International Affairs

International Affairs

George W. Sledge, MD, FASCO

Sep 03, 2010

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.”



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Nise Hitomi Yamaguchi, MD, PhD

Sep, 03 2010 9:35 PM

I am sitting at the Dulles Airport in Washington after two days of intense discussion about the topics Dr Sledge mentioned. What I want to share is the fulfillment of my expectations when I first came to the ASCO headquarters in Alexandria and we have had a flavor of the strong organization ASCO has built over the years. The commitment of each member of the committee to bring the concerns and needs is just surpassed by the standing efforts of the ASCO staff under the guidance of Doug and Donna and the decisions made will have an impact on the whole cancer Arena. Dr Cazap the Board liaison to the IAC has asked for support to put the Non- Communicable Diseases including Cancer , at the priority of the WHO next year general Assembly. We will have a task effort to bring more fellows to participate in the Society and to foster Leadership in Cancer Care. To participate together is inspiring and gives us the t oohs to accomplish our work better! I feel humbled to learn with such wonderful partners the next steps to a better panorama in cancer prevention and to diminish inequalities in cancer care.

Tanja Cufer, MD, PhD

Sep, 05 2010 7:15 AM

I have just returned to my home country Slovenia, still having a very fresh memories to the last few days of our IAC meeting. Having a privilage working for IAC Committee for the fourth year I can not more than agree with all said by the current ASCO president dr. George Sledge. For a fruitfull work of AIC a continious and efficient connection with all other ASCO committees and ASCO officers is of upmost importance. As a chair elect of IAC I was really pleased to see the ASCO president and the laisons of many other committtes to attend our meeting and to give us an opportunitiy for a shared discussion on most important global cancer control issues, such ar prevention, research, survivorship and on educational activities. Such a close collaboration gives me a confidence that we can improve some important global cancer control issues and strategies in a near future. Many thanks to all of you. Tanja

Lobna M. Sedky, MD

Sep, 08 2010 8:48 AM

I am an asco member from the MENA region (EGYPT), and pioneer awardee of 2002 IDEA award. Over 20 years I have been observing a great turn in the ASCO path towards expanding it's global partnership. I would like to convey my greetings to the new chairman of the IAC and encourage very much his dream of International iLEAD program guided by ASCO but outside the USA. With especial emphasis to mid-low income countries & nations whose cancer behaviour as well as needs of cancer patient care may differ widely from the developped countries because of cultural, ethnic and may be genetic descripencies.
There is no doubt that on call from the IAC, many expertise oncologists from the developing world will volunteer happily in the proposed strategies...Finally, I am proud of my ASCO membership but I agree that ASCO listening from outside USA is very HARD.
Prof Dr Lobna Sedky,memberMENA-NCCN breast cancersteering committee & EASO scientific committee.Cairo, EGYPT

Surendra Gauchan, MD

Sep, 09 2010 6:07 AM

I m a resident from Department of Oncology at Bir Hospital, Nepal and have my own perception on IDEA. IDEA is an honor to oncologist from the developing countries. It's a celebration and a great experience to share and bring back valuable lessons and much more of benefits. Well i believe the IDEA should be awarded to residents in filed of Oncology where the practices and resources are frustrating. IDEA can aspire and inspire high morale and commit young starters in this discipline

Edward Paul Balaban, DO, FACP, FASCO

Sep, 17 2010 6:07 AM

Dr. Sledge (George) I agree with your comments. I have had the opportunity to sit in on an IAC meeting and have been interested in that comitttee's efforts for quite some time. I had tried over the past few years (as a memeber of the prior named Health Services Commitee and charged in figuring out ways to dessiminate ASCO guidelies) to sort through just how ASCO guidelines could be implemennted internationally. It will be difficult and unfortunately almost impossible in some cases depending on available resources and issues such as governmental regulations, etc. Nevertheless it is absolutley necessary to be reminded that our focus and attention as a society goes far beyond the North American continent. I continue like you to have a deep interest in this whole issue. Good for you to log about this. Thanks

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