By Inas Abuali, MD, FACP, and Aparna R. Parikh, MD

“With rare exceptions, all of your most important achievements on this planet will come from working with others—or, in a word, partnership.” —Paul Farmer, MD

Globally, more than two-thirds of cancer deaths occur in low- and middle-income countries (LMICs), many of which could be avoided if effective prevention and treatment options were available and accessible.¹According to the World Health Organization, the global health workforce shortage is projected to reach 10 million by 2030,² predominantly impacting LMICs due to limited capabilities in investing in education and training of health care workers, compounded by talent drain due to international migration brought on by economic and political instability in many regions.

There is a rising interest in carving a career path in global health and global oncology due to the widening inequities, with diverse pathways based on background, interests, skills, and opportunities.

“My exposure to global health started during my childhood, where I spent summers in India and noted the extreme poverty and lack of access to care,” Dr. Parikh reflected. “My parents immigrated to the United States, sacrificing their day-to-day comforts to improve opportunities for my siblings and myself. We were raised in a household where we recognized our tremendous privilege and were taught to utilize it in the service of others.”

Dr. Parikh has worked extensively overseas in several African countries, Haiti, Honduras, and India, with her work mostly focused on the latter in recent years. As the inaugural director of the Global Cancer Care Program at Massachusetts General Hospital (MGH), she is committed to developing global oncology initiatives that aim to reduce disparities by improving access to cancer screening, therapies, clinical trials, and palliative care.

Dr. Abuali joined the leadership team of the Global Cancer Care Program shortly after joining MGH, due to alignment in goals and vision. An Egyptian immigrant who moved to the United States in 2012, Dr. Abuali’s work focuses on improving access to professional development, training, and educational opportunities for health care workers in resource-limited settings.

“The years I spent training in and practicing medicine in Egypt highlighted the daily struggle of lack of access throughout the entire continuum of health care as an LMIC,” Dr. Abuali reflected. “As a global community, we need to utilize our enormous privilege to bridge the gap and invest in improving access to resources and training opportunities.”

Guided by the moral compass of Dr. Paul Farmer, we believe there is a moral and ethical imperative to ensure that all people, regardless of location, have access to high-quality care. (Dr. Farmer was the cofounder of Partners in Health, a nonprofit organization that provides health care in areas of extreme poverty and need.) Moreover, there is such a tremendous need for the remarkable scientific work of investigators from LMICs, and they need to have equitable opportunities to share their contributions.

POETIC (Program for Enhanced Training in Cancer), a fellowship exchange program to supplement the training of African oncologists practicing in their home countries, was one initiative launched as a result.³ Discussions with alumni of the program highlighted the need to create an ongoing space for a collaborative global community. Clinical care discussions and exchange of ideas to foster innovation and accelerate scientific advancements carry immense value and foster a sense of community and belonging in the field.

Establishing a Global Oncology Community of Practice

As long-term volunteers serving on various ASCO committees and task forces, embedding a Global Oncology Community of Practice (Global Onc CoP) within ASCO was the logical next step. ASCO’s strategy to enhance its global oncology engagement efforts is built upon three pillars: innovative global oncology research, quality improvement, and professional development.⁴ This led to initiatives that included the launch of JCO Global Oncology (JCO GO) in 2015, inclusion of a Global Health Track in the Education Program at the ASCO Annual Meeting starting in 2017, expanding the Quality Oncology Practice Initiative (QOPI) and QOPI Certification Program internationally, and awarding the inaugural cohort of the Global Oncology Young Investigator Award (GO YIA) in 2018 by Conquer Cancer, the ASCO Foundation. The International Development and Education Award (IDEA) and the International Innovation Grant (IIG) are examples of ASCO’s commitment to supporting leadership and research in LMICs. In addition, the ASCO Academic Global Oncology Task Force (AGOTF) was created in 2017 to promote a formal inclusion of the field of global oncology given its valuable impact on research, education, and the practice of oncology.⁵

Nearly 40% of ASCO members reside outside the U.S., with professionals from LMICs comprising approximately 18%. Free or discounted membership is offered to oncologists in LMICs to improve accessibility. The goal of the Global Onc CoP is to serve as a space to amplify the voices of ASCO members outside the global north, to foster true bidirectional partnerships, alliances, and an exchange of knowledge, resources, and expertise. With financial and visa restrictions barring many oncologists overseas from being able to attend educational conferences and professional development opportunities in the global north, we aim to host many activities virtually to improve equitable access and to invest in collaborative partnerships with local sites.

Our Global Onc CoP’s first virtual meeting was held on February 15; members from 15 different countries joined a meet-and-greet to discuss priorities and future directions for our community. Dedicated task forces will be developed focusing on regional clinical care guidelines, membership, education, research, and mentorship. Our CoP’s growing leadership team across the globe includes Dr. Eulade Rugengamanzi (Rwanda), Dr. Aju Mathew (India), Dr. Panot Sainamthip (Thailand), Dr. Haydeé Verduzco (Mexico), and Dr. Sarah Nyagabona (Tanzania).

Join Us at ASCO24

We are excited to host the first Global Onc CoP in-person gathering during the 2024 ASCO Annual Meeting on May 31 from 1 to 3 PM (CT). You can join the community online at ASCO myConnection and fill out our membership interest form.

References

1. Knaul FM, Arreola-Ornelas H, Rodriguez NM, et al. Avoidable Mortality: The Core of the Global Cancer Divide. J Glob Oncol. 2018;4:1-12. doi: 10.1200/JGO.17.00190.
2. World Health Organization. Health workforce. Available at: who.int/health-topics/health-workforce#tab=tab_1. Accessed 2024 Feb 20.
3. Fish M, Parkes J, Dharsee N, et al. POETIC (Program for Enhanced Training in Cancer): An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa. Oncologist. 2019;24:1557-61. doi: 10.1634/theoncologist.2019-0207. Epub 2019 Jun 10.
4. Hortobagyi GN, Pyle D, Cazap EL, et al. American Society of Clinical Oncology's Global Oncology Leadership Task Force: Findings and Actions. J Glob Oncol. 2018;4:1-8. doi: 10.1200/JGO.17.00060. Epub 2017 Aug 11.
5. Gralow JR, Asirwa FC, Bhatt AS, et al. Recommendations from the ASCO Academic Global Oncology Task Force. JCO Glob Oncol. 2020;6:1666-73. doi: 10.1200/GO.20.00497.