Disparities in Cancer Care for Women: An Urgent Global Need. A panel presentation to be given at the Committee for the Status of Women Forum, Recorded Presentation – March 16, 2022

Watch the recorded presentation at this link

https://youtu.be/UquSTyoia4g

 

Disparities in Cancer Care for Women: An Urgent Global Need

 

Disparities in cancer care 2022

Recorded for the CSW66 Forum,
16 March 2022, 8:00-9:30am (EDT time)

Panel Moderator: Donna O’Brien, ICEC, Strategic Visions in Healthcare, New York

Panelists:
Manjit Dosanjh, ICEC, University of Oxford and CERN
Silvia Formenti, Weill Cornell Medical Center, New York Presbyterian Hospital, New York
Surbhi Grover, University of Pennsylvania and Gynaecological cancer clinic director and Oncology Consultant at Princess Marina Hospital, Gaborone, Botswana
Daniel Petereit, Monument Health Cancer Care Institute in Rapid City, South Dakota, and Director of Disparity Research at the Avera Cancer Care Institute in Sioux Falls, South Dakota, Director of American Indian “Walking Forward” Program
Rohini Batia, Johns Hopkins, PGY-3 in Radiation Oncology

When it is detected early and treated effectively, cervical cancer—the fourth most common cancer in women—is one of the most highly curable cancers. In the United States (U.S.), the rate of infection and death from cervical cancer has decreased significantly in the past 40 years, due to increased screening, including for the human papillomavirus (HPV), which causes the cancer; the HPV vaccine; and access to radiation therapy—which is the foundation for curative treatment for advanced cancers.

In low- and middle-income countries (LMICs), where access to radiation therapy is scarce or non-existent, the story is starkly different. For a young woman in Tanzania or Ethiopia, for example, a diagnosis of cervical cancer is likely to be a death sentence. Left untreated, she will suffer a long and painful illness. She can lose bladder and bowel function and be ostracized from her family and community—sent away to die alone.

The impact of her death is devastating in other ways: since cervical cancer is most often diagnosed in women under 50, children of these women are often left as orphans and neglected resulting in additional needless suffering and deaths. In LMICs, successfully treated breast cancer also depends on the availability of radiation therapy. The BBC reported last summer from Zimbabwe on 44-year-old Tendayi, who began a course of radiation therapy after undergoing breast-conserving surgery and chemotherapy for stage III breast cancer. When the radiation therapy machine broke down, she was told the only way it could be fixed was to fly in an engineer from South Africa which can take months. Without timely radiation treatment, her oncologist told her that she should start thinking about having a mastectomy as her only remaining option.

Unfortunately, Tendayi’s story is all too common among women in LMICs where radiation therapy technology breakdowns and long servicing delays are the norm or where it is not available at all. The lack of access to cancer care contributes to staggering outcomes, with nine of 10 cervical cancer deaths and seven of 10 breast cancer deaths occurring in LMICs. Overall, LMICs bear the burden of 70 percent of cancer deaths.

With more than 18 million new diagnoses of cancer worldwide in 2018 and more than nine million cancer deaths, and with new cancer cases expected to reach 27 million by 2040, the need to improve access to treatment, especially radiation therapy, that can extend and save millions of lives has never been more critical.

Donna O’Brien, MHA
Donna O’Brien is President of Strategic Visions in Healthcare, LLC, a healthcare consulting firm specializing in healthcare strategy, population health, cancer program and translational research program expansion, and facilitation of strategic partnerships. Building upon her extensive healthcare management experience she launched this firm in 2005.  Strategic Visions has clients across the U.S. including health systems, academic medical centers, research institutes, and government. She is a member of the Board of Directors of the International Cancer Expert Corps.

Manjit Dosanjh, PhD
Dr Dosanjh has had a long career at CERN where she served as Director of Medical Applications and played a key role in launching the ENLIGHT (European Network for Light Ion Hadron Therapy). She has a PhD in Biology is on the faculty of the University of Oxford and she has served as a mentor and advisor for many students from across the globe.  Her work has included many initiatives to expand access to care for those in Low Middle-Income Countries and for advancing career opportunities for women in science. She is a member of the Board of Directors of the International Cancer Expert Corps and project leader of STELLA.

Silvia Formenti, MD
Dr Formenti is the Chair of Radiation Oncology at Weill Cornell Medical College/Weill Cornell Medical Center. She is a recognized leader in breast cancer research and her groundbreaking work has transformed the paradigm in radiation biology, demonstrating the efficacy of combining radiotherapy with immunotherapy to control cancer cell growth in solid tumors.   She has been a champion of efforts to improve access to care for underserved populations and her research includes studying the impact of cancer in women in LMICs on families. She is a member of the Board of Directors of the International Cancer Expert Corps.

Surbhi Grover, MD, MPH
Dr Grover is a Radiation Oncologist at the University of Pennsylvania’s Abramson Cancer Center.  Her research interests include racial and ethnic disparities in cancer care and outcomes, HIV-related malignancies, implementation and up-scaling of prevention and treatment programs in low resource settings.  Since 2011 she has been engaged with the UPENN Botswana partnership and is currently serving as Gynaecological cancer clinic director and Oncology Consultant at the Princess Marina Hospital in Botswana.

Daniel Petereit, MD, FASTRO
Dr Petereit is a Radiation Oncologist at Monument Health in Rapid City South Dakota. He is the founding Director of the NCI-funding “Walking Forward” Program in South Dakota which serves the American Indian population on reservations in South Dakota. He has served as President of the American Brachytherapy Society and championed global health programs. He is a member of the Board of Directors of the International Cancer Expert Corps.

Rohini Batia, MD
Rohini is currently a PGY-3 resident in Radiation Oncology at Johns Hopkins University. She is interested in working to mitigate disparities in access to quality oncologic care in resource-limited settings. She graduated with a degree in Epidemiology from the University of Rochester and was a Fulbright-Nehru Scholar in Delhi where she investigated predictors of tobacco use among women. She has worked with Dr. Surbhi Grover since 2015 on a variety of projects, including quantifying delays along the patient care continuum in oncology. She has worked with the multidisciplinary women’s clinic in Gaborone helping to pilot test a new smartphone application and refine clinic workflow and is currently working on understanding the uptake of hypofractionationed radiation therapy in low resource settings.

Surveying the Challenges to Improve Linear Accelerator-based Radiation Therapy in Africa: a Unique Collaborative Platform of All 28 African Countries Offering Such Treatment

Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate, and service, especially for low- and middle-income countries(LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime.

A global initiative was launched in 2016 by ICEC and CERN to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognized that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK, and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries. Read more…

Research-Driven Radiation Oncology: A Narrative on the Ongoing Legacy of Henry S. Kaplan

In this rapidly evolving time of precision medicine and scientifically based cancer care, how radiation oncology became a strong research-based scientific discipline in the United States after its separation from diagnostic radiology might be lost. The importance of generational mentorship, “family trees,” and interpersonal relationships can be difficult or impossible to trace absent personal narrative recollections of those involved. Henry S. Kaplan is a central figure and the focal point for 3 generations of research-based academic department chairs. This report establishes a first draft of a living record of the radiation oncology history of the Kaplan legacy to serve as an example of how knowledge networks grow and flourish and as an impetus for others to trace the legacy of other radiation oncology academic “trees.” Read the full article…
Published by Elsevier Inc.

 

Achieving flexible competence: bridging the investment dichotomy between infectious diseases and cancer

Today’s global health challenges in underserved communities include the growing burden of cancer and other non-communicable diseases (NCDs); infectious diseases (IDs) with epidemic and pandemic potential such as COVID-19; and health effects from catastrophic ‘all hazards’ disasters including natural, industrial or terrorist incidents. Healthcare disparities in low-income and middle-income countries and in some rural areas in developed countries make it a challenge to mitigate these health, socioeconomic and political consequences on our globalised society. As with IDs, cancer requires rapid intervention and its effective medical management and prevention encompasses the other major NCDs. Furthermore, the technology and clinical capability for cancer care enables management of NCDs and IDs. Global health initiatives that call for action to address IDs and cancer often focus on each problem separately, or consider cancer care only a downstream investment to primary care, missing opportunities to leverage investments that could support broader capacity-building. From our experience in health disparities, disaster preparedness, government policy and healthcare systems we have initiated an approach we call flex-competence which emphasises a systems approach from the outset of program building that integrates investment among IDs, cancer, NCDs and disaster preparedness to improve overall healthcare for the local community. This approach builds on trusted partnerships, multi-level strategies and a healthcare infrastructure providing surge capacities to more rapidly respond to and manage a wide range of changing public health threats. Read the article…

 

Article: Coleman CN, Mansoura MK, Marinissen MJ, et al. Achieving flexible competence: bridging the investment dichotomy between infectious diseases and cancer. BMJ Global Health 2020;5:e003252. doi:10.1136/ bmjgh-2020-003252

Capturing Acquired Wisdom, Enabling Healthful Aging, and Building Multinational Partnerships Through Senior Global Health Mentorship

Capturing the acquired wisdom and experience of mentors in global health offers a capstone for their careers and provides a purposeful healthspan for these professionals to continue to be engaged in meaningful work while leveraging their expertise to solve challenging health care problems. This article addresses such opportunities available for individuals in the latter part of their careers including postretirement done either as a continuation of their role as career-long mentors or as a new challenge to be met with their lifelong experience. The expanding and branching tree of mentors to mentees enables a career path in global health and geometric growth to fill in the current enormous capacity gap.  Read the full article…

 

The number of people per radiotherapy machine per African country

Designing new radiotherapy technologies to treat cancer in low and middle-income countries

June 11, 2020

Innovative Technologies towards building Affordable and equitable global Radiotherapy capacity (ITAR)

A new project, “Innovative Technologies towards building Affordable and equitable global Radiotherapy capacity” (ITAR), supported by the Science and Technology Facilities Council (STFC), aims to design and develop new radiotherapy technologies to give more cancer patients in Sub-Saharan Africa access to treatment and to save lives. The project will contribute to the development of novel radiotherapy machines, specifically designed to meet the needs of African hospitals. The challenge brings together an international team of accelerator physicists and engineers, medical physicists, radiobiologists, radiation oncologists, radiologists, IT experts, and health system researchers.

The state of cancer care

The number of people per radiotherapy machine per African country

The annual global incidence of cancer is projected to rise to 27.5 million cases by 2040, leading to more than 13 million deaths. Up to 70 percent of these will occur in low and middle-income countries (LMICs). Radiotherapy is an essential component of cancer care being a very effective means of curing the disease, as well as palliative treatment, and where available, is used to treat more than half of patients.

Many low and middle-income countries in Africa have acute shortages of radiotherapy machines. In the lowest-income countries, only four percent of cancer patients that need radiotherapy treatment are able to be treated. There are currently only 385 radiotherapy machines in the region, and 60 percent of those are located in just three countries – South Africa, Egypt and Morocco.

A report by the Lancet Oncology Commission – Global Task Force on Radiotherapy for Cancer Control (GTFRCC) of the Union for International Cancer Control (UICC) recently estimated that by 2035 at least 5,000 additional megavolt-class treatment machines would be needed to meet radiotherapy demands in low-and middle-income African countries.

A collaborative effort

The ITAR project, a critical part of a larger international project that includes the International Cancer Expert Corps (ICEC), CERN, STFC (Daresbury Laboratory), and Lancaster University, is led by Lancaster University and Oxford University and will bring together partners from the Cockcroft Institute, STFC’s Accelerator Science and Technology Centre (ASTeC), John Adams Institute, Swansea University, King’s College London, ICEC and CERN.

In ITAR’s first phase, the project will define the persistent shortfalls in basic infrastructure, equipment and specialist workforce which remain barriers to effective radiotherapy delivery, and develop novel solutions leading to a detailed specification and conceptual design. The project will then progress to a prototype development phase at STFC’s Daresbury Laboratory.

Professor Manjit Dosanjh, from CERN and Oxford University, and member of the ICEC Board of Directors, and who leads the overall international project, said: “I am really excited that the idea, first presented by Dr Norman Coleman of the International Cancer Expert Corps at the 2014 ICTR-PHE meeting held in Geneva, continues to flourish. Having Lancaster and Oxford Universities, along with Daresbury Laboratory and others working on this with STFC’s critical support and ICEC’s expertise, is a significant step in addressing the need for a novel medical linear particle accelerator to generate the radiation for LMICs and other challenging environments.”

Local stakeholder participation is vital to the project’s success

Dr. Taofeeq Ige (National Hospital Abuja, Nigeria) in front of one of the hospitals radiotherapy LINACs

Dr. Taofeeq Ige (National Hospital Abuja, Nigeria) in front of one of the hospital’s radiotherapy LINACs.

A critical aspect of the project’s challenge cluster is the involvement of the international partners. Dr. Taofeeq Ige and Dr. Simeon Aruah, of the National Hospital Abuja, Nigeria, and Dr. Surbhi Grover, of the Botswana-UPENN Partnership and Princess Marina Hospital, are key partners working in African hospitals. They will gather information from a network of other hospitals in Botswana, Ghana, Kenya, Nigeria, South Africa, Tanzania, Zambia and Zimbabwe and play a key role in the definition of the specification for the new machines.

In addition, ICEC provides a network of international oncologists, medical physicists, and engineers working in radiotherapy systems. They are already providing training and mentorship in lower- and middle-income countries and will continue with their assistance in the development of the radiotherapy system in this project.

Professor Graeme Burt, of Lancaster University and the Cockcroft Institute, and who is leading the phase 1 project said: “Current radiotherapy machines are optimised for use in western countries. The ITAR project aims to design specifically for use in Africa making it far more tolerant to the local environment, which will greatly increase the capacity for more lives to be saved.”

Professor Deepa Angal-Kalinin, of STFC and the Cockcroft Institute, University of Manchester, and who is leading the accelerator design said: “I am keen to apply the knowledge and expertise at Daresbury Laboratory to develop a novel medical linac design in this phase of the project which will prepare us to build a prototype to test our novel ideas.”

Media queries should be sent to:
nina.wendling@iceccancer.org or graeme.burt@cockcroft.ac.uk

A Broad Impact for Global Oncology

Global oncology demands attention, with approximately 9 million people dying from cancer annually. It provides an extraordinary opportunity to address the urgent need for cancer care and be a catalyst for solutions to address critical societal issues including the disruptive forces in and among countries involving the health of individuals and the planet, relationships among cultures, the digital revolution, inequality, and the sociopolitical conflict of globalism vs isolationism.  Read the article published online in JAMA Oncology

ICEC’s response to The Lancet, “Offline: Why has global health forgotten cancer?”

ICEC’s response to Richard Horton’s thoughtful commentary, “Offline: Why has global health forgotten cancer?” was published in The Lancet.

While prevention is critical, tackling cancer is about much more than just prevention. “The solution to the deficit of global cancer care is a systematic approach to build expertise, capacity, and capability using a sustainable model that recognizes the mutually beneficial links among cancer, the other non-communicable diseases, infectious diseases, and health-care systems, while also producing economic benefit”. Read more…