STUDENTS FOR GLOBAL ONCOLOGY & GLOBAL ONCOLOGY (GO)
February 8, 2014 – Dana-Farber Cancer Institute
2014 is quickly becoming notable as a transitional year for network-building among segments of the Global Health puzzle that had long been perceived as unsolvable due to complex infrastructure requirements and corresponding costs. Following quickly on the heels of the Boston Meeting of the Lancet Commission for Glob al Surgery, the Students for Global Oncology and Global Oncology (GO) hosted a Symposium on Global Cancer Care on February 8, 2014, drawing together a multidisciplinary cadre of passionate experts and advocates. As with surgical care, conversations surrounding access to universal oncologic care quickly become mired in cost and whether the pragmatism of answering the “easier” needs of acute conditions outweigh the less guaranteed rewards of treating a chronic disease. For surgeons, the role of surgery as an essential lynchpin in the delivery of effective cancer care seems an obvious one, but necessary to emphasize, avoiding unnecessary siloing and highlighting surgery’s fundamental place in overall health system strengthening.
Implementation is everything. We need to get the science of delivery right; otherwise, even if the funding is available, we won’t be able to deliver the medicines, diagnostics, and preventitives treatments and interventions to the patients who need them. – Prof. Rifat Atun, Imperial College, Executive Management Team of the Global Fund to Fight AIDS, Tuberculosis and Malaria
LEARNING FROM THE AIDS MOVEMENT
During the morning session, Professor Rifat Atun discussed how lessons learned from the AIDS movement could be translated to building momentum for the cause of global oncology. This theme is not new to discussions related to global surgery, but its presentation here was especially concise and well-spoken. With no change in approach, oncology could be easily broadened to encompass broader issues of healthcare delivery requiring infrastructure investments with the need to harness the power of patient voice, develop and refine a platform for advocacy, and create a unified “ask”.
(For video of the event: http://video.dfcionline.org/accordent/Go3020814/ – please note that Microsoft Silverlight is required for viewing)
In a breakout session, Robert Riviello (Brigham and Women’s Hospital), AK Goodman (Massachusetts General Hospital), James Cusack (Massachusetts General Hospital), Jennifer Kreshak (Human Resources for Health – Rwanda), and John Durfee (Boston Medical Center) spoke to the challenges and opportunities in providing surgical oncologic care in resource limited settings. The panelists offered diverse accounts of engaging in local health systems in Guyana, Rwanda, Uganda, Liberia, the Philippines, and Bangladesh, sharing several common themes:
- The Foundation – for all the complexity required to successfully design and orchestrate an oncologic treatment plan, without the basic infrastructure in place to combat healthcare associated infection, ensure postoperative follow-up, and mitigate the misuse and unavailability of pharmaceuticals, all such plans are negligible in scalable value.
- The Ethics of “No” – Working in low-resource environments presents a poignant challenge to a physician’s role as patient advocate: how can one offer a treatment plan that is unavailable or that the patient cannot afford under the current system? As physicians step up to engage on a policy level, these decisions become further embroiled – to what extent should less complicated cases be “triaged” ahead of more challenging ones and is a nonlocal caregiver in a place to make or contend such value choices?
- The Challenge of Hope – Despite the limitations imposed by lack of resources and heavy oncologic burden, it is important to instill hope that there is more that can be done than “just amputate” (Dr. Kreshak) and that changes to practice are possible now and not simply in an undefined future.
- The Next Generation – The best case for hope in improving the delivery of quality surgical care for oncologic conditions is the next generation. Residency partnership programs provide a pathway and a firmer foundation on which to build relationships and improve communication as well as promoting local ownership over medical education. Residents, no matter the country of origin, offer an opportunity to support a culture of networking and camaraderie and instill a hope and commitment to the ideas that hospice care and amputation are not the sole outcomes available.
For more information regarding Global Oncology (GO) – a collaboration which focuses on networking between members of the Harvard Medical School, the Harvard School of Public Health, Harvard-affiliated hospitals, and beyond – please contact Ami Bhatt, MD PhD or Franklin Huang, MD PhD through (http://globalonc.org/). In addition to partnering with Malawi at Queen Elizabeth Central Hospital, GO is also working with the National Cancer Institute’s Center for Global Health to develop a “cancer resource map” to catalogue ongoing efforts in global cancer research, healthcare delivery, and outreach.