disease Control and Prevention, the centre became operational in March 2019.

The cancer burden has come to the forefront, especially in low- and middle-income countries, and Rwanda has worked to identify solutions to tackle the vast financial and human resource requirements of such diseases. Globally, cancer is among the leading causes of death, claiming over 70% of its victims in low- and middle-income countries, where prevention and treatment remain limited.

 

CANCER INCIDENCE

In 2018, estimates from the International Agency for Research on Cancer (IARC) indicate the incidence in Rwanda to be 10,704 new cancer diagnoses 4,520 cases among men and 6,184 cases among women were registered and annual mortality rates stood at 7,662.

The Government of Rwanda embarked on a journey to decrease the burden of disease through prevention, early detection, treatment, and care interventions. In 2016, the idea for a modern radiotherapy cancer centre, called Rwanda Cancer Centre (RCC), was established at Rwanda Military Hospital (RMH) in Kanombe as the first step in ultimately providing a full-service cancer centre. At the time, RMH already had advanced and existing cancer services in place and the human resource skills required to run the radiotherapy.

 

BUILDING CAPACITY

The newly completed radiotherapy unit is made up of two linear accelerators using Volumetric Modulated Arc Therapy (VMAT), which directly administers radiation to cancerous tumors, and one CT scan for treatment planning purposes. Thus far, 350 patients have been treated, and of the 350 treated patients, more than 57% have been covered by "Mutelle de Sante" while others have been privately funded.

Currently, the centre is averaging 50 patients per day with the capability to treat up to 150 patients per day at full capacity.

The facility will complement existing prevention, diagnosis, and treatment services including a 20-bed chemotherapy unit already in operation. In addition, the centre will allow full scale up of screening and early detection for cancers such as cervical, breast, and those related to hepatitis C virus.

Future plans indicate further diagnostic and inpatient services to be gradually added in order to provide comprehensive cancer treatment and palliative care to those with late state diagnosis. In addition, specialists are currently being trained in order to provide the necessary skill level and staff are currently undergoing training with the support of the International Atomic Energy Agency (IAEA).

 

Interview with Dr. Pacifique Mugenzi

Clinical Oncologist
Head of Rwanda Cancer Centre

Previously, we had to send patients who would ordinarily benefit from this type of radiotherapy treatment abroad, and the cost was exorbitant. Depending on where we would send patients, they would not get adequate treatment. The initiative started very early on, together with the Ministry of Health, and we started by approaching the manufacturers. We wanted to acquire a solution, as opposed to just buying equipment, which is expensive to buy in isolation and to maintain. We also did not have the full set of skills required to maintain and run such a centre, which is why we sought out a solution.

The centre is equipped with two linear accelerators, it is one of the latest models in terms of providing radiotherapy, and we have a CT scan which is dedicated for treatment planning. The treatment we give is precise, and we target the area of the cancer that we want to treat and spare as much as we can the healthy tissue surrounding it. In order to achieve that, you need to use a planning CT scan. Using the images from the CT scan that you acquire, you can perfect the exact cancerous area, so to speak.

The modality of treatment we give is VMAT, Volumetric Modulated Arc Therapy. The machine will do a 360 degree around the patient and adjust and adapt the treatment field to the size of the tumor, which allows it to deliver efficient treatment with minimal side effects. Initially where patients were seeking treatment, they were using a relatively old treatment modality and one of the side effects was burning of the skin. Without going into the technical aspect, by simply looking at the patients we are treating, it is easy to see their skin is not burned after treatment. It's a testimony to how advanced our treatment is, by looking at the patients treated at our centre versus others with inferior technology.

In principle, radiotherapy can work alone or in combination with chemotherapy. It may also be used before or after surgery, and all that depends on the type of tumor, the stage, and whether it is part of a curative combination or part of alleviating one of the symptoms identified on a given patient. Thus, radiotherapy is used as a local treatment, and there is no patient first seen for radiotherapy treatment. The patient needs to first go through diagnosis, which is done in most of our referral hospitals and Butaro Cancer Centre.

Once the preliminary workup is completed, we then get the full stage and type of cancer. Often, several doctors sit together to decide the best treatment modality and the sequence for each patient. This is done two ways, through multidisciplinary teams or tumor boards. Tumor boards are meetings to discuss the findings on a patient without having the patient directly in front of us. The sequence must be agreed upon, because the role of the surgeon might have an impact on what the radiotherapy will do, or the radiotherapy will have an impact on the type of surgery that will be done. At the moment, the doctors working here at the centre take part in the decision-making process at other hospitals, as well as on site here. Therefore, they will have already identified the patient that is going to come to the centre for treatment and make arrangements prior to the patient coming.

The staff consists of three main levels. The first level is the doctor level, who sees the patient, decides on treatment modality, decides on the radiotherapy prescription, and uses planning tools to determine how the treatment should be conducted.

The second level is the physicist, who shows how the treatment will be implemented using the capacity and the physical aspect of the radiation beam. Most importantly, the physicist is involved in safety and quality assurance and making sure the radiation isn't harming the patient, the staff, and the public.

The third level is the radiotherapy technician, who will then put the patient on the machine based on the specificity and reference points set by the doctor and the physicist and execute the treatment.

So far, we have treated around 350 patients. In terms of capacity, we have two linear accelerators. Depending on the numbers of hours we are putting in, we have the potential to treat 80-100 patients per day, per machine. At the moment, because we are in the very early stage, we are treating 50 patients per day, which is the capacity of one machine. We also have one physicist, with the hopes of having a minimum of three in the future, and four technicians who work on both machines. In reality, four technicians should be dedicated to one machine.

In terms of expansion, even though it is called Rwanda Cancer Centre, it's important to point out that we are not a full-fledged cancer centre at the moment. Currently, we have radiotherapy and chemotherapy treatments, and the chemotherapy we are focusing on is the type that is given concurrently with radiotherapy.

This unit was the first step in eventually establishing a full-fledged cancer centre. The services I mentioned, people are currently getting them at King Faisal and other referral hospitals, and the idea would be to have all the services offered at one site. It has been proven to be efficient for patients because it reduces the time between diagnosis and treatment, and it reduces the cancer cases that are missed.

The staff consists of three main levels. The first level is the doctor level, who sees the patient, decides on treatment modality, decides on the radiotherapy prescription, and uses planning tools to determine how the treatment should be conducted.

The second level is the physicist, who shows how the treatment will be implemented using the capacity and the physical aspect of the radiation beam. Most importantly, the physicist is involved in safety and quality assurance and making the sure the radiation isn't harming the patient, the staff, and the public.

The third level is the radiotherapy technician, who will then put the patient on the machine based on the specificity and reference points set by the doctor and the physicist and execute the treatment.

Radiotherapy was the missing link in terms of cancer management, and we were offering an incomplete package until we managed to get it. With this type of technology, it's the type of investment that is long term. We made sure to acquire technology that will not be obsolete in a year or two, because the cancer world is rapidly evolving. We positioned ourselves ahead of the game which allows us to treat different types of cancers efficiently. It's a huge step forward, and of course we eventually need more than one centre in Rwanda to cover the entire population. The technology platform that we invested in has allowed us to run satellite centres without having to duplicate what we have done at the centre here in Kigali. With the type of technology used here, we are capable of running centres that are a distance from Kigali.