An equal access to quality care services comes with, among other factors, the availability of a well-trained specialised healthcare workforce at a local level (WHO Global strategy on human resources for health: Workforce 2030). In oncology, the variability in training requirements in different countries due to a diverse recognition of medical oncology as a standalone specialty, as well as the lack of easy-to-access education opportunities in some under-resourced areas risk to further exacerbate inequalities. As part of its commitment to tackle global diversity in oncology and progress further in ensuring quality cancer care to all, ESMO has recently launched the International Cancer Foundation (ICF) which will bring new opportunities in those geographical areas where they are needed the most as highlights ESMO and ICF President, Prof. Solange Peters.
What is the mission of the International Cancer Foundation?
Clinicians in some countries are missing out on educational activities and support, including those offered by ESMO. They do not have the time or resources to attend our congresses or get involved in research. Having talked to some of these highly valued colleagues, we realised that our Society is in a position to reach out to them and address their specific needs and concerns. The ICF aims to support, financially and practically, activities that enhance cancer prevention, diagnosis, treatment and follow-up where they are most needed. We will do so by going where others have not thought or the courage to go before, including regions where it is difficult to imagine that optimal cancer care could arrive. The ICF will have behind it the full weight of the knowledge and experience of an ESMO community eager to contribute to the common good.
What kind of activities does the Foundation plan to support?
In under-resourced areas the Foundation will offer education and training opportunities such as fellowships and exchanges which will be designed to local needs. For example, we already know that there is a significant need for pathology training in Central America to implement diagnostic tests for cancer, such as for hormone receptors in breast samples and other biomarkers, and to validate methodology.
Through the Foundation, a new generation of fellows will have the opportunity to receive financing for research projects that can benefit developing countries. Moving forward, exchanges of doctors could be enabled between developing and less-developed countries: an opportunity for the former to acquire specialised skills or learn new techniques, and for the latter to gain access to expertise on malignancies which have become rare in the developed world, such as cervical and HIV-related cancers.
In addition to education, the ICF will be uniquely positioned to garner support for clinical trials for these diseases, for which skills and infrastructure are currently lacking, and to advocate for taking down barriers like the systematic exclusion of HIV-positive patients from oncology research.
How will the ICF respond to local needs to tailor its activities in specific under-resourced areas?
Through the ESMO network, the Foundation will work closely with colleagues who know the local environment so that to fully understand local health systems. Following this approach, Country Reports will be developed regularly to provide details on the epidemiological situation on individual territories, their unique health systems and the accessibility of medicines and care in local realities. This information will be paramount to determining how resources should be shared to the greatest effect in the future and will allow the Foundation to act in the real interest of patients according to the local challenges they face. The Country Reports will be made available to the broader oncology community via ESMO’s open access digital journal ESMO Open.
Will part of ICF’s activities be dedicated to cancer prevention where ESMO has taken its first steps in the last year starting a collaboration with IARC?
The medical oncology community has traditionally considered prevention to be mainly a topic for family doctors and organ specialists, but it is not. As disease specialists, we must be able to provide competent answers also on prevention based on a firm grasp of the latest numbers, survivor data and research findings. Recognising the need to educate a broader base of doctors on emerging knowledge from research in this area, the Foundation will continue and build upon ESMO’s existing work to help protect populations from cancer risks and guide them towards health-promoting lifestyles. This will be even more crucial in low- and middle-income countries (LMICs) which are disproportionately affected by cancer due to local risk factors like viral infections and where a paucity of resources and inadequate implementation of cancer preventive measures exist (JAMA Oncol. 2017;3(4):524-548). Cancer cases are expected to increase to nearly 30 million by 2040 worldwide, but the majority will occur in LMICs, so it is very important to take some actions now at a local level to educate the public. Evidence-based campaigns on smoking, diet and lifestyle have been run in many countries, however, there is a need to extend and tailor these messages for those areas where cancer screening and immunisation against infections such as hepatitis, HIV and HPV are of primary importance. And information must be provided in a language that people understand so that we can really make a difference.
Will ICF be also a driver of cancer patients’ education?
There is an urgent need to help people have a better understanding of cancer, its treatment, and the latest advances in the field. A part of our efforts with the ICF will be in the direction of giving more people access to the orientation provided by ESMO’s Patient Guides. By facilitating the Guides’ translation into new languages, it will empower patients to start their disease journey well-informed, in the familiar terms of their native tongue. And going even further with an ambition to update patients on evolutions in oncology as they unfold, it will make available a free online platform designed to decode how new scientific data will ultimately change the care they receive.
What are the first project in the ICF’s pipeline?
To start with, three countries – Nicaragua, Botswana, and Vietnam – have been identified among those where ESMO has strong collaboration. We will begin to implement exchange and other support programmes to facilitate improvements in cancer care and test the concept of ICF investment. In the next future, we will consider proposals competitively so that to respond to local needs.
How will the ICF be funded?
Initially, the ICF will receive a significant contribution from ESMO and additional unrestricted grants and donations from charitable and commercial organisations. We have been delighted by the initial response from potential donors; like us, they see that there is a clear need for this foundation to promote equity of cancer care across all nations.