Bridging Innovation and Outreach to Overcome Global Gaps in Radiation Oncology Through Information and Communication Tools, Trainee Advancement, Engaging Industry, Attention to Ethical Challenges, and Political Advocacy☆
Introduction
Unlike the challenging cases we may confront in our clinics each day, there is little debate on whether to expand our services to those in dire need, the 80% of the world׳s population with cancer, who primarily reside in low- and middle-income countries (LMICs), formerly referred to as the “developing world.”1, 2 Much effort has been made on the critical role of defining the problems that exist in these underserved regions of the world. The published literature has recently undergone a transformation, with multiple oncology-specific journals devoting entire issues to this topic (Fig. 1).2, 3, 4, 5 As our specialty has sought to better understand these global disparities that exist in oncology, this has led to the development of a number of pivotal outreach efforts that exemplify a commitment to lifelong learning through a combination of hands-on experiences as well as through the advancement of information and communication technology (ICT).6
We review some key initiatives that have been launched recently to highlight innovative approaches that have fostered improved collaboration and coordination of global health efforts in radiation oncology (RO). We acknowledge that this is not a comprehensive description of all ongoing global health strategies in our field, but merely a snapshot of certain programs that have proven successful and offer hope and promise for the ongoing mission to expand our services to the underserved. We pay particular attention to (1) the evolution of our organizational leadership, (2) ICT tools in action, (3) highlight how trainee leadership and involvement has been critical to the growth of collaborative global outreach, (4) the role of industry in helping close these gaps in global access, (5) emphasize the importance of global advocacy, and (6) discuss some of the ethical challenges of global outreach.
Section snippets
Evolution of Organizational Leadership
In 2011, the United Nations (UN) call for action on combating the global burden of noncommunicable diseases (NCDs) spurred much needed momentum into ongoing efforts to help close the gap that exists in health services to underserved populations suffering from cancer worldwide.7 Since 2002, the American Society for Radiation Oncology (ASTRO) International Education Subcommittee (IES) has been committed to this end, and recently under the leadership of former President of ASTRO, Dr Timothy
ICT: Tools in Action
Profound disparities exist across the globe in the delivery and practice of radiation therapy, technological infrastructure, and manpower.11 Compounding the problem has been the rapid and wide-spread acquisition of advanced RO techniques including intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery, and image-guided radiation therapy that have dramatically increased the need for educated and experienced RO teams to deliver high-quality and safe treatment.2 Training of such a
Leading the Charge: Trainees at the Forefront of Global Outreach
Before the restructuring of IES in 2011, the Association of Residents in Radiation Oncology (ARRO), the trainee section of ASTRO, underwent its own change in 2009, with the establishment of the following subcommittees: Education, Global Health, and Website. The primary objective of this restructuring was to increase participation in resident-driven initiatives beyond the work of the 6 elected ARRO officers, so as to effect change on a national level with greater productivity and efficiency.19
Industrial Revolution: Catalyzing Collaboration and Support for Technology Transfer to Underserved Populations
Industry is on the cusp of very significant growth with the increasing body of evidence supporting the need for radiation therapy services in LMICs4 as well as the growing number of successful pilot programs in LMICs.21 Therefore, this may be a monumental opportunity to help address the global gaps of radiotherapy provision in comprehensive cancer care, while growing the scope of business and technology to a more expanded global sector. Furthermore, the areas where industry may play a role
Ethical Challenges
There are several key ethical issues that rapidly become apparent as global travel and international communication, and advancing technology bring international health care systems into close partnerships. These increasingly prominent ethical challenges would undoubtedly confront practitioners who seek to improve global access to care. The literature regarding specific ethical challenges facing oncologists participating in global health is sparse and practically nonexistent for radiation
Advocacy
Perhaps one of the most critical, yet historically weakest components of this global mandate for improved technology and resources available to LMIC is advocacy: engaging people, businesses, government, and the scientific community to establish a solid base of support to ensure that the message to combat the growing global burden of cancer remains strong. Little is known about the social and political factors that influence priority setting for different health services in LMIC, yet these
Conclusion
The ASTRO IES restructuring that took place in 2012 has helped catalyze a movement toward a more region-specific, needs-based approach to helping close the gap in radiation services to LMICs. Global health initiatives have significantly grown in recent time, with a paradigm shift to include a focus on enhancing education and training of those living in LMICs with ICT, as evidenced by (1) the NCCN Framework for Resource Stratification of NCCN guidelines, (2) ASTRO e-Contouring, (3)
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Smart Solutions to Address the Global Gap in Radiation Oncology Through Trainee Engagement and Partnerships with Industry
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Global Health Perspectives Among Radiation Oncology Residency Program Directors: A Knowledge, Attitudes, and Practices Survey
2020, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Third, PDs who have global health programming could share such initiatives with interested PDs through a mechanism such as the Association of Directors in Radiation Oncology and perhaps in collaboration with ARRO’s GHSC to share “best practices” and collaborative models to ensure feasibility and sustainability. Lastly, given the strong consensus from PDs that global health could be a mechanism to alleviate health disparities, bilateral opportunities should always be considered.33 This would allow LMIC trainees from partner programs to reap direct benefits from their institution’s participation through such formal arrangements.
Utilization of a Web-Based Conferencing Platform to Improve Global Radiation Oncology Education and Quality—Proof of Principle Through Implementation in India
2019, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Chartrounds has been an effective web-based tool in the United States to connect radiation oncologists with disease-site specialists for peer review and education. Importantly, information and communication technologies, such as Chartrounds, have been identified as a key mechanism to foster collaborative global outreach in radiation oncology (4). Furthermore, a recent needs assessment survey of radiation oncologists in India highlighted the potential advantages of establishing a cross-institutional case review program (5).
Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low- and middle-income countries: A qualitative study
2020, Asia-Pacific Journal of Clinical Oncology
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Conflict of interest: Dr. Deepak Khuntia is employed by Varian Medical Systems, Vice President of Medical Affairs.