Dec 03, 2020
In the days leading up to the first-ever Best of ASCO Africa 2020 Virtual meeting, to be held on December 11-12, organizer Kenneth D. Miller, MD, discusses the upcoming program, and shares his personal experience supporting cancer education and research in Uganda, Ethiopia, and Ghana.
How did you first become interested in cancer care in Africa?
KM: In 2004, I left community practice and transitioned to academia as a member of the faculty at the Yale Cancer Center. On a bulletin board that was overflowing with flyers of all sizes and colors, I happened to see a very small announcement about the Johnson & Johnson Global Health Scholars Program, which was sponsoring faculty to work and study in low-resource settings. This sounded quite exciting and adventuresome. I applied and was given a 4-week assignment at the Uganda Cancer Institute (UCI).
What was your first trip to Uganda like?
KM: I had heard about Uganda as the home of Idi Amin, a country with a very high HIV rate, and where children had been kidnapped and turned into child soldiers. As I flew into Entebbe Airport, I was a bit nervous.
A few hours later, I met my hosts at the UCI, Dr. Jackson Orem and Dr. Fred Okuku, who were two out of only three oncologists for a country of 30 million people. During the next month, I made rounds with them, saw patients together in their clinic, listened, learned, and shared. We taught students, gave lectures, and did a small research study on breast cancer together. I learned and understood that foreign does not mean scary, that cancer is a global problem, and that oncologists in low-resource settings are doing the best that they can in profoundly difficult situations.
Dr. Jackson Orem, Dr. Kenneth Miller, and Dr. Fred Okuku during Dr. Miller's most recent visit to Uganda.
You have described the experience as life-changing—how so?
KM: I saw the dedication and compassion that Jackson and Fred, the residents, and the nurses gave to the overwhelming number of patients with advanced cancer who came to the UCI each day, and these patients were then followed by more patients the next day. The volume of suffering was great, but each patient was treated with quiet respect. There was a ward full of little children being treated for Burkitt lymphoma accompanied by parents who had the same depth of despair and worry that I had seen in our hospitals as well. Cancer is a humbling disease and the face of suffering is international.
My trip was also life-changing because I have been fortunate to have Jackson and Fred as close friends ever since. I am so proud of what they have accomplished with their colleagues. The UCI now has a staff of 35 medical, surgical, gynecologic, and radiation oncologists and programs that are training the skilled workforce that is needed.
The Ugandan people whom I met were wonderful, loving, cheerful, bright, and spiritual. I understand better now that, globally, we have more in common than we are different.
Medically, I saw more advanced cancer than I had ever seen and it was a reminder of how much we need to do in order to cure people with cancer around the world. Undoubtedly there are important clues in Africa and elsewhere that can improve cancer treatment everywhere. In the U.S. we have health education in schools, campaigns to promote public awareness, routine physical exams, preventative health care, mammograms, CT scans, MRIs, PET scans, and advanced labs testing. In many African countries, patients present with very advanced cancer and the diagnosis and treatment plan are largely clinical. I admire these oncologists’ experience and judgment.
How have you been involved with the program at the UCI since that first visit?
KM: I have been back to the UCI several more times since my first visit. I helped to ship Mammovans from the Yale Cancer Center and Dana-Farber Cancer Institute to the UCI, where they have been primarily helpful in promoting breast cancer awareness, rather than in direct care.
I am very thankful to ASCO and to Doug Pyle, ASCO’s vice president of International Affairs, and his team for helping me to grow as a member. As a part of ASCO’s International Cancer Corps and as faculty for ASCO Cancer Control in Primary Care courses, I went with an ASCO team to two Ethiopian cities to teach medical students about cancer. I also made a site visit to a hospital in Ghana to see how ASCO could help them build their training program. I am very excited to help bring ASCO volunteers to the UCI and perhaps later to Ghana when the pandemic is over!
Several years ago, my ASCO friend Dr. Miklos Simon and I volunteered in Ethiopia together and then co-edited the textbook Global Perspectives on Cancer: Incidence, Care, and Experience (Prager Press). We are thankful to then ASCO president Dr. Sandra M. Swain and to so many international ASCO members and oncology trainees for participating in writing this textbook.
What prompted you to produce the upcoming—and very first—Best of ASCO Africa 2020 Virtual meeting?
KM: I personally have enjoyed and valued attending the ASCO Annual Meeting and Best of ASCO meetings over the years. The 2-day Best of ASCO meetings have been really helpful to me in keeping up with the progress in our field. I have wanted to make the Best of ASCO available to providers in countries in Africa who have not had access to this resource. A virtual Best of ASCO meeting during the COVID-19 pandemic seemed like a great way to start.
Best of ASCO Africa 2020 Virtual is a meeting for African oncologists to see and hear the very best of what was presented and shared at the ASCO20 Virtual Scientific Program and Virtual Education Program this year. Oncology nurses, pharmacists, social workers, and other professionals are also welcome to participate. A Certificate of Participation will be available through the website after the conference.
What will the meeting cover?
KM: This 2-day virtual meeting, being held on December 11-12, will feature the most important presentations from ASCO20 in the following areas of oncology: breast, gynecologic, lung, gastrointestinal, and genitourinary cancers, leukemia, lymphoma, sarcoma, and rare tumors.
A special plenary session on supportive oncology care will take place on the second day, December 12, presented by the City of Hope Cancer Center faculty and colleagues in Africa. Presentations will include psycho-oncology, pain management and palliative care, nutrition, exercise, and cancer survivorship.
Who is involved with you in this effort?
KM: Best of ASCO Africa 2020 Virtual is a collaboration between Living Well Beyond Cancer (a not-for-profit group promoting cancer survivorship in Africa), the UCI, the African Organization for Research and Teaching in Cancer (AORTIC), and the Oncology Nursing Society (ONS). We also are thankful for the participation of so many African oncologists, oncology nurses, and patients with cancer as well.
Please tell us about the concurrent nursing seminar.
KM: ONS is cohosting a 1-day meeting for African oncology nurses on December 12 to discuss the challenges in oncology nursing care in Africa. Oncology nurses are also invited to participate in the plenary session on supportive care as well as the Best of ASCO presentations.
Dr. Miller is a medical oncologist and hematologist in Baltimore, MD, and has been practicing for almost 30 years. He served as the founding director of the Yale Cancer Center's Cancer Survivorship Program and then as the director of the Perini Family LiveStrong Cancer Survivorship Program at the Dana-Farber Cancer Institute. Dr. Miller has been a volunteer in ASCO's International Cancer Corps program for many years. Disclosure.