Aug 31, 2016
By Jame Abraham, MD
Director, Breast Oncology Program at Taussig Cancer Institute
Co-director, Comprehensive Breast Cancer Program of Cleveland Clinic
India is a classic example of a transition economy faced with a high incidence of noncommunicable diseases, such as cancer. At any given time, India has about 2.8 million patients with cancer and more than half a million deaths from cancer per year. The Indian government is taking steps to address the rise in cancer incidence by investing in cancer programs at existing medical college hospitals such as Mysore Medical College and Research Institute.
Publicly funded medical colleges like Mysore are the cornerstone of a large public health care system in India, offering free care for millions of patients; for the majority of the poor patients, medical colleges are the only available option.
My mentee, Dr. Mukesh Shanthilal, is a radiation oncologist at Mysore Medical College and Research Institute. The college’s cancer department offers specialties such as radiation oncology, surgical oncology, and medical oncology. Each year about 700 to 800 new patients seek cancer treatment from the hospital, including about 220 new patients with breast cancer.
I started working with Dr. Shanthilal as a part of the ASCO Virtual Mentors program. Initially we scheduled hour-long calls once or twice a month. Our first conversation focused on our backgrounds and expectations. As an oncologist who was born and educated in India, it was easy for me to connect with Dr. Shanthilal; I could picture his situation—his department provides valuable services for thousands of patients with advanced cancer. Most of the patients have stage III or IV diagnosis by the time they reach his clinic; curative intent and splitting hairs about marginal benefit from various regimens or expensive targeted therapies have limited role in this structure.
The focus of our calls evolved into discussions about cases. Dr. Shanthilal would briefly present a case of a complicated patient with a breast cancer diagnosis, and we would discuss how it was managed by him and how I would treat that patient at Cleveland Clinic. The dialogue helped us to clearly understand that the standard of care in various settings could be hugely different depending upon resources, perception and culture. Late-stage diagnosis, no access to some of the novel treatments, pay-for-service structure, lack of insurance coverage, and a patient’s perception of cancer diagnosis and treatment could play a major role in making these decisions. In this setting, there were no right or wrong answers.
Very often I discussed Cleveland Clinic care paths and our multi-disciplinary approach to care through tumor boards and clinics. Dr. Shanthilal saw this as an immediate opportunity to improve his program. He expressed a strong interest in learning more about Cleveland Clinic’s multi-disciplinary patient care and, after several months of our virtual interaction, Mukesh decided it may be more useful for him to see first-hand how multi-disciplinary care is delivered at Cleveland Clinic. He applied for a Union for International Cancer Control (UICC) International Cancer Research Technology Transfer Fellowship (ICRETT). Through this fellowship, doctors from the developing world spend one month at a sponsoring institution to exchange knowledge and develop skills that can be used in their home organization when they return.
Dr. Shanthilal also applied for and was accepted as an international observer at Cleveland Clinic through our Global Health Program. He will be spending a month with me, learning about our comprehensive breast cancer program, one of the largest breast cancer programs in the country. We continue working to improve the care of our breast cancer patients through a weekly tumor board, where we discuss Cleveland Clinic care paths, national guidelines and clinical trials to make sure that we provide the same standard of care across the system.
Dr. Shanthilal’s goal is to learn how to set up effective, integrated, coordinated and comprehensive tumor board meetings for the management of cancer patients in Mysore Medical College. As per UICC, 80 percent of its fellows continue to collaborate with the host institution in the future. I expect Dr. Shanthilal and I will continue to collaborate and learn from one other to improve the lives of patients with cancer.
My story is an excellent example of how the ASCO Virtual Mentors program is having a direct impact on helping cancer specialists and, hence, patients, from across the globe.