Twinning Programs and Mentoring Relationships
ICEC is a network-oriented global partnership that emphasizes sustainability and growth through ICEC’s “Twinning Programs”. A twinning program is a collaborative relationship between a university department or cancer program (or private practice) in an upper-income country (an ICEC Hub with ICEC Experts) and a cancer program/facility in a low- or middle-income country (an ICEC Center with ICEC Associates). This capacity building strategy facilitates the creation of a sustainable platform for the sharing of best practices and learnings from each other through information and technology transfer. The ultimate aim is for the ICEC Centers and Associates to progress to become ICEC Hubs and Associates for their specific regions.
ICEC Centers and Associates/Hubs and Experts
The roster of ICEC partnerships continues to grow from existing twinning programs. ICEC assesses where they fit into the “5-Step Progression Plan” in order to phase in the education, training and mentorship metrics to track the progression of the ability of programs to deliver high-quality care with the long-term goal of each program’s becoming a recognized regional cancer center. ICEC continues to support the piloting and use of the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification of NCCN Guidelines (NCCN Framework™) and the NCCN Harmonized Guidelines™ for Sub-Saharan Africa. NCCN’s goal “is to identify appropriate treatment at four resource levels—Basic, Limited, Enhanced, and Maximal—and deliver a tool for health care providers to identify treatment options that will provide the best possible outcomes at a given resource level”. The NCCN Harmonized Guidelines™ for Sub-Saharan Africa represent both the optimal care that these countries aspire to provide and pragmatic approaches that provide effective treatment options for resource-constrained settings.
Both resources are particularly valuable tools to be used in LMICs and other challenging environments. ICEC appreciates the unique opportunity to work toward formal guideline and protocol development with an expert group and one connected closely with the major academic cancer centers.
“Twinning Programs” continue to build mentoring relationships through affiliations with many well-known academic medical centers as well as private practices. If you or a program with whom you are working would like to become part of an ICEC Twinning Program, contact ICEC at email@example.com or on ICEC’s website at https://www.iceccancer.org/apply/
Highlighted Twinning Programs/Mentoring Relationships:
- Weill Cornell Medical Center, Department of Radiation Oncology, New York, USA and the National Center of Oncology, Yerevan, Armenia; and the Angondje University Hospital & Cancer Institute in Libreville, Gabon (Dr. Onyinye Balogun*)
- University of Pennsylvania Abramson Cancer Center Pennsylvania and Princess Marina Hospital in Gaborone, Botswana (Dr. Surbhi Grover*)
- Duke Global Health Institute, North Carolina, USA and the Bugando Medical Centre in Mwanza, Tanzania (Dr. Kristin Schroeder*)
- ICEC, Washington, DC, USA and the Bugando Medical Centre Department of Radiation Oncology in Mwanza, Tanzania
- Stanford University, Department of Radiation Oncology California, USA and the Kenyatta National Hospital, Nairobi, Kenya; with additional mentoring partnerships at Lagos University Teaching Hospital and the Ahmadu Bello University in Lagos, Nigeria; and Ocean Road Cancer Institute (ORCI), Dar Es Saleem, Tanzania (Dr, Agnes Ewongo, Dr. Chika Nwachukwu* and Dr. Lynn Million)
- Walking Forward Program, South Dakota, USA, and Avera Health; working with the American Indians/Indigenous populations (Lakota Sioux),(Dr. Daniel Petereit)
- South Florida Proton Therapy Institute (Dr. Timothy Williams)
ICEC: Responding to a Critical Need
Using a three-fold approach ICEC’s program encourages resource-appropriate cancer care using guideline-and protocol-based education, training and treatment in resource-poor settings by:
- enlisting Hubs of expertise to include academic medical centers/universities, private practices and an ICEC Central Hub
- enrolling Expert-Mentors affiliated with a university, practice or ICEC Central Hub including Individual physicians and other necessary allied healthcare workers, Global Health track practitioners and retirees
- identifying Centers – clinics/hospitals/and other care delivery sites in underserved areas, and Associates – physicians/allied healthcare workers seeking mentoring and education to guide the development of cancer care to reach global standards. As expertise of Associates and Centers grows, Associates achieve Expert-Mentor status and Centers become Hubs.
Chika Nwachukwu, MD PhD
Kenyatta National Hospital, Nairobi Kenya: Transitioning from 2D to 3D radiation treatment planning.
Kenyatta Hospital (Nairobi Kenya) is the only public hospital in Kenya that is dedicated to cancer management. Radiotherapy is an integral component of cancer care in this region. At Kenyatta, a linear accelerator was installed in March 2016 and treatment of patients is slowly ramping up on this machine. The major road blocks to ramping up include technological glitches, unfamiliarity with the 3D treatment planning system.
Using a multidisciplinary approach and a team comprising of clinical radiation oncologist, radiation therapists and medical physicists our focus was to improve radiotherapy delivery and the theme centered around the transition from 2D to 3D radiotherapy. This was accomplished with carried out with hands on teaching including simulation and set -ups, contouring, treatment planning and patients management.
Lagos University Teaching Hospital and Ahmadu Bello University Teaching Hospital, Lagos, Nigeria: Developing a Multidisciplinary Tumor Board
Using a needs assessment, we examined barriers to improving cancer care and developed short term and long-term goals to improve cancer care at two teaching hospitals in Nigeria. The goal was to determine if an adequate system exists to evaluate the cancer burden and determining the available resources to tackle the burden. From our needs assessment, two short term goals identified include improving radiotherapy delivery by teaching the transitioning from 2D to 3D treatment planning and as well as developing a multidisciplinary tumor board.
Ocean Road Cancer Institute (ORCI), Dar Es Saleem, Tanzania: Establishing research collaboration with Ocean Road Cancer Institute (ORCI), Dar Salem Tanzania
Tanzania has a high burden of cervical cancer cases. Patients are managed with chemo radiation similar to the US standards. At ORCI ~70% of the patients have cervical cancer and there is high disease recurrences among the patients at this institution. Our goal is to develop research collaboration with physicians at ORCI to study these tumors and determine predictors of aggressiveness.
For more information on Dr. Nwachukwu’s work with Stanford University’s Department of Radiation, click here.
Surbhi Grover, MD, MBA
UPenn-Botswana Partnership, Princess Mariana Hospital Gaborone
Dr. Grover and her fellow researchers at Princess Marina Hospital in Botswana developed a multidisciplinary team (MDT) approach to accelerate care and improve communication between healthcare professionals and their patients so that patients would have access to treatment facilities faster. The team established weekly meetings with providers, including radiation oncologists, clinical oncologists, gynecologists, nurse coordinators, and palliative care specialists to discuss patient cases and develop treatment plans in collaboration. Together, the team worked to submit paperwork and other documentation, reducing delays in treatment and simplifying the overall process.
Over the course of six months, the team treated 135 patients. With the implementation of the new MDT approach, they were able to reduce the time between diagnosis and treatment initiation by more than 50 percent, cutting the median delay from biopsy to treatment initiation to 39 days — a significant improvement from the previous average of 108 days.
For more information on Dr. Grover’s work with the University of Pennsylvania Abramson Cancer Center, click here.
Onyinye D. Balogun, MD
Weill Cornell Medicine and the National Center for Oncology, Yerevan, Armenia
Dr. Onyinye Balogun serves as an attending Radiation Oncologist practicing at Weill Cornell Medicine in New York City. While engaged in her clinical duties, Dr. Balogun has developed a keen interest in global health projects focused on improving the delivery of cancer care. As a designated ICEC Ellen Lewis Stovall Early Career Leader and grant awardee, Dr. Balogun is spearheading global health programs in Armenia, Gabon, and other low- and middle-income countries, designing educational curricula to train clinical and radiation oncologists and radiation therapy professionals to successfully familiarize them with the foundations of 3D conformal radiation therapy (3-DCRT). Her curriculum is an important contribution to improving care, but more work remains to address education gaps, equipment needs, and to develop a long-term plan to sustain excellent cancer care in these regions.
Born in Nigeria and moved to the US as a child, Balogun carries with her memories of a trip to Nigeria to visit an aunt who had breast cancer. Shocked by scars from what she first attributed to surgery, but later learned were from poorly administered radiation therapy, Balogun was galvanized to become a doctor and find better ways to practice radiotherapy. True to her mission, Balogun graduated from Harvard University and spent a year in Ibadan, Nigeria, working with a breast cancer advocacy group focused on providing accurate educational information to patients about radiotherapy. After graduating from Yale University School of Medicine, she initiated her residency training at the University of Chicago and completed her final year at New York University. In addition to serving as an attending Radiation Oncologist, Balogun serves as an Assistant Professor of Radiation Oncology at Weill Cornell Medicine specializing in the treatment of breast and gastrointestinal malignancies.
Dr. Balogun was introduced to ICEC in 2014 by Dr. Silvia Formenti, Chair of Radiation Oncology at Weill Cornell Medical College and Radiation Oncologist-in-Chief at New York-Presbyterian/Weill Cornell Medical Center, who introduced her to Dr. C. Norman Coleman who helped conceptualize the ICEC mentorship-model. Impressed by ICEC’s innovative approach to sustainable cancer care in LMICs, Balogun joined the organization as an Early Career Leader and submitted a grant to support the development of a pilot curriculum for the implementation of 3-dimensional gynecological conformal radiation therapy.
In 2015, Balogun piloted a 2-week curriculum for implementing 3-DCRT for breast cancer at the National Center of Oncology, Yerevan. Its success convinced her the curriculum’s model could have broader applications and adapted for treating other types of cancer. Dr. Balogun returned to Armenia in October 2017 to expand the curriculum to gynecologic cancers. During this recent trip, Balogun identified critical needs for improving radiation therapy treatment and ensuring high-quality care into the future, endeavoring to introduce a Varisource brachytherapy unit, treatment planning software for brachytherapy (internal treatment) for cervical cancer, and to identify resources to purchase other equipment and medical needs.
The next phase of work is to further establish the ongoing twinning relationship with Weill Cornell and the National Center of Oncology in Yerevan and to increase the level of cancer expertise in Armenia generally while working toward a sustainable model for excellence in cancer care. These efforts require support for professional time (one day per week year-round) to work, via telemedicine, with the Radiation Oncologists, Physicists, and Technicians at the Center in Yerevan, and the implementation of intercontinental teleconferencing system oriented to oncology specialties to support treatment planning for patients. ICEC will continue its work with Balogun supporting mentees, otherwise known as ICEC Associates, through making travel opportunities available to attend global cancer conferences as either presenters or participants. ICEC will also offer funding incentives to ICEC Associates who commit to working with ICEC Experts to enhance skills/knowledge with the end goal to deliver high-quality cancer care.
For more information on Dr. Balogun’s work with Weill Cornell Medicine, click here.