Current areas of focus
Current areas of focus
ICONIC has taken practical steps towards establishing activities in several areas recognised as being fundamental for developing science and its application to improving people’s lives. As a reminder, so far, we have carried forward activities around the following critical themes:
- Building broader capability and more robust capacity for excellence in research and practice in Africa, with the longer-term ambition to develop a high-quality, context-specific research programme in this region;
- Facilitating international collaboration and developing activities in the area of childhood cancers, with the ambition to create a Community of Practice focused on diet, nutrition, physical activity and cancer in children, teenagers and young adults (CTYA) that seeks to align research and communication to advance the adoption of essential practices and better inform care for young cancer patients;
- Establishing the particular role played by professional nutritionists in establishing school meals as a system to improve the health of school children as well as become a vehicle for broader education on the nature and origin of foods and diets, their biological functions, their relationship to health, social structures, economics and more general social connections.
- Developing a framework for establishing prehabilitation (in terms of personalised management of exercise, nutrition and psychological support before the start of definitive treatment) formally and in the context of quality implementation science.
Capacity building in Africa
While the incidence of cancer is rapidly increasing in LMICs and changing dietary patterns play an important role, grant proposals on nutrition and cancer submitted by LMICs scientists rarely qualify for funding. Working with Wageningen University and a newly formed group of African scientists within the African Nutrition Society, Cancer and Nutrition in Africa (CANA), the aim has been to develop an online course to improve grant writing capabilities across Africa in the first instance, as an imperative for the development of a high quality, relevant and context specific research programme in this region. The longer-term ambition is to develop a series of studies across the continent using standardised and validated methodologies that together will create the equivalent of an EPIC (European Prospective Investigation into Nutrition and Cancer) for Africa.
The Cancer and Nutrition Epidemiology in Africa online grant writing course is based on experience of similar courses within Wageningen University and intends to cover various aspects of grant writing such as formulating a research question, designing the most appropriate study, calculating study size, planning and budget, as well as other training skills relevant for grant writing. A pilot study was conducted early in 2021 as part of Wageningen University’s ongoing distance learning programme, offering a chance to evaluate and refine the course at an early stage. CANA is made up of a group of extremely enthusiastic and committed African scientists who themselves completed the first pilot study. With support from Wageningen University and ICONIC, CANA then planned and led two further pilot courses modified to be sensitive to the African context, offered in West Africa later in 2021 and 2022. A further course was offered in 2023, which saw twelve participants enrolled and broader representation from across Africa (Kenya, Ghana, Nigeria, Botswana and Uganda). The team also recruited participants from previous cohorts as assistants to support them in the course delivery – this was a positive indication of the enthusiasm and commitment of these participants to the longer-term ambition. In recognition of the importance of building research capacity in Africa, the activity has received support from the UK Nutrition Society and the Love Hope Strength Foundation.
Participants have expressed how beneficial the course has been for them, addressing specific challenges experienced in LMICs and enabling them to feel more confident in writing grant proposals. The online course will be offered each year to African scientists who want to gain knowledge and experience with writing grant proposals in this specialist area.
Developing a Quality Assurance Framework for Cancer and Nutrition
There is increasing acknowledgement of the absence of quality assurance data internationally for the formulation of secure policy, particularly in the area of cancer and nutrition, and this has been identified as a fundamental constraint which limits progress towards every aspect of the UN Sustainable Development Goals.
For research studies, the training and oversight of those taking measurements is usually conducted with care, but this is not necessarily the case in the context of routine care, even though life and death decisions might be based on the interpretation of these measurements. More recently, there has been promotion of digital health platforms in which measurements taken as part of routine care by persons of uncertain skill and competency are to be used either individually or aggregated to determine policy, for programmatic purposes and as the basis for individual clinical judgements. This raises a serious concern about the validity and utility of measures taken by staff without formal training, oversight, and some form of quality assessment. Needs have been identified for:
- Standardisation of measurement methodology and protocols
2. Defined training and demonstrable competency of those responsible for making and supervising measurements
3. Measures to be conducted within a QAF that provides the necessary structures and systems to monitor performance and fidelity against defined processes.
A Working Group of ICONIC has been tasked with the development and escalation at scale of a Quality Assurance Framework, initially for anthropometry, but eventually for other markers of nutritional wellbeing. The ambition is that this should be available across sub-Saharan Africa as the Quality Assurance Framework and Nutrition for Africa (QAFANA) for the collection and curation of secure nutritional data that can be used with confidence for policy, planning, monitoring and evaluation in critical areas of the health sector (cancer), the education sector (childhood obesity) and the agricultural sector (food and nutrition security).
As a first step, colleagues from Ghana spent two weeks at the University of Southampton for training and competency assessment required to the level of trainer. During their stay, the Working Group had the opportunity to also discuss the wider introduction of QAFANA: its scope, nature and strategy.
Two recognised Centres for Nutritional Assessment (CNAs) have now been established in host academic institutions in Ghana: Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi and the University of Health and Allied Sciences (UHAS) in Hohoe. The necessary quality assurance structures, systems and processes have also been developed. Dr Reginald Annan and Mrs Patience Dormediame have since led the training and competency assessments of students and national service personnel in these institutions – they continue to build and assess competency amongst these individuals and core teams have been established within both CNAs. The experience is subject to the appropriate monitoring and evaluation, which is being used to help assess and refine the training programme.
In October 2023, Dr Stephen Wootton from the University of Southampton, visited Ghana on behalf of ICONIC to sign off on both CNAs and to seek continued support from the senior leadership in each institution. Whilst there, Dr Wootton also supported colleagues in hosting a symposium before the Conference on Nutrition and Dietetics (COND) to create awareness of QAFANA and its objectives among the Ghana Association of Nutritionists and Dieticians (GAND). The symposium successfully created awareness and generated support and engagement at the national level. Senior representatives from three other Universities in Ghana indicated they wished to work collaboratively with colleagues in UHAS and KNUST – The University of Accra in Legon, The University of the Cape Coast and The University for Developmental Studies in Tamale.
In 2022, financial support was secured from the World Cancer Research Fund (WCRF) International to fund the first year of the activity – Dr Panagiota Mitrou from WCRF said “WCRF is delighted to be able to support this important initiative and help Africa be a beacon of good practice for the rest of the world.” The activity has also received support for a second year from the Love Hope Strength Foundation, which will support extending the activity to French-speaking African countries with colleagues in Togo and Cameroon.
Nutrition in children, teenagers and young adults (CTYA)
Despite improvement in treatment and outcomes, cancer remains an important cause of death in childhood, and survivors carry significant risks to their long-term health in adult life. The response to treatment, survival and health outcomes, of children, teenagers and young people (CTYA) with cancer, is greatly improved, when attention is given to diet, nutrition and physical activity as integral to routine care.
With multiple stakeholders leading and supporting initiatives in research in the area of nutrition and cancer in CTYA, ICONIC supports the development of an agreed framework that will help to share current knowledge, identify gaps and set research priorities that together will enhance opportunities for improved care.
It is recognised that the efforts of those who are working to achieve more successful outcomes would be greatly strengthened, if relevant experience could be shared more readily, through the use of a suitable and accessible platform. ICONIC, together with the Aladina Foundation in Spain and Cancer Warriors Foundation in the Philippines, have been exploring how this might be achieved through establishing a Community of Practice (CoP) to facilitate the exchange of knowledge and experience in this area, which will also contribute directly to supporting and promoting the broader global agenda on chronic non-communicable diseases.
This area of work was the focus of the first of a series of Virtual Dialogue sessions in 2021, hosted by ICONIC in collaboration with UICC. This brought together experts in the field to share their experience and the group has since been looking to see how they might work together moving forward and where activities might align.
A proposal has been submitted for a session on this topic at UICC’s World Cancer Congress in 2024.
Global Research Consortium for School Health and Nutrition
ICONIC has contributed directly to the global school feeding initiative of the School Meals Coalition launched in 2021 with the World Food Programme as the lead agency and supported by UN Nutrition. Professor Jackson, Chair of ICONIC, sits as an observer for IUNS. ICONIC has been instrumental in the formation of a Special Interest Group within the Nutrition Society and the organisation of a session during a meeting in October 2022 to celebrate the first year of the School Meals Coalition. The session, ‘Schools as a system to improve nutrition’ (available on the School Meals Coalition YouTube channel) discussed issues affecting the delivery of school meals to children in the global south, and what strategies could be adopted to improve coverage and delivery of safe/quality school meals.
ICONIC is continuing to explore opportunities to collaborate with the Coalition to improve school meals and the health of school children, especially in LMIC.
Following publication of a report by NIHR in collaboration with Macmillan (a cancer care charity) and the Royal College of Anaesthetists “Principles and guidance for prehabilitation within the management and support of people with cancer” in 2019, ICONIC committed to explore opportunities to make these prehabilitation guidelines for people with cancer more widely available and consider how the findings might be projected internationally. The report called for a greater focus on prehabilitation, including nutrition, physical activity and psychological support, in the delivery of cancer care.
In December 2021, ICONIC was pleased to host the second in its series of online Special Focus Dialogues in collaboration with UICC, this one with a focus on prehabilitation and cancer: Special Focus Dialogue: Prehabilitation – Multimodal interventions to improve resilience and response to treatment in cancer | UICC. Experts came together to share their experience in developing, implementing and evaluating prehabilitation interventions, including how being nutritionally, physically and psychologically ‘unfit’ might influence the resilience to cancer and how multimodal prehabilitation can help decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. This was also one of the topics that formed part of ICONIC’s symposium at the 22nd IUNS International Congress of Nutrition (ICN) in Tokyo in December 2022.
ICONIC is currently considering plans for next steps in this area.