ASCO and Global Oncology

November 18, 2020

Information

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.