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Dr. Rossana Ruiz Discusses Her Global Cancer Fellowship

Through GCI’s Fellowships and Scholarships, young oncologists from low- and middle-income countries have the opportunity to come to Boston and gain exposure to clinical practices, education, and research in the U.S. They participate in all of the projects we do here at GCI, from leading research publications on cancer control in their home countries to designing access-to-care initiatives to help their patients back home. Dr. Rossana Ruiz is an oncologist at the Instituto Nacional de Enfermedades Neoplásicas, in Lima, Peru, and has been our Fellow since October 2015. Rossana has been such a wonderful and energetic addition to our team here in Boston, and in the last week of her Fellowship, I was able to chat with her about her time in Boston, the projects she has been working on, and the lessons she will carry back with her when she returns to Peru.


 

Alexandra: Could you tell us a little bit about your background and what you do?

Rossana: I am a Peruvian oncologist, and I completed my medical training at the Peruvian National Cancer Institute, INEN. After I finished my residency in Clinical Oncology in 2014, I worked as a medical oncology attending for adolescents and young adults with hematological malignancies for almost a year, which was the most fulfilling and gratifying experience I have had as a clinician. I am fascinated by the challenge of understanding and treating cancer in the young, and, since then, I have been working on projects and publications on this special population of patients. Then in October 2015, I started my fellowship at the Global Cancer Institute.

 

A: How do you like Boston?

R: I am in love with Boston and you know it! This is a great city to live in and enjoy; it is organized, safe, and beautiful. As it is a university city, its population is friendly, multicultural, and highly educated, which I think is an awesome combination. In its streets, authentic history mixes with a youth vibe to create a unique atmosphere. A wide variety of cultural and musical activities await around every corner, at every time, and are accessible for everyone. Plus, it is very easy to get around the city – you can just walk anywhere while admiring the views! Being able to go the Charles River Esplanade just for lunch or just walk through Boston’s amazing parks on a sunny – or snowy – day is something I am definitely going to miss. In fact, as Dr. Goss told me on the day I arrived, a piece of my heart will remain in Boston forever.

 

A: What has been your favorite experience so far in your Fellowship?

R: One of the experiences that I have enjoyed the most is being able to experience real teamwork and being treated as peer for every single project. It is amazing how when people work together, knowledge and unique perspectives blend, and creativity booms to reach a common goal. It has been an honor to work with a network of such intelligent and passionate, yet humble, people here in Boston and around the world! I have had the opportunity to meet so many of these people individually, and it gives me great satisfaction to consider them my colleagues and outstanding role models, but above all, great friends.  

 

A: 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 Lima?

R: I have worked with very talented colleagues under the mentorship of Dr. Goss on various projects, ranging from current clinical topics in oncology to purely public health issues. We designed and conducted a survey to assess the patterns of clinical practice of more than 3,000 breast cancer specialists across Latin America, with the objective of identifying adherence to clinical practice guidelines and its determinants. The results of this assessment will constitute the framework for implementing targeted educational interventions that will aid in improving clinical care. We have also analyzed the worrisome situation of access to high-cost cancer drugs across Latin America and proposed feasible ways to overcome its multiple challenges, all from a physician’s perspective. Currently, we are working on implementing a Patient Navigation Program, as well as a very promising protocol to identify factors that predispose a certain group of young women to a deadly form of breast cancer that is related to pregnancy. Once back in Lima, I am very excited to start working right away on a multicenter database for young breast cancer patients, a highly impactful but understudied disease, more frequently seen in my region of the world.

 

A: What do you think will be your biggest take-away or lesson learned from your time here at GCI?

R: Being in Boston has been a game-changing experience for me. Besides my personal growth, working with GCI has allowed me to take time to analyze the Latin American cancer situation from a wider, mentored perspective. Our problems transcend individual jurisdictional boundaries and are common to the region, and that is why collaboration is so relevant. I learned that along the continuum of cancer care – from prevention to primary treatment and supportive care – there are multiple deficiencies that, when added up, drive the huge difference in cancer mortality between our countries and the Western world. One of the most important take-home messages for me is that every gap or barrier represents an opportunity for improvement. Therefore, each barrier needs to be properly identified, researched, and documented in order to construct goal-driven and evidence-based interventions. In this way, we obtain effective and reproducible solutions that are amenable to be applied to bigger populations.    

 

A: What advice would you give to young oncologists, doctors, or students who are thinking about getting into public health or cancer research?

R: Cancer incidence and mortality is expected to markedly increase in developing countries like mine in the following years. In our everyday practice, health inequities and the deficiencies and weaknesses of our healthcare system (evidenced by the high prevalence of advanced disease in developing countries) just jump out at us. In this setting, a public health perspective cannot be disconnected from the practice of oncology. Research is for sure the first step, and the opportunities are endless and frequently at the patient’s bedside. Doctors and researchers, especially through collaborative networks, are in a strategic position to draw authorities and public attention to our reality and our needs.

Global Tumor Boards Connect Doctors to Improve Patient Care

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 info@globalcancerinstitute.org !