Letter from the CEO: ASCO's Global Oncology Program

Letter from the CEO: ASCO's Global Oncology Program

Clifford A. Hudis, MD, FACP, FASCO

@CliffordHudis
Aug 29, 2016

On June 27, 2016, I officially began my service as your CEO and I am delighted to provide my first note in this role. The range of programs within ASCO and the critical education, research, and policy areas that volunteers and staff address on a daily basis is extraordinary, but I today I want to focus on just one—our Global Oncology program. As we plan our next steps, I want to pose several questions for your consideration.

By way of background, ASCO’s Board of Directors and its volunteers and members have been steady in expressing their enthusiasm for these programs. Beginning in 2012, we have allocated significant resources to support Global Oncology programs, and more recently, we asked former ASCO President Dr. Gabriel Hortobagyi to lead a task force to update our goals and plans for these initiatives. Dr. Hortobagyi’s April, 2016 commentary describes ASCO’s Global Oncology Leadership Task Force and provides his perspective on the international opportunities that Task Force members have recommended. These recommendations are being finalized and will be disseminated soon, but, as we await them, there are several questions we can begin to think about.

First, do you have to be an oncologist to treat cancer? In many resource-constrained environments, quality palliative care, appropriate diagnosis, and referral may be achieved by training physicians and health care providers outside of traditional oncology roles. For these non-oncologists, what kind of programs and support would be scalable and sustainable? What factors would identify successful participants? And what metrics would assure us that we were making a difference through the work of non-oncologists?

Second, how do we define quality in resource-constrained environments? Is it based on standards set in wealthier countries and regions? Is it adjusted for locally available resources? If so, how? This is perhaps an even more challenging issue given the rapid increase in access to digital educational materials that can serve to highlight gaps in access to optimal medications and treatment in some situations. At the personal level, this can clarify gaps between “should” and “can” with regard to treatment, but at the societal level, it could lead to misunderstandings about what kinds of treatments are expected or acceptable.

There are, of course, a much larger number of critical questions to think about and I welcome your thoughts and comments on these or any ASCO related matters at hudis@asco.org.

 

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Comments

Waseem Abbas

Sep, 06 2016 11:02 PM

This is really great...step forward to provide oncology care to people with resource poor settings

Ridha Oueslati, PhD

Sep, 07 2016 5:02 AM

Oncology is an integrative science by excellence.This is why , in part, an international effort is necessary. Each way of activity have prepared in group or by team,  the quality of work depend of the relative menagement linked to the regional environment.

Mitra Rado, MN, ARNP, AOCNP, FNP

Sep, 07 2016 1:46 PM

I am compelled by your second question, defining quality in a resource constrained environment. I found myself challenged by this very issue when volunteering in Vietnam through HVO. I think the answer is complex in that we have to have an understanding of the theory behind a quality standard that we impose on a region. The limitations of a region must be identified and goals set within the constrains to improve health care delivery. Will it always meet the quality standards that we expect? No, but if we look at our own historical achievement, they too evolved over decades. And our attempt to speed things up overnight may create other consequences that will become new stressors to the region that we are actually trying to help. Often I think it translates to the need for technology that they cannot afford. Sometimes it is a knowledge gap and  we can provide the education to fill that gap. This may be an easier to resource assuming we can penetrate the language and cultural barriers.

I can go on forever on this issue. I think simply put, we need to identify the limitations within region focused on. Be clear about the theory or the science behimd the quality standard, then modify the process of the change to work within the constrains of the region's resources.

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