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In Nigeria, a country of roughly 238 million people, the fight against childhood cancer has long faced a fundamental obstacle: the absence of dedicated paediatric radiation oncology services.
That gap began to close in 2020, when Adedayo Joseph founded the country’s first programme of its kind at the Medserve-LUTH Cancer Center of Lagos University Teaching Hospital.
Joseph, who serves as the centre’s director of clinical research, has since become a leading voice in a broader effort to ensure that cancer care in Africa is shaped by evidence gathered from African patients, rather than relying on data from other continents.
Her work spans clinical research, patient support, and the difficult task of building a specialised team from scratch. In an interview with SciDev.Net, she discussed the challenges and the progress made so far.
A trial for African patients
Joseph is Nigeria’s principal investigator on HYPOAfrica, a multi-country trial examining hypofractionated radiotherapy, a treatment approach that delivers radiation in fewer, higher doses than standard therapy.
The trial aims to determine whether this method is as safe and effective for African patients as it has proven in mostly European and American populations.
“We don’t need to copy and paste international data,” Joseph told SciDev.Net. “African patients deserve African evidence.”
Most previous studies included very few African participants, she noted, making it unsafe to assume the results apply locally.
The trial is also testing feasibility within overstretched health systems, where machine shortages, staff deficits, and long travel distances for patients are common.
If shorter courses prove effective, Joseph said, they could expand access to radiotherapy across the continent. Recruitment for HYPOAfrica has ended, and the trial is now in its follow-up phase, with initial results being prepared for publication.
Joseph hopes hypofractionated radiotherapy will become standard practice across African institutions, supported by government investment in equipment and training, freeing patients from long treatment courses that disrupt work, income, and family life.
Building a programme from nothing
Before 2020, Nigeria had no dedicated paediatric radiation oncology programme.
To gain the necessary expertise, Joseph trained abroad at the West German Proton Therapy Centre in Germany and at Vanderbilt University Medical Center in the US, as nothing comparable existed in Sub-Saharan Africa.
“If you think about the fact that Nigeria has about 200 million people and there was no paediatric radiation oncology programme anywhere in the country, it might seem very daunting,” she said.
Completing her training was only the first hurdle. Building a team required finding individuals with three specific traits: competence, character, and commitment.
“If someone is competent but has poor character, poor judgment or isn’t trustworthy, you’ll have a problem,” Joseph explained.
Assembling a core team of a medical physicist, a radiation therapist, and a paediatric oncologist took time and patience.
Joseph also had to persuade hospital management and the board of the programme’s value, acknowledging that it is not a profitable venture. She argued it would enhance the institution’s expertise, reach, and opportunities for collaboration.
“We started with what we had and kept building. We still haven’t reached every goal we’ve set, but we’ve continued to grow,” she said.
The role of patient navigation
Through her leadership of the Dorcas Cancer Foundation, Joseph came to understand that medical access alone was not enough. In the foundation’s early years, the focus was on securing treatment for children, but outcomes did not match the effort.
“If caregivers don’t understand the importance of follow-up, you won’t see that child again until the cancer has returned and is no longer curable,” she said.
Caregivers who have been out of work for months may need to return to earning immediately, making follow-up appointments difficult.
Grandparents who do not understand the treatment may steer families toward alternatives, and children who fall behind in school risk being lost in another way.
Many caregivers were left exhausted and traumatised, with some telling Joseph they wanted to die. “That means everything you did to get them through the first phase was wasted, because without completing treatment, you can’t improve outcomes,” she said.
The foundation’s response was a patient navigation programme that arranges transport, calls to keep families on schedule, and sometimes involves driving out to collect a patient.
The results have been significant: time from diagnosis to starting treatment has been cut from around 200 days to just over 50, and treatment abandonment has dropped from more than 50 per cent to under 10 per cent.
“No matter how brilliant you are as an oncologist, without psychosocial support all your work is going to be wasted,” Joseph said.
A career shaped by circumstance
Radiation oncology was not Joseph’s initial choice. She was training in medical oncology in the US when she decided to return to Nigeria, only to find the country had no medical oncology programme, only clinical oncology, which combines both paths.
“I wasn’t particularly excited about radiation at first because I felt I had no choice,” she said. “But as I went deeper into the specialty, I became passionate about it.
I always say it was destiny.”
Her career has drawn recognition beyond the clinic.
In April, she chaired the scientific committee of the SIOP Africa Congress 2026, of the International Society of Paediatric Oncology, and was named in the Ascent Top 100 Career Women in Africa 2026 list.
She sees this as recognition of her work building systems. “The award recognised the work of building systems that will outlast me, not simply treating patients,” she said.
In a largely male-dominated field, Joseph insists leadership is not about titles. “Leadership starts with leading yourself, being consistent, committed, disciplined, humble.
Leadership begins when you take the initiative. You don’t have to become a clinical research director before you start leading research.
That’s how you grow into positions of leadership.”
Source: Sub-Saharan Africa
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