GlobalRT has released it’s latest short film!

In less than 2 minutes, we highlight a few of the social consequences of untreated cancer. We hope that after watching the clip, you’ll be able to share it among your friends, family and colleagues in order to raise awareness of this important cause.

Kevin_Tan

Kevin Tan

Kevin Tan, a radiation oncology registrar working in Gippsland, Australia and creator of this short film, had this to say about the film:

“I’ve found that some some of the most meaningful work we can do is often also the most humble. Combating cancer on a global scale needn’t be pioneering stuff, nor is it particularly sexy. It begins simply by counting, by framing the challenge, and advocating for interdisciplinary solutions. I am optimistic that the global community will rise to this challenge. But first, let’s get the agenda on the table! Help us spread the word!

 

A new perspective: Reflections from Mulago Hospital, Uganda

John Mac Longo

John Mac Longo

I spent the month of July working at the Radiotherapy Department at Mulago Hospital, Uganda’s flagship public hospital located in the teeming, rambunctious capital city of Kampala.  This is the only radiation oncology center in Uganda, a country of 36 million people.  The clinic also draws patients from South Sudan, Eastern Congo, and parts of Kenya. The workhorse of the clinic is a singular Cobalt-60 machine, originally installed in 1994. The cobalt source has not been changed in 12 years. In order to accommodate the patient load, the machine treats patients 24 hours a day, Monday through Friday, reserving most Saturdays for larger palliative fractions.

The physicians, house officers, nurses, therapists, and staff embraced me from the moment I crossed the clinic threshold and quickly incorporated me into their busy practice.  As I arrived early each morning for LDR brachytherapy insertions, dozens of patients would be lined up.  Many of them had spent the previous night camped out on the hospital grounds. By the time the morning chart rounds and tumor boards were over and we were ready to start, new consultations, patients under treatment, and follow-ups filled every inch of the waiting area.

Clinic was ripe with both learning opportunities and challenges. I developed a level of comfort managing cervix, nasopharynx, and other cancers common in Uganda but less prevalent in the US. Seeing the radiation oncology zebras like endemic Kaposi’s sarcoma and penile cancer seared these sites in my mind. The neglected breast, rectal, or vulvar cancers called attention to the lack of screening and general cancer awareness in the country.

mulagohospitaluganda

Soon after settling in, I was given my own cramped office and a stack of patient files to see each day. Although the physicians were available for help, they encouraged autonomy.  I was forced to overcome language barriers (60 tribes in Uganda, each speaking their own language), work around limited medical records, and navigate a foreign healthcare system. There were frustrating and stressful moments. But there were many more moments of the privileged patient provider connection that drove me to pursue medicine in the first place.

mulagohospitaluganda2

Exposure to 2D planning was a highlight. The clinic lacks a CT sim, so the majority of cases were planned using fluoroscopy.  Others were planned using tumor and bony anatomy alone. Field dimensions and separation were measured, recorded, and outlined with marker and torn pieces of plaster.  There were many times I missed the seemingly limitless planning tools and image guidance available at home but I also came to appreciate the simplicity, efficiency, and efficacy of 2D planning.  In between procedures, meetings, and clinics, I managed to deliver twelve radiation oncology -focused lectures. This teaching component enabled me to share educational resources and insights from the West. This peaked the curiosity of my Ugandan colleagues and generated robust discussions.

My experience in the Radiotherapy Department at Mulago Hospital was transforming professionally and personally. My commitment to working in resource-limited settings domestically and internationally has been solidified. I look forward to building upon the relationships I have made in Kampala and helping others in our field connect with cancer care providers around the world.

John Mac Longo is a fourth year resident in radiation Oncology at the Medical College of Wisconsin in Milwaukee, Wisconsin (USA).

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.