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

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An evolving paradigm in global outreach in radiation oncology has been the implementation of a more region-specific, needs-based approach to help close the gap in radiation services to low- and middle-income countries through the use of innovative tools in information and communication technology. This report highlights 4 information and communication technology tools in action today: (1) the NCCN Framework for Resource Stratification of NCCN guidelines, (2) ASTRO e-Contouring, (3) i.treatsafely.org, and (4) ChartRounds.com. We also render special consideration to matters related to global outreach that we believe require distinct attention to help us meet the goals established by the 2011 United Nations׳ Declaration on noncommunicable diseases: (1) trainee advancement toward careers in global health, (2) ethical challenges of international outreach, (3) critical importance of political advocacy, and (4) collaboration with Industry.

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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    Conflict of interest: Dr. Deepak Khuntia is employed by Varian Medical Systems, Vice President of Medical Affairs.

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