Mentoring a Nigerian junior investigator with a mixed-methods analysis of barriers to colorectal cancer presentation in Nigeria

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SUMMARY/ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 22-036. This is an administrative supplement to our parent award R01 CA246620 (PI: Alatise/Du/Kingham) focused on identifying risk factors for colorectal cancer (CRC) in Nigeria. Our work is motivated by the rapidly rising incidence and mortality of CRC in sub-Saharan Africa. This increasing burden is mirrored in Nigeria, the most populous country in Africa, where >50% of patients die within one year of diagnosis. These statistics highlight the need for new prevention, screening, and treatment interventions tailored to this limited-resource region. However, traditional risk factors that serve as a basis for CRC interventions are far less common in Nigeria compared to Western populations. To better understand the unique risk factors of CRC, we are recruiting 600 CRC cases and 1,200 matched cancer-free population-based controls for a case-control study as part of our ongoing parent R01. Participants complete a questionnaire to assess demographic, anthropometric, reproductive, lifestyle, dietary, and medical history. We expect to obtain knowledge of CRC risk factors to identify high-risk subgroups that can be targeted for screening and/or early detection. In addition, through this work, we have built research capacity to facilitate complementary CRC studies. As such, the overarching goals for this supplement are to strengthen capacity for high-quality research through mentorship of a promising junior surgeon-scientist, and to generate evidence that will complement our R01 findings. Specifically in this supplemental project, we will conduct a mixed-methods study to determine knowledge of CRC and barriers to CRC early diagnosis in patients in Lagos, Nigeria. Patients ≥50 years of age (n=350) who are healthy controls in our R01-funded case-control study will participate in quantitative assessment of knowledge of CRC symptoms and treatments. For the qualitative phase, community-based focus groups in people without CRC and in-depth one-on-one interviews with patients with CRC will be conducted. The study's key outcomes are knowledge of CRC symptoms, CRC diagnosis practices, and barriers to CRC early diagnosis. We expect this supplemental project to generate rich data that paired with our R01 findings can guide future improvements in CRC diagnosis in Nigeria to ultimately improve treatment options and outcomes.