Fighting Cancer with Numbers

What do you mean by that?

Margaret Chan, Director-General of the World Health Organization has said ‘What gets measured gets done’. One major challenge to cancer control is to understand what we’re up against. What needs to be improved, and by how much? How many cancers are there in each country and region? What are the survival and mortality trends? How is the cancer control system performing? Answering these questions requires counting and categorizing information about many individuals and situations. This information then needs to be interpreted to create useable knowledge. Once this sort of knowledge is created, it must get into the hands of the right people, at the right time.

TimHannaTell us about yourself

My name is Timothy Hanna, and I am a Canadian radiation oncologist involved in health services research. In my research, I investigate access to cancer care and quality of cancer care. The goal is to seek out ways to improve cancer control. These research themes are of global importance given the increasing incidence of cancer across the globe. Being a radiation oncologist, my work focuses on cancer treatment, particularly radiation therapy.

What are you working on right now?

There are a few things. As one example, I’m investigating the achievable benefit of radiation therapy in the general population. If we were able to get this cancer treatment to everyone that needed it, how many people would we help? The primary work focuses on Australia, but this will be adapted to other settings. I’m working on this with a team in New South Wales, Australia. This work will inform the investment framework under development by the Union for International Cancer Control’s (UICC) Global Task Force on Radiotherapy for Cancer Control (GTFRCC).

How did you get involved?

I have had a longstanding interest in global health. As a medical student, I spent some time in Niger. I was struck by the limited cancer treatment resources where we were, the late stage of presentation and social determinants impacting access to cancer care. That was an important exposure that helped me think about global disparities and inequities in cancer care and health care. In residency, I had the chance to work with an experienced radiation oncologist clinician scientist who showed me how health data could be used to shed light on inequities and other quality issues in cancer care. This led to my fellowship work at the Ingham Institute in Sydney, Australia, and ultimately to my work at Queen’s University in Kingston, Ontario where I work as a radiation oncologist and clinician scientist supported by the Ontario Institute for Cancer Research (OICR).

Why do you think radiation therapy is important?

Radiation therapy is an irreplaceable part of cancer control. Cancer is a global problem, affecting countries of all levels of economic development. Radiation therapy delivers outstanding value for money, and is especially important in contexts where there is a burden of advanced cancers requiring treatment. When radiation therapy reaches those who need it, lives can be saved, body function maintained, and quality of life improved. These are all exceedingly important to people diagnosed with cancer.

Meet Mei Ling Yap

Mei is a radiation oncologist in Sydney, Australia and has written Global RT’s inaugural blog post. Learn about how she has combined a career in radiation oncology and global health.

Who are you and where do you work?

Mei Yap

Mei Ling Yap

My name is Mei Ling Yap and I am a radiation oncologist from Sydney, Australia. My clinical practice is at Liverpool and Macarthur Cancer Therapy Centres, in the South-western region of Sydney. It is a unique part of Australia, very culturally diverse – so I see an interesting case mix of patients. My clinical sub-sites are lung, breast and gynecological cancers. As well as my clinical role, I keep busy through research, undergraduate and post-graduate teaching and my role as the director of registrar (resident) training.

Why radiation oncology?

I decided to specialize in oncology as I feel that it’s a very ‘human’ specialty. My patients and their families are so inspiring. Working in oncology, one has the potential to help people through what is an important and challenging time in their lives, and that truly is a privilege.

I chose radiation oncology in particular as I felt it was a field where we can make a difference for patients. Radiotherapy is often the primary treatment used to cure patients, in sub-sites such as head and neck, prostate and cervix cancer, to name a few. Achieving cure for cancer patients is a wonderful outcome. Equally as important, I feel, is the ability to palliate incurable patients from potentially distressing symptoms such as pain and bleeding – with radiotherapy able to achieve that in usually more than 2/3 of cases.

How did you become involved in global health, and in particular global access to radiotherapy?

Global health has been an interest of mine since my medical student years at the University of New South Wales, where I was involved in an Australian medical student-run aid organization (MSAP), and did a posting in Chennai, India. It was alarming to witness upfront, the lack of access to medical treatment, which exists in many parts of the world.

In 2008-9 I did part of my radiation oncology training at the National University Cancer Institute in Singapore. I found it interesting to manage a different case-mix of patients (e.g. High incidence of nasopharyngeal cancer), and learn the different cultural perceptions of cancer, which exist there.

It was while I spent a 2-year fellowship at Princess Margaret Cancer Centre (PMCC) in Toronto that I realized that my passions for radiation oncology and global health could be united. Dr Mary Gospordarowicz, at that time the head of PMCC and now UICC, was harnessing members of the radiation oncology community who were interested in tackling the issue of global access to RT. After returning back to Australia, I was fortunate enough to be given the opportunity to work alongside my GTFRCC mentor, Professor Michael Barton, who is an extremely prolific researcher in global cancer health research, as part of his team at CCORE.

What is your role in GTFRCC?

My role in the GTFRCC is as part of the burden and outcomes working group, which is working to define the scope of the need for radiotherapy in low and middle income countries, as well as estimating the benefit in outcomes that radiotherapy would add to these countries. The work that we are performing will be a significant part in the GTFRCC ‘white paper’ to be launched at the UICC meeting in Melbourne in December. I am also part of the GTFRCC Young Leader’s program.

What research are you doing in global health?

At present, I conduct cancer health services research as part of CCORE, Ingham Medical research, Liverpool. The CCORE team, under the direction of Professor Michael Barton, developed an evidence-based model, which estimates the optimal utilization of radiotherapy in a developed country. We are currently adopting this model to low and middle-income countries to measure the optimal utilization of radiotherapy in those countries, with projections up to 2035. We are also estimating the differences between what should be, and what is currently available, in terms of radiotherapy resources – and comparing the present deficit to that of a decade ago.

Why do you think advocacy for improved access to radiation is important?

Advocacy for improved access to radiation oncology will play a central role in achieving the goal of closing the gap in terms of radiotherapy resource provision. We have made huge gains in term of cancer outcomes in high-income countries, but unfortunately cancer in low and middle-income countries has gone largely ignored. This cannot continue! The statistics are harrowing – 70% of cancer deaths occur in low and middle income countries, and cancer causes more deaths worldwide than malaria, TB and HIV put together – yet majority of people are unaware of this. This is where I think globalRT will make a huge difference. We need to communicate these facts, particularly harnessing social media – twitter, facebook etc etc. So readers, go ahead and spread the word!

Where is the most interesting place that your global RT work has taken you?

There have been many interesting visits, but my most recent was to Imam Khomeini Hospital in Tehran, Iran. The radiation oncology department, headed by Professor Peiman Haddad, is currently in the process of some exciting developments. It was especially nice to meet the radiation oncology residents, currently 10 of the 13 are female.