Guest Commentary by Dr. Edward Trimble
Building Momentum: NCI's Center for Global Health
“There were two oncologists for 30 million people in Uganda and four oncologists for 87 million in Ethiopia.”
That’s how Dr. Kenneth Miller, an oncologist from Maryland, described what he encountered during several volunteer trips to these countries to help treat patients and train a new generation of oncology care professionals.
For those of us who live in the United States and other developed countries, these statistics are shocking. Our conversations about cancer often focus on new therapies that can target a tumor’s underlying molecular drivers or advances in survivorship that are allowing those affected by cancer to live longer, healthier lives—not on whether there is a trained oncologist available to treat a patient’s disease.
With cancer incidence and death rates climbing rapidly in the developing world—by 2030, it is estimated that of the more than 20 million global cancer deaths, nearly two-thirds will occur in these countries—this is serious cause for concern.
Soon after arriving at NCI, Director Dr. Harold Varmus announced that improving global cancer health was among his top priorities, and he formed NCI’s Center for Global Health (CGH) to better coordinate and expand the institute’s global research activities.
Despite tight budgets, Dr. Varmus and I agree that the opportunity and the obligation to address the global burden of cancer have never been greater. Our efforts can build on the strong foundation created by the success in combating infectious diseases like malaria and AIDS.
Since CGH was formed, a number of important activities have taken place, including a stakeholder meeting in March that included approximately 150 participants. That was followed by a strategic planning process to define CGH’s mission, vision, and, most important, its priorities.
The priorities, which reflect consistent themes from feedback NCI has received, include
- Supporting research that can have the largest impact on the global burden of cancer
- Leveraging partnerships to optimize NCI’s investments
- Monitoring research efforts to help spur the translation of results into practice and policy
- Catalyzing training, information dissemination, capacity building, and cancer control
To be certain, there is no shortage of cancer-related problems that require further research. For example, the east coast of Africa, from South Africa to Somalia, has a strikingly high incidence of esophageal cancer, while Chile has the highest rate of gallbladder cancer of any country in the world. NCI can work with researchers in those countries to better understand why those cancers are so prevalent there by collaborating on epidemiologic and molecular biology studies and developing clinical trials to test new prevention and treatment interventions.
Conducting and supporting cancer control and treatment research outside of the United States is nothing new to NCI. The institute has longstanding programs and research collaborations in places such as the Middle East, China, and, more recently, Latin America. Through CGH, we will build on these efforts.
One of the things we have heard repeatedly, for example, is the need to develop global cancer research career tracks at universities in the United States. And we’re working across NCI to develop proposals for a variety of research projects that can influence care beyond our borders, including expanding clinical trials run by NCI-funded cooperative groups to include more sites outside the United States. As we learn more about the molecular biology of different cancers, we have realized that we need to cast a global net to accrue patients to important scientific studies quickly.
Given tight budgets, leveraging existing partnerships and establishing new ones will be essential to expanding our global research efforts. We will work with U.S. Department of Health and Human Services agencies, like other NIH institutes and the Centers for Disease Control and Prevention, the U.S. President’s Emergency Plan for AIDS Relief, the U.S. Agency for International Development, organizations such as the American Society of Clinical Oncology and the Union for International Cancer Control, and universities in the United States and abroad.
As Dr. Miller’s observation about Uganda and Ethiopia demonstrates, there is a desperate need in many countries to build both human and physical capacity. Noted economist Dr. Jeffrey Sachs of Columbia University stressed at the CGH stakeholders meeting that hundreds of millions of people in developing countries are still “not covered even by a rudimentary primary health system.”
Simply put, our collective task is large. Education and training are needed to boost the numbers of oncology professionals, and infrastructure and systems for screening and treatment must be established. Several U.S. cancer centers are already doing excellent work in this area, and through CGH we hope to build on their successes. (See “A Conversation with Dr. Patrick Loehrer” in this issue.)
One way in which we can do that is to take advantage of tremendous advances in information technology, which have the potential to revolutionize cancer control and care in many low-income countries. For example, smartphones and other technologies could be used to enhance access to pathology resources to help diagnose diseases and guide treatment, as well as to monitor patients who live long distances from a treatment center.
By its very nature, global health research is complicated. It requires partners on the ground; cooperation with national and local governments; and training of clinicians, nurses, data managers, and others involved in day-to-day research activities. No two countries’ health or research systems are alike. To be successful, we will need to be creative, nimble, and flexible.
Much work remains to be done to improve cancer care around the world, and we believe this is the right time to expand NCI’s efforts in the global health arena. What we learn in the process will not only ease the cancer burden in developing countries but also enhance our understanding of this complex array of diseases, ultimately benefiting people around the globe, including right here at home.
Dr. Ted Trimble
NCI Center for Global Health