By Dorothy C. Lombe, MD
Sitting at this year’s ASCO Annual Meeting Opening Session on June 2, having been a recipient of the Conquer Cancer Foundation International Development and Education Award (IDEA) in 2016 and now the Long-term International Fellowship (LIFe), I was overcome with gratitude. Gratitude not only for myself but also on behalf of the people where I come from and whose lives are touched by the work we do. Listening to each of the speakers reaffirmed a mission that I hold close to my heart, and that is to conquer cancer.
At first glance conquering cancer seems like an impossible task, especially in my homeland of Zambia where a large proportion of patients present with late-stage disease and resources are disproportionate to the burden. However, conquering cancer for me as an oncologist practising in a lower middle-income country is as much a loaded statement as it is a loaded challenge.
Cancer brings with it fear, pain, and sometimes death. Each of those things represents a separate battle that we have to fight with cancer; some can be won and some cannot, for now. I feel that I conquer cancer in my environment because I do things that don’t need so many resources as they have in high-income countries, yet they still make a difference for my patients. I am able to eliminate the fear of cancer by counselling my patients and their families. I am able to prevent a painful death by prescribing appropriate analgesic medications. I address as many symptoms as I can. I am able to rationally discuss options with my patient that are contextual and culturally appropriate. Even more important, I am able to teach others to do the same and strive for more.
The recent trend to stratify guidelines according to available resources is a positive one. It drives us not to accept substandard care, as stratification can sometimes be misunderstood to represent, but rather to strive to a place of excellence and ignite a curiosity that could have otherwise be subdued. Implementation science is a true science and the recognition that evidence and practices in one part of the world may not be a fit in another, not just at material level but also at a human and cultural level, gives me great courage to be part of the bid to conquer cancer. Even resource limitation is so different. With the recent global efforts to improve cancer management, one lower-income country may have excellent radiotherapy but inadequate surgery or vice versa, and the ability to recognise these differences is what will help us reach success. One size does not fit all for sure. Adopting cultural structures when implementing international guidelines may assist, rather than trying to reteach a culture.
On May 19 this year, World Health Organisation director-general Dr. Tedros Adhanom Ghebreyesus sent out a call for action against cervical cancer, which affects over half a million women and kills a quarter of a million each year. A disease that is not only preventable but also treatable when caught in time. In my home country that statistic fits snugly in proportion. I know many efforts have been put in place to escalate prevention, both primary and secondary, but I know that we will still see the horrors of this disease through a generation of women. Advanced cervical cancer is a disease that robs women in my country of their dignity, and for most of them, dignity is all they have. It robs families of their solid rocks. A common saying is that when a woman dies, a family breaks. Though African women are vulnerable by certain standards, they are paradoxically the cornerstones of many communities. That is why I carry this collective gratitude on behalf of my countrywomen that I have received this generous grant from the Conquer Cancer Foundation to enhance the way we treat our advanced cervical cancer cases. In a couple of months, I will be able to hold more women’s hands and say yes where I had previously said no.
When Dr. Bruce E. Johnson spoke during his presidential address about precision medicine, it resonated with me so much. I thought about the many women who seemingly present with curable cervical cancer at an appropriate stage, undergo appropriate treatment, and yet succumb a year later. There is something going on there. Precision medicine has a place in cervical cancer, especially in Sub-Saharan Africa where we see a multitude of cases. Spending time with a world-class mentor and gaining access to high-technology laboratories whilst improving my research skills through the LIFe is what will see people like me winning more battles against cervical cancer with our brave women of Sub-Saharan Africa.
Dr. Lombe is a clinical and radiation oncologist at the Cancer Diseases Hospital in Zambia. During her Long-term International Fellowship year, she is training at BC Cancer Agency, Canada, under the mentorship of Dr. Juanita Crook. She is a member of ASCO’s Resource-Stratified Guideline Advisory Group. Follow her on Twitter @lombe_dorothy.