I type this blog as I am flying home from ASCO headquarters, having just returned from the meeting of the International Affairs Committee. This committee may have my favorite name of an ASCO committee: it sounds rather like something you would read in a spy novel, with perhaps a touch of romance thrown in. But this committee is altogether more solid, and arguably important to the future, not just of our society but also of our profession.
Roughly three in ten of our members are from outside the United States, as are slightly more than half of those attending our Annual Meeting. The cancer research enterprise has increasingly become a true international affair, as the globalization of clinical research has resulted in many new agents approved for use based on studies conducted largely outside the United States. Many of these are carried out through international contract research organizations. Several members of the IAC shared their concerns over such research with me. They see the swoop-in, swoop-out phase III trials as examining drugs that will be unaffordable in the low-income countries where they are tested once approved, leaving no infrastructure behind and creating no lasting value as regards investigator-initiated trials. These concerns are mirrored by those of clinical researchers in high-income countries, who have seen the progressive outsourcing of cancer research: it isn’t only the automotive industry that can go away when “the world is flat.”
To sit through a meeting of the International Affairs Committee is to enter, quite literally, a different world. The committee itself is distinguished and truly global, with members representing all of the major regions around the world. The committee includes distinguished cancer researchers, a former Minister of Health, and the former director of International Agency for Research on Cancer. It is ably led by its first chair from the African continent, Dr. Clement Adebamowo of Nigeria.
Committee members hail from both low- and high-income countries, and it would diminish the very real differences between these countries to suggest that the interests of our international committee members are uniform. But certain themes, particularly with regard to low income/low resource areas, emerge. How does one create the workforce infrastructure in countries where there is a lack of training across the entire spectrum of cancer care? How does one diminish the blood-red tide of virally induced cancer mortality when a hepatitis or papillomavirus vaccine costs more than the annual per capita health expenditure for all diseases? How do we bring talented young clinicians into the international research tent when they lack mentors and opportunity? How does one apply superb ASCO guidelines developed in high-resource countries to low-resource realities?
As ASCO’s understanding of its international member’s interests and needs has improved (through the persistent efforts both of our committee members and Doug Pyle’s excellent ASCO staff), so to has our commitment to addressing these needs. I lack room here to discuss all of our international efforts. One of the more fascinating stories I heard at the meeting was about the International Cancer Corps, a new ASCO initiative that connects ASCO volunteers to institutions in low-resource countries. This is done, not in a haphazard “oncotourism” sort of way, but after a careful needs assessment carried on by an ASCO staff/volunteer team in conjunction with the host institution and in a partnership with Health Volunteers Overseas. The program is in its infancy, but even the briefest of looks suggests its ability to harness the wonderful volunteer spirit and specific expertise of our altruistic members. Kudos to Kara Garten and Higinia Cardenes for leading our first fine effort in Tegucigalpa, Honduras. Future efforts in Vietnam and Ethiopia are under development. As Dr. Cardenes (a radiation oncologist from the Canary Islands who makes her home in Indianapolis) told the committee, “the important thing is just to listen,” and ASCO is listening hard.
That we are all are in this grand fight together is not just some cliché, it is increasingly a reality. On a personal note, my grandmother died of cervical cancer before I was born. Her rural American South of the 1940s lacked Pap smears and HPV vaccines, and so she died a miserable death that scarred my own mother for life. That this still happens regularly in much of the world is not so much a cause for despair as a call to action. We do not have the resources to solve every problem in the world, but we do have special expertise and a special commitment to that exchange of knowledge that will allow progress to the IAC’s stated goal: “To reduce disparities in cancer care internationally and maximize chances of cancer survivorship.”