Global Health Track to Highlight Cancer Care Disparities in LMICs

Global Health Track to Highlight Cancer Care Disparities in LMICs

Dr. Felicia M. Knaul, credit Donna Victor Photography
Dr. Fred R. Hirsch
Dr. Nagi S. El Saghir
Cancer care varies widely between high-income countries and low- and middle-income countries (LMICs). Four Education Sessions during this year’s ASCO Annual Meeting will explore disparities in cancer care in LMICs and approaches for improving the quality of care in these areas. These sessions are part of a new Global Health Track within the Annual Meeting Program.

“ASCO has embraced the fact that cancer care around the world is inequitable, and in many countries, cancer care either does not exist at all or is substandard or suboptimal,” Lawrence N. Shulman, MD, of the Abramson Cancer Center at the University of Pennsylvania, said. He will chair the Education Session “Recognizing Global Oncology as an Academic Field” on June 5.*

The four sessions will cover a range of topics, including the need for better cancer care in LMICs, strategies to improve care at all levels of the health system, and challenges with delivering basic or cutting-edge treatment advances in low-resource settings.

“In many countries, there is no in-country oncology expertise, so there is no place for the country to get started. It has a trickle-down effect; if there are no oncologists in the country, then there is no cancer care, and physicians and nurses who are training do not have any interest in cancer care because they do not know what it is,” Dr. Shulman said.

This was the situation in Haiti and Rwanda, both low-income countries, when he and colleagues started working there in 2011.

Creating Academic Paths

During Dr. Shulman’s session, presenters will discuss strategies to overcome obstacles in delivering cancer care in LMICs. There are a growing number of partnerships between physician groups, ministries of health in these countries, and U.S. academic institutions, such as the Dana-Farber Cancer Institute, Dartmouth College, and University of Pennsylvania, and they are building the infrastructure to establish and strengthen cancer centers. Presenters will discuss how attendees can get involved with, or pursue careers at, cancer centers in these settings.

These partnerships help set the stage for creating academic paths focused on global cancer medicine.

“It is a real academic field,” Dr. Shulman said. “Like any other study, you have a hypothesis, you design an experiment—in this case, how to best deliver cancer care in these settings—you measure your outcomes, and design your next experiment, trying to improve the outcome.” Dr. Shulman is part of the working group that helped create the Global Health Track and develop mechanisms to support training in this area.

“ASCO is invested in global oncology becoming a well-honed academic track that would attract people who want to dedicate their careers to the field,” Dr. Shulman said. As an example of ASCO’s investment, the Society launched the Journal of Global Oncology, which focuses on cancer care settings with limited resources, in 2015.

The session will cover efforts underway at the National Cancer Institute to support academic tracks in global oncology through funding grants and other mechanisms.

Strengthening Overall Care

Cancer care and control in LMICs involves a myriad of challenges and opportunities that span the cancer care continuum at various levels of health care delivery. Tertiary care at cancer centers, where diagnosis, tumor testing, and treatment should occur, faces high patient volume and, even in upper-middle–income countries, a lack of subspecialty oncologists.

At the level of primary care, which is usually delivered at local clinics, gaps also exist. These primary care centers should and could play a critical role in the delivery of services across the cancer continuum, from prevention and early detection to survivorship and palliative care. Efforts to improve primary health care delivery and expand access to cancer care will be the focus of an Education Session called “Alternative Approaches to Prevention, Early Detection, and Implementation in Global Health” on June 3.

“We are working on embedding cancer prevention in public health programs, HIV programs, and sexual and reproductive health programs that are already rolled out across countries, and we are promoting early detection, screening, and healthier lifestyles,” Felicia M. Knaul, PhD, of the University of Miami Institute for Advanced Study of the Americas and chair of the session, said. The session will include a discussion of strategies to introduce cancer-prevention education.

Strengthening prevention and early-detection activities requires training a different cadre of primary health care personnel, namely health promoters and community health workers, to identify high-risk individuals. It also requires training clinicians to detect tumors at earlier stages without access to imaging equipment available in high-income settings.

Presentations in this session will also discuss strategies to expand training and follow-up treatment, survivorship, and palliative care at local hospitals and clinics so patients can access related services closer to home. Strengthening primary health care services, the point of care closest to home, can help reduce expenses and potential income losses that may result from traveling long distances for treatment. Progress in this direction requires an innovative referral system, involving a communication chain so cancer centers can supervise and consult primary and secondary care centers, Dr. Knaul said.

The Case of Lung Cancer

One of the Education Sessions in the Global Health Track will be dedicated to lung cancer. Globally, 1.8 million people are diagnosed with lung cancer, and 1.6 million people die of the disease every year.

In addition to the magnitude of the disease, one of the reasons for the session is, as session Chair Fred R. Hirsch, MD, PhD, of the University of Colorado Cancer Center and CEO of The International Association for the Study of Lung Cancer, put it, “we have seen so many scientific advances over the last years, both in terms of lung cancer screening and particularly personalized therapy for lung cancer. So, there is even more demand to try to implement those advances in the low- and medium-resource countries.”

Dr. Hirsch will chair the Education Session “Prevention, Diagnostics, and Treatment of Lung Cancer in Low- and Medium-Resource Countries” on June 3.

He will discuss the practice of molecular testing and personalized therapy for lung cancer and challenges with their implementation in low- and middle-income areas of Eastern Europe, East Asia, the Middle East, and Latin America.

“There is a great heterogeneity in practices in these geographic areas, and in many countries, there is a lack of infrastructure and drug access. There is a lack of labs to do the testing and specialists to prescribe and monitor the drugs, and there is a high drug pricing,” Dr. Hirsch said. “However, in some countries, molecular testing and drug supply is provided by the industry. This makes implementation of national guidelines for molecular testing and treatment very challenging.”

The other two presentations in the session will focus on tobacco prevention initiatives and the challenges associated with implementing new surgical techniques in low-resource settings.

Perspectives From LMICs

The Meet the Professor Session “Perspectives on Oncology Careers in Global Health,” on June 4, will highlight ASCO International, which represents collaborations between ASCO and national and regional oncology societies around the world. Programs within ASCO International include the Multidisciplinary Cancer Management Courses, International Clinical Trials Workshops, Best of ASCO® International program, and grants such as the International Development and Education Award.

“We will talk about the role of national and regional oncology societies to support local research, to identify special regional and ethnic differences in incidence and characteristics of cancer in their countries, and to assess needs for cancer care in these countries,” Nagi S. El Saghir, MD, FACP, of the American University of Beirut, who will chair the session, said.

“As these societies hold meetings to discuss cutting-edge therapies, they should not forget the importance of cancer-prevention programs, improving access to care and quality of care, and implementing current guidelines,” he said.

For example, the Lebanese Society of Medical Oncology organizes annual meetings and monthly continuing medical education lectures to discuss state-of-the-art advances, cancer care issues, and research in Lebanon.

Dr. El Saghir will discuss partnerships with ASCO and other international volunteer organizations that advance oncology education, promote community work and research, and improve quality of care for patients and cancer prevention. Dr. El Saghir will also discuss the need for national oncology societies to partner with ASCO to distribute resource-stratified guidelines and to work with universities in their country to promote the ESMO/ASCO Global Curriculum for Training in Medical Oncology.

The session will largely follow a Q&A format, although the presenters will project introductory slides to lay the groundwork for discussion.  

–Carina Storrs

*Program information updated as of March 9. For session time and location information, please refer to the ASCO iPlanner on the Attendee Resource Center.