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Organizational chart. The structure and terms of office are detailed in the business plan and by-laws. There is a Board of Directors overseeing the organization. A Steering Committee is a subset of the Board active in the detailed management. A Board of Advisors will provide input to the Board of Directors. The functions of and relationships among the hubs, experts, associates, and centers are described above including Figure 1. See text below for detailed discussion of ICEC operations.
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The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs) and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps is pioneering a novel global mentorship-partnership model to address workforce...
Citations
... 16 Although there is a worldwide shortage of RT services, this shortage is most pronounced in LMICs where over 50% of patients with cancer lack access to RT services. 17 High-income countries have an estimated one RT machine available for every 120,000 people, compared with one machine to over one million people in middle-income countries and one machine to five million or more people in low-income countries. 6 The radiation therapy utilization (RTU) rate measures the proportion of patients with cancer requiring at least one treatment course of RT during their disease process. ...
Radiation therapy (RT) is an essential part of the multidisciplinary treatment of pediatric cancer. Over the past five decades, significant advances have been made in the delivery of RT, with better dose delivery to disease targets while minimizing exposure to nearby organs at risk. These advances have led to improved treatment outcomes, increased survival, and reduced treatment-related toxicities. Advanced treatment techniques, however, require significant investment in infrastructural and personnel resources. This review documents what is currently available regarding expertise and infrastructure for pediatric radiation oncology practice in Nigeria. It was performed to serve as a foundation for the creation and design of tailored solutions (initiatives and policies) to increase pediatric radiation availability, accessibility, and equity in Nigeria and ultimately improve pediatric cancer treatment outcomes in the region.
... 1-4 Limited capacity to provide necessary cancer therapy in LMICs is multifactorial and, beyond material resource constraints, is caused by a lack of provider training and infrastructure development. 5 For instance, locally advanced cervical cancer, a leading cause of death in women in LMICs, [6][7][8] is often curable with high-dose-rate (HDR) brachytherapy. [9][10][11][12] HDR brachytherapy involves the delivery of a radiation treatment by temporarily placing a high-activity radioactive source inside or near a target volume. ...
PURPOSE
Our objective was to demonstrate the efficacy of a telehealth training course on high-dose-rate (HDR) brachytherapy for gynecologic cancer treatment for clinicians in low- and middle-income countries (LMICs)
METHODS
A 12-week course consisting of 16 live video sessions was offered to 10 cancer centers in the Middle East, Africa, and Nepal. A total of 46 participants joined the course, and 22 participants, on average, attended each session. Radiation oncologists and medical physicists from 11 US and international institutions prepared and provided lectures for each topic covered in the course. Confidence surveys of 15 practical competencies were administered to participants before and after the course. Competencies focused on HDR commissioning, shielding, treatment planning, radiobiology, and applicators. Pre- and post-program surveys of provider confidence, measured by 5-point Likert scale, were administered and compared.
RESULTS
Forty-six participants, including seven chief medical physicists, 16 senior medical physicists, five radiation oncologists, and three dosimetrists, representing nine countries attended education sessions. Reported confidence scores, both aggregate and paired, demonstrated increases in confidence in all 15 competencies. Post-curriculum score improvement was statistically significant ( P < .05) for paired respondents in 11 of 15 domains. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .009), treatment planning system commissioning (2.2 to 3.9, P = .0055), and commissioning an HDR machine (2.2 to 4.0, P = .0031). Overall confidence in providing HDR brachytherapy services safely and teaching other providers increased from 3.1 to 3.8 and 3.0 to 3.5, respectively.
CONCLUSION
A 12-week, low-cost telehealth training program on HDR brachytherapy improved confidence in treatment delivery and teaching for clinicians in 10 participating LMICs.
... 1 While there are many efforts originating in LMICs to address the growing cancer burden, financial and human resources in the health sector are often inadequate. [1][2][3][4][5][6][7][8] In high-income countries (HICs), several specialties and sub-specialties such as infectious disease, primary care, and maternal and child health have well-established global health initiatives. [9][10][11][12] These often leverage research or clinical support from medical institutions in HICs to improve healthcare delivery in LMICs. ...
... There was representation from all four United States Census Bureau regions, with 22% (12) in the Northeast, 26% (14) in the Midwest, 26% (20) in the South, and 16% (9) in the West. Median number of residents per program was 8 (IQR: [6][7][8][9][10][11], with 20 programs with 6 or fewer residents, 23 programs with between 7 and 11 residents, and 12 programs 12 or more residents. Results by program size are reported in supplemental Table 1. ...
Purpose/Objective(s)
Global health interest has risen among medical students applying to and residents training in radiation oncology, often outpacing available educational offerings. The Association of Residents in Radiation Oncology (ARRO) Global Health Subcommittee (GHSC) sought to determine the perceptions of program directors (PDs) in radiation oncology and their current or planned global health curricular opportunities.
Materials/Methods
A standardized, Knowledge, Attitudes and Practices (KAP) survey composed of 32 binary items was sent to PDs for all Accreditation Council for Graduate Medical Education (ACGME)-accredited radiation oncology programs.
Results
Program response rate was 60% (55/91). Responding programs were distributed evenly geographically and included a range of training program sizes. Most PDs (77%) knew that most nations did not meet standard minimum benchmarks for radiation therapy access. While 89% would support residents to pursue global health rotations, only 22% would support departmental funding of such rotations. Further, 94% felt that global health was a field worthy of an academic career, but only 39% felt that it yet had appropriate rigor. Only 8% of programs had dedicated global health rotations.
Conclusion
Radiation oncology PDs largely expressed favorable views of global health as a pursuit and affirmed a high degree of resident and medical student interest. However, faculty commitment and program offerings currently lag behind the interest level. In particular, a substantial number of program directors do not perceive that global health is yet a rigorous academic endeavor. Future progress in academic global health in radiation oncology will require strategies to systematically support pathways for development of experience and scholarship both within and beyond residency.
... 14, 15 These drifts likely reflect a combination of demographic factors associated with social and economic development, including the postponement of childbearing and having fewer children, greater levels of obesity and physical inactivity, and increases in breast cancer screening and awareness. 14 Because of limited resources, the increase in burden of breast cancer in these regions would bring with it increase suffering [16][17][18] including difficulty to access radiotherapy services due to distance. ...
... A similar endeavor initiated by nongovernmental organizations such as the International Cancer Expert Corps is commendable. 42 Moreover, because many countries lack a structured training program, the IAEA course curricula for radiation oncologists, medical physicists, and RT technologists could be adopted. [43][44][45] This would allow trainees to be educated at their own center with the advantage of an experienced international mentor who could be involved closely with the faculty of the host country. ...
Purpose: In 2015, the United Nations proposed “The 2030 Agenda for Sustainable Development” goals (SDG), which envision reducing the premature mortality from non-communicable diseases by one-third by 2030. As radiation therapy (RT) is required by >50% of cancer patients, the existing gaps in RT infrastructure in low- and middle-income countries (LMICs) and additional requirements by 2030 were examined. Cost-effective strategies to address this challenge were explored.
Methods and Materials: Public domain databases of the United Nation organizations were accessed. RT requirements for 2030 were estimated according to the International Atomic Energy Agency recommendations. To explore a feasible cost-effective solution, a teleradiotherapy network (TRTNet) was conceived with 4 to 8 primary RT centers (PRTCs) (each with 1 teletherapy unit, US$ 2.05 million) linked to a secondary RT center (SRTC) (2 teletherapy and 1 brachytherapy units, US$ 5.05 million).
Results: Of the 137 LMICs, 51 (37.3%) presently lack RT facilities. The remaining 86 LMICs have 5084 teletherapy units (gap: -7741) and thus a mean access to RT of 33%. By 2030, an additional 12,133 teletherapy units would be required for 14.2 million cancer patients. A TRTNet linked 4 to 8 PRTCs with 1 SRTC could yield a return of investment (ROI) between -181.1% and +757.6% depending on the TRTNet configuration, 2-year survival, gross national income/capita and employment-population ratio of the individual LMICs. 65 (47.4%) of these could be expected to attain a positive ROI (+7.1% to +757.6%) with a 2-year survival of 50% and a TRTNet configuration of 1 SRTC and 8 PRTCs.
Conclusion: Optimized TRTNets through resource sharing could be a cost effective and financially viable option to create RT infrastructure and facilitate capacity building towards realizing the SDG goals in most LMICs. Low-income and some lower-middle countries not expected to gain positive ROI should be considered for external financial assistance.
... There are numerous examples, including the International Cancer Expert Corps (ICEC), Radiating Hope, and the European Society for Radiotherapy and Oncology (ESRTO) Global Impact of Radiotherapy in Oncology (GIRO) initiative. The ICEC was founded in 2013 and aims to engage collaborators from high and low resource settings using a mentorship model to foster expertise and develop technology needed to improve radiotherapy and cancer care (18,19). Radiating Hope was founded in 2007 and aims to raise funds to purchase and donate machines and support equipment maintenance (20). ...
Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.
... Inaction is unacceptable when some people remain uncounted due to inadequate surveillance systems, untreated due to workforce capacity constraints, and without access to the most basic pain relief [18]. Access to effective, evidence-based cancer care is possible when we build capacity from "the inside out and the bottom up" [19]. ...
In order to celebrate the accomplishments of the Centers for Disease Control and Prevention’s (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a reflection of 20 years of building successful partnerships to prevent and control cancer; planning and implementing strategic cancer control; collaborating to address national cancer prevention and control priorities; evaluating efforts; sharing successes; and, in later years, serving as a model for global cancer control planning and implementation. The CDC currently supports cancer control planning and implementation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and U.S. territories through the NCCCP. CCC is an approach that brings together multi-sector partners to address the cancer burden in a community collectively by leveraging existing resources and identifying and addressing cancer related issues and needs. The Comprehensive Cancer Control National Partnership (CCCNP), a partnership of national organizations, has been committed to supporting comprehensive cancer control efforts since 1999. We summarize the efforts described in this Special Issue. We also describe opportunities and critical elements to continue the momentum for comprehensive cancer control well into the future.
... Worldwide, cancer accounts for about 1 in 7 of all deaths. Given the far-reaching impact of cancer, affordable and remotely utilizable imaging technologies are needed to improve diagnostic accuracy, treatment efficacy, and the value of post-treatment surveillance in cancer care [1]. ...
For 2018, the American Cancer Society estimated that there would be approximately 1.7 million new diagnoses of cancer and about 609,640 cancer-related deaths in the United States. By 2030 these numbers are anticipated to exceed a staggering 21 million annual diagnoses and 13 million cancer-related deaths. The three primary therapeutic modalities for cancer treatments are surgery, chemotherapy, and radiation therapy. Individually or in combination, these treatment modalities have provided and continue to provide curative and palliative care to the myriad victims of cancer.
Today, CT-based treatment planning is the primary means through which conventional photon radiation therapy is planned. Although CT remains the primary treatment planning modality, the field of radiation oncology is moving beyond the sole use of CT scans to define treatment targets and organs at risk. Complementary tissue scans, such as magnetic resonance imaging (MRI) and positron electron emission (PET) scans, have all improved a physician’s ability to more specifically identify target tissues, and in some cases, international guidelines have even been issued. Moreover, efforts to combine PET and MR to define solid tumors for radiotherapy planning and treatment evaluation are also gaining traction.
Keeping these advances in mind, we present brief overviews of other up-and-coming key imaging concepts that appear promising for initial treatment target definition or treatment response from radiation therapy.
... A presentation on entrepreneurial strategies highlighted how disruptive innovation [32] requires cooperation across disciplines. ICEC's unique strategy is to establish a sustainable team of mentors to guide local cancer care providers throughout the various phases of training and implementing guideline-or protocol-based cancer control and treatment programs [33,34]. In this way, each cancer disparities region radiation treatment center would be aligned with mentors based in a university cancer center or private practice radiotherapy center in a resource-rich country. ...
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... Organizations like the International Cancer Expert Corps and the International Atomic Energy Association (IAEA) have accepted the clarion call to improve cancer care and expand the availability of radiotherapy to LMICs [12]. To better support these efforts, there is a need to understand the barriers to effective patient care. ...
Introduction: Nigeria has the biggest gap between radiotherapy availability and need, with one machine per 19.4 million people, compared to one machine per 250,000 people in high-income countries. This study aims to identify its patient-level barriers to radiotherapy access.
Material and methods: This was a cross sectional study consisting of patient questionnaires (n = 50) conducted in January 2016 to assess patient demographics, types of cancers seen, barriers to receiving radiotherapy, health beliefs and practices, and factors leading to treatment delay.
Results: Eighty percent of patients could not afford radiotherapy without financial assistance and only 6% of the patients had federal insurance, which did not cover radiotherapy services. Of the patients who had completed radiotherapy treatment, 91.3% had experienced treatment delay or often cancellation due to healthcare worker strike, power failure, machine breakdown, or prolonged wait time. The timeliness of a patient’s radiotherapy care correlated with their employment status and distance from radiotherapy center (p
