ASCO and Global Oncology

Transcript

• 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.