In response to a world in which cancer is a growing global health challenge, there is now a greater need for US Medical Physicists and other Radiation Oncology professionals across institutions to work together and be more globally engaged in the fight against cancer. There are currently many opportunities for Medical Physicists to contribute to alleviating this pressing need, especially in helping enhance access to Medical Physics Education/training and Research Excellence across international boundaries, particularly for low and middle-income countries (LMIC), which suffer from a drastic shortage of accessible knowledge and quality training programs in radiotherapy. Many Medical Physicists are not aware of the range of opportunities that even with small effort could have a high impact.
Faculty at the two CAMPEP-accredited Medical Physics Programs in New England: the University of Massachusetts Lowell and Harvard Medical School have developed a growing alliance to increase Access to Medical Physics Education/training and Research Excellence (AMPERE), and facilitate greater active involvement of U.S. Medical Physicists in helping the global fight against cancer and cancer disparities. In this symposium, AMPERE Alliance members and partners from Europe and Africa will present and discuss the growing global cancer challenge, the dearth of knowledge, research, and other barriers to providing life-saving radiotherapy in LMIC, mechanisms for meeting these challenges, the different opportunities for participation by Medical Physicists, including students and residents, and how participation can be facilitated to increase AMPERE for global health.
- 1.To learn about the growing global cancer challenge, areas of greatest need and limitations to accessing knowledge and quality radiotherapy training programs, especially in LMIC;
- 2.To learn about the range of opportunities for Medical Physicists, including students and residents, to work together in global health to help increase AMPERE and alleviate the growing global burden of cancer;
- 3.To present and discuss a new model for harmonizing Medical Physics Training across countries and how this model (UMass and Heidelberg) could be extended to LMIC in collaboration with the IAEA;
- 4.To highlight a new platform and program for facilitating contributions by Medical Physicists to increase AMPERE towards the elimination of global cancer disparities.
Challenges in Cancer Control in Africa Twalib A. Ngoma, MD, Professor, Executive Director, Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
Cancer care in Africa is beset by lack of attention, political will, cancer registries, cancer plans, human resources, financial resources and treatment facilities.. As a result of this, cancer patients in Africa are far more likely to die of their disease than those in developed countries.
According to data from the WHO 750,000 new cancer cases occur in Africa every year and this number is predicted to rise by 70% by 2020. To make matters worse, an estimated 75% of cancer patients in Africa have advanced or incurable cancers at diagnosis making palliative care the most realistic approach to their management.
Furthermore, Cancer prevention is nearly nonexistent, cancer detection is rare and treatment usually comes too late and is inefficient. The overall mortality-to-incidence ratio for men with cancer in the Africa is 0.75 compared with 0.54 in the developed world while the ratios for women in Africa, is 0.65 compared with 0.45 for women in the developed world.
There is also limited access to radiotherapy. According to the International Atomic Energy Agency (IAEA), whilst developed countries usually have one radiotherapy machine per 250,000 people, most African nations have only one machine per ten million people.
The above numbers are alarming and speak for themselves. The only solution to improve this alarming situation is to address the major challenges which African countries face in provision of cancer services which include but not limited to lack of cancer registries, lack of funding, lack of human resources, lack of radiotherapy machines, lack of cancer drugs and lack of accessible and affordable cancer screening, early diagnosis, treatment or palliative care services.
Since there are considerable differences among African countries, in my presentation I will share with the audience how we address cancer control challenges in Tanzania in general and specifically in radiation oncology.
The African continent cancer plan 2013 2017 Folakemi Odedina, PhD, Professor & Director of Health Disparities, UF Health Cancer Center, University of Florida
The burden of cancer is rising in Africa, in addition to current heavy burden of communicable, and other non-cancer related non—communicable diseases. Conquering cancer in Africa will require a comprehensive collaborative approach with cancer clinicians, scientists, patients, advocates, policy makers and community leaders working hand-in-hand at the local, state, national, and continent levels with the primary mission: To reduce the number of deaths from cancer and improve the quality of life of cancer patients, survivors and caregivers. Unfortunately, less than 40% of African countries have a credible cancer control policy and program. The African Organization for Research and Training in Cancer (AORTIC) decided to create an African Cancer Plan to provide cost-effective strategies that can be employed throughout the continent to fight cancer. Based on the African proverb that “It takes a village to raise a child”, the Cancer Plan provides specific strategies that can be used by individuals, employers, organizations and policy-makers to fight cancer. In addition, we have provided overarching strategies to address cancer in Africa and targeted 5-year plan for prostate, breast, cervix, lung and liver cancers.
In developing this Cancer Plan, our primary goal is to decrease cancer incidence and mortality in Africa. This goal can only be achieved by stakeholders and dedicated individuals to lead and implement the strategies outlined in this plan. If you are interested in partnering with AORTIC to reduce the burden of cancer in Africa, please send an email to email@example.com.
Synergies in research and clinical care through international collaboration Thomas Bortfeld and David Gierga, Massachusetts General Hospital, Harvard Medical School, MA
Medical Physics relies on high technology that is not distributed equally. The whole spectrum of Medical Physics technologies is not available at every hospital or research institute, and not even in every high income country. One example is heavy ion therapy equipment which is currently only available in Japan, Germany and Italy. There is also a large global variation in terms of research infrastructure and focus.
A student of Medical physics cannot gain broad experience, certainly not hands-on experience, by staying at one place only. While it is debatable what a good trade-off between breadth and depth in Medical Physics education is, it is generally agreed upon that some breadth is necessary. Researchers in Medical Physics have to cross borders if they need specific technologies for their projects. Therefore it is self-evident that international programs in Medical Physics education and research make sense. Yet, very few programs of this type exist.
In this presentation we will report on our own experience of pursuing an international career in Medical Physics, with international student programs, and with the international exchange of researchers. We will present new or planned opportunities such as the medical beamline at CERN in Geneva.
We will also report on the synergies in clinical care through international collaborations between partners in high and low income countries. One example is the partnership of the MGH/Harvard Medical School community with the oncology community and government of Botswana to form the BOTSOGO (BOTSwana Oncology Global Outreach) initiative. This collaborative effort in oncology care was spurred by existing relationships in HIV/AIDS research and care delivery developed within the Botswana-Harvard AIDS Institute Partnership (BHP). The initial efforts of the BOTSOGO initiative have been organized as follows: 1) on-site visits to share expertise in clinical cancer care for capacity building purposes (e.g. cervical brachytherapy), 2) developing a forum for multi-disciplinary case discussions and education and 3) relationship building with local stakeholders for long-term sustainability and growth.
An international system for the certification of medical physicists Raymond K. Wu, Chairman, IOMP Professional Relations Committee; Chairman, AAPM Exchange Scientist Program Subcommittee
An international system for the certification of medical physicists is an important issue. The International Organization for Medical Physicists (IOMP) has in collaboration with a number of member countries established the International Medical Physics Certification Board (IMPCB) to address this issue, and to provide a mechanism to mark the milestone for the professional development of clinical medical physicists. Raymond Wu, PhD, is the CEO of IMPCB and the Chairman of the IOMP Professional Relations Committee. He is the invited speaker recommended by IOMP to give a talk on this important subject. He will give the latest update of the work of IMPCB, its near term goals, and pathways to the goals. He will also discuss the importance of such an International System of certification in the training/education of next generation Medical Physicists, including those in low and middle income countries (LMIC) where such training is crucial in the fight against cancer.
- 1.Understand the certification program as described in the IOMP Policy Statements.
- 2.Understand the plan of the IMPCB to establish the accreditation process of national certification programs.
- 3.Understand the goals of this international collaborative effort and the potential impacts to the quality of clinical medical physics practice.
Medical Physics Education Across Continents: The UMass Lowell and Heidelberg University Joint Coordination Effort Erno Sajo, Director of Medical Physics, University of Massachusetts at Lowell
Medical Physics education has unique flavors across institutions within the US and shows significant differences across continents. In the latter, even the definition of Medical Physics may differ. Not only is there a difference in topical coverage, but often what is considered a cohesive topic in one institution, and taught as a single course, is fragmented among several other courses in the other institution due to a different philosophy. Because of the regulatory and certification requirements, these differences impact the mobility of medical physicists across continents. As a result, physicists who wish to practice in the US or Canada but have completed their education elsewhere often find that they have to take remedial courses or even obtain a new degree in Medical Physics despite the fact that they already have one. Outreach to developing countries, therefore, is even more difficult.
The University of Massachusetts Lowell and Heidelberg University recently completed a joint coordination effort, in which they identified topics that are common versus complementary in their medical physics curricula. A student exchange program was developed that permits students to take any of the common topics at the other institution while taking complementary courses as electives, which count towards their degree requirements at their home institution. Thesis research is also mutually accepted. When properly documented, in this way CAMPEP recommendations can be met across the institutions. Therefore, students participating in this program satisfy both the American Board of Radiology (ABR) requirements and the European regulatory requirements.
The framework on which this collaboration rests and the cross-comparison methods developed therein may be implemented in other exchange programs and thus a similar approach can be adopted in outreach programs with developing countries.
IAEA PACT Program and opportunities for support and collaboration Susan Morgan, Program Coordinator, International Atomic Energy Agency, Vienna, Austria
In response to the developing world's cancer crisis, the International Atomic Energy Agency (IAEA) established the Program of Action for Cancer Therapy (PACT) in 2004 to fully realize the public health impact obtained through global partnerships in cancer control and technology transfer in radiation medicine. PACT's vision strives for global partnerships to confront the cancer crisis in developing countries, notably with our sister United Nations agency, the World Health Organization (WHO), and our Joint Programme on Cancer Control established in 2009.
The IAEA, through PACT, the WHO, the International Agency for Research on Cancer (IARC) and other cancer-related organizations work together to make a coordinated global response in supporting low and middle income (LMI) IAEA Member States in the implementation of comprehensive national cancer control programmes.
PACT's goals are:
- •To build global partnerships of cancer-related organizations committed to addressing the challenge of cancer in LMI Member States in all its aspects;
- •To mobilize resources from charitable trusts, foundations, and others in public and private sectors sources to assist LMI Member States to develop and implement their radiation medicine capacities within a national cancer control programme (NCCP); and,
- •To ensure the effective and sustainable transfer of radiation medicine technologies or knowledge to all LMI Member States where unmet needs exist.
PACT work focuses on:
- •imPACT: Assessing Cancer Burden
- •PMDS: Developing Global Partnerships
- •VUCCnet: Promoting Cancer Control Training
- •AGaRT: Making Radiotherapy Accessible
Facilitating increased participation and professional development of Medical Physicists and other Radiation Oncology professionals in global health Wilfred Ngwa, Harvard Medical School, University of Massachusetts Lowell, MA
The 2014 World Health Organization (WHO) Cancer report highlights an alarming increase in the global burden of cancer. It also highlights what it terms “the cancer divide”, or disparities, evinced by a substantially higher cancer burden in low and middle income countries (LMIC) in Asia, Central/South America and Africa. The WHO even predicts a potential African cancer epidemic by 2020 if significant progress is not made in global cancer control efforts. Evidence that collaborative global health approaches have led to major progress in controlling infectious diseases including in LMIC suggests that similar approaches will be useful for non-communicable diseases like cancer. In consonance with this, leaders in cancer policy from the USA and 14 economically diverse countries recently concluded that successful campaigns to control cancers with existing methods and to improve current strategies will increasingly depend onconcerted multinational collaborations (Sci Transl Med 5, p. 175, 2013). Hence there is growing urgency for increasing collaborative global cancer Care Research and Education (CaRE), as well as support for greater effectiveness of already existing initiatives involving partners from different nations, diverse economic and cultural backgrounds. The good news is that there is a growing awareness of the importance of global health and growing interest including amongst Medical Physicists and other Radiation oncology (RadOnc) professionals to participate in global health. However, many are unaware of currently existing opportunities for participation that even with small effort could have a high impact. Over 50% of cancer patients in the developed world depend on RadOnc professionals for their treatment, and hence participation of RadOnc professionals in global health efforts in the global fight against cancer is crucial. It is also important that the next generation of RadOnc professionals (students, and residents) be trained with a global perspective, to be global health leaders in cancer CaRE. This presentation will highlight a novel platform for enhancing participation and professional development of Medical Physicists and other RadOnc professionals in global health. Ways in which this platform can facilitate contributions by Medical Physicists and other RadOnc Professionals, students and residents in global health towards the elimination of global cancer disparities will be discussed. This will be followed by a panel discussion by some of the pioneers/leaders in collaborative global cancer CaRE on the growing cancer burden, challenges and opportunities for greater active involvement and professional development.