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.”

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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…

Developing Innovative, Robust and Affordable Medical Linear Accelerators for Challenging Environments

Motivated by stunning projections regarding the rise of cancer cases globally to 25 million cases in 2035 with 70% of those occurring in low- and middle- income countries, coupled with the paucity of access to radiotherapy treatment – an essential component of curative and palliative care – a group of individuals from the International Cancer Expert Corps (ICEC), Science and Technology Facilities Council (STFC UK), CERN and others, took on the challenge to meet the demands for cancer care focusing on the need to develop a medical linear accelerator to be used in resource-limited settings.  Read the Editorial in Clinical Oncology