Table 6. Summary of the major findings; strategies and impact, challenges and recommendations for cancer control in Africa.

Theme	Sub-theme	Activities	Impact/outcome
Strategies for cancer control during COVID-19 pandemic	Adaptation of service delivery models to maintain cancer services	Use of telehealth, technology and tele-mentoring	Health workers developed a joint understanding and appreciation of effective telehealth communication in cancer care Enhancement of digital platforms in cancer care, telehealth and drone drug delivery
		Developing, modifying and sharing cancer treatment protocols	Improved knowledge sharing and standardisation of treatment protocols Reliance on radiotherapy as opposed to surgical interventions
		Reconfiguring chemotherapy infusion centres, screening space and patient waiting areas.	Screening services were stopped and areas turned into COVID-19 screening area
		Decentralisation of cancer treatment to local and lower-level facilities	Lower-level facilities got overwhelmed with the number of cancer patients
COVID-19 related challenges and unresolved dilemmas	Fear of exposure to COVID-19 infection at the health facility, by both patients and health workers	Lack of PPE	Patient abandonment to cancer services Increased use of simple strategies for infection control such as sanitising working stations and use of hand sanitising gels
		Crowded and congested hospital space and chemotherapy infusion space
		Lack of room for social distancing/isolation due to open patient wards
		Lack of readily accessible washing facilities
		Lack of psychosocial support services to allay fear and anxiety
	Overall disruption of cancer services spanning the whole cancer control continuum	Travel restrictions	Cancer screening, some surgeries and cancer registration services were halted
		Diversion of already scarce resources (staff and money) to the COVID-19 response
		Limited access to health facilities
		Compromised supply chain for cancer drugs, equipment and clinic supplies
		Lack of electronic data collection systems
	Challenges of telehealth and technological limitations	Patient discomfort with telehealth and technology	Many patients missed cancer care services during the COVID-19 pandemic
		Slow bandwidth and Internet connectivity
		High Internet costs and mobile airtime
		Inadequate skills/capacity in use of telehealth and telecommunication for physical assessments by health workers
Recommendations for cancer control during and after the COVID-19 pandemic	Health system strengthening	Integrating cancer control services in the health service structures	May strengthen the health system along the entire cancer control continuum that will withstand disruptions during future pandemics.
		Continuing and increasing use of digital technology for cancer control
		Creating and sharing contextualised guidelines for cancer control in Africa
		Leveraging the infrastructure and momentum developed in response to COVID-19 pandemic to further strengthen cancer response
		Developing well-conceived and comprehensive NCCPS