The Ripple Effect: Working to Close the Care Gap for People Living With Cancer Around the World

The Ripple Effect: Working to Close the Care Gap for People Living With Cancer Around the World

ASCO Commentary

Feb 02, 2023

By ASCO Chief Medical Officer Julie R. Gralow, MD, FACP, FASCO

As ASCO becomes an increasingly global organization with one-third of our members representing more than 160 countries outside the U.S., we are continually finding new ways to integrate our international members’ knowledge and experience to better meet their professional needs. ASCO has long understood and appreciated that it is our members who are best able to ascertain and address the needs of oncology professionals, other cancer care providers, and patients with cancer in their communities. Only by understanding, through their active engagement, what is needed to provide high-quality care, can we collectively work to address those needs.

On this World Cancer Day, we want to share one of the ways we’re expanding our engagement of members in different regions of the world, "uniting our voices and taking action": our regional councils. These councils are helping us reach members of the global oncology community so they can access and adapt the research, educational, and quality tools they need to deliver the best care possible. To date, ASCO has launched three regional councils: the Asia Pacific Regional Council, the Latin America Regional Council, and the Sub-Saharan Africa Regional Council.

Asia Pacific

The first council to be stood up was the Asia Pacific Regional Council in 2019. Council members quickly identified career development for young oncologists as a key priority to foster the next generation of oncology leaders. To help with this, the council adapted ASCO’s long-running Leadership Development Program for the Asia Pacific region.

To best meet the needs of leaders in the region, it was important to listen to how leaders develop and understand their unique challenges and opportunities. Sixteen established leaders from 11 Asian countries representing ASCO members and non-members were invited to share their experiences during an informational interview. They shared their career pathways, views on leadership, perceived needs for leadership training for young oncologists in Asia, and views on their leadership culture and potential differences from the West. One unique feature of the region is that there are many cultural groups represented including “Anglo” in Australia and New Zealand, “Confucian Asian” in China, and “Southern Asian” in Thailand (as defined by the GLOBE Study on cultural leadership). Many of those interviewed relayed the hierarchical nature of their work environments and an importance to respect these boundaries. These findings helped craft the Leadership Development Program – Asia Pacific (LDP-AP) under the direction of the council and subject matter experts Dr. Frank D. Ferris and Dr. Shannon Moore.

In 2021 the inaugural LDP-AP cohort began a yearlong program to develop leadership skills in self-awareness, communication, team management, conflict resolution, strategic planning, and presentation skills. These are skills that successful leaders exhibit. “Leadership is relationship—it is all about who we connect with and how we build those relationships,” said Dr. Ferris.

Over the course of their program, the LDP-AP class explored the practices of exemplary leaders and what behaviors result in good leadership. They also worked on several group projects under the direction of the Asia Pacific Regional Council, including examining barriers and opportunities to collaborative clinical research, models for sustainable cancer registries, and strategies to garner political will for cancer control efforts at the country level. Each small group had a mentor and coach to help guide the projects.

The second cohort has been selected, and the 2023-2024 LDP-AP year will kick off in association with the ASCO Breakthrough meeting in Yokohama, Japan, on August 1–2.

In addition to career development, the Asia Pacific Regional Council also identified disparities in quality of cancer care as another regional priority for council action. One way that the council has worked to address this priority is through ASCO’s International Cancer Corps (ICC) program, which pairs ASCO volunteers with cancer hospitals in low- and middle-income countries to enhance their oncology capacity through ASCO training and practice tools. After issuing a Request for Proposals (RFP) that attracted 16 applicants, the council selected Sarawak General Hospital in Sarawak, Borneo, Malaysia, in 2020 to be an ASCO ICC site. The ICC provides education and training to clinical staff based on the needs of the institution in the context of improving multidisciplinary management of common cancers, integrating palliative care, and measuring and improving quality of care.

ASCO has held several training courses focused on palliative care and multidisciplinary care in Sarawak. Largely due to the COVID-19 pandemic, these trainings have been done virtually, which has had the added benefit of engaging practitioners beyond Sarawak General Hospital to include colleagues in other parts of Malaysia.

The training participants’ experiences extending to patients and colleagues have had a powerful ripple effect, leading to improved care in the near term and greater commitment for improvements for the longer term. An initial Palliative Care eCourse offered at Sarawak General Hospital “sparked interest amongst palliative care providers from the Malaysia Ministry of Health,” said course faculty member Sharon Choo, MD, MRCP. “This has led to further meaningful developments, such as the Palliative Care Train-the-Trainer Course and a second ASCO Palliative Care eCourse.”

Both of these courses had an impact on the clinicians who participated and on the care they have provided since then. The post-course survey of the Palliative Care Train-the-Trainer Course “showed important takeaways: (1) The participants reported that they were able to provide and use the skills they learned in their daily practice; and (2) The most-reported changes were related to communication followed by assessment of pain and symptom management,” said Dr. Choo. “Many colleagues reported an increase in confidence providing palliative care.”

Results from the 2022 Palliative Care Train-the-Trainer Program post-course assessment “showed that 80% to 90% [of participants] reported an increase in their ability to present information effectively,” said Dr. Choo. “It also demonstrated an improved ability to facilitate discussion and an increase in providing effective feedback. This course has successfully enabled Malaysian palliative care providers to be effective facilitators and trainers.”

The Asia Pacific Regional Council is currently working with the JCO Global Oncology editors on a special series devoted to cancer care in Asia Pacific that will publish later this year. The series will focus on culturally sensitive and equitable care delivery, as well as global and regional cancer care partnerships, including partnerships with the council. Approximately 10 to 15 articles will cover topics such as cancer screening, communication, information resources, and developing future leaders in the region.

Latin America

ASCO’s second regional council, the Latin America Regional Council, was established in 2021. This council has just wrapped up the process of bringing the most recent ICC site to Bolivia. The host institution for Bolivia’s ICC, Instituto Oncológico del Oriente Boliviano, plans to focus initially on palliative care training. Courses will begin by emphasizing to clinical staff the importance of integrating palliative care into health care systems and destigmatizing the use of pain therapies. This will be followed by a more specialized ASCO virtual course for oncology staff that delves more deeply into palliative care for patients with cancer.

In addition, the Latin America Regional Council is working on a new grant and a leadership development program. Early in its deliberations, the council identified as a priority the need for more cancer research in Latin America. In 2022, the council began working with Conquer Cancer, the ASCO Foundation, and Pfizer to develop a grant to improve the quality of care and address inequities for patients with metastatic breast cancer (mBC) in Latin America. Applications opened on January 18 and are due March 6. The grant will support innovative approaches to diagnose inequities and improve the quality of mBC patient care. Grant recipients will be expected to share the initial results of their projects with the Latin America Regional Council at a 2024 meeting.

Building on the experiences of the Asia Pacific Regional Council, the Latin America Regional Council also is collaborating with ASCO staff to adapt ASCO’s leadership training expertise and resources to support the next generation of oncology leaders in their region. Similar to the approach in Asia Pacific, the council and ASCO staff have conducted research in Latin America to better understand leadership development needs and challenges in the region. Applications for the 2023-2024 program are expected to open later this year.

Sub-Saharan Africa

Our newest regional council is the Sub-Saharan Africa Regional Council, which was established in August 2022. The 12 council members are leading oncologists from Sub-Saharan Africa: three from southern Africa, three from eastern Africa, and six from western Africa, including three members from Anglophone and three from Francophone countries.

The council members met to identify several priority challenges faced by physicians and patients in the region, including:

  • The critical importance of improving clinical cancer research opportunities in the region and improving inter-regional research collaborations, as well as addressing patient hesitation to participate in clinical trials.
  • The need to address the multiple barriers to access to cancer treatment (both longstanding and newer therapies), including financial, geographic, and workforce barriers.

“Our first meeting engendered extensive and exciting discussion and debate and was followed by a poll of potential topics for council action,” explained Sub-Saharan Africa Regional Council chair Paul Ruff, MD. “The most important and exciting topic was that of access to cancer care in our region. The whole council plans to work together with ASCO to try to begin to overcome the many barriers to cancer care in Sub-Saharan Africa, as well as other low- and middle-income countries—including excessive costs of newer medicines, lack of access to or usage of ‘older medicines,’ and an opportunity for regulatory authorities and other key stakeholders in Sub-Saharan Africa countries to engage in this topic.”

Additionally, the council plans to establish two sub-committees to develop and implement strategies to improve early cancer detection in Sub-Saharan Africa and to support oncology training curricula and standards in the region. Like the other regional councils, the Sub-Saharan Africa Regional Council plans to issue an RFP to hospitals throughout the region inviting them to apply to be ASCO’s next partner in the ICC program. The RFP is expected to be announced on March 1.

In all of this work, the council and its members will be looking to engage ASCO members, stakeholders, and partner societies in the region. A key ally among the African cancer organizations is the African Organization for Research and Training in Cancer (AORTIC), with which ASCO signed a Memorandum of Understanding (MOU) last year. The ASCO-AORTIC MOU focuses on enhancing cancer research in Africa through research training, mentorship, and funding opportunities and offers a collaborative platform for regional council plans and activities either in the research domain or on other topics of shared concern. ASCO and AORTIC are currently discussing planned activities for this year to advance the collaboration, including ASCO participation in the AORTIC Biennial Conference to be held in Dakar, Senegal, in November. The Sub-Saharan Africa Regional Council also plans to meet during the AORTIC meeting.

Our Continued Commitment

Through each of these regional initiatives, ASCO is working to more closely engage and align its efforts with the needs and challenges of its members worldwide. At the same time, ASCO actively is seeking opportunities to add its voice to global campaigns that highlight what is being achieved and can be achieved in the global fight against cancer. Among these is the World Cancer Day campaign led by the Union for International Cancer Control (UICC), which this year is focused on uniting our voices and taking action to ensure everyone has better access to health and cancer services—a theme ASCO has embraced with its regional councils.

In recognition of World Cancer Day, ASCO’s online journal JCO Global Oncology has curated a selection of articles that reflect the day’s theme of enabling more people to seek and receive the care they need and deserve while celebrating progress being made against cancer. This journal, with its original research and perspectives, is another demonstration of our commitment to high-quality cancer care around the globe, a commitment that we will continue to advance and strengthen.

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