Nepal: Developing by ov70Wv87

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									Making a Difference:
Strategies for Success
Aiming for effective cancer control
in countries with limited resources –
a collaborative venture

        Annual meeting 2005, Chennai, India
Why Cancer?
   In 2002, more than half of the 11 million
    estimated patients with cancer were in
    developing countries which have perhaps
    5% of global resources
   Developing countries still have a lower
    incidence of cancer than affluent nations,
    but will account for an ever increasing
    fraction of the global cancer burden: NOW
    IS THE TIME FOR ACTION
   The WHA has approved a resolution (May
    2005) recommending that countries develop
    and implement cancer control plans
Crude Incidence; Cases

500                                      3500
                                         3000
400
                                         2500
300                                      2000

200                                      1500
                                         1000
100
                                          500
 0                                         0
           Males        Females                      Males        Females

      Less Developed   More Developed           Less Developed   More Developed



        Per 100,000 per annum                     Thousands per annum

                                        2002
             Estimates of All Cancer Cases,
             Males and Females, Trends Included

                      14000
Thousands per Annum




                      12000
                      10000
                       8000
                       6000
                       4000
                       2000
                         0
                                2002        2005        2010        2015       2020

                                    Less Developed       More Developed

                              Influence of aging and increases in population size
The Problem: a Vicious Cycle

             Many Patients    High
             With Advanced    Mortality
  Limited     Disease and     Rate
 Resources   Many Potential
                Patients
                 POOR          Unmet
    LOW         ACCESS        need for
  CAPACITY                    terminal
                                care
The Solution: Build Capacity
                                Education
                Prevention
                                Screening

                                       Lower
                  Fewer Patients       Mortality
 Less Limited    with More Limited     Rate
  Resources         Disease and
                  Fewer Potential
                      Patients
                                       Less need
  GREATER            IMPROVED         and greater
                                      capacity for
  CAPACITY            ACCESS            terminal
                                          care
     Mission Statement
INCTR is dedicated to helping build capacity for
cancer treatment and research in countries in which
such capacity is presently limited ……and to increase
the quantity and quality of cancer research throughout
the world.

Catalysis    Concerted Effort       Communication

                   Sustainability
The Goals

   To prevent as many preventable
    cancers as possible
   To cure as many curable cancers as
    possible
   To improve the quality of life of
    patients with cancer at all stages of
    their disease
The Mechanism

   Establishment of long term collaborative
    projects which will have an immediate
    impact on prevention or treatment
   Associate such projects with education and
    training
   Use information collected in the course of
    such projects as a foundation on which to
    build future endeavors
The Tool: Collaboration
INCTR’s Network




 Offices and Branches   Collaborating Units
    Advisory Board

   Special Panel of cancer experts from
    countries with limited resources
    – Provides advice on INCTR activities
    – Selects of INCTR Awardees
    – Determines venues of Annual Meetings
   Disease-specific experts
    – Scientific review of projects and
      participation in strategy group meetings
Offices and Branches

   USA, UK, France, Brazil, Egypt,
    Tanzania, Saudi Arabia, India, Nepal
   Regional/national coordination of
    INCTR programs and projects
   Access to regional/national resources
   Expansion of local capacity
   Guiding principles : INCTR Charter
Associate Membership

   Corporate Membership (3)
    – Partnerships with the corporate world
   Institutional/Organizational Membership (109)
    – Provides access to a broad range of expertise
    – Participation in INCTR activities
   Individual Associate Membership (75)
    – Contributions, financially or in kind
    – More important role in the future
Partnership with NCI

   OIA has sponsored many of INCTR’s
    educational meetings, courses or
    specific training programs in INCTR-
    recognized training centers
   Recently a collaboration has been
    developed with MECC – joint meeting
    in Cyprus
Corporate Partnerships
   Eli Lilly
    – INCTR has provided off-site data
      management for a randomized trial
      sponsored by Lilly in locally advanced Cx
      cancer in 10 developing countries
    – Support of Clinical Trials Workshops
   CTIS
    – Provided INCTR with a powerful web Portal
    – Is helping INCTR to develop clinical data
      bases and to IT-based training tools
Collaboration with Other
Organizations
   ACS – Partnership: Palliative care, ACSU
   UICC – Steering Committee for MyChildMatters
    (Sanofi-Aventis)
   WHO – Technical Committee for Global Cancer
    Control
   Institute of Medicine – Report on Cancer Control
   IAEA – Collaboration in breast cancer and
    potentially, expanded cancer programs
   ESO – Plan to hold joint meetings
   Global Alliance for the Cure of Children with Cancer
    –Organizations/institutions for pediatric cancer
   AORTIC – Discussion phase
Strategy Groups
International groups
identify and implement
disease specific
activities in prevention,
treatment, education


                                Cx Cancer, August 2004


                            Implementation Meeting, African
                            BL, Tanzania, August 2004
Active Projects (8)
   Reasons for late presentation of retinoblastoma – 15
    centers in 11 countries
   Survey of breast cancer management - 4 countries
   Cx Cancer screening (with IARC) – 2 countries, 4 sites
   Treatment of advanced cervical cancer (with Eli Lilly) –
    10 centers in 10 countries
   Treatment of metastatic osteosarcoma - 6 countries
   Treatment and study of ALL in India - 4 centers +
   Treatment and study of Burkitt’s Lymphoma in Africa -
    4 centers in 3 countries
   Provision of palliative care – Nepal (3 centers)
Projects in Planning
Phase (6)
   Treatment of locally advanced
    retinoblastoma
   Treatment of locally advanced breast cancer
   Treatment of locally advanced Cx cancer
   Extending cervical cancer screening into the
    health care structure – India
   Expansion of palliative care program to
    Tanzania and India
   Cancer control in Cameroon
Relevant Meetings and
Expert Visits in Last Year
    Workshops                         10
    Strategy Groups                   5
    Committees Meetings               4
    Individual training/fellowships   16
    Training Courses                  3
    Monitoring Visits                  2
    Expert Visits/Presentations       38
New Funded Projects

   INCTR collaborating centers and
    branches have successfully competed
    in the UICC MychildMatters program
    funded by Sanofi-Adventis and NCI:
    being awarded 4 of the 14 projects
    (Egypt: 2, Tanzania, 1, Philippines, 1)
   INCTR designated by Steering
    Committee to assist these projects
New Funded Projects

   INCTR and the American Cancer
    Society will work together in
    promoting palliative care in India
INCTR Strategies
   Conduct demonstration projects in specific
    areas of cancer control (cancers in women
    and children highest priority)
   Use centers involved as training sites to
    improve regional and national coverage
   Use clinical trials as a complete approach to
    training, education, research and patient
    care
   Maximize use of IT in training, education,
    monitoring and measuring outcomes
     Non-
 Governmental     Visiting    External
 Organization     Experts     Training
                       FUNDING
    E-learning?                            Government
                      Locally Run          or Local NGO
Education of         Demonstration
other                   Project
primary
health care
workers or
trainees



Dissemination to             Dissemination to
Health Care System           other centers
Population Coverage:
Example (Wide Application)
   700 cases of BL in
    Tanzania
   Identify centers
    capable of care
   Develop improved
    diagnostic and referral
    systems
   Provide training where
    necessary
   Develop targets for
    extending care to 80-
    90% of cases
                              Year 1   Year 2   Year 3
Value of Clinical Trials
   Improved access of patients and professionals to
    the limited number of experts:
    – Carefully designed treatment approach
    – Diagnosis and staging must be standardized
    – Supportive care must be addressed
    – Loss to follow up must be reduced
    – May include non-therapeutic components (epidemiology,
      molecular characterization)
    – Data must be accurately collected (surveillance)
   Increased communication and hence learning
    among all participants
   Instills good habits of clinical care, and a research
    perspective in junior staff – wide impact
   Provides a local data base that can be built upon
Comparison of Treatment
Guidelines and Clinical Trials
         Research                         Guidelines
   Designed for a specific            Based on available evidence
    population in the context of        – may be from a different
    available resources                 population and with
   Usually entails collaboration       different resources
    and mutual learning                Rarely entails collaboration
   Associated with quality             or learning
    assurance and ethical review       No quality control or ethical
   Identifies deficiencies             review
   Associated with outcome            No identification of
    measures                            deficiencies
   Generates new information          No outcome measures
                                       No new information
Obstacles to Conducting
Clinical Trials in LR Settings
    Lack of academic mindset – health care is
     increasingly seen as a business or service
     by practitioners and outcome is ignored
    Lack of financial or professional rewards
    Lack of required infrastructure and funds
    Lack of institutional will to collaborate
    Lack of incentive to perform trials (except
     financial inducement by Pharma)
    Inability to ensure good follow-up
Disadvantages of Joining
Existing Cooperative Groups
    Can join existing groups based in affluent
     countries, or Pharma trials but…
     – Many, perhaps most, such trials will not address
       locally important problems
     – Patients may not be comparable to those
       entered in affluent countries
     – Limited opportunities to play a role in identifying
       or designing studies
     – May be limited availability of resources (unless
       Pharma sponsored, when sustainability an issue)
     – Regulatory differences can inhibit collaboration
Maximizing IT - 2006
   Use telesynergy or
    internet based lectures
    and discussions
   Provide presentations,
    documents and
    training modules on
    portal
   Identify sources of
    funding (Fund Raising
    Committee) consistent
    with the new IT era
IT – the Nervous System
of the Global Community
   New major projects underway that require
    collaboration and standardization:
    – Cancer Control Planet (NCI)
    – caBIG (NCI project to develop a universally
      valuable and collaborative bioinformatics grid)
    – Requires standards for communication – syntax,
      vocabulary, semantics, messaging etc.
    – Various systems exist and are being harmonized,
      particularly in USA – CDISC, HL7, BRIDG
    – Global Community of Practice – WHO, UICC, BCC
   INCTR will work with partners, especially
    CTIS, to try to ensure that developing
    countries are involved from the beginning
Annual Meeting 2005
   Award lectures (Dennis Wright, Suresh Advani)
   Individual presentations (posters, oral)
   Reports on ongoing activities
   Keynote lectures
   Educational sessions and workshops on
    regionally important cancers
   Consensus panels – hereditary breast cancer
   Multidisciplinary conference – DLBCL
   Meet the expert sessions
   Members meeting
       Local Host: Cancer Institute (WIA), Chennai, India
Thanks to Sponsors
   Cancer Institute (WIA), Chennai
   Office of International Affairs, NCI
   Pasteur Institute, Brussels
   Leukemia and Lymphoma Society (workshop
    on ALL)
   Susan Komen Foundation (workshop on
    breast cancer)
   Jiv Daya Foundation
   Agfa, AstraZeneca, GlaxoSmithKline, MSD
   Local sponsors
Special Thanks
   Drs Shanta, Rajkumar, Sagar, and Local Committee
   Organizing/Scientific Committee, Indian National
    Committee and INCTR India (Dr Bhargava)
   INCTR administrative staff: Cedric, Elisabeth, Béné
    and Suzanne, Tom
   INCTR Program Directors: Melissa Adde, Ama
    Rohatiner, Aziza Shad, Stuart Brown, Kishor Bhatia
    and Marina Gutierrez, Sabine Perrier-Bonnet
   All speakers and presenters
   Delegates
   All who have contributed to INCTR activities or
    collaborated in the past years
Countries Associated with
INCTR

								
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