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ASCO and Global Oncology

November 18, 2020

ASCO and Global Oncology

 .
  • 00:00And what an as as folks are logging in.
  • 00:04Wanna welcome everyone again
  • 00:06to Kansas in a grand rounds.
  • 00:09The theme for today is
  • 00:11an important one, namely global
  • 00:13onkologie and obviously the our
  • 00:16attention has been particularly drawn
  • 00:18this year to the public health crisis.
  • 00:21That's the kovid pandemic. But as many
  • 00:25know really over the past several years.
  • 00:28The National Cancer Institute.
  • 00:31The World Health Organization.
  • 00:33The American side of conchology ACR,
  • 00:36among others, have really increasingly
  • 00:38wanted us to emphasize elements of our
  • 00:42work on the global needs.
  • 00:44An global oncology Ann, and
  • 00:47so it's really my privilege
  • 00:49to introduce the introducer.
  • 00:51For today's session I've I've had the
  • 00:54privilege actually of working with
  • 00:56Donna Spiegelman for many decades.
  • 00:59I guess Don, as you know,
  • 01:01is the Susan Dwight
  • 01:03Bliss professor by statistics,
  • 01:05the director for
  • 01:06the Center of Methods and
  • 01:08Implementation and Prevention Science,
  • 01:10the director of the Interdisciplinary
  • 01:12Research Methods Core for the Center
  • 01:14for Interdisciplinary Research on
  • 01:16AIDS, and particularly relevant to today.
  • 01:19The Assistant Cancer Center director
  • 01:21for global oncology, Dana has.
  • 01:23Legions of accomplishments,
  • 01:24but they include her or productive
  • 01:26work and global ecology,
  • 01:28and I'll turn it over to Donna
  • 01:30to introduce today's speaker.
  • 01:33Thanks so much Charlie and indeed
  • 01:35it's been a pleasure working with you
  • 01:38both at Harvard and now here at Yale.
  • 01:41And thank you so much for supporting
  • 01:43my work and interest through
  • 01:45connecting me to the Cancer Center
  • 01:47in the global oncology program.
  • 01:50This is our 2nd of this academic years.
  • 01:53Yale Cancer Center grounds.
  • 01:56I'm global Oncologix our first one.
  • 01:59We had an in person this pre covid Dr
  • 02:02Jorge Sam around from Unum universe
  • 02:05National University Autonomous
  • 02:07University of Mexico City and the
  • 02:10National Institute of Health of Mexico.
  • 02:13Who has been doing work for many many
  • 02:16years on cervical cancer prevention and
  • 02:19screening and we're continuing to work
  • 02:22with him along with colleagues in a pool.
  • 02:25Today we're very pleased
  • 02:27to get a very big picture.
  • 02:30Type of you,
  • 02:31which I'm really excited about
  • 02:32by having our guest Doug Pyle,
  • 02:35who unfortunately we can wine and
  • 02:37dine except in our imaginations.
  • 02:39But we're so happy to have him
  • 02:41today for this zoom seminar.
  • 02:43He's the vice president of International
  • 02:45Affairs at the American Society of
  • 02:47Clinical Oncology, well known as ASCO,
  • 02:49and each of us today for a discussion
  • 02:52centered around global oncology.
  • 02:54He graduated with his MBA from
  • 02:56the Yale School of Management.
  • 02:58We also found out this morning
  • 03:00at a very early.
  • 03:01Meeting morning call.
  • 03:03He was so kind to have with myself,
  • 03:06Melinda Irwin and Marcella Nunez Smith,
  • 03:08also leading various related efforts with
  • 03:11the El Cancer Center that his wife did
  • 03:14her pediatric residency here at Yale,
  • 03:16so New Haven,
  • 03:17Yale is something he's part
  • 03:19of our community as well.
  • 03:21And after Yale School management,
  • 03:23he went on to become Director of
  • 03:26Business Solutions International
  • 03:28Services for the American Red
  • 03:30Cross and then joined as Co in 20.
  • 03:32Seven he is responsible for
  • 03:34directing its international programs.
  • 03:36An invite advising the society
  • 03:38on the needs and interests of its
  • 03:41international members and constituents.
  • 03:43He has more than 25 years of experience
  • 03:46in international affairs in the public,
  • 03:49nonprofit in corporate center sectors.
  • 03:51Um earlier earlier in his career,
  • 03:54he was the vice President and Chief
  • 03:56Operating Officer for the Center for
  • 03:59International Rehab Rehabilitation.
  • 04:00The manager for strategic planning
  • 04:02and business development for the
  • 04:05US sub Spirit City Area,
  • 04:06East Side and administered technical
  • 04:08assistance projects funded by the US
  • 04:10Agency for International Development,
  • 04:12USA, ID.
  • 04:13Today's talk is Co sponsored by
  • 04:15the El School Public Health Center
  • 04:17for Methods and Implementation
  • 04:19in prevention science.
  • 04:20See Maps,
  • 04:21which I lead.
  • 04:22And I'm very excited to turn things
  • 04:25over to Doug to let the audience
  • 04:28know you can write questions
  • 04:29and comments in the chat box.
  • 04:32I'm not sure if it's possible to
  • 04:34actually activate so you can talk,
  • 04:37but Charlie and I are both monitoring
  • 04:39the chat box and we welcome your
  • 04:42comments and we will potentially check
  • 04:44in with Doug at suitable times to
  • 04:47inject your questions and comments.
  • 04:49And presumably they'll be some
  • 04:51time at the end as well, so.
  • 04:53Thank you very much,
  • 04:54Doug. We're looking forward to your talk.
  • 04:57Now this is great.
  • 04:58I've been really looking forward to this
  • 05:01and thanks so much for the invitation.
  • 05:04I'm delighted to talk on. Yeah, I agree.
  • 05:07Important topic, just real quick.
  • 05:09My also I don't know if you
  • 05:11can see but I'm channeling.
  • 05:14It's blocked out.
  • 05:15I'm channeling my New Haven by
  • 05:17having my 1990s era Doodle mug here.
  • 05:20So your first see me question is how
  • 05:23many of you know what the Yankee Doodle
  • 05:26Diner was in the wave in which I guess, is?
  • 05:30Since closed,
  • 05:31I had to I had to look that up.
  • 05:34But glad to be here and dive
  • 05:36right in so Donna and Charlie,
  • 05:38yet let me know what kind
  • 05:40of questions are coming up.
  • 05:41And also let me know how I'm doing on timing.
  • 05:44I got a lot of stuff to go through.
  • 05:47We want to make sure that we have
  • 05:48plenty of time for discussion
  • 05:50'cause I want to hear what the Yale
  • 05:52Community thinks about some of these
  • 05:54themes were going to talk about.
  • 05:56You're my dispute.
  • 05:57I'm sorry
  • 05:58I said OK, I'll keep an eye on
  • 06:01the time for you Doug great thank
  • 06:03you so no conflicts to disclose.
  • 06:06So here are my learning objectives.
  • 06:08Give you talking bout the
  • 06:10overall global cancer trends,
  • 06:12mainly in the context of the rise of non
  • 06:15communicable diseases or NCD's primary
  • 06:17primarily in low and middle income countries.
  • 06:21I'm gonna talk about Ask's overall strategy
  • 06:24and programs to help address these trends.
  • 06:28Then I'm going to get him to the impact
  • 06:31of the pandemic on Askos response and
  • 06:34what are some of the silver lining?
  • 06:37Some of the opportunities for innovation
  • 06:39that we discovered during this time
  • 06:42and then looking beyond the pandemic.
  • 06:44Looking at reviewing Ask's position
  • 06:46on the future of global on College
  • 06:49B as an academic discipline.
  • 06:51Why that's important.
  • 06:52And as goes role in supporting
  • 06:55Cleveland Cology So first,
  • 06:57starting with the global picture here.
  • 07:00So I'd like to start actually with
  • 07:02the global burden of Disease Study,
  • 07:05a landmark study that was published
  • 07:07in The Lancet in 2012.
  • 07:10The really documented this global
  • 07:12health shift from child and maternal
  • 07:14health and infectious diseases,
  • 07:16which is, I think,
  • 07:18how most people think of global health.
  • 07:21Two non communicable diseases or N CDs,
  • 07:24including cancer.
  • 07:24And so you can see this shift here,
  • 07:28just kind of comparing these two columns.
  • 07:311990 and 2010 and looking at the main
  • 07:34risk factors for disease in in 2010,
  • 07:37these are the top risk factors
  • 07:40an all of them relate to.
  • 07:43NCD's.
  • 07:43Most of them relate to cancer.
  • 07:47So is in this context that ASCO
  • 07:49came together with a host of
  • 07:51organizations around the world,
  • 07:53not only in cancer,
  • 07:54but we partnered with our friends at
  • 07:57cardiology and across other societies
  • 07:59to really press for the importance
  • 08:01of a UN high level meeting on CDs.
  • 08:04So why is this important?
  • 08:05So the UN at the time at only held one
  • 08:08other high level meeting on a health
  • 08:11topic and that was during the AIDS crisis.
  • 08:14So that gives you a sense of the
  • 08:17importance of these high level meetings.
  • 08:19And invite the meeting was held in 2011.
  • 08:22The world came together and the reason
  • 08:25I'm pointing this out is because
  • 08:27this was a transformative moment
  • 08:29when cancer was really recognized
  • 08:31as a global health priority is not
  • 08:34only a disease of rich countries,
  • 08:36but really seen as a global health
  • 08:39issue along with other diseases,
  • 08:41including in the NCD kind of
  • 08:43framework in the world,
  • 08:45came together and it set a world target
  • 08:47to reduce overall NCD mortality rates.
  • 08:50By 25% by 2025. So it's now 2020.
  • 08:56Anne, how are we doing?
  • 08:59Well, unfortunately,
  • 09:00the gains that we saw early on an NCD.
  • 09:04Mortality rates reduction are slowing so.
  • 09:09Up till 2010 to the reduction is about 1.6.
  • 09:14Percent per year and that gave us
  • 09:17optimism that 25% was achievable.
  • 09:19Since then it has been slow
  • 09:22to about little more than 1%.
  • 09:25Why is that?
  • 09:26Well,
  • 09:27this could be a topic for hold another talk,
  • 09:30but in the factors are complex.
  • 09:32One of them, of course,
  • 09:34is that these this NCD burden is hitting
  • 09:37countries that in fact are in transition.
  • 09:40So there are facing infectious diseases
  • 09:42and they have a health system is calibrated
  • 09:45to address infectious diseases at the
  • 09:47same time they need to re calibrate their
  • 09:50health system to address the NCD's.
  • 09:52But one other dynamic I just want to.
  • 09:55Slide that is interesting is there
  • 09:58is a shift in the risk factor trends,
  • 10:02so this is again WHO data.
  • 10:04And when we look at some of
  • 10:07the risk factors France, DDS,
  • 10:09so you see that alcohol consumption
  • 10:12has ticked up a little bit.
  • 10:14Not too dramatic, but has risen a bit.
  • 10:17While it appears that tobacco
  • 10:19use is declining,
  • 10:20that rate of decline is starting to slow,
  • 10:23which is concerning and then obesity.
  • 10:26You know,
  • 10:27when we talk about cancer and other end CDs,
  • 10:30we don't talk very often about obesity.
  • 10:33But this is a.
  • 10:34Diet is changing and this is a growing
  • 10:38risk factor and you can see this not only.
  • 10:41Globally, but in in regions that
  • 10:44you may not necessarily think of,
  • 10:46such as the African region,
  • 10:48so these are shifts in risk factors
  • 10:51that are driving this.
  • 10:52This change taken together.
  • 10:54Cancer of course,
  • 10:56along with cardiovascular diseases,
  • 10:57are the number one killer in the world,
  • 11:00and it's projected to grow
  • 11:02quite dramatically.
  • 11:03And most of this growth is going to be
  • 11:06hitting low and middle income countries,
  • 11:09so both in terms of new cases
  • 11:11of cancer and cancer deaths,
  • 11:14the bulk of that growth is going
  • 11:16to be in the countries they can
  • 11:19least afford it and where it's
  • 11:21going to be most challenging.
  • 11:23Now we can draw it.
  • 11:25Drill into.
  • 11:26Specific diseases here you can see that
  • 11:30the incidence rates of specific cancer
  • 11:33diseases are higher in high income
  • 11:36countries than low income countries.
  • 11:39I would caution a bit on this data,
  • 11:43so a couple of issues.
  • 11:46One of course,
  • 11:47is the pathology capacity and low
  • 11:50income countries is a challenge and so
  • 11:54the actual the true incidence rate.
  • 11:57In low income countries will
  • 12:00likely be be higher.
  • 12:02But then in also in low income
  • 12:04countries that the data and cancer
  • 12:06registries is a major limitation.
  • 12:08So we just you have to take the
  • 12:11data with with a grain of salt.
  • 12:14But looking at the mortality rates
  • 12:16you can see that in many of the
  • 12:19cancer types the mortality rate is
  • 12:21the same or higher than in the high
  • 12:24income countries and and then just
  • 12:26kind of looking down at cervical cancer.
  • 12:28Now we want to take some time here
  • 12:31to pause with cervical cancer.
  • 12:33The course the incidence rate is much
  • 12:35higher for cervical cancer in low
  • 12:37income countries and the mortality
  • 12:39rate is is significantly higher.
  • 12:41And when we look at sort of a map.
  • 12:45You can see that in Sub Sahara
  • 12:49Africa this is a mortality data.
  • 12:52By the way, mortality rates.
  • 12:55From the global can database
  • 12:57Arquivo candy today's 2018 and
  • 12:59so you can see in separate sub Saharan
  • 13:02African countries and other low
  • 13:05income countries around the world.
  • 13:07The rates are quite high so is in
  • 13:10this context actually that some of
  • 13:13you may know the Director general of
  • 13:16The Who has declared a plan to for
  • 13:19the elimination of cervical cancer,
  • 13:21the World Health Assembly in
  • 13:24August approved a plan.
  • 13:25For the elimination of cervical
  • 13:28cancer and actually just before
  • 13:30this call is on a call with PAJA,
  • 13:33the Pan American Health Organization
  • 13:35to layout the plan for elimination
  • 13:38of cervical cancer in in the
  • 13:40Latin American region.
  • 13:42Now this is going to be a long of
  • 13:45obviously along time to achieve when
  • 13:48you have a vaccination campaign,
  • 13:50but then acted area of focus
  • 13:53for The Who and for the.
  • 13:55Global community Stepping back again,
  • 13:58so clearly outcomes in cancer
  • 14:01is highly correlated to income.
  • 14:03The bottom axis there is the
  • 14:06segments of countries that the
  • 14:09low income countries low,
  • 14:11lower,
  • 14:11middle income countries and so
  • 14:14forth and and on the left axis the
  • 14:18ratio of mortality to incidence,
  • 14:20and so clearly more resources
  • 14:23in different countries across
  • 14:25a range of cancer types.
  • 14:27Affects the outcomes in those countries.
  • 14:29So when we talk about resources,
  • 14:32let's drill into a little more
  • 14:34granular detail and this you know,
  • 14:36we often talk about.
  • 14:39Access to the highest price
  • 14:41drugs in other countries.
  • 14:44But really these are fundamental
  • 14:46aspects of cancer care.
  • 14:49Really that the building blocks
  • 14:51that are that are limited in
  • 14:55the lower income countries,
  • 14:57so surgical facilities access to key
  • 15:00drugs such as essential drugs like tamoxifen,
  • 15:05access to palliative care,
  • 15:07or a morpheme.
  • 15:09And the the percentage of out of pocket
  • 15:12health expenditure that the individual faces.
  • 15:15I actually think so.
  • 15:16That's about 50% out of pocket
  • 15:19in low income countries and low
  • 15:22lower middle income countries.
  • 15:24I might actually.
  • 15:25My sense is out of data to back this up.
  • 15:29My sense is that actually understates
  • 15:32that when you factor in the cost of
  • 15:35transportation and get to a facility,
  • 15:37the expense in many of these
  • 15:40countries individuals are going to
  • 15:42traditional healers as a first course.
  • 15:44So they're spending money
  • 15:46on other approaches,
  • 15:47and these expenses are obviously
  • 15:49catastrophic for any individual
  • 15:51in these countries seeking
  • 15:53any kind of cancer treatment.
  • 15:55Not on this slide,
  • 15:57but equally if not more
  • 16:00critical is pathology.
  • 16:02Asity access to pathology
  • 16:04and laboratory diagnostics,
  • 16:06which is,
  • 16:07as you all know,
  • 16:09is the key part of the cancer
  • 16:14care process and a key factor in.
  • 16:17Now comes if you can diagnose
  • 16:20it earlier on and get a correct
  • 16:23diagnosis at the outcomes.
  • 16:25Of course,
  • 16:26are much better access radiotherapy
  • 16:28and other issues that is analysis by
  • 16:31International Atomic Energy Agency,
  • 16:33and you can see again countries
  • 16:36in Sub Saharan Africa that have no
  • 16:39radiotherapy machines access whatsoever.
  • 16:41This data is a little bit dated,
  • 16:44so this is 2010,
  • 16:46but really the.
  • 16:47The picture has not changed
  • 16:50dramatically since then.
  • 16:51Gives you a sense again
  • 16:54of where some of those
  • 16:56disparities are and in
  • 16:58terms of human resources.
  • 17:00So there isn't existing a comprehensive,
  • 17:03quantifiable, comprehensive analysis
  • 17:05of the global oncology workforce.
  • 17:07This is one of the better
  • 17:10studies that I've seen.
  • 17:12This was published in Ask's Jayceeoh
  • 17:15Global Oncology Journal, so this is.
  • 17:18Not the JC.
  • 17:20Oh, but the sister Journal to the
  • 17:23JCO is focused on global oncology.
  • 17:26So Doctor Raju and colleagues.
  • 17:29Looked at data around the world,
  • 17:32different data sources,
  • 17:33bearing definitions of what an oncologist is.
  • 17:36So again, you need to sort of take
  • 17:39the findings with with some caution,
  • 17:42but they arrive at the ratio of new
  • 17:45cancer cases cases per oncologist and
  • 17:47just gives you sort of a benchmark.
  • 17:50A sense of what the ratios are.
  • 17:53So for example,
  • 17:55in the United States,
  • 17:56133 new new case of cancer
  • 17:59per oncologists Ethiopia.
  • 18:0010,000 new cases of cancer for
  • 18:03oncologists and as some of you may know,
  • 18:07Ethiopian government has actually launched
  • 18:10a multiyear program to significantly
  • 18:13expand its oncology workforce and to
  • 18:15extend services beyond the capital
  • 18:18city to other centers across the country.
  • 18:21But it gives you a sense of
  • 18:24the magnitude of the issue.
  • 18:27So with that as the kind of global picture,
  • 18:31I'll then now sort of transition to
  • 18:35what task is doing in this regard.
  • 18:39So just a primer if you will.
  • 18:43On Asko, it is more than just
  • 18:46four days in Chicago in June.
  • 18:50It's it's.
  • 18:51It's actually quite vibrant oncology society,
  • 18:54so our main programs annual meeting
  • 18:57we have thematic symposia that
  • 19:00some of you may be familiar with.
  • 19:03Our journals,
  • 19:04cancer.net is our patient information portal.
  • 19:07Conquer cancer is our foundation.
  • 19:10And cancer link is and I hope
  • 19:13there aren't any questions.
  • 19:15I cancelled because of rapidly get on my
  • 19:18death but it is our big data platform
  • 19:21that is drawing information from
  • 19:23HR's currently in the United States.
  • 19:26Analyze overall a patient
  • 19:27Terra trends and insights.
  • 19:29So this is the ASKO strategic plan.
  • 19:32I'm not going to go through it in detail,
  • 19:36but you'll see the four goals.
  • 19:38Kind of running through the.
  • 19:40The middle of the slide there and on
  • 19:43the right hand side you'll see making
  • 19:46a global impact is front and well,
  • 19:49not friends center,
  • 19:50but a main component of the
  • 19:53ASCO strategic plan.
  • 19:54I just think that this really demonstrates
  • 19:57the seriousness that ASCO takes.
  • 19:59With respect to it,
  • 20:02it's global.
  • 20:03Sort of profile its responsibility to
  • 20:06its members and its constituents and its
  • 20:10commitment to to having a global impact.
  • 20:14Because Asko is a global organization,
  • 20:16so half of our meeting attendance
  • 20:19is international.
  • 20:20Almost exactly 1/3 of our
  • 20:22membership is international.
  • 20:24Our journals,
  • 20:25the Journal Clinical Oncology,
  • 20:27and, as I mentioned,
  • 20:29that JC Oaklawn Cology are red
  • 20:32around the world and in effect
  • 20:35practice around the world.
  • 20:37So with that kind of global commitment,
  • 20:40an profile.
  • 20:41What is Asco's international strategy
  • 20:43to address some of these issues?
  • 20:46Well,
  • 20:46there's three parts.
  • 20:48Is the strategy,
  • 20:49and I'll go through it.
  • 20:52Go through it briefly and happy
  • 20:54to talk more about in the Q&A.
  • 20:58But there are three components
  • 21:00that intersect with each other,
  • 21:02so first is leadership development.
  • 21:04As a member Society of
  • 21:07course we're focused on.
  • 21:09Engaging our members and it's really
  • 21:11a global health truism if you will,
  • 21:14that if you're going to have
  • 21:16an impact and change practice,
  • 21:18you need to engage agents of change
  • 21:20change agents who can incorporate and
  • 21:23lead those those programs for you.
  • 21:25So the leadership development is a key piece.
  • 21:28Then we work with those leaders to
  • 21:31implement access to quality of care programs,
  • 21:34which I'll get into and this and then
  • 21:37underlying all this activity is researched.
  • 21:39So we have a sense today of how
  • 21:42we can improve access to care,
  • 21:44but we always need to be searching
  • 21:47for those better solutions and
  • 21:48understand the evidence base and
  • 21:50going where the evidence takes us.
  • 21:53And the only way,
  • 21:54as you all know to do that
  • 21:56is through research.
  • 21:58So just really briefly,
  • 21:59I'll go through some of these programs.
  • 22:02So in terms of leadership, we engage
  • 22:04with oncology leaders around the world.
  • 22:06Through we have our International
  • 22:08Affairs Committee,
  • 22:09which is a global body.
  • 22:11And then,
  • 22:12more recently we've started
  • 22:13creating a regional councils,
  • 22:15so our first one here is the
  • 22:17Asia Pacific Regional Council.
  • 22:19In these councils are members who
  • 22:21will help ask a really deep in our
  • 22:24engagement in specific regions of the world,
  • 22:26understand what are the challenges
  • 22:29with what are the opportunities in
  • 22:31ways that we can engage the oncology
  • 22:34community in each of these regions.
  • 22:36So those are current leaders,
  • 22:38but then we also have to develop the
  • 22:41next generation of oncology leaders.
  • 22:44Some of you may be familiar
  • 22:46with our idea program.
  • 22:48I know many Yale faculty have
  • 22:51been idea mentors pictured here.
  • 22:53As you can see,
  • 22:55I'm yells own doctor in these type car
  • 22:58and her mentee mercy CJ from from Nigeria.
  • 23:02We also have the virtual mentoring program,
  • 23:05so these programs identify young
  • 23:07emerging on koleji leaders,
  • 23:09primarily in low and middle income countries.
  • 23:12Mentor them,
  • 23:12bring them into the ASCO fold,
  • 23:15and then,
  • 23:16as I'll mention more later on,
  • 23:18we then work with these leaders
  • 23:21and engage the manasco programs and
  • 23:23help us to do implement programs
  • 23:26in countries around the world.
  • 23:28We also have a leadership
  • 23:30development program which also.
  • 23:32And this was one of the first participants
  • 23:35in and actually how a nice and.
  • 23:38I first met each other and we have
  • 23:41international participation in this
  • 23:43leadership development program.
  • 23:45As we work them with these leaders
  • 23:47to improve the quality of care
  • 23:50delivered in their countries,
  • 23:52we do this through a number of
  • 23:54modalities versus training.
  • 23:56So we do in person training when
  • 23:58back when we could do that and
  • 24:01hopefully will be able to resume that
  • 24:04through ASKO international courses
  • 24:05or courses are focused on palate
  • 24:08if care multidisciplinary care.
  • 24:10Cancer prevention and in clinical
  • 24:12trials I'm here.
  • 24:13You have picture another picture
  • 24:15of the knees that promises
  • 24:17my last picture of a nice but
  • 24:19doing a training course for us.
  • 24:21I believe in the Philippines.
  • 24:24And then online training through our E
  • 24:27Learning platform and another online.
  • 24:31Mechanisms that we have that I'll
  • 24:33get into now, ask, of course,
  • 24:35has guidelines that we have.
  • 24:37The ASCO standard ASCO guidelines
  • 24:38and then we also have resource
  • 24:40stratified guidelines so busy you
  • 24:42are not familiar with the concept.
  • 24:45Basically, it goes back to the evidence
  • 24:47base and says well if a certain
  • 24:50treatment modality is not available,
  • 24:52what is the evidence?
  • 24:53Say that is the next best
  • 24:55and then the next best,
  • 24:57and so it enables you to have
  • 25:00the best standard of care.
  • 25:02In different practice settings,
  • 25:04still based on the available admins,
  • 25:07so we're incorporating these
  • 25:09guidelines into our training.
  • 25:11We're also using increasingly
  • 25:13internationally quality measures.
  • 25:14Some of you may be familiar
  • 25:17with Askas kopi program,
  • 25:19the quality Oncology Practice initiative.
  • 25:22This takes data from deidentified
  • 25:24anonymized data from charts,
  • 25:26and compares it against established
  • 25:29evidence based quality measures
  • 25:31and produces a report card.
  • 25:33Back to the practice on how they're doing
  • 25:36on their quality and more and more.
  • 25:39We're doing this internationally
  • 25:41to really assess the quality
  • 25:43of care and health practices,
  • 25:45improve the quality of care that's
  • 25:47being delivered internationally,
  • 25:49and then finally sites.
  • 25:50So increasingly,
  • 25:51we are performing these programs at
  • 25:53specific sites for ASCO has a multiyear
  • 25:56sort of commitment winning relationship.
  • 25:59If you will,
  • 26:00with hospitals through international
  • 26:02cancer core programs that were active in.
  • 26:05Nepal and Vietnam and Honduras.
  • 26:08Bouton Uganda.
  • 26:09Working with specific hospitals to
  • 26:13enhance their cancer care capacity and
  • 26:17then through a program started by.
  • 26:20I see see the city cancer talent
  • 26:23where we're taking that same
  • 26:25kind of long-term collaborative
  • 26:27model and applying it to cities.
  • 26:30So we're working with colleagues in Cali,
  • 26:34Colombia, Ascencion, Paraguay,
  • 26:35Kumasi in Ghana,
  • 26:36and Yanggang Mian Mar and we'll be
  • 26:40expanding that so it kinda drill down here.
  • 26:43Case example cancer course site
  • 26:46in Honduras so we're working at
  • 26:48the hospital Escuela in hospital,
  • 26:51San Felipe.
  • 26:52Is one of our first programs start in 2010.
  • 26:56Now we've had about 100 volunteers to date.
  • 27:00Travel to Honduras and work
  • 27:02with their colleagues there on
  • 27:05the focus there is on Kynoch.
  • 27:08Safe administration of chemotherapy.
  • 27:10Multidisciplinary care in palliative care.
  • 27:14We've done this again by working with
  • 27:17some pass ID recipients in Honduras,
  • 27:21organizing international courses,
  • 27:22doing virtual tumor boards,
  • 27:24and more recently I mentioned the
  • 27:27pathology challenges or recently working
  • 27:30with the College of American Pathologists.
  • 27:33An apologist in Honduras and as
  • 27:36well as the oncology community to
  • 27:39develop pathology capacity and.
  • 27:42Support their efforts in that regard.
  • 27:45And now they've started collecting
  • 27:47data and publishing their data again,
  • 27:50this is the JCO global oncology.
  • 27:54And all of this as I mentioned,
  • 27:56needs to be informed by research.
  • 27:59So when we talk about research,
  • 28:01there are some key components as you know,
  • 28:04but just to highlight them,
  • 28:06you need to be training investigators
  • 28:08in these resource limited
  • 28:09settings to conduct the research
  • 28:11because the research needs to
  • 28:13be done in these settings.
  • 28:15That's how you're going to
  • 28:16move the needle forward.
  • 28:18So Askos, doing clinical trials workshops
  • 28:20in low and middle income countries,
  • 28:22training investigators on the best practices.
  • 28:25With the conduct of research and also
  • 28:28working with partner organizations in India
  • 28:30and Australia to do sort of bales type,
  • 28:33I believe many of you may be familiar
  • 28:36with the Dalek or so this is to design
  • 28:40research protocols in Cancer Research.
  • 28:42Take that sort of Dale model and apply
  • 28:45it to India in Asia Pacific region
  • 28:48Credo in India and Accord in Australia.
  • 28:51These are slightly different however,
  • 28:54in the topic of the research is being done.
  • 28:57Was the veil tends to be on drug development,
  • 29:02credo and accord armor.
  • 29:04Multi modality and it's also looking
  • 29:07at research where your re purposing
  • 29:10low-cost existing drugs to improve
  • 29:13outcomes in resource limited settings.
  • 29:16So again emphasizing the need for specific
  • 29:19research for a resource limited environment,
  • 29:23ASKO, through its Conquer Cancer Foundation,
  • 29:26provides research funding.
  • 29:27We're one of the greatest largest
  • 29:30funders of Cancer Research,
  • 29:32specifically for low and
  • 29:34middle income countries.
  • 29:35Through innovation grants or fellowships.
  • 29:37And why is in global
  • 29:39oncology and then finally,
  • 29:41in terms of research, dissemination.
  • 29:43So this is where I think things that
  • 29:46separates ASKO from a typical foundation.
  • 29:49Because then we're able to
  • 29:52marry up that research funding.
  • 29:54Those does findings with the
  • 29:56channels that the global channels
  • 29:59that Apsco has to get that.
  • 30:01Out into practice.
  • 30:02So the JCO global oncology or annual
  • 30:05meeting as a global health track,
  • 30:07and most recently our breakthrough meeting
  • 30:09that we started in Thailand in 2019.
  • 30:12So here is kind of a map
  • 30:14of our activity last year,
  • 30:16this year has been obviously
  • 30:18affected by pandemic.
  • 30:19Not get into that, but just kind of.
  • 30:22I'm not going to go through all these pins,
  • 30:25but just kind of gives you a sense of
  • 30:28the breadth and depth of ask's activity.
  • 30:31Globally just kind of pick out a
  • 30:35few things so that the dark blue
  • 30:39pins are the innovation grants.
  • 30:41So these are investigators
  • 30:43in these countries.
  • 30:45Discovering novel cancer control
  • 30:47solutions for a lower resource
  • 30:50or lower metal resource setting.
  • 30:52The the purple pens are I
  • 30:55mentioned the quality measures.
  • 30:57These are copies certified practices,
  • 30:59so these are practices that have been
  • 31:02certified to be providing the same
  • 31:04level of care as the copies survive
  • 31:07practices in the United States,
  • 31:10and again is A and we're looking to move
  • 31:13this more into lower resource settings,
  • 31:16but we're we're hopeful that this can
  • 31:19serve as a benchmark for quality care
  • 31:23delivery in a range of practice settings.
  • 31:27OK,
  • 31:27so you may be thinking that all sounds great,
  • 31:31but in terms of a pandemic,
  • 31:33how are you able to do some of
  • 31:36these international programs?
  • 31:37Right now,
  • 31:38before I talk about the impact
  • 31:40of the pandemic on ASKO course,
  • 31:43we need to pause here for a
  • 31:45moment and justice
  • 31:46acknowledges, as you all know,
  • 31:48better than I really.
  • 31:50The impact of cancer of the
  • 31:52pandemic on cancer care delivery,
  • 31:54and in the Q&A I'd be really
  • 31:57interested to hear what yells
  • 31:59experience has been in this regard.
  • 32:01I just want to like this
  • 32:03really interesting study again.
  • 32:05Published in the jaeseok level,
  • 32:07Oncology 350 cancer centers
  • 32:08in about 50 countries.
  • 32:10Snapshot of the impact of the pandemic.
  • 32:12So this was what I'll call the 1st wave.
  • 32:15'cause now we're in the second
  • 32:17wave and the table is just sort
  • 32:20of gives you a sense by encourage
  • 32:23you to take a look at it.
  • 32:25And the impact of the pandemic on cancer
  • 32:28care in low and middle income countries
  • 32:32can also be the subject for another talk.
  • 32:37You know Asko has its registry there.
  • 32:40Other covid registries in other
  • 32:42countries think the impact on delay,
  • 32:45diagnosis and ultimately,
  • 32:47patient outcomes and cancer as a result
  • 32:51of the pandemic is yet to be seen.
  • 32:54And and that will be important data to see.
  • 32:59Turning to the impact of the
  • 33:01pandemic on asking.
  • 33:02Well, first and foremost, of course.
  • 33:04The annual meeting.
  • 33:05We had to shift.
  • 33:07What is a massive scientific meeting
  • 33:09in Chicago and move it all online.
  • 33:11Basically in the matter of about 6 to
  • 33:138 weeks it was a massive undertaking.
  • 33:16Those of you who did participate
  • 33:18I'd be really interested here.
  • 33:20What you thought we were.
  • 33:22We were quite pleased with it.
  • 33:24We the number of attendees were
  • 33:26comparable to the in person in
  • 33:28terms of countries we actually got.
  • 33:30Even greater participation globally and
  • 33:32actually much greater or not surprisingly,
  • 33:36greater participation from countries
  • 33:38where participation in the in person
  • 33:41might would be more challenging,
  • 33:43so just easier for clinicians to
  • 33:46access the insights that are presented
  • 33:50at the annual meeting this year.
  • 33:53So that was that was very helpful,
  • 33:56very informative and just actually
  • 33:58a final point there.
  • 34:00I think we learned a lot from
  • 34:03this experience.
  • 34:04The benefits of having that come
  • 34:07online experience says to us
  • 34:09that having some kind of hybrid
  • 34:12experience even after a pandemic,
  • 34:14I'm in a post pandemic environment,
  • 34:17will likely have some online or hybrid
  • 34:20components to the annual meeting.
  • 34:22Going forward it was.
  • 34:25Extremely helpful.
  • 34:26So from the start of the pandemic,
  • 34:30as some of you may know,
  • 34:33Asko created a resource library
  • 34:35for care during the pandemic,
  • 34:38and I just want to highlight this because
  • 34:42this is another example of innovation.
  • 34:45Where let's go really crowd
  • 34:48sourced from its membership.
  • 34:50What are the challenges for the
  • 34:53practitioner in the pandemic environment?
  • 34:56And then Furthermore,
  • 34:57crowd source the solutions and
  • 34:59work with its membership to arrive
  • 35:02at the solution says and answers
  • 35:04those questions and then compiled
  • 35:06it all together into this into
  • 35:09this repository resources.
  • 35:10So it really kind of shifted.
  • 35:13I think our relationship in a way with
  • 35:16our with our membership in a very direct way,
  • 35:20and I think,
  • 35:21operas,
  • 35:21lessons for how we can engage
  • 35:24our global membership going forward.
  • 35:26So we took the insides from that repository,
  • 35:30worked with our international members to kind
  • 35:33of globalize the guidance and the insights,
  • 35:37translated the report into 7
  • 35:39languages and put it out and to
  • 35:43inform practice around the world.
  • 35:46Like everyone else,
  • 35:48as goes been organizing webinars,
  • 35:50I think for a society like ASCO that
  • 35:54again has this global membership.
  • 35:57The webinar series was really an
  • 36:01incredible experience because again we
  • 36:04were able to tap into very early on
  • 36:07in the pandemic when it was really.
  • 36:11When Italy and Spain and Asia
  • 36:15were really being affected.
  • 36:17Drastic way by the pandemic we were able to
  • 36:21tap into our members in those countries and.
  • 36:25Host webinars, connect them with
  • 36:27our members in other countries,
  • 36:29understand what they were going through,
  • 36:32what they were learning on the ground,
  • 36:34and incorporate that into lessons for for our
  • 36:37members and constituents in other countries.
  • 36:40So is a very,
  • 36:41very helpful way for us to connect
  • 36:44our membership and learn from them.
  • 36:47And these were recorded.
  • 36:49So if you're interested there
  • 36:51an ask's YouTube channel.
  • 36:52All of those programs that
  • 36:55I mentioned earlier on.
  • 36:56We're shifting them over to
  • 36:58virtual frameworks.
  • 36:59I won't get into this in detail.
  • 37:02Happy to get into in the
  • 37:04Q&A if there is interest,
  • 37:07so some of you may be familiar
  • 37:10with Project Echoes,
  • 37:11which is sort of a Tele education platform.
  • 37:15So we're doing project Echoes with
  • 37:17colleagues around the world case
  • 37:19discussions we've been doing.
  • 37:21Even doing some guidelines
  • 37:23adaptation example here,
  • 37:24working with colleagues and other.
  • 37:26Countries around the world and
  • 37:28other collaborative projects.
  • 37:30So what were some of the lessons learned?
  • 37:33So again,
  • 37:34I think ask was learned quite
  • 37:37a bit in terms of.
  • 37:39It's meetings and how does it
  • 37:42help to educate its membership
  • 37:45in the cancer community?
  • 37:47There are ways that we can supplement
  • 37:50the in person education with with
  • 37:53the online and virtual elements,
  • 37:55we've discovered ways that we
  • 37:57can scale up our our global
  • 37:59impact through E volunteering and
  • 38:01exploring strategies around that.
  • 38:03And we've discovered ways that we
  • 38:06can engage our members in a much
  • 38:09more direct way to glean from
  • 38:11them their insights and put that
  • 38:14into practice in terms of care,
  • 38:16delivery, and research, I think.
  • 38:18Ask as members and practices learned
  • 38:21quite a bit from this experience.
  • 38:24Just a preview of coming attractions.
  • 38:27Asko formed a task force called
  • 38:30the Road to Recovery Task Force
  • 38:33that outlines some very specific
  • 38:36lessons learned from the pandemic,
  • 38:39so efficiencies and innovations that
  • 38:41can be applied to practice going
  • 38:44forward and these recommendations
  • 38:46will be published I believe soon.
  • 38:49And JC are so. Keep an eye out for that.
  • 38:55In the meantime,
  • 38:56turning again to Jaeseok level oncology.
  • 38:58I recommend that you take a look at this.
  • 39:02This really interesting paper
  • 39:03by Selene and colleagues.
  • 39:05Serve emphasizing some of these same points.
  • 39:08Ways that we can re imagine
  • 39:12global oncology clinical trials.
  • 39:14So the increased use of technology
  • 39:17opportunities to so called
  • 39:20cut the clutter, make the
  • 39:22regulations and paperwork simplified.
  • 39:25Driving speedy approvals and always
  • 39:28keeping the patient in the center.
  • 39:32So, looking beyond the pandemic and
  • 39:36future directions in global oncology.
  • 39:43So here I actually just want to step
  • 39:47back in time a little bit to 2016,
  • 39:51which is so ask around.
  • 39:53This time the Board of directors of
  • 39:56ASCO convened a task force called the
  • 40:00Global Oncology Leadership Task Force.
  • 40:03Charged with helping Oscar to chart the
  • 40:06next round of expansion Brasco globally
  • 40:09and ask US role in global oncology.
  • 40:12One of the recommendations of this
  • 40:15task force was the following.
  • 40:17As you can see on this slide
  • 40:20that there is a roll,
  • 40:23there's an opportunity for ask a transition.
  • 40:26Global oncology.
  • 40:27From what?
  • 40:28Had husband,
  • 40:29largely informal field to a formal
  • 40:32field with a strong research component
  • 40:35and recognize value to oncology
  • 40:39training and the practices oncology.
  • 40:42So ask her being ask are then
  • 40:45formed another task force to
  • 40:47look at this question in detail?
  • 40:49And this task force was chaired
  • 40:52by Julie Gralow.
  • 40:54With the following members and
  • 40:55actually we just published the
  • 40:57recommendations of this task for
  • 40:59us again on JCO Global Oncology.
  • 41:01I recommend that you take a look at it.
  • 41:04But I'll go through that.
  • 41:06Some of the highlights with you today.
  • 41:09So first we had to define global
  • 41:12on card out there.
  • 41:14Need to have low,
  • 41:16more specificity around this
  • 41:18generally seen as the oncology
  • 41:20as applied to go global health,
  • 41:22but the task force felt the need to
  • 41:25have some more definition on this.
  • 41:28I'll pause here to let you
  • 41:31read the definition.
  • 41:38So a fairly comprehensive approach
  • 41:40and really speaks to the importance
  • 41:43of level oncology is not solely the
  • 41:46practice of oncology in a resource
  • 41:49limited setting, but looking at it,
  • 41:52holistic Lee across the board,
  • 41:54and so I think that holistic
  • 41:57approach is really important.
  • 41:59So just kind of go through some
  • 42:03of the recommendations here.
  • 42:05The first was that, and by the way,
  • 42:08the Ask a board of directors has
  • 42:12approved these recommendations.
  • 42:13Anasco is working to implement
  • 42:15these and I can provide some some
  • 42:18highlights or updates on that.
  • 42:21So first and foremost,
  • 42:22the importance of raising awareness
  • 42:25of global oncology and the
  • 42:27importance of our opportunities or
  • 42:30incorporating global oncology in heme
  • 42:32ONC and met on training programs.
  • 42:34And I'd be really interested to hear.
  • 42:38What yells experienced in
  • 42:40has been in this regard,
  • 42:42and what opportunities,
  • 42:44if any, provide your your
  • 42:46trainees in global programs?
  • 42:48Because Asko Ashley and in talking
  • 42:51with a CG MA am identified?
  • 42:54I think more opportunities for
  • 42:57innovation around the training programs
  • 42:59that was previously understood.
  • 43:01So there's no.
  • 43:03And then beyond.
  • 43:06Demog working with other special societies,
  • 43:10Astro and so forth to identify
  • 43:13opportunities for global to
  • 43:16incorporate global oncology in the
  • 43:20training of other subspecialties.
  • 43:23So global oncology competency.
  • 43:25So what is it?
  • 43:27What's required to do global on koleji?
  • 43:31So ASCA will actually be coming
  • 43:33out with a companion publication,
  • 43:36hopefully in the soon in the
  • 43:38coming year on specifically what
  • 43:41global oncology competences are,
  • 43:43so some of them are in a traditional
  • 43:46sort of global health framework
  • 43:48or global health training.
  • 43:51And then there are aspects to
  • 43:53onkologie in the practice of
  • 43:56oncologix in a resource limited
  • 43:58setting that one would not normally.
  • 44:01Receive as part of their standard.
  • 44:05Oncology training and so we outline of those.
  • 44:09Does competency Zaskia perceives them?
  • 44:14And then we can.
  • 44:15There's a role for us going
  • 44:17creating a repository of these
  • 44:19training opportunities and resources
  • 44:21as the field develops.
  • 44:23As the formal academic discipline.
  • 44:26So turning them to research and practice.
  • 44:30We need to advocate for the
  • 44:33importance of global oncology research
  • 44:35and I just want to pause here a
  • 44:38moment to to make a point that I
  • 44:41think is particularly important.
  • 44:42I, you know, I think we have sort of.
  • 44:46Sometimes created sort of
  • 44:49false distinction between.
  • 44:52Addressing disparities and access
  • 44:54to care issues in the United States
  • 44:57and disparities in access to care
  • 45:00issues outside the United States.
  • 45:02So one we sort of think as sort
  • 45:05of domestic issues and then press
  • 45:09or sort of global health issues.
  • 45:12I think there is a huge opportunity
  • 45:14for us to breakdown that barrier
  • 45:17so the global oncology research
  • 45:20can directly inform.
  • 45:22The insights and the improvements
  • 45:24to care that we potentially can
  • 45:28make in the United States.
  • 45:30So, for example,
  • 45:32in innovation around access to care,
  • 45:35that's this developed in Mumbai or in in
  • 45:39another setting outside the United States,
  • 45:42can provide insights to improve access
  • 45:45to care in the rural United States or
  • 45:49other disadvantaged areas in populations.
  • 45:52So we need to sort of think
  • 45:54about the role for this kind of
  • 45:58research domestically as well.
  • 46:00Make that case.
  • 46:01So we need to find bridge funding
  • 46:04so there is funding for getting
  • 46:08started and global oncology research.
  • 46:11But we need to support
  • 46:13investigators through the.
  • 46:15The continued part of their their
  • 46:17profession and keep them on the path.
  • 46:20Through Jaeseok live
  • 46:21oncology and other channels,
  • 46:23we've been to same disseminating
  • 46:26global oncology research.
  • 46:27But are there opportunities for us to,
  • 46:30for example,
  • 46:31present more scientific research at the
  • 46:34ASCO annual Meeting on Global Oncology?
  • 46:37And how can we do that?
  • 46:40And then we need to promote
  • 46:43equitable relationships between the
  • 46:44researchers in high resource settings.
  • 46:47An investigators in the
  • 46:49lower resource settings,
  • 46:50making sure that we're learning from
  • 46:53the listening to investigators in
  • 46:56those layers or resource settings,
  • 46:58because that's the whole point, isn't it?
  • 47:02Making sure that that's
  • 47:04equitable relationship.
  • 47:06And then in terms of
  • 47:08professional development.
  • 47:10This role for ASCO as a professional home
  • 47:13for the global oncologist community.
  • 47:17So for the next generation helping
  • 47:20to connect them with networking
  • 47:22opportunities to be mentored from The
  • 47:26Pioneers in global oncology and being
  • 47:30a repository for career opportunities
  • 47:32as they emerge in global oncology.
  • 47:36As I said,
  • 47:37there are many pioneers in this
  • 47:40field and the role for professional
  • 47:43society like Oscar to recognize these
  • 47:47leaders celebrate them and again
  • 47:49support the emergence of this as a
  • 47:52respected and recognized field and
  • 47:54then some overall recommendations.
  • 47:56Integrating global oncology into
  • 47:58all those international programs
  • 48:00that I highlighted previously
  • 48:02on the importance of partnering
  • 48:05with oncology societies another.
  • 48:07Organizations including DNC.
  • 48:08I've NCI Center for Global Health
  • 48:11in the ovary center.
  • 48:13So in the time remaining,
  • 48:16I hope I'm still doing OK with time.
  • 48:20Just a few sort
  • 48:22of personal reflections on
  • 48:2410 minutes. Doug perfect. So
  • 48:27these are sort of more my personal
  • 48:30reflections don't necessarily
  • 48:32reflect ask as formal position,
  • 48:34but as was mentioned in the
  • 48:36introduction and thanks again
  • 48:38for that very kind introduction.
  • 48:41I came to ask.
  • 48:42Oh, not from the cancer community.
  • 48:45I didn't have professional
  • 48:47background and cancer,
  • 48:48certainly not on koleji And I was
  • 48:51new to the Medical Association field,
  • 48:55so I came from the standard sort of
  • 48:58global health international NGO world.
  • 49:01So with that sort of outsiders press
  • 49:05perspective really kind of actually
  • 49:07came clear to me quite quickly.
  • 49:10What a huge environment,
  • 49:12vibrant and surprisingly for me
  • 49:14surprisingly vibrant community,
  • 49:16the oncologist society community
  • 49:18is so not just ask, of course.
  • 49:22Ash Astro ACR pathology societies ACP.
  • 49:28Mother's doing great work.
  • 49:31International societies with.
  • 49:33Sigh up in Pediatrics.
  • 49:35I ogan geriatric oncology and of
  • 49:37course all the national societies
  • 49:39in countries around the world.
  • 49:41And so when I look at this community,
  • 49:44I just I see a huge opportunity for
  • 49:47societies like Oscar to support Global
  • 49:50Cancer Control and Global Health.
  • 49:52You know when?
  • 49:53When I was working with the Red Cross
  • 49:56and we would do start a program
  • 49:59in another in another country,
  • 50:01there are significant investments that
  • 50:03International Energy needs to make.
  • 50:05To do programs you know you need
  • 50:07to set up the field office hire
  • 50:10staff and stones these Jeeps
  • 50:11you know all that sort of thing.
  • 50:14These international NGOs would would
  • 50:16give their right arm for the assets
  • 50:19that societies potentially can
  • 50:20bring to bear to to global health.
  • 50:23So first and foremost we have our
  • 50:26members that depth of the knowledge
  • 50:28of our members and their experience.
  • 50:31Which is a huge asset.
  • 50:33These members are in the field,
  • 50:35so right now as we speak we have
  • 50:38hundreds of ASCO members practicing
  • 50:40oncology and low and middle income countries.
  • 50:43This is their day today and the
  • 50:46insights and experiences that they
  • 50:48have from their practice is a huge
  • 50:51asset as we think about how to
  • 50:53improve the care in these settings.
  • 50:55The network,
  • 50:56so these members all have
  • 50:58professional relationships,
  • 51:00formal and informal,
  • 51:01that we can tap into to improve,
  • 51:04to deliver programs.
  • 51:05Societies are always forward looking,
  • 51:07so a big research component
  • 51:09always like you know what is the
  • 51:12evidence says so in our guidelines.
  • 51:15In our in our presentations.
  • 51:17In our in our publications it's always
  • 51:20forward looking and building on the evidence.
  • 51:23Societies have authority.
  • 51:25It's societies like Oscar.
  • 51:27Their opinion is respected and
  • 51:29carries weight and related to that
  • 51:32we have influence that we have
  • 51:35access to policymakers either in
  • 51:37the United States or are members
  • 51:40in countries around the world.
  • 51:42Often are in position to influence
  • 51:45policy makers in their countries.
  • 51:48So taken together there is enormous
  • 51:50potential life thing for societies
  • 51:53to have a positive impact.
  • 51:55In in global oncology in global
  • 51:58health generally it maybe because
  • 52:00I've two teenagers at home.
  • 52:01I sort of think of it this way,
  • 52:04but I think the societies
  • 52:06and global health are at
  • 52:08a sort of an adolescent stage.
  • 52:11I think we're just scratching the
  • 52:13surface were growing internationally,
  • 52:14starting to apply our strengths,
  • 52:16but but I think we can do more where
  • 52:19the challenges of the world and figuring
  • 52:22out what is the role for societies like
  • 52:25Ascot to address these challenges.
  • 52:27ASKO, in other societies were
  • 52:29not going to do it all. You know.
  • 52:32We have our niche you can see in
  • 52:35the bottom right of the slide.
  • 52:37Our tagline knowledge conquers cancer or
  • 52:39focuses on knowledge and capacity building.
  • 52:41How does that slot into the other components
  • 52:45of global oncology in global health?
  • 52:47And overall,
  • 52:48I just think it's a very exciting time
  • 52:51of promise and potential in that regard.
  • 52:54What are the challenges to realizing this?
  • 52:57So in global health,
  • 52:59as many of you know,
  • 53:01you have to strengthen the health
  • 53:03systems you have to take a systems approach.
  • 53:07And quite honestly,
  • 53:08this is not always emphasized and so
  • 53:11we need to be mindful of that and try
  • 53:14to approach it from a systems perspective.
  • 53:17Implementation signs.
  • 53:18We always need more data and evidence
  • 53:21on how to what programs have impact.
  • 53:23How do we know that they have
  • 53:26impact and incorporate that into
  • 53:28the actions that we that we take?
  • 53:30Our volunteers are outstanding.
  • 53:31We couldn't do what we do without
  • 53:34our volunteers,
  • 53:35but there are there volunteers that
  • 53:37are dedicated but they need to be
  • 53:40supported and their work needs to be
  • 53:43formalized in a way in our in country.
  • 53:45Members have multiple demands
  • 53:47on their time and that's.
  • 53:49That's always a challenge,
  • 53:50so this kind of,
  • 53:51in my mind points again to the
  • 53:53need to formalize global oncology.
  • 53:55And doing that,
  • 53:56we need to learn from other global
  • 53:59health disciplines and experiences.
  • 54:01So, just to summarize,
  • 54:03the take home messages,
  • 54:05I hope I've helped helped everyone to
  • 54:08sort of informed you with about the
  • 54:11rising global cancer burden and that
  • 54:14this has been this rises private.
  • 54:17Overall shift and CDs and low
  • 54:19and middle income countries ask
  • 54:22was not just an organization,
  • 54:24the community that can be harnessed
  • 54:27to address these challenges,
  • 54:29the pandemic, while a global catastrophe,
  • 54:31of course.
  • 54:32Has Forrest innovations that
  • 54:34kind of a lasting and potentially
  • 54:36positive impact on this response and
  • 54:39it's critical to formalize global
  • 54:42oncology in terms of training,
  • 54:44mentorship,
  • 54:44research and practice in societies
  • 54:47like Costco can have a major role
  • 54:51in global health.
  • 54:52So I'd like to thank the
  • 54:55International Affairs Committee,
  • 54:56in particular the chair of our
  • 54:58committee Clarissa Mathias or Brazil,
  • 55:01and all of our members.
  • 55:03You can see from all over the world
  • 55:06and just a fantastic group volunteers,
  • 55:09the international favorite staff,
  • 55:11small small Team but call them
  • 55:14my special forces because we're
  • 55:16small but high impact.
  • 55:18And then finally, if all through all this,
  • 55:21some of you have been thinking well,
  • 55:23this global health sounds like, well,
  • 55:25like the restoration of a vintage car.
  • 55:27Well,
  • 55:28you'd be spot on because like global health,
  • 55:31you need a range of stakeholders to do
  • 55:33this work, including your dog Jasmine.
  • 55:35And sometimes you need to do things
  • 55:38differently. So in this case,
  • 55:40installing the engine from underneath
  • 55:42the car is supposed to from
  • 55:44above and you always have to be
  • 55:46thinking about the next generation.
  • 55:48This case, my daughter Taylor
  • 55:50and teaching her how to work on
  • 55:53cars so that happy to welcome any
  • 55:55questions and answer any questions
  • 55:58and look further discussion.
  • 56:00Thanks Doug, that for this incredible
  • 56:03overview of all the work that ASCO is doing,
  • 56:06I was not aware of the breath and
  • 56:08scope of it all and really thought it.
  • 56:11But I know many of my Harvard colleagues
  • 56:13go to the conference in Chicago,
  • 56:16and they've presented a lot of the
  • 56:18epidemiologic research and so forth,
  • 56:20so I had been aware of the extent
  • 56:22of your work and global oncology.
  • 56:25I'm wondering just to start off,
  • 56:27we have a few other questions as well,
  • 56:29like the NCI has picked up as.
  • 56:32On global oncology being very important.
  • 56:34As Charlie mentioned,
  • 56:35I think early on and I'm wondering
  • 56:38was that just like parallel worlds
  • 56:40or is it a result of sort of some?
  • 56:43The advocacy that your Department
  • 56:45has been doing an you know how are
  • 56:48you working with MCI and where
  • 56:50do you see NCI going with
  • 56:52this? Yeah, no an NCI.
  • 56:55They've been terrific partners.
  • 56:56We work very closely together.
  • 56:58I really think Donna,
  • 56:59so this is really emerged and
  • 57:02one of the reasons I started
  • 57:04with that that the UN meeting I
  • 57:06really think over the past 10 or
  • 57:0915 years there has been emerging
  • 57:11consensus and focus on this issue.
  • 57:13I think arising awareness of the rise of
  • 57:16cancer in low and middle income countries.
  • 57:18And so I think the NCI center was an
  • 57:21outgrowth of that rising awareness and.
  • 57:24Just sort of been the zeitgeisty.
  • 57:27Well they were all working on this
  • 57:30step. Yeah, great now I need childcare
  • 57:32is ask can you speak to how institutions
  • 57:35and Ella Mai sees low and middle income?
  • 57:38Countries can become Q API certified.
  • 57:40I don't even know what that means
  • 57:42so maybe you can answer that for
  • 57:44those of us who don't know and
  • 57:46then maybe addressed the question.
  • 57:49Yeah, so this is this is the copy program,
  • 57:52so this is a quality measurement program and
  • 57:55and so there is a legal component to it.
  • 57:58So you know there's some time to get into it.
  • 58:01But are lawyers need to assess
  • 58:04the patient data privacy laws in
  • 58:06each countries to see whether we
  • 58:08can do copy in those countries?
  • 58:10But assuming that we,
  • 58:11the legal analysis has been done in a
  • 58:14particular country with where center is,
  • 58:16I'd be very happy to connect them
  • 58:19with our clinical Ferris staff
  • 58:21and start looking at that.
  • 58:23Great and
  • 58:24Melinda Irwin said very positively.
  • 58:26She loves the ASCO global
  • 58:29oncology definition.
  • 58:30I do as well and she's wondering
  • 58:33if others agree with the focus on
  • 58:36disparities in differences and the focus
  • 58:40on implementation science and policy.
  • 58:43So that's sort of a question to
  • 58:46others I guess, not necessarily.
  • 58:47You presumably you agree with that.
  • 58:51Yeah, I mean I, you know I do.
  • 58:53Of course. Of course the volunteers
  • 58:55developed the definition.
  • 58:56I'm just staff but but I think you do
  • 58:58have to look at Holistic Lee for the
  • 59:01reasons I tried to share in my talk.
  • 59:05OK, well we're a little a minute
  • 59:07over the hour so I think it might
  • 59:10make sense to thank you again.
  • 59:12Very much leisure to meet you
  • 59:14and for you to reconnect with
  • 59:16some of your old friends and we
  • 59:18appreciate you virtually coming and
  • 59:20giving this presentation today.
  • 59:23Well thanks again and I apologize.
  • 59:25I took so much time I meant to
  • 59:27leave more time for discussion,
  • 59:29but you know if there are any
  • 59:32unanswered questions you have my email,
  • 59:34please send them my way.
  • 59:35I'd be very happy to answer
  • 59:37any of that that I can and look
  • 59:40forward to hearing more about
  • 59:42the work of Yelling Global Ontology. Great,
  • 59:44OK, so thank you Doug and thank you all.
  • 59:47Bye bye thank you.