Sep 18, 2019
ASCO develops recommendations, programs to establish global oncology as an academic discipline
By Carson Rolleri, ASCO Communications
Cancer is a leading cause of death worldwide. Globally, there are between 2.6 and 4.3 million deaths from cancer each year that could be avoided with effective prevention and treatment, and low- and middle-income countries (LMICs) account for the majority (70% to 80%) of this avoidable cancer mortality.1 Further, 60% of the world’s total new cancer cases are diagnosed in low- and middle-income countries.2
Impassioned early-career medical professionals seek to create a world where the geographic location of a patient with cancer does not determine the disease’s outcome. In an ASCO In-Training Exam survey of oncology trainees, more than half of respondents (57.1%) would choose to have an in-country global health experience during their fellowship if such an opportunity was offered.
“When I made the choice to specialize in hematology and oncology, I wanted to make sure that my commitment to caring for these underserved patients, which I had found so rewarding and meaningful, didn’t go by the wayside,” said Ami Siddharth Bhatt, MD, PhD, a member of ASCO’s Academic Global Oncology Leadership Task Force and Journal of Global Oncology Editorial Board. “Learning that the majority of patients with cancer are overseas and that the international investment in the care of patients with cancer is largely focused on high-income countries, I decided that I would try to work with others to find creative solutions to improve care for all.”
On the whole, global oncology is a relatively new and informal field, relying heavily on volunteers’ time, effort, and ability to manage multiple priorities. There is also a lack of dedicated resources, support, and funding for those who are looking to pursue global oncology as a career focus, even after their training.
“A key barrier is for global oncology to be recognized as a formal field, with respected academic and research components, within a comprehensive cancer center environment,” said Julie Gralow, MD, FACP, FASCO, chair of the Academic Global Oncology Leadership Task Force and 2018 ASCO Humanitarian Award recipient. “A barrier for a clinician involved in global oncology is being physically away from clinic for periods of time and managing how to provide seamless care for clinic patients.”
Despite demonstrated interest in pursuing global oncology as an academic discipline, many oncology trainees feel that this opportunity is not offered or available to them: in the same ASCO survey, 82.3% of respondents were unaware of in-country global health experiences in their fellowship program.
“I have come across many barriers in pursuing this career interest that range from a lack of awareness of cancer and education about cancer in many lower income, lower resource settings, all the way to the lack of financial support to make a formal career in global oncology,” said Dr. Bhatt. “If we don’t support our trainees to develop careers where they can dedicate their effort, intellect, and passion to this pressing problem, we are unlikely to make the advances we need to in order to move the needle and improve cancer care for all.”
Recognizing the demand for more formalized programming, funding, and support for interested professionals to rigorously pursue this aspect of cancer care, ASCO has created a number of programs and initiatives to bring this budding academic discipline to fruition.
“ASCO is ideally positioned to make a difference in this space,” said Patrick J. Loehrer, MD, FASCO, a member of the Academic Global Oncology Leadership Task Force. “The Society has a large international member base, a strong educational program, and a clear commitment to research. It’s our job to provide opportunities for future medical professionals to pursue their passions and model servant leadership across the globe.”
ASCO’s Academic Global Oncology Task Force
In 2014, the ASCO Board of Directors created a Global Oncology Leadership Task Force to identify how ASCO could continue to expand its international efforts. In its 2016 recommendations to the Board, the task force articulated the Society’s global strategy, built upon three pillars: innovative global oncology research, quality improvement, and professional development.
“[ASCO] has established global oncology as one of the Society’s priorities, aiming to collaboratively address disparities and differences in cancer prevention, care, research, education, and the disease’s social and human impact, improving results around the world,” said Gilberto de Lima Lopes Jr., MD, MBA, FAMS, FASCO, editor in chief of the Journal of Global Oncology and a member of the Academic Global Oncology Task Force. “We are supporting a full spectrum of activities ranging from epidemiology to implementation science to public health policy.”
The Global Oncology Leadership Task Force’s recommendations included a suggestion that ASCO “serve a role in transitioning global oncology from an informal field of largely voluntary activity to a formal field with a strong research component and recognized value to oncology training and the practice of oncology.” Thus, the Academic Global Oncology Task Force was formed, charged with identifying current barriers and recommendations on how to overcome them.
“We were faced with the question, ‘How do we help with the training for someone with an interest in global oncology facing specific requirements for credentialing and board certification, such as continuity clinics and sites of practice, that were not designed for time and work done remotely?’” said Dr. Gralow. “Once they become junior faculty, how can we help them have opportunities within their practice and research, so that they can specialize in global oncology in a way that’s going to support their productivity and promotion? Also, how do we help people already engaged in this field with their own professional development?”
The members of the task force met regularly to answer these questions, sharing their own experiences, identifying barriers, conducting research, and debunking misconceptions about training requirements.
“[The task force] spent a fair amount of time working with the Accreditation Council for Graduate Medical Education (ACGME), helping us to better understand their regulations for training programs, and help them understand why this was an important field, and how their own rules and regulations could be interpreted to better support trainees, particularly oncology fellows and certainly global oncology careers,” said Lawrence N. Shulman, MD, FASCO, a member of the Academic Global Oncology Task Force and 2019 ASCO Humanitarian Award recipient.
The task force also hosted a Stakeholders Summit to draw from the perspectives of other disciplines. The summit included leaders in global health, pediatrics, infectious diseases, and other medical subspecialties, as well as representatives from global health organizations such as the National Cancer Institute (NCI) Center for Global Health (CGH), the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO). The summit also included the viewpoints of cancer center directors and training program directors to help determine the best way to establish global oncology as a formal, respected field with valuable training and professional development resources.
The resulting recommendations, which were presented to the ASCO Board of Directors in December 2018, included a framework of competencies identified by the task force. This framework outlines the necessary concepts a trained and certified oncology professional would need to understand and practice as a specialist in global oncology, grouped into two categories: essential global health competencies that can be obtained through participation in a standard global health academic program, and oncology-specific competencies at the global level. The recommendations included a clarification that trainees did not have to receive onsite mentoring, but could receive remote mentoring from a board-certified oncologist, as defined by the requirements set forth by the ACGME. (Read a summary of the recommendations below.)
Global Oncology at ASCO: Mentoring and Research Support
Another product of the Global Oncology Leadership Task Force’s recommendations was the Global Oncology Young Investigator Award (GO YIA). First awarded in 2018, the GO YIA supports early-career researchers in three different capacities: investigators in low-resource settings on a research question that can be applied both to their community and high-resource settings; investigators in high-resource settings on issues in low-resource settings; and collaborations between investigators in low- and high-resource settings on an aspect of cancer care that affects both communities. As of 2019, Conquer Cancer, the ASCO Foundation, has awarded more than a dozen early-career investigators internationally with funding totaling more than $600,000.
Additionally, ASCO offers several mentoring programs, both short and long term, that are dedicated to supporting researchers from, or interested in work in, LMICs.
For investigators from LMICs, ASCO offers the International Development and Education Award (IDEA). ASCO’s oldest international program, IDEA pairs a mentee oncologist from an LMIC with a mentor from a high-income country to help support and expand the mentee’s learning and professional development. Support from the award enables the mentee to attend the ASCO Annual Meeting and visit the mentor’s institution.
“The IDEA program gave me the opportunity to be in contact with different resource environments all at the same time,” said Maria Teresa Bourlon, MD, MS, a 2013 IDEA recipient, member of the Academic Global Oncology Leadership Task Force, and member of the IDEA Working Group. “I come from a middle-income country (Mexico), and the IDEA allowed me to be immersed for the first time in a comprehensive cancer center in the United States. But in addition, the IDEA program gave me the opportunity to interact with other awarded fellows from middle- to low-income nations in different regions of the world. Some of them faced the same challenges I had at home, but others had even more limited health care resources, and the provision of cancer care for them was even more challenging. The IDEA experience allowed me to recognize the different settings and understand that despite environments being so diverse, we were all brought together by one objective: to improve cancer outcomes.”
The success of the IDEA program led ASCO to launch the Virtual Mentors program, which also pairs a mentee oncologist with a mentor; in this case, the year-long partnership between mentor and mentee is completely virtual.
First awarded in 2010, the Long-term International Fellowship (LIFe) provides early-career oncologists in LMICs the support and resources needed to advance their training by deepening their relationship with a mentor in the United States, Canada, or European Union. During the 1-year fellowship, the recipients receive valuable training and experience, which they use to effect change in cancer care in their home country.
Launched in 2015, the Journal of Global Oncology (JGO) is an online-only, open access journal showcasing research that details challenges faced by practitioners in LMICs throughout the cancer care continuum. Through the ASCO Journals Editorial Fellowship, early-career oncologists can shadow seasoned editors for JGO and other ASCO journals, develop reviewing skills, and learn more about the publication process.
ASCO offered its first global oncology mentoring hours at the 2019 ASCO Annual Meeting, designed to facilitate conversations about pursuing global oncology as a career choice. Volunteers from the JGO Editorial Board answered questions and imparted advice as mentees guided these interactions. The mentoring hours will be available at the 2020 ASCO Annual Meeting.
Moving Forward for a Better World
While there is still work to be done to establish global oncology as a structured academic discipline, ASCO is committed to supporting early-career professionals and their interest in building a better world. The staff and volunteers of ASCO are planning to implement additional recommendations of the task force in order to advance the goal of formalizing the field of global oncology.
“I have junior faculty members who just completed their fellowships and are truly dedicated specialists in global cancer medicine,” said Dr. Shulman. “They’re working in Rwanda and Botswana primarily, but this is really the first generation of U.S.-trained, high-level faculty who are committed to this field. ASCO helped us understand what’s involved in pursuing an academic career through the task force, and the best ways we can support their careers.”
“Overall, we’ve made substantial progress in the past 10 years in developing global oncology as a discipline,” said Dr. Bhatt. “But clearly, this is just the beginning.”
- Knaul FM, Arreola-Ornelas H, Rodriguez NM, et al. J Glob Oncol. 2018 Jul;4:1-12.
- International Agency for Research on Cancer. World Cancer Report 2014. Accessed June 26, 2019.
Academic Global Oncology Leadership Task Force Recommendations
ASCO’s Academic Global Oncology Leadership Task Force identified several necessary action items to further develop global oncology as an academic discipline. The final 13 recommendations 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 ASCO’s Journal of 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.