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.
The Global Cancer Institute (GCI), a 501(c)(3) public charity, has a mission to improve the survival and quality of life of underserved cancer patients worldwide. It’s an ambitious goal, but GCI is accomplishing this by connecting a network of global oncologists through an integrated and easily accessible technology platform: Google.
GCI unifies its global projects on the Google platform, utilizing the resources offered by Google for Non-Profits. Google allows GCI to connect substituents via Google Apps. Google Apps is HIPAA-compliant, which is an important capability since GCI works with health data and adheres strictly to HIPAA standards. Google’s HIPAA compliance ensures that GCI’s data remains protected, even within this cloud-based technology platform.
Some of the key Google Apps products that assist GCI in meeting its goals are as follows:
Google Drive allows GCI to give access to shared documents to their global network of doctors through a single platform, which is particularly important considering GCI’s network of over 350 doctors in more than 20 countries around the world. Google Drive allows GCI to control multiple folders and documents and thereby effectively manage and control all of its global projects with many constituents.
Google Hangouts is a videoconferencing tool that allows GCI to connect an unlimited number of viewers to participate in our Global Tumor Boards – live, doctor-to-doctor meetings that allow discussion and collaboration on complex patient scenarios from around the world. It is an extremely valuable educational tool and offers the opportunity for doctors to collaborate and learn from each other – even from different continents.
Google Forms provides a simple way to create patient questionnaires, activity tracking logs, and clinical surveys, which help collect important data for many of GCI’s projects.
Google Sheets acts as a back-end for the data collection that happens through Forms, functioning as an easily shareable spreadsheet that updates in real-time as data is gathered from around the world.
Google Extensions, like AppSheet, expand the capabilities of the Google Apps. AppSheet is a tool that converts the Forms that GCI creates into applications for an iPhone or tablet. This allows patient questionnaires and activity tracking logs to be housed on a tablet’s home screen, easily accessible and user-friendly for both patients and health workers. It also allows use in areas that do not have wi-fi, an important capability in low resource areas. The data is then uploaded to Sheets when a wi-fi connection is established.
Google Analytics allows GCI to track activity on their website in order to gauge their audiences, expand their reach, and engage with followers and potential donors.
GCI recently hosted a Global Tumor Board Special Session on genetic profiling for metastatic breast cancer, led by Dr. Ben Park from Johns Hopkins and Dr. Aditya Bardia from Massachusetts General Hospital. Genetic profiling is a way to analyze patient tumor samples and analyze on a molecular level the alterations that are unique to different tumors. A new and exciting field, the goal of genetic profiling is to create targeted therapies for cancer patients, based on their unique genetic sequence.
While this technique has great potential for advancing the field of cancer research, its benefits may not be accessible for most cancer patients in low- and middle-income countries (LMICs):
First, genetic sequencing is very expensive, with single tests ranging from $3,000 to $5,000 for a single patient. The final cost increases from there when considering the price of the personalized treatment plan that results from the genetic analysis. This price tag is too high for most, especially for patients who can barely afford standard cancer care.
Second, sequencing requires efficient and streamlined laboratory networks – samples need to be collected and delivered to the lab within hours, and the sequencing itself requires advanced tools and techniques. For many fragmented health systems with few resources, this may be too tall an order.
Finally, even clinical trials – one way many disadvantaged cancer patients are able to receive at least some sort of cancer therapy – may be largely inaccessible for patients in LMICs in this case. The majority of genetic profiling clinical trials are likely to be remain in high-income countries due to the aforementioned barriers in LMICs.
So, is there anything that can be done to share the technological advances of the U.S. and other wealthy nations with the millions of cancer patients in LMICs? Of course, over many years these genetic profiling techniques will get older, become cheaper as newer techniques are developed, and make their way to lower income countries (this happens with many things: TVs, iPhones, and even cancer therapies considered “old school” in the U.S. that have become more mainstream in LMICs.)
Rather than sitting back and waiting for this day to come, Dr. Park said that there a few promising paths that can be considered now:
- Technology: Currently, “next generation sequencing” (or “NGS”) requires expensive machines and materials. But technology is getting better, faster, and cheaper. Dr. Park imagines that, in the future, we could see “portable kits” for community oncologists to use to sequence quickly, easily, and for low costs. In fact, several companies are continuously updating both their hardware and software – technologies are on the horizon where sequencers may even be plugged into a USB port.
- Education: Educating community oncologists, both in the U.S. and in LMICs, is another important and inexpensive way to progress the field and start building capacity for when the technology does become available. Lectures, like this one hosted by GCI as part of our Global Tumor Boards, are a good first step, but a more systematic approach is needed to help oncologists understand and interpret genomic tests, information, and how they can help guide therapies.
- Philanthropy: Philanthropic organizations could support the creation of a “pipeline” whereby patients’ tumor samples can be processed and shipped from LMICs to the U.S., analyzed, and the results sent back to physicians.
However, this last point would also mandate that drugs and trials be available for these patients once they get the results of their sequencing, which Dr. Park says is a much more difficult issue. Personalized therapies are prohibitively expensive and therefore inaccessible to most patients in LMICs (in fact, many personalized therapies are not even covered by insurance providers in the U.S.) So, unless drugs and clinical trials become accessible to these patients – or the pharmaceutical companies bend to allow greater access to high-cost meds for the majority of the world’s population – there would be no utility in making the genetic profiling technology available. Dr. Park concluded, “It has to be an end-to-end solution.”
Jessica St. Louis is the senior program coordinator for GCI and has been with GCI since its inception. Among her many duties, she coordinates Global Tumor Boards: live, online videoconferences that connect doctors from around the world to discuss complex patient cases. Here, Jessica answers some of the most frequently asked questions about these tumor boards and how she works with GCI’s global network to make them happen.
What are tumor boards?
Global Tumor Boards are meetings where a multidisciplinary team of doctors get together to discuss complex patient cases. They are not only valuable for patients, who of course benefit from having multiple doctors reach a consensus on best treatment and care, but they are also an important educational tool. They offer an opportunity for doctors to collaborate and learn from each other – even from different continents.
How exactly do Global Tumor Boards work?
Our tumor boards are online videoconference meetings with the ability to host 15 cameras and unlimited numbers of viewers who can watch the meeting. This is unique in that we can connect and communicate with hundreds of doctors at once in real time from our office in Boston! Doctors can also go on YouTube and watch recordings of our previous tumor boards at any time.
Who are the doctors that join tumor boards? Where do they come from?
Doctors who join our tumor boards are from over 18 countries in Latin America, Eastern Europe, Africa, and Asia. In total, our tumor boards have reached over 350 doctors worldwide. The patient impact of Global Tumor Boards is huge, considering that one doctor typically treats hundreds of patients per day.
What exactly do these doctors talk about during the one-hour meeting?
GCI holds monthly tumor boards on breast and gynecologic cancers. In each meeting, we invite hospitals from low- and middle-income countries (LMICs) to present challenging patient cases to a panel of multidisciplinary experts from prestigious cancer centers in the United States, including Johns Hopkins, Stanford University, MD Anderson, and others. Our panel of experts help the doctors reach a consensus on each patient’s treatment. We find that many doctors have similar challenges when providing cancer care in LMICs with limited resources. We discuss these resource challenges as well as GCI’s research initiatives and interventions to improve access to clinical care.
Why does GCI do tumor boards?
Global Tumor Boards are an effective way to improve patient care through doctors. The doctors in these countries often work in multiple hospitals and see hundreds of patients a day without the guidance of their peers. This burden prevents doctors from keeping up to date on clinical practice guidelines.
They are a great way to engage doctors in patient care discussions with their peers – doctors really enjoy talking about medicine with one another! It creates a “beehive effect” where doctors can learn together and build similar levels of clinical knowledge and styles of practice. We also engage the doctors in discussions about how their patient cases relate to “bigger picture” cancer control issues and public health interventions.
Besides that, it is very comforting for patients to know that their cancer is being watched by a team of doctors who came to a consensus about the best step forward.
What kind of technical capabilities are required to be part of a tumor board?
All that’s needed is a computer with a camera, microphone and an internet connection.
How can I join?
If you are a doctor in a LMIC and would like to join Global Tumor Boards, please contact us at firstname.lastname@example.org !