Global Oncology: Putting Our Vision of an Equitable World Into Action

May 14, 2021

  • Children in Nigeria with GO Comic Book

By Ami S. Bhatt, MD, PhD, and Franklin W. Huang, MD, PhD

We started our work around 2012, a time when global oncology was still in its beginnings as a focus area in global health. At that time, most people considered cancer as a “first-world disease” and didn’t recognize that an overwhelming majority of the cancer burden is in low- and middle-income countries. Looking at the data, we recognized the immense need for cancer care and research in the hardest-hit countries, which lacked the resources to care for patients with cancer. 
 
We looked around and did not see many career paths in global cancer care, especially for medical trainees. As such, we were inspired to build a pathway for others like us who shared the goal of extending all of the advances we provided to our patients with cancer here in the United States to those with cancer in lower-resourced countries. We were supported in our efforts by leaders and colleagues like Edward J. Benz Jr., MD; Paul Farmer, MD, PhD; Lawrence N. Shulman, MD; Felicia Knaul, PhD; Amy Judd, MS; Richard Marlink, MD; and Bruce A. Chabner, MD. 

Formalizing Our Efforts Under the Global Oncology Nonprofit Organization

We began by building a community at Harvard Medical School of trainees and faculty who wanted to work and collaborate in projects in global oncology as well as mentoring the next generation of global oncology leaders. This eventually grew into the launch of our nonprofit organization Global Oncology (GO) in 2013. During the early years of Global Oncology, we launched a global cancer-focused symposium, created the Global Oncology Map (to enable easy connections between global cancer activists, researchers, and care providers) and developed low-literacy, graphical Cancer Education Materials that help patients understand the side effects of chemotherapy and radiation therapy. These projects were largely staffed and fueled by passionate volunteers from around the world and from all walks of life. 
 
While we originally started as a Boston-based organization (during our time at Harvard), we moved our headquarters to the San Francisco Bay Area in January 2020, which was marked by a big kickoff celebration atop the iconic San Francisco Salesforce Tower. 
 
We continue to be a predominantly volunteer-powered organization, but are delighted to have awesome staff and interns who help us maintain our momentum! We’re always looking for more volunteers, and we are keen to engage the international oncology community in our mission to make cancer care, education, and research available equitably all over the world. Our potential to scale our efforts is huge. If every ASCO member volunteered 30 minutes of their time per year or made a modest donation to our cause, we could easily expand our impact 10-fold. 
 
Recently, we have been working on three major projects, conducting campaigns in Nigeria and Belize and building a portfolio of educational materials on our website. 
 
We have been spearheading The Cervical Cancer-Free Nigeria campaign, a grassroots initiative to eradicate cervical cancer in Nigeria by educating the public about how to prevent cervical cancer through the HPV vaccine. The campaign leverages innovative educational tools such as the GO Comic Book, a 21-page, full-color comic book that teaches Nigerian adolescents and their families about the causes of cancer, the safety and efficacy of vaccines, and how the HPV vaccine prevents cervical cancer. We’ve also recruited an array of distinguished Nigerian leaders to serve as campaign ambassadors, including Otunba Abimbola Ogunbanjo, president of the National Council of The Nigerian Stock Exchange; Senator Lanre Tejuoso, chair of the Legislative Initiative for Sustainable Development; and Dr. Zainab Shinkafi Bagudu, First Lady of Kebbi State and founder and CEO of Medicaid Cancer Foundation, among others. During the week of World Cancer Day, these ambassadors appeared on 10 television shows, including several on two of Nigeria’s most prominent television networks, as well as Nigeria’s first “women’s radio station”—WFM 91.7. We believe that this push to raise education and awareness is the first step to a successful national vaccination campaign. 
 
We launched Belize’s first public oncology clinic at the Karl Heusner Memorial Hospital. Our volunteers, in collaboration with Dr. Ramon Yacab, Belize’s only medical oncologist, helped found the country’s first public oncology unit and have developed treatment protocols and an integrated patient navigation program to enable Belizeans to be treated for their cancer in their own country. In the last year, since the unit opened, over 400 patients have been seen and 1,000 patient visits have been facilitated at the clinic. 
 
We have continued to develop and adapt our Cancer Education Materials. These materials outline common side effects of chemotherapy and radiation therapy, ways to ameliorate these side effects, and worrisome side effects, such as fevers or chest pain, that warrant seeking professional medical attention. These materials have been incredibly successful; they have been translated into 20 languages and are being used in over 25 countries around the world. Most recently, we translated our Cancer Education Materials booklet into Arabic, Kinyarwanda, and four local Nigerian languages (Hausa, Yoruba, Igbo, and Pidgin English). 

Our Vision for the Future: Equity as the Cornerstone of Cancer Care

We envision that all careers in oncology—ranging from research to clinically focused—will consider health equity as a priority. Whether it is thinking about how to improve access to care for people living in rural areas or determining why certain populations have a higher incidence or prevalence of cancer than others, equity is and should continue to be a cornerstone of our practice as physicians and scientists. In that way, we hope that all oncology specialists will participate in global cancer medicine in some shape or form. 
 
We also anticipate that specialists with expertise in marrying a global and equity focus with basic science, translational science, clinical trials, outcomes research, and implementation research will emerge. In so doing, careers in the global cancer medicine field will look like many of the successful career paths for oncologists and scientists in modern fields such as precision medicine and immuno-oncology. We feel that innovation in global cancer medicine will fuel advances that will benefit patients in both low- and high-income settings. 
 
We’ve seen encouraging progress in global oncology as an academic discipline over the past several years. A number of universities and cancer centers have established formal programs in global oncology, which have provided opportunities for the growing number of trainees and faculty who have become interested in the field. Funding for global oncology remains a major gap, as there have yet to emerge large donor groups in global oncology, but there have been important initiatives to support trainees such as the ASCO and Conquer Cancer Global Oncology Young Investigator Award. 
 
As oncologists, we know the pain and suffering that cancer can cause; we also know that our colleagues all over the world are keen to ensure that the level of cancer care that they provide their patients is available to the most vulnerable. Unfortunately, right now only about 5% of the world’s population can access high-quality cancer care—so we certainly have our work cut out for us.

Advice for Building Your Career in Global Oncology 

For oncology trainees and fellows interested in pursuing careers in global oncology, we recommend four things:
 

1. Find good mentors. Global oncology is a growing field, and there are a small number of academic faculty members who have substantial experience in this space. Often, faculty who participate in global oncology outreach and research efforts also have other activities that are their primary efforts. This is, in part, because funding is hard to come by, and most academics have to financially support their efforts either through research dollars, administrative service, or clinical revenue. For that reason, it may be important to have both an oncology mentor and a global health mentor. The infectious disease field, for example, has a larger number of academicians who make global health their primary effort. 

2. Recognize that global collaboration is about equal intellectual exchange. We have at least as much to learn from our global colleagues as they have to learn from us. Approaching collaborations with a sense of humility, compassion, and equity is critical. It is important that we understand the social, cultural, and political contexts in which we work, and it is critically important that we do a lot more listening than talking when we engage in global collaborations. One of our mentors, Dr. Marlink, head of the Rutgers Global Health Institute, taught us an important lesson when we got started in global health. He told us that the most important question to ask when you start a new global collaboration is simply, “How can we help?” Don’t assume that you know what others need: ask and listen early and often. 

3. Develop a focused skill set. The way that we can be most effective in contributing to improved health outcomes in the cancer realm is by becoming very, very good at a particular skill. For example, if you are interested in population health, you could learn how to carry out a rigorous epidemiological study that will enable you to contribute in a specific, expert way. If you are a genomics expert, you can contribute by becoming the best genomics researcher you possibly can and then by helping to develop and support local, in-country researchers to develop these skills as well. 

4. Plan for how your interventions and efforts will be sustainable. We need to move toward a goal of building local capacity to improve care and carry forward research and development efforts in the cancer space. In particular, we think it is important to avoid another wave of colonization in which researchers go overseas, pick up samples, come back to their high-income country, and write fancy, high-profile papers. These types of studies, while informative, often do little to advance the science, medicine, and scholarship of our global community.

Learn more, donate, and get involved with the work of Global Oncology and follow on Twitter. 

Dr. Bhatt is an associate professor of medicine and genetics and director for global oncology in the Center for Innovation in Global Health at Stanford University. In addition to her global oncology-related work, Dr. Bhatt is the principal investigator of a research laboratory that studies the relationship between the microbiome and morbidity/mortality in patients with cancer. With Dr. Huang, she is the co-founder and co-director of Global Oncology, Inc.

Dr. Huang is an assistant professor in the Department of Medicine at the University of California San Francisco where he runs a research laboratory focused on cancer disparities. Dr. Huang is working to improve cancer treatment in underserved and understudied populations. His research focuses on prostate cancer and on the role of non-coding mutations in cancer. With Dr. Bhatt, he is the co-founder and co-director of Global Oncology, Inc. Follow him on Twitter. 

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