Dana-Farber around the world: Working to create equity in cancer care

Cancer accounts for 10 million deaths globally each year, according to the World Health Organization (WHO), making it the second leading cause of death around the world. Of these, approximately 70 percent of deaths occur in low- and middle-income countries, where there is often less access to treatment and fewer resources to prevent and treat disease.

To help decrease the burden of cancer globally, Dana-Farber Cancer Institute leads many international efforts, for both adult and pediatric cancers, to educate, train, and conduct research, with the goal of creating equity in cancer care and outcomes on a global scale. The Institute’s Center for Global Cancer Medicine (CGCM), with support of institutional and philanthropic dollars, was formed in 2012 to work toward this goal, collaborating with other American cancer centers and developing long-term partnerships with the Butaro Cancer Center of Excellence in Rwanda and the University Hospital of Mirebalais in Haiti through the non-profit organization Partners In Health. Dana-Farber oncologists and nurses regularly visit these centers to provide training, support, and mentorship, and have helped providers in both Rwanda and Haiti develop systems to effectively deliver high quality care to both adults and children. Clinicians from Rwanda and Haiti also spend time at Dana-Farber through observerships, to receive mentorship from clinical teams in Boston.

One of the most successful aspects of the CGCM’s program is these long-term, bi-directional relationships with in-country colleagues, explains Lori Buswell, NP, MS, executive director of the CGCM. “It allows for trust, friendships, bi-directional learning, and appreciation of each other’s culture, as well as continuity for long-term progress on various components of the cancer programs,” she says.

This collaboration works to address disparities in mortality between low-income and high-income countries, which is due in large part to cancers being found at later stages. To help address the need to improve early detection, part of Dana-Farber’s education and research work in Rwanda, along with its partner Brigham and Women’s Hospital, involves working with community health workers to build awareness of breast health, how to recognize lumps, and building a referral pathway, helping to detect breast cancers earlier to improve outcomes.

Another large part of prevention is vaccination against cancer-causing infections, most notably HPV, which can cause cervical cancer, among others. According to the WHO, HPV and hepatitis are responsible for a quarter of cancer deaths in lower- and middle-income countries, and nearly 90 percent of all cervical cancer deaths occur in these countries. Improving access to HPV vaccination and cervical cancer screening worldwide is crucial to lowering these numbers. The WHO is working with countries around the world to improve vaccination and screening access, to support the World Health Assembly’s goal of eliminating cervical cancer as a public health problem by 2030.

In addition to vaccine and screening issues, many of the challenges facing low- and middle-income countries revolve around access to medication, says A. Lindsay Frazier, MD, ScM, a pediatric oncologist at Dana-Farber Cancer Institute and a member of the joint Global Health Initiative with Boston Children’s Hospital. “Access to quality pediatric care and diagnosis at an earlier stage is key,” she says. “A major issue, even in some high-income countries, is medication shortages. Our team built a model to predict the total amount of chemotherapy and its cost to treat childhood cancer, which we are making publicly available to help with planning and purchasing at the hospital, national, and regional levels. The goal is to ensure all countries are prepared and can ensure children have access to the lifesaving medications they need, as soon as possible.”

This tool, FORxECAST, predicts the drug quantity and cost for 18 pediatric cancers to help policymakers and governmental institutions estimate their needs, ultimately resulting in global improvements in pediatric medication access. Frazier and other members of her team are also part of a Lancet Oncology Commission that gathered and presented evidence to justify increased funding for childhood cancers in low- and middle-income countries, where children have not benefited from the increased survival rates found in many higher income countries, due to disparities in access to effective care, medication, and technology, and the later stage at which disease is diagnosed. The Commission found that 6.2 million childhood cancer deaths could be avoided between 2020 and 2050 with increased funding in these countries, averting more than half of the deaths anticipated in that time.

While the global pandemic has put physical travel between Dana-Farber and its global partners on hold, the exchange of ideas, guidance, and research is ongoing. Frazier is giving Zoom lectures to oncology fellows in Ghana, where she was set to be a professor in residence during 2020. And the CGCM continues to be actively involved with oncology teams in Rwanda and Haiti, through virtual tumor boards, educational sessions, and participating in quality improvement and planning projects.

Cancer is a devastating disease in every way—on the personal and family level, within local communities, and on an international scale. By collaborating with partners across the country and the world, Dana-Farber doctors, nurses, and researchers are taking tangible steps to improve prevention, detection, and care for children and adults worldwide.

This post is part of a series for Cancer Prevention Month, February 2021. With your generous support, the Jimmy Fund and Dana-Farber Cancer Institute are working to stop cancer before it starts, by improving prevention and detection for adults and children in Boston and around the world. You can support this lifesaving work by making a donation today.