February 4th is World Cancer Day, a UICC-led initiative promoting awareness about how everyone and anyone can do their part to reduce the global burden of cancer. I want to emphasize the word “global” in that sentence, because in my experience, nearly everyone in the U.S. – including many of my colleagues in the medical profession – is focused primarily on cancer-related challenges that directly affect patients here.
Even the Cancer Moonshot initiative, a worthy endeavor that is technically global in scope, will truly only impact the U.S. That’s because there is an enormous gap between U.S. patients and those in the rest of the world, another gap between developed and developing countries, and then a third gap between rich and poor inside developing countries. Even if a cure for cancer were found tomorrow as a result of this Moonshot, it wouldn’t affect the vast majority of the world’s cancer patients.
The burden of cancer is greatest in low- and middle-income countries (LMICs). In 2012, 57% of new cancer cases and 65% of cancer deaths occurred there, and the average patient in a developing country is roughly twice as likely to die from their cancer than a patient in the U.S. That increased risk is primarily from lack of screening, lack of access to treatment, and treatment methods that are decades behind those used in the U.S. One jarring statistic to illustrate the delta: 58% of breast cancer patients in Mexico present with advanced-stage cancer, versus just 12% of breast cancer patients in the U.S.
The U.S. already provides the most advanced cancer care in the world. We have a responsibility to now help the rest of the world catch up.
There are some simple steps we can take to help measurably improve survival rates for underserved cancer patients worldwide. Here at GCI, we work directly with cancer doctors in LMICs to propagate simple interventions that are common in the U.S. and have been proven to accelerate diagnosis, access, and treatment. Some examples are:
- Global Tumor Boards, which help physicians and oncologists in developing countries connect directly to U.S. physicians by videoconference to discuss challenging cancer cases and ask advice.
- Patient Navigation Programs, intended to help ensure cancer patients have rapid access to treatment. Patient Navigators help patients find physicians, deal with insurance companies, book treatment appointments, and follow up to make sure patients get to appointments. This low-cost intervention is making a big impact: In a Mexico City pilot, the program reduced the median time from diagnosis to referral to a cancer center from two months to 11 days, boosting patient outcomes and survival rates.
- Cancer Databases, to track and understand socio-demographics, treatment choices, and outcomes in patients in developing countries, to bring attention to long-standing cancer control problems (such as the larger proportions of young women with breast cancer in LMICs, like Mexico).
Do we need to find a cure for cancer? Yes, of course. But in the meantime, the U.S. has a wealth of medical knowledge that can and should be shared with the rest of the world to make an impact today. On World Cancer Day, let’s think not just about how to reduce cancers in the U.S., but globally. The rest of the world needs a Cancer Moonshot too.
Dr. Eduardo Paulino from Rio de Janeiro, Brazil, served as a 2016 GCI Global Fellow from June to December. Throughout his Fellowship, Eduardo participated in all of the projects we do here at GCI, from leading research publications on cancer control in Brazil to helping design projects that will help patients in his home country and beyond. Eduardo has been a fantastic and energetic addition to our GCI team, and in the last few days of his Fellowship, I was able to speak with him about the projects he has been working on with GCI, his time in Boston, and his goals upon returning to Brazil.
1. Could you tell us a little bit about your background, your work as an oncologist, and what you do in Rio?
I’m a medical oncologist, dedicated specifically to treating gynecologic tumors. I work in the department of Gynecology Oncology at the National Cancer Institute (Hospital do Cancer II) in Rio de Janeiro, Brazil, which is a public cancer institute. Most of my patients are under-resourced and have some serious obstacles when they try to access high-quality cancer care. In my hospital, we are able to provide public care for all women with the best evidence-based practices, which is a very rewarding environment to work in.
2. Do you like Boston? How has your experience been in our city?
Boston is an amazing city, and it has been a great host. I have had no problems at all (if you don’t count apartment hunting…) Wherever you are, you always have access to markets, drugstores, gyms, grocery stores, etc. The city is also very welcoming to foreign students and tourists, with so many schools, hospitals, and things to do. All of the Bostonians that I have met are very friendly and helpful.
3. What has been your favorite experience in your fellowship so far?
My favorite experience in my fellowship has been the opportunity to share my ideas and have them taken into account. The interaction with my mentors was very fruitful, and I believe that both sides benefited from collaborating together. It is great to work with so many different people and to meaningful contribute to projects that will change the landscape of cancer care for patients in my country.
4. What kinds of projects are you working on here with Dr. Goss and GCI? What projects or ideas are you most excited about sharing with your colleagues and starting at your hospital when you get back to Rio de Janeiro?
My projects with Dr. Goss and GCI are based on the barriers that patients in low- and middle-income countries (LMICs) face when trying to access quality cancer care. We believe that the first step is to find these obstacles and create plans to overcome them, in order to better serve cancer patients in under-resourced countries. GCI’s patient navigation programs and prospective databases are the most exciting projects that I would like to implement in my hospital. GCI already has a global database for young women with breast cancer, but since I specialize in gynecologic oncology, I helped to design a cervical cancer database, so we can begin to learn more about the treatment choices and outcomes for women in Brazil and elsewhere who are suffering from this disease. It will be very exciting to implement this database with my own patients and contribute to a global body of data that will help us help women around the world.
5. What do you think will be your biggest take-away or lesson-learned from your time here at GCI?
Multidisciplinary work! Here, I really got to experience how important it is to engage in multidisciplinary teamwork–taking into account everyone’s opinions, respecting everyone’s experience, and maximizing our impact with the best approach. This pattern of working with multidisciplinary teams is one of GCI’s key goals, and it is used in patient care, as well as any kind of research project the group performs. By engaging the right people and various experts in the field, we are able to make the best decisions possible for our patients.
6. What advice would you give to young oncologists, doctors, or students who are thinking about getting into public health or cancer research?
That is possible to make a difference! Public health, especially in LMICs, is challenging. When you hit your first obstacle, don’t give up because there will be many more ahead. With continuous effort, you do have the ability and power to change patient care (whether that is by treating individual patients, improving screening practices, connecting a patient to other services, providing palliative care, or even finding a cure). Believe in yourself!