ASCO and Global Oncology
November 18, 2020Information
Yale Cancer Center Grand Rounds | November 17, 2020
Doug Pyle
ID5900
To CiteDCA Citation Guide
- 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.