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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?.

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making a difference strategies for success

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
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
Crude Incidence; Cases

Per 100,000 per annum

Thousands per annum


estimates of all cancer cases males and females trends included
Estimates of All Cancer Cases, Males and Females, Trends Included

Thousands per Annum

Influence of aging and increases in population size

the problem a vicious cycle
The Problem: a Vicious Cycle

Many Patients With Advanced Disease and Many Potential Patients

High Mortality Rate

Limited Resources


Unmet need for terminal care


the solution build capacity
The Solution: Build Capacity




Lower Mortality Rate

Fewer Patients with More Limited Disease and Fewer Potential Patients

Less Limited Resources

Less need and greater capacity for terminal care



mission statement
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


the goals
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
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
inctr s network
INCTR’s Network

Offices and Branches

Collaborating Units

advisory board
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
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
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
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
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
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
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
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
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
new funded projects
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 projects1
New Funded Projects
  • INCTR and the American Cancer Society will work together in promoting palliative care in India
inctr strategies
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 Organization

Visiting Experts

External Training



Government or Local NGO

Locally Run Demonstration Project

Education of other primary health care workers or trainees

Dissemination to Health Care System

Dissemination to other centers

population coverage example wide application
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 1Year 2Year 3

value of clinical trials
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
Designed for a specific population in the context of available resources

Usually entails collaboration and mutual learning

Associated with quality assurance and ethical review

Identifies deficiencies

Associated with outcome measures

Generates new information

Based on available evidence – may be from a different population and with different resources

Rarely entails collaboration or learning

No quality control or ethical review

No identification of deficiencies

No outcome measures

No new information

Comparison of Treatment Guidelines and Clinical Trials



obstacles to conducting clinical trials in lr settings
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
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
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
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
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
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
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