By Deebya Raj Mishra, MBBS, MD, DM
On September 30 and October 1, 2022, the Department of Pulmonary, Critical Care and Sleep Medicine at the B.P. Koirala Institute of Health Sciences (BPKIHS), with the collaboration and guidance of ASCO, hosted the ASCO Cancer Control in Primary Care (CCPC) in Lung Cancer course at BPKIHS in Dharan, Nepal.
Dharan is a town in Eastern Nepal. Until about six or seven years ago, cancer care in Nepal was available only in the capital, Kathmandu, and the large city of Bharatpur. The reality was that any patient with cancer, anywhere in the country, was referred to those two places. The last few years have seen a gradual increase in local specialists dealing with cancer in Eastern Nepal. Our department started a lung cancer clinic in 2018 and now provides both diagnostic and treatment services. A persistent observation has been the reluctance of primary care physicians to engage with patients with cancer. While diagnostic and routine treatment of cancer does require specialists, preventive aspects and palliative care are areas where primary care physicians have a role.
The ASCO CCPC course was designed with a special focus on these two elements—prevention and palliation—against the background of lung cancer. The participants included 23 general practitioners and internists, two specialties frequently encountering patients with cancer at various stages of care, from Eastern Nepal. The course consisted of didactic and interactive sessions, role-play scenarios, and listening to actual perspectives of cancer survivors and caregivers.
The course offered an outline of lung cancer management by Dr. Navneet Singh, the central role of tobacco in cancer/s and practical tobacco prevention strategies by Dr. Laura Makaroff, and the role of primary care physicians in the palliative care of patients with cancer by Dr. Dinesh Goswami. An overview of cancer care in Nepal was given by Dr. Sudip Shrestha; Dr. Birendra Yadav and Dr. Sulav Sapkota, prominent oncologists from Eastern Nepal, and Dr. Lokesh Shekher Jaiswal, a thoracic surgeon, discussed how cancer care in general and lung cancer care in particular have evolved in Eastern Nepal and gave the participants an idea of the referral network available to them.
A session was dedicated to the voices of a cancer survivor and two cancer caregivers. This session provided an emotional perspective of the cancer journey from the other side, a side often not explored and understood enough. The session had a deep and lasting impression on everyone involved. These interactions make clinicians more understanding of the need, situation, and thought process of the survivors and caregivers.
How ASCO CCPC in Nepal Came to Be
I received the International Development and Education Award (IDEA) from ASCO and Conquer Cancer, the ASCO Foundation, in 2019. IDEA participants are expected to take what they learn from the program back to other health care professionals in their home countries, and we document our plans for this knowledge-sharing after the award program in a Dissemination Commitment Worksheet. Having realized the need to get primary care physicians involved in the preventive and palliative care aspects of lung cancer, I made a commitment to bring the ASCO CCPC course to Eastern Nepal.
To make my commitment a reality, I worked with the ASCO International Affairs team to submit an application with a proposed course agenda, proposed budget, and a letter of support from an ASCO member. The applications go through a review process before being approved. Once approved, the ASCO International Affairs team works in very close collaboration with the local team. Behind the scenes, the planning involves ASCO staff, a course director assigned by ASCO (Dr. Singh served as our course director), and the course director from the host country. The course organizers work together via email and virtual meetings to plan content details and identify faculty. The process is seamlessly coordinated by the ASCO International Affairs team. Their attention to detail spills to the venue, accommodation and transport for faculty and participants, as well as the health and safety of all involved. The whole process is a learning experience and I realized the in-depth behind-the-scenes work that goes in to make even one course a success.
We initially applied towards the end of 2019 to host the ASCO CCPC course in 2021. However, due to COVID-19, the dates were delayed; we were finally able to host the course in 2022. With the right mix of international and local faculty to achieve the proposed goals of the course, the sessions offer a wonderful opportunity to expose clinicians in host countries to different aspects of cancer care. The interactions with international faculty members give the participants different perspectives and insights on how best to optimize local resources to achieve the global standards of cancer care.
We believe our course was able to offer the primary care physicians of Eastern Nepal the impetus to take up the preventive and palliative aspects of cancer care. We have confidence that this will be translated into clinical practice and that these types of courses will encourage the participants to pursue cancer care with more intent and thought.
Our team is thankful to the ASCO International Affairs team, the international and local faculty members, the course participants, and the cancer survivors and caregivers for making this course a success.
Dr. Mishra is an associate professor of pulmonary, critical care and sleep medicine at B.P. Koirala Institute of Health Sciences, Nepal. He is a passionate advocate of thinking in terms of “resource optimization” rather than “resource constraints.” Dr. Mishra serves in volunteer roles at ASCO, IASLC, and APSR, and is the associate editor of the Nepalese Respiratory Journal. He received an International Development and Education Award from ASCO and Conquer Cancer in 2019. Disclosure.
Participant and Faculty Comments From ASCO CCPC Nepal 2022
“I consider myself a lucky, proud, and satisfied participant of the really successful and fruitful ASCO CCPC in Lung Cancer. It’s my pleasure to share my experience about the seminar in the following points:
- The seminar was well organized and conducted, and the registration was free for all participants. Snacks and drinks were served in a timely manner.
- The presentations were of a high standard and delivered by cancer experts from Nepal and abroad. The Q&A session was interactive and informative.
- The seminar demonstrated a good collaboration between ASCO and the BPKIHS team. The Certificate of Participation and Continuing Professional Development (CPD) points accredited from Nepal Medical Council were another invaluable outcome.
- A session in which patients with cancer (cancer warriors) shared their stories of struggle and challenges left an emotional atmosphere in the room. Faculty member Dr. Laura Makaroff herself shared her story which was remarkably touching to everyone. I realized that I was also in tears. I instantly wrote a letter of appreciation for the young cancer warriors thanking them for inspiring me to be more compassionate and sensitive towards the future of my patients. I recited the letter among the young cancer warriors. The moment was overwhelming as I received huge applause. It became the most memorable moment throughout the entire seminar.
“I want to conclude my heartfelt words by thanking all the organizing team, distinguished speakers, participants, those cancer warriors, catering staffs, volunteers, and my department (General Practice and Emergency Medicine at BPKIHS, where I am currently doing residency) for providing me this opportunity to attend, learn, and motivate myself towards primary care of patients with cancer. The certificate will remain not only as a memento but one of the greatest assets in my medical career.”
—Dr. Buddhinath Shah, BPKIHS, Nepal, PGY2 and CCPC Participant
“It was a pleasure being an integral part of the CCPC Nepal course from the time of its conceptualization just before the COVID-19 pandemic began and finally traveling to Dharan for this purpose in September 2022. Short, focused meetings like these always provide ample time for attendees and faculty to interact with each other and this was very well exemplified by some of the feedback received from attendees. It was also good to learn about the practices and local beliefs/logistical issues that play such an important role in the process of diagnostic evaluation and treatment of lung cancer in Eastern Nepal. Our hosts Dr. Deebya Raj Mishra and Dr. Narendra Bhatta both are doing their very best and attempting the utmost feasible (in terms of ‘resource optimization,’ as they themselves put it) in the field of lung cancer and pulmonology as a whole.”
—Dr. Navneet Singh, Postgraduate Institute of Medical Education and Research, India, CCPC Faculty
“The opportunity to be a part of the CCPC course in Dharan, Nepal, was really incredible. I was honored and humbled to be a part of the faculty and to meet all of the participants. It is truly remarkable to see what the Department of Pulmonary, Critical Care and Sleep Medicine at BPKIHS is doing to bring cancer care to their community and to improve high-quality cancer care for the people of Eastern Nepal. The primary care physicians participating in the course were very engaged and showed a commitment to changing their practice based on what they learned.
“There is a critical role for primary care to play in the prevention of cancer, early detection, referral for treatment, and primary palliative care. This course helped address those needs and will change the lives of patients cared for by the course participants. The work ethic and dedication of all of the physicians that I met was truly inspiring. They are working under challenging conditions and resource constraints, but they give their all to each patient and have a lot of fun as a team, too.
“There was much planning that went into the course and many people who helped make it a success. Thank you to all. I came home with many gifts, including a greater appreciation of the global burden of cancer and the many people working so hard to make a difference in the lives of patients.”
—Dr. Laura Makaroff, American Cancer Society, United States, CCPC Faculty