MedCity Influencers, Opinion

What the U.S. needs to do to assist cancer patients and their physicians in developing countries

Tumor boards can help physicians in developing countries get access to U.S. expertise and represent one way to democratize state-of-the-art care for cancer patients throughout the world.

The U.S. has among the best-quality healthcare in the world. If you have to get sick, this is where you want to be.

Consider two breast cancer patients. One lives in Boston, and one lives on a Bangladeshi farm. It probably won’t surprise you to hear that the second patient is twice as likely to die from her cancer. That increased risk is primarily from lack of screening, lack of access to treatment, and treatment methods that are decades behind what we use here in the U.S.

But U.S. healthcare providers are waking up to the reality of this inequity, and doing more to share their knowledge with the rest of the world. For the past several years, I’ve been participating in tumor boards run by the Global Cancer Institute, headquartered in Boston, and it’s changed my outlook on practicing medicine.

Tumor Boards allow physicians to share difficult cases and seek advice and ideas from peers and they are often utilized by U.S. hospitals but rarely in developing countries.

Physicians in these countries often work more than one job and have 14-hour days. There is no time for research and few colleagues to compare notes with. Having access to a tumor board can give these physicians a sounding board and advice on difficult cases. The need in these developing countries is so strong that tumor boards can draw hundreds of foreign physicians for each session, impacting thousands of their patients.

It was through such a tumor board – I was a consulting U.S. physician – that I learned of a 14-year-old girl from a small farm in rural Bangladesh. She was only eight years old when the first lump was found, leading to her long battle with breast cancer. In six years, the girl endured two lumpectomies, two cycles of chemotherapy, a mastectomy with axillary lymph node dissection, and four final chemotherapy cycles. After exhausting all possible alternatives, the treating oncologist presented the case during a GCI Breast Tumor Board and asked the network for guidance.

The multidisciplinary and multinational board reviewed the case and ultimately recommended molecular testing for an ETV6-NTRK3 fusion based upon the rare type of breast cancer this was described to be. This was later confirmed through collaboration between Johns Hopkins and Memorial Sloan Kettering in the U.S.  Based on this diagnosis, oncologists were able to gain approval for an experimental drug known as LOXO-101, a TRK inhibitor. The treatment was performed at the Department of Pediatrics at Memorial Sloan Kettering Cancer Center and was a success. Now in full remission, the patient has returned home. She takes a pill daily and remains well.

I’ve treated thousands of patients during my career as a physician and this girl’s case was one of the most impactful. The fact that we even connected is miraculous. The fact that the tumor board physicians were able to immediately identify that she was a good candidate for a new drug in a clinical trial in New York, even more so. And as a result, her healthcare team – including her amazing and tenacious physicians in Bangladesh, and her dedicated parents – was able to save her life.

These stories are happening every day thanks to the work of non-profits with tumor boards, but not often enough.

How can providers help?

  • By participating in programs such as GCI or other tumor boards, where expertise is always needed. The more physicians we have, the more tumor boards we can host.
  • By taking physicians from developing countries under their wing, either virtually or through fellowships and internships.
  • By supporting programs and foundations that can bring patients from across the world to participate in clinical trials when appropriate.

The U.S. healthcare system needs to step up and work harder to share its knowledge with providers in other countries, and in developing countries in particular. Knowledge is power, and it should be available to all physicians and patients, not just those in the U.S. Tumor boards are one way to democratize state-of-the-art care for cancer patients throughout the world, so that this miraculous story becomes the rule, not the exception.

CGToolbox, Getty Images

 

 

 

Dr. Park has pioneered the use of “liquid biopsies” to help guide future management of breast cancer therapies. He has also led the formation and implementation of molecular tumor boards at Hopkins and other institutions, and more recently at the Vanderbilt-Ingram Cancer Center. Dr. Park attended The University of Chicago for his A.B. degree, followed by dual training at The University of Pennsylvania School of Medicine where he received both his M.D. and Ph.D. degrees. Dr. Park then trained in Internal Medicine and Hematology/Oncology at The University of Pennsylvania prior to completing a post-doctoral fellowship in the laboratory of Dr. Bert Vogelstein at Johns Hopkins. Dr. Park then joined the faculty in the Breast Cancer Program at The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and was Professor of Oncology, Associate Director of Education and Research Training and Associate Dean of Postdoctoral Affairs for the School of Medicine prior to joining Vanderbilt University Medical Center in 2018. He is currently the Donna S. Hall Chair in Breast Cancer, Professor of Medicine and Associate Director for Basic and Translational Research in the Division of Heme/Onc, Co-Leader of the Breast Cancer Research Program, Associate Director for Translational Research and Director of Precision Oncology at the Vanderbilt-Ingram Cancer Center. His research program involves identifying and validating genetic targets for breast cancer therapy and diagnostics.

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