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Today, more than half of new cancer cases and over two-thirds of cancer deaths occur in low- and middle-income countries.
Ami S. Bhatt, MD, PhD
Franklin W. Huang, MD, PhD
Teodora Kolarova, Harvard Medical Student
Dana-Farber Cancer Institute
Today, more than half of new cancer cases and over two-thirds of cancer deaths occur in low- and middle-income countries. Underlying this burden of cancer is an unequal distribution of global resources, a lack of coordinated care for oncology patients, and a multitude of social, cultural, and economic factors that lead to late diagnosis and incomplete palliation in the developing world.
Bridging the Equity Gap
To combat the growing cancer burden, concerted action is needed from the global health and oncology communities. In her Presidential Address to the 2013 Annual Meeting of the American Society of Clinical Oncology, Sandra Swain, MD, highlighted the “possibilities and promise in global health equity,” encouraging oncology leaders worldwide to join the effort to bridge the “access gap” in cancer care. The Global Oncology Initiative (GO; www.globalonc. org), an academic and grassroots volunteer organization based out of Boston, Massachusetts, seeks to do just that. GO connects local and global oncology communities and is developing programs aimed at alleviating worldwide cancer care disparities.
Building Community Locally
GO was founded in May 2012 by two hematology/ oncology fellows from the Dana-Farber/Partners Cancer Care program, with the initial objective of breaking down silos between members of the Harvard cancer community who were involved in global health efforts. Supported by the Dana-Farber Cancer Institute Center for Global Cancer Medicine and by member institutions of the Dana-Farber/ Harvard Cancer Center, GO launched a series of global oncology-focused seminars, the “GO talks,” in November 2012. The themed lectures have featured the work of several current leaders in global cancer care, including Drs Paul Farmer, Eric Krakauer, Julie Livingston, and Raul Ribeiro. Topics have ranged from palliative care, to pediatric oncology twinning programs, to an ethnographic analysis of the Botswana cancer culture. Since launching, the GO Talks have been attended by over 1000 people and viewed freely on GO’s website in more than 20 countries. The talks provide an educational platform and opportunity for networking within the community as evidenced by the rapid growth of GO efforts over the past year.
Building Community Globally
Working to “break down silos” between members of the global oncology community, GO has used information and communications technologies to develop novel tools in cancer care and control. While numerous organizations work in resource-limited settings, these efforts often function in isolation and may miss the opportunity to share and strategically merge efforts to optimally deliver critical services. In order to address this need, GO has collaborated with the National Cancer Institute’s Center for Global Health to develop a mapping platform that depicts the efforts of those pursuing global cancer research, care, and outreach internationally. Currently, a multidisciplinary team of GO volunteers that includes physicians, public health experts, and computer scientists, is working to launch “version 1.0” for the community. In line with GO’s objectives, a “cancer resource map” of global oncology projects is an innovative way to help align the goals of government agencies, academic medical centers, and local and international oncology efforts.
Another innovative GO project has focused on addressing the day-to-day, on-the-ground challenges of cancer care delivery faced by practitioners in healthcare systems with limited resources. To improve the coordination and delivery of care, GO developed an open-source software platform that integrates local resource information with current best practices to provide stepwise directions for the management of cancer patients. At present, there are well-established cancer treatment guidelines for use in high-income settings (NCCN, NICE) and more recently, these guidelines are being adapted for use in low- and middle- income countries. However, a platform that takes into account the shifting availability and location of resources in developing settings does not currently exist. Through an innovative pairing of resource cataloguing and guidelines that are sensitive to the available resources, the GO Guideline platform seeks to help healthcare workers deliver care that maximizes the utilization of scarce resources.
Any good collaboration begins with mutual respect and understanding. Maintaining open communication regarding the needs of partners in resource-limited settings ensures that tools and services provided are not only useful, but streamline rather than complicate the workflow of already overburdened systems. Nurturing relationships between GO members and professionals abroad has been a top priority for the organization. A GO collaboration with Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, was initiated in January 2013 by the hospital’s head oncologist, Dr Leo Masamba. This partnership has established a monthly tumor board and a social work “twinning” program to improve social work capacity within QECH. At the request of QECH, a budding endeavor will explore creating patient education materials that are appropriate for low-literacy patients.
Building a Pipeline of Future Leaders
Many of the current global oncology leaders have transitioned into the field mid-career. With the growing needs of the world cancer community, supporting the development of future leaders in this field is a priority. The GO initiative helped establish Students for GO, whose members include medical, dental, and public health students from the Boston community. The group participates in GO volunteer projects and hosts monthly case seminars where students and their mentors present patient cases to discuss health system barriers and the unique cultural and social aspects of cancer care. To promote GO’s commitment to innovation and education, the student group also leads an Expert Interview project that highlights notable papers in global oncology. With the rising burden of cancer globally, there is an urgent need to improve early diagnosis and control of cancer in resource-limited settings and address the needs of underserved cancer patients. Through the integration of academic and communitybased efforts, GO aims to address this important call to action and welcomes oncologists in high-income settings to do the same. For those interested in volunteering or learning more about the Global Oncology Initiative, please visit www.globalonc.org. Also on the website is a calendar of upcoming seminars, lectures, and volunteering opportunities at www.globalonc.org/event.