The Global Pursuit of Excellence in Cancer Care

May 08, 2017

Participate in Global Health Track sessions at 2017 ASCO Annual Meeting

By Peter Paul Yu, MD, FACP, FASCO
Hartford HealthCare Cancer Institute

As ASCO has evolved into an international organization and our Annual Meeting has truly become a crossroads for the world, I have come to realize that the word “global” has more than one meaning. In medicine, the term “global health” generally refers to the state of health care that exists in World Bank–defined low-, low medium-, and high medium-resource countries. Very appropriately, these countries deserve the attention of high-income countries through both public and private initiatives, exemplified by the U.S. National Institutes of Health (NIH) and the Rockefeller and Bill and Melinda Gates Foundations.

Indeed, a global question can be asked: if we, as people of this Earth, cannot find common cause to study, ameliorate, and cure cancer, what hope is there for us to make inroads on the even greater societal problems that lead to war and social injustice?

That raises a second meaning of the word “global”: a term that signifies a comprehensive and catholic perspective of an issue. In the business world, corporations use “global” to designate an organization-wide business unit that integrates across all related activities, and in so doing levels internal silos. These two meanings of the word “global” are neither at odds nor incompatible. Rather, they suggest to us a larger dimension in which we can grow ASCO’s global health programs.

In 2015 and 2016, ASCO added a Global Oncology Symposium to the Annual Meeting, held on Friday afternoon on the first day of the meeting. This format consolidated our global health sessions to highlight ASCO’s commitment to address global health issues both at the Annual Meeting and in our extensive committee work throughout the year. However, in so doing, there was also a risk that global oncology might become a silo to itself, sequestered in one session and, along with the ASCO International Affairs Committee, be a place for the choir to sing a message to itself that in fact all of us need to hear. Consequently, the Cancer Education Committee—under the leadership of Michael A. Thompson, MD, PhD—decided to expand the sessions assigned to global oncology and to integrate those sessions throughout the Annual Meeting. Concomitantly, the newly inaugurated Global Health Track will offer sessions that examine what common touch-points exist that are so intrinsic to oncology that they serve as crossroads of human intercourse and knowledge exchange. (View all the sessions in the Global Health Track on the 2017 iPlanner.)

“Recognizing Global Oncology as an Academic Field” is a session suggested by ASCO President Daniel F. Hayes, MD, FACP, FASCO, to encourage universities and medical departments to support academic careers in global health. Research and education in nontraditional areas of study may not be appreciated relative to more proven career paths, and extended time abroad decreases interaction with colleagues back at the home institution. At the same time, oncologists facing heavy patient care loads in low- and medium-resource countries struggle to find time and resources to study and publish. Lawrence N. Shulman, MD, and Alexandru E. Eniu, MD, PhD, will present the U.S. and eastern European situations, and the NIH efforts to make global health more global will be presented by Edward L. Trimble, MD, MPH.

“Alternative Approaches to Prevention, Early Detection, and Implementation in Global Health” will explore a global viewpoint on value-based medicine that has not been previously discussed at our Annual Meeting. For the last several years, ASCO leadership has tasked presenters at the Annual Meeting with discussing financial and patient-centric concerns that are often barriers to the implementation of the exciting science being presented. Health economics is a discipline unto itself that brings a different perspective to understanding affordability and scalability of medical technology. Felicia Knaul, PhD, combines her multifaceted perspective as a health care economist with expertise in South American health systems and as a breast cancer survivor. As session chair and in her presentation, “Vaccines or Screening: ROI When Resources Are Finite,” she will help us understand the trade-offs to be considered in assessing the deferred value of prevention through vaccination—where the cancer to be prevented is in the distant future—versus the immediate value of early detection, when doing both is not affordable. Dinesh Pendharkar, MD, PhD, chair-elect of the ASCO International Affairs Committee, will speak to increasing value by use of alternative workforce in India; Jeannine M. Brant, PhD, APRN, AOCN, FAAN, will discuss common cultural factors that play a major role in women’s health across countries using her field experience in the Middle East and with Native American tribes in Montana.

A third session will address global aspects of lung cancer and continues the tradition of selecting a high-incidence cancer and examining what lessons can be learned from differing or emerging approaches across the world. In “Prevention, Diagnostics, and Treatment of Lung Cancer in Low- and Medium-Resource Countries,” we will cover public policy, precision medicine, and surgical oncology topics. Fred R. Hirsch, MD, PhD, will discuss implementation of “Biomarker Testing in Limited Resource Environments,” a necessary first step in treating advanced lung cancer if we are to achieve any measure of social equity in these countries. In part due to the multifocal natural history of lung cancer, thoracic surgeons in Asia have pioneered replacement of anatomic lung resections of cancer with wedge resections. Hisao Asamura, MD, will present evidence supporting this approach. With the increasing popularity of electronic nicotine devices among those who had not previously consumed nicotine-based products, it is timely to consider tobacco control public policy, and this topic has been added to the session.

In our last Global Health Track session, I will present the recommendations of the ASCO Global Oncology Leadership Task Force to the ASCO Board of Directors that have informed the Society’s direction going forth in global health. Mary K. Gospodarowicz, MD, FRCPC, FRCR, FASTRO, and Ophira M. Ginsburg, MD, FRCPC, respectively representing the Union for International Cancer Control and the World Health Organization, will describe the ongoing efforts of these two major international organizations in radiation oncology and women’s health.

Finally, there is a gap between the ideal and reality that cannot be ignored. Global Health Track members Sana Al Sukhun, MD, MSc, and Gilberto de Lima Lopes Jr., MD, MBA, FAMS, will discuss the challenge of implementing new evidence in low- and medium-resource countries and the evidence- and consensus-based modification of guidelines appropriate to the resources available.

The Bard wrote, “All the world’s a stage, And all the men and women merely players; They have their exits and entrances, And one man in his time plays many parts”—a global view of the life of a physician. See you in Chicago!

The 2017 ASCO Annual Meeting is supported in part by the Conquer Cancer Foundation of ASCO.

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