Jan 14, 2020
For Fredrick Chite Asirwa, MD, the path to better cancer outcomes around the world begins with the education of a well-trained global oncology workforce. Dr. Asirwa is a consultant physician, medical oncologist, and hematologist, and the director of the International Cancer Institute (ICI) in Eldoret, Kenya. He served on ASCO’s Academic Global Oncology Leadership Task Force, a volunteer group tasked with identifying the necessary steps to formalize global oncology as a recognized academic discipline (see below). In addition to his role on the task force, Dr. Asirwa is a member of ASCO’s Education Council and has served on the International Affairs Committee, Multidisciplinary Cancer Management Course Working Group, and International Development and Education Award Working Group.
As ASCO and its volunteers work to drive global oncology forward as a recognized professional field, Dr. Asirwa discusses how his perspective is shaped by experiences in the United States and Kenya, and his vision for the future success of this discipline. Find advice on pursuing a global oncology career.
What inspired you to pursue a career in oncology education?
FCA: There currently exists a huge deficit in oncology education in Sub-Saharan Africa. During my undergraduate studies for the Bachelor of Medicine and Bachelor of Surgery degree in Kenya, my entire training curriculum had less than 8 hours devoted to cancers, and most of that time was spent on pediatric malignancies.
As I did my internship in Kenya and then my residency in the United States, I interacted with a lot of patients with cancer and cancer survivors. I was pleasantly surprised to see survivors who were 20 years out from their cancer diagnosis. This was both disturbing and inspirational. Disturbing because, in Kenya, cancer was an automatic death sentence at the time. I had not met a survivor during my undergraduate studies—I was disturbed by the potentially thousands of patients with cancer that we must have lost. But inspirational because it meant that there is hope and there is a lot that we could learn in order to optimize cancer treatments for our patients. This led me on a quest to learn as much as I could during residency in all disciplines in medicine, but with a special interest in oncology, and to do a fellowship in hematology and oncology at Indiana University.
I brought this knowledge and experience back to Kenya and Sub-Saharan Africa and worked initially through AMPATH Oncology, thereafter through the ICI of Kenya, to help create an oncology workforce in the region. In 2011, when I moved back to Kenya from the United States, there were no training centers in Kenya for cancer care at any level. Now, we have been able to create various in-country fellowship programs in medical oncology and gynecologic oncology, and other middle-level trainings in oncology nursing and physician assistant programs on oncology. ICI has expanded its courses to include oncology for pharmacists, pharmaceutical technicians, and histotechnicians. Improving patient outcomes through training has been a driving force for oncology education in Kenya and by extension the Sub-Saharan African region.
How did your experience on the ASCO Education Council shape your viewpoint on academic global oncology?
FCA: The Education Council of ASCO is one of the most inspirational groups of dedicated educators that I have ever met. The Education Council’s role in identifying gaps in ASCO’s educational programming helped reveal the need for global oncology as an academic discipline.
I am aware of the current training paradigms in hematology and oncology at a fellowship level in the United States, and in my own experience, when relocating back to Kenya in 2011, I found there was a glaring absence of various aspects of practice in resource-constrained settings that the current training does not prepare one for. There are several missing competencies—including cultural context, epidemiology, practice issues, and geographic disparities in cancer control and research—in the training as it stands currently in the standard U.S. heme/onc fellowship. As a member of the Education Council, I was able to see that the same applies not only to Sub-Saharan Africa but also to other continents and even to remote rural areas in the United States. Therefore, this knowledge of academic global oncology is not just for low- and middle-income countries, but for high-income countries as well!
How did ASCO’s Academic Global Oncology Leadership Task Force come to identify its 13 recommendations?
FCA: The task force worked through meetings with stakeholders, program directors, cancer center directors, ASCO member committees, regulatory bodies, and accreditation bodies to get a full 360-degree view. There were many times when even the definition of what academic global oncology was took a lot of back-and-forth so that all the voices were heard, and most importantly, so that we landed on a functional definition.
ASCO is truly a trailblazer in this work! Although some organizations have suggested aspects of global oncology that may be useful, ASCO brought all of it together and created a truly remarkable document that I am hopeful will be adopted and incorporated into the U.S. fellowship trainings for those who would be interested in this career path. I am truly proud of ASCO for doing this.
Are there any benchmarks for progress in accomplishing the work behind these recommendations? What will success look like?
FCA: First, the ASCO Board adopting the recommendations was a great starting point. Recognition of global oncology as an academic field and not just a volunteer activity will be a great next step. Most important will be ACGME and accreditation bodies providing global oncology training as an option in fellowship programs—this formal curriculum would go a long way toward the realization of this huge but often marginalized field. Funding agencies, including the U.S. National Cancer Institute, can also recognize this field by creating research grants that benefit programs that support academic global oncology. ASCO itself (through Conquer Cancer, the ASCO Foundation) has established a Global Oncology Young Investigator Award to support the next generation of global oncologists.
What progress have you seen in global oncology as an academic discipline over the course of your career?
FCA: So much is happening. We have seen a progression from a few scattered individuals doing uncoordinated work in some countries to more organized university-wide global programs in many of the well-known academic centers in the United States, many working through their centers for global health and a few through various creative funding mechanisms. The challenge that remains is in support for faculty: twinning programs and funding for multidisciplinary global research that is collaboratively done with the faculty of the local institutions. This field of global oncology needs more than just oncologists. It needs epidemiologists, biostatisticians, policy scientists, behavioral scientists, data analysts, etc.
What do you envision a career in global cancer medicine will look like in the future?
FCA: A career in global oncology will involve culturally competent clinical practice, education, and research, as well as skills in networking, philanthropy, and partnerships. There should be strong program management, data analysis, and leadership skills. Graduates of global oncology programs will possess the skills necessary to pursue careers in academia, industry, government, the United Nations, foundations, and non-governmental organizations. Some of the areas would also include biomedical research, health systems, health policy, development of cancer control programs, innovative technologies, and drug discoveries using the huge untapped global pool of genetic material that may be the basis for future targets for cancer cures.
As a professional organization with vast representation in membership from across the globe, ASCO is uniquely positioned to make this a reality as it speaks with one voice for many and gears its programs towards its vision of a world where cancer is prevented or cured, and every survivor is healthy. Its advocacy in the global community can extend beyond education and lifelong learning to support the creation of a discipline that cuts across the patient’s entire journey, no matter where they live, making every patient with cancer count.
Academic Global Oncology: ASCO Recommendations
ASCO’s Academic Global Oncology Leadership Task Force identified 13 recommendations to further develop global oncology as an academic discipline, which were presented to and approved by the ASCO Board of Directors in December 2018. A detailed discussion of the recommendations, including proposed global oncology competencies, will be published in JCO Global Oncology.
Global Oncology Training
- ASCO should promote awareness of global oncology concepts and inclusion of global oncology opportunities in hematology-oncology training programs.
- ASCO should partner with other oncology subspecialty societies as well as other Review Committees of the ACGME to determine if the various subspecialty training programs have flexibility to offer global oncology opportunities to their trainees.
- ASCO should outline competencies for those seeking to specialize in the field of global oncology.
- ASCO should serve as a repository for information on global oncology training opportunities and resources.
Global Oncology Research and Practice
- ASCO should be a vocal advocate for the relevance of global oncology research to understanding risk factors and cancer biology around the world, and disparities and resource-constraints in the U.S. as well as internationally.
- ASCO and Conquer Cancer should lead by example by awarding “bridge funding” opportunities for global oncology research.
- ASCO should enhance the dissemination of global oncology research.
- ASCO should promote equitable and sustainable collaborations between researchers in higher-resource and low/middle-resource settings.
Global Oncology Career Paths and Professional Development
- ASCO should serve as the professional home for the global oncology community.
- ASCO should consider recognition for leaders in global oncology.
- ASCO International programming should be leveraged to advance academic global oncology.
- ASCO should partner with other oncology societies to build sustained support for global oncology.
- ASCO should engage with the U.S. National Cancer Institute (NCI), the NCI Center for Global Health (CGH), and the Fogarty Center to further the field of global oncology.