By ASCO Chief Medical Officer Julie R. Gralow, MD, FACP, FASCO
I am very pleased to join ASCO in my new role as chief medical officer (CMO), and look forward to advancing ASCO’s global mission in collaboration with our international members. My relationship with ASCO began in 1995, when I received an ASCO Career Development Award that ignited my career in oncology. For the past 25 years, ASCO has provided me with many opportunities for learning and growth, as it has for many other oncology professionals. By advancing our field’s knowledge, ASCO has made an enormous difference in the care of people with cancer, including my own patients. I have tremendous admiration for the organization and am honored to contribute to it as CMO.
My initial exposure to global oncology was in the late 1990s, when asked to serve as consultant to a USAID-sponsored Ukraine Breast Cancer Assistant Project coordinated by PATH, a Seattle-based global health nonprofit. I had no formal training in global health, but did have a passion for enhancing cancer care, based on evidence and tailored to available and attainable resources and infrastructure, for patients around the globe. Our initial evaluation revealed that Ukrainian physicians felt their patients would not tolerate “Western” chemotherapy regimens, so standard practice was to deliver lower drug doses than those proven optimal in clinical trials. This led to the development of a preoperative chemotherapy trial in collaboration with oncologists in Odessa, introducing the team to coordinated multidisciplinary care and clinical trials standards. The trial evaluated the feasibility, efficacy, and safety of delivering regimens developed in high-resource settings with the standard supportive care medications and care delivery infrastructure available in Ukraine. The trial was a success—Ukrainian women tolerated the therapy, tumors responded—and my colleagues in Odessa helped lead the way in conducting evidence-based clinical research in Ukraine.
Another project addressed the lack of open dialogue, readily available information, and provider-patient communication regarding cancer in Ukraine. On my first trip to Kyiv, a journalist asked me to explain “the American Project,” without using the words breast or cancer. The Ukraine project facilitated dialogue on cancer diagnosis and treatment between patients and providers, which led to the formation of the first breast cancer support group in the country, the Amazonkas. In 2001, the Amazonkas held an unprecedented public March for Life and Hope in Kyiv to promote breast cancer awareness “for their daughters.”
Impressed by the strong will of these Ukrainian women and the movement that had been ignited, I created the Women’s Empowerment Cancer Advocacy Network (WE CAN) to support the patient advocates after conclusion of the Ukraine project and to connect advocates across the region. WE CAN held an initial Eastern Europe/Central Asia breast cancer education, outreach, and advocacy summit in Lithuania in 2003 in conjunction with Nedelsk, a Lithuanian breast cancer organization. WE CAN has subsequently coordinated eight additional WE CAN summits in Eastern Europe/Central Asia, in coordination with local cancer organizations, bringing together patient advocates from over 12 countries, and connecting patient advocates with medical professionals and policymakers as partners in improving cancer outcomes in their region.
My experience with cancer in sub-Saharan Africa began with the partnership between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute (UCI), formed in 2004 as a collaboration in cancer training, research, and clinical care with an initial focus on infection-related cancers. Because breast cancer is a leading cause of cancer-related mortality in Uganda, I became involved early on. The UCI-Fred Hutch partnership led to the first comprehensive cancer center in sub-Saharan Africa jointly built by U.S. and African cancer institutions, with support from USAID, which opened 2015. With funding from the African Development Bank, the UCI established the East Africa Center of Excellence in Oncology, which launched an adult hematology-oncology fellowship training program, with a formal curriculum and core competencies, in 2018. I served on the fellowship advisory committee and participated in lectures, tumor boards, and examinations with the highly motivated fellows. On an early trip to Uganda, I met patients with breast cancer who were members of the Uganda Women’s Cancer Support Organization, an impressive organization with a broad network providing information and support to patients with newly diagnosed cancers. We discussed a possible WE CAN collaboration in the region, and WE CAN East Africa was initiated in Uganda in 2013, bringing together breast and cervical cancer patient advocates from 12 countries, and continuing to connect regularly through five subsequent regional conferences in East and Southern Africa.
The Role of ASCO International
ASCO International has a wide array of cancer education, quality care delivery, and research programs, with a variety of volunteer opportunities. I became involved in ASCO’s global programs as a member of the International Affairs Committee, and have since volunteered for a wide range of ASCO International projects. I’ve developed course content and served as faculty for ASCO International courses, including the Cancer Control in Primary Care course, the ASCO International Clinical Research Course, and the ASCO Multidisciplinary Cancer Management Course. I’ve participated in ASCO-sponsored and -endorsed meetings around the globe, including the recent 2020 Best of ASCO Africa.
I’ve particularly enjoyed participating in professional development opportunities for young oncologists in low- and middle-income countries. I’ve mentored four outstanding young global leaders through the ASCO International Development and Education Award (IDEA) program, and have been proud to continue to support their career development and watch them emerge as leaders in their countries.
I served on the ASCO Global Oncology Leadership Task Force, and more recently chaired the ASCO Academic Global Oncology Task Force, helping provide guidance to ASCO in developing its global strategy. Until becoming ASCO’s CMO earlier this year, I co-chaired the ASCO Resource-Stratified Guidelines Advisory Group, which has to date issued evidence-based, resource-stratified guidelines on cervical cancer, palliative care, and colorectal cancer.
Cancer is now the second leading cause of death globally, accounting for about 10 million deaths annually, approximately 70% of which occur in low- and middle-income countries. Data from the International Agency on Research in Cancer (IARC) show that 88% of cancer diagnoses and 94% of cancer deaths occurred outside of the U.S. in 2020.1 We can’t begin to make a dent in reducing this cancer burden unless we address cancer from a global perspective.
ASCO is committed to supporting all our members, over one-third of whom live outside of the U.S., representing 150 countries. One of the four pillars of ASCO’s current 5-year strategic plan is to make a global impact. We aim to do this by supporting the global oncology community through education, professional development, quality tools, and research. ASCO International has a large and expanding portfolio of programs and networks, including the new Asia Pacific Regional Council and soon-to-launch Latin American Regional Council.
ASCO has undertaken recent initiatives designed to enhance its impact globally and expand its international efforts. JCO Global Oncology (JCO GO) launched in 2015 as an online-only, open-access journal focused on cancer care, research, and care delivery issues unique to countries and settings with limited health care resources. An ASCO Global Oncology Leadership Task Force made recommendations to the ASCO Board of Directors in 2016, outlining a global strategy for ASCO.2 The report led to the inclusion of a Global Health Track at the ASCO Annual Meeting beginning in 2017, acceleration since 2016 of the Quality Oncology Practice Initiative (QOPI) Certification Program internationally, the launch of the Global Oncology Young Investigator Award (GO YIA) in 2018, and the launch of the ASCO Breakthrough meeting in 2019.
More recently, an ASCO Academic Global Oncology Task Force developed recommendations for formalizing global oncology as a recognized academic field, supporting the training of experts to think critically about innovative solutions to global cancer care, and providing them with the tools and support to conduct critical research and implement change.3 In my new role as CMO I’ll be working closely with our ASCO staff and volunteers on implementing those recommendations and creating opportunities and tools supporting all of our members in addressing the global oncology problem.
Success in battling the global cancer burden will require collaboration across all sectors of our global health and oncology communities and strong alliances with key stakeholders. A proverb I’ve heard often in Africa is, "If you want to go fast, go alone; if you want to go far, go together." I want to go far in eliminating the equity divide in access to cancer care—and that means strengthening our partnerships and relationships and working on this together. The issue of how we can better partner with other cancer societies and organizations is a high priority for me in my new position of CMO.
I’d like to encourage both U.S.-based and international ASCO members to help ASCO with our strategic goal of making a global impact. ASCO provides many opportunities for its members to participate in international education, research, networking, and clinical experiences. If you have an interest in participating in any of these programs, reach out to firstname.lastname@example.org! We’d like to hear from you!
- International Agency for Rearch on Cancer. All Cancers Fact Sheet. December 2020.
- Hortobagyi GN, Pyle D, Cazap EL, et al. American Society of Clinical Oncology's Global Oncology Leadership Task Force: Findings and Actions. JCO Glob Oncol. 2018;4:1-8.
- Gralow JR, Asirwa FC, Bhatt AS, et al. Recommendations from the American Society of Clinical Oncology (ASCO) Academic Global Oncology Task Force. JCO Glob Oncol. 2020;6:1666-73.