Improving Access to Care in Africa, Collaboration is Key

Oct 10, 2017

By Dinesh Pendharkar, MD, PhD
ASCO International Affairs Committee Chair

Every patient with cancer, regardless of where they live, deserves access to high-quality, affordable care and treatments that can prolong or improve their lives. Detailed recently in The New York Times (“As Cancer Tears Through Africa, Drug Makers Draw Up a Battle Plan” [subscription may be required]) was a plan launched by the American Cancer Society (ACS) and Clinton Health Access Initiative (CHAI) that marks an important step forward in improving cancer care in Africa, where access to care is extremely limited in some regions.  

A notable feature of the plan is the collaboration with drug makers that have agreed to make critical cancer medicines available at more affordable prices. ASCO has long advocated for solutions to address disparities in health care access and the high cost of cancer care. Starting with establishing the Cost of Care Task Force in 2007, ASCO has worked to raise awareness about the impact of financial burden on patients with cancer, educate its membership about discussing drug costs with patients and the importance of appropriate resource utilization, and develop policy recommendations that will help enable global access to the highest-quality care at the lowest cost. At the same time, ASCO is working with the Union for International Cancer Control to advise on the expansion of the World Health Organization’s Essential Medicines List, which identifies the highest priority drugs needed for cancer treatment and supportive care around the world. The progress being made towards increased access for people living with cancer in Africa and is truly gratifying but we continue to advocate for similar models in other areas of the world.

As part of the initiative announced by ACS, ASCO and the Oncology Nursing Society—which have published guidelines on the safe administration of chemotherapy—are now focusing on the provision of training programs for the providers in Africa. For all of our work in Africa, we collaborate with many of our 400 dedicated members on the African continent. With a range of ASCO programs in Africa we aim to develop the future leaders of oncology in the region, enhance quality of care through physician training, and support innovative research in Africa that can address access-to-care issues in new ways. Your colleagues—ASCO members within and outside of Africa—are the key to helping advance care in meaningful and sustainable ways!

In Addis Ababa, Ethiopia, for example, ASCO volunteers helped colleagues at the Black Lion Hospital start the country’s first residency program in clinical oncology, an important part of the Ethiopian government’s efforts to expand access to cancer care beyond the capital city.  More recently, ASCO volunteers worked with Ethiopian colleagues to train several hundred primary care physicians in the country to recognize cancer warning signs and screen for breast and cervical cancer. It takes many efforts and broad resources to truly build a sustainable, improving care system and we are optimistic that the ACS and CHAI initiative will galvanize a major step forward in this regard.

In the end, ASCO is about our members and our volunteers are the critical resource we can deploy to contribute to improved care in Africa and around the world. I urge you to visit ASCO International programs—which connect the global community of cancer care providers through education, mentorship, and knowledge exchange—to learn more about our programs and find opportunities to volunteer. There are many ways that you can get involved personally that will help all of us improve cancer care worldwide.


Stephen B. Strum, MD, FACP

Oct, 19 2017 8:43 AM

I wholeheartedly agree that one of the concepts of humanity, aka human-unity, is collaboration and collegiality.  One of the wonderful aspects of the early years of the Internet was the ability to help people anywhere on the globe with almost instant feedback re recommendations, especially if those recommendations were made from a source of prolonged and intense experience.  I have been in both cancer research and clinical care of patients since 1963 with my initial focus on HD (Hodgkin’s disease), then later re anti-emetics, venous access, biomarkers, tumor IHC (Immunohistochemistry) and for the last 35 years subspecialized in prostate cancer (PC).  Yet despite being an elected member of ASCO, ASTRO and AUA and publishing all during my many decades in oncology, I find collaboration and collegiality within the USA from "fellow" oncologists to be sorely lacking.  In the last 15 years of my life I have acted as a remote oncologist reviewing medical records of patients wishing to tap my experience in PC.  I generate detailed EHRs (electronic health records) that are medically resolution oriented with recommendations & yet at least 50% of so-called colleagues will not even look at those "Recommendations to discuss with local MDs" despite their basis being within the peer-reviewed literature.  I see outdated modes of staging being done by academic oncologists, a failure to use technologies that have been available for at least ten years, and often a neglect of supportive care of the patient.  So for me, the emphasis on collaboration is one that should begin at "home" with an understanding that anyone can learn something from another if they take the initiative to open their eyes and minds and truly collaborate.  If this is not done then all we have is more pablum, more spiel instead of action, and with what is going on throughout virtually all aspects of life in this country, we do not need more of that "stuff". 

Stephen B. Strum, MD, FACP 
Jacksonville, Oregon 97530

Board Certified: Internal Medicine, Medical Oncology since 1973
ASCO (American Society of Clinical Oncology) since 1975
FACP (Fellow American College of Physicians) since 1979
PCRI (Prostate Cancer Research Institute) First Medical Director and Co-Founder 1997
AUA (American Urological Association) since 1998
ASTRO (American Society for Therapeutic Radiology and Oncology)  since 2002 

Robert W. Carlson, MD

Oct, 20 2017 3:00 PM

The African initiative detailed in the first paragraph of Dr. Pendharkar’s blog is a collaborative effort of the American Cancer Society (ACS), Clinton Health Access Initiative (CHAI), IBM, the National Comprehensive Cancer Network (NCCN), and the African Cancer Coalition (ACC). The initiative involves many parts – including the ability to quickly estimate systemic therapy needs in low- and mid- resource regions, to purchase steeply discounted anti-cancer agents, to identify within a micro-region which facilities or pharmacies actually have drugs available, to provide the adaptation of NCCN Clinical Practice Guidelines and NCCN Frameworks for Resource Stratification for use in Sub-Saharan Africa, and ultimately to  implement the adapted guidelines and training of an expanded group of cancer care providers. This effort has resulted in the adaptation of the NCCN Clinical Practice Guidelines and Frameworks into the NCCN Harmonized Guidelines for Africa for breast cancer, cervical cancer, lymphoma, CLL, prostate cancer, Kaposi’s sarcoma, adult cancer pain, and palliative care. The initial versions of these adaptations will be released at the upcoming African Organisation for Research and Training in Cancer (AORTIC) conference in Kigali, Rwanda this November. Additional disease oriented adaptations for Sub-Saharan Africa will be produced and released in 2018.

Key to the success of this effort has been the involvement of experts from Africa. Over 40 African Cancer Coalition members from 12 Sub-Saharan Africa countries have participated in the adaptation process, including clinical oncologists, educators, representatives from health ministries, and health care administrators. This initiative spans national borders in Africa and spans continents in a collaborative effort. The knowledge that the ACC individuals bring to the table is extensive and invaluable. They know the challenges and many solutions to delivering cancer care in resource constrained environments. They have impressive knowledge of oncology and oncology care. If there is success in the effort to improve oncology care in Africa, it will because of the dedication and participation of our African colleagues.

ASCO’s and ONS’s efforts, and those of multiple other organizations such as ACS, CHAI, IBM, NCCN, and ACC towards education, clinical training, and logistical solutions to cancer care in Africa are all important. To improve cancer care in resource-limited regions of the world takes not a village, but rather the global community’s participation.

Robert W. Carlson, M.D.

Chief Executive Officer, NCCN

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