Expanding care—and defying cancer—globally
According to the World Health Organization, cancer is the leading cause of death worldwide, and access to care varies widely around the world, with comprehensive treatment available in more than 90% of high-income countries, but less than 15% of low-income countries. While working to improve access to care locally and nationally, Dana-Farber Cancer Institute is also dedicated to improving care and resources worldwide, to reduce the burden of cancer for everyone. In recognition of World Cancer Day, February 4, we spoke with Temidayo Fadelu, MD, MPH, a member of Dana-Farber’s Center for Global Cancer Medicine, to learn more about what Dana-Farber is doing internationally and why improving access to care is vital to the Institute’s mission. These responses have been edited for space and clarity.
Q: What is your role at Dana-Farber and what led you to working here?
A: I wear multiple hats at Dana-Farber. I am a member of our Center for Global Cancer Medicine, I do research in our Division of Population Sciences, primarily on breast cancer, and I also work clinically seeing patients on the inpatient service. I came to Dana-Farber for my fellowship in 2015, before which I was living in Rwanda and working at the Butaro Cancer Center of Excellence, which had been established in 2012 through a partnership between Partners In Health and the Rwanda Health Ministry, with technical support from Dana-Farber. I had studied in America but am originally from Nigeria, so I wanted to do something professionally in Africa between my residency and fellowship. At the time, I was an internist, and this was my first introduction to Dana-Farber’s Center for Global Cancer Medicine. I worked in Rwanda for two years before pursuing a fellowship at Dana-Farber but have since been back many times in my current role.
Q: How did Dana-Farber originally get involved in cancer care in Rwanda?
A: In 2012 in Rwanda, there was recognition from the Ministry of Health and the nonprofit Partners In Health that there was a huge gap in oncology care. At the time, there was only one trained oncologist in the entire country, and there was no systematic cancer care delivery program within the public health system. Patients with resources could travel outside Rwanda or pay for care, but it was challenging to get your care in-country. From the beginning, Dana-Farber brought in technical expertise to help the country figure out how to start developing its own care program and what made sense for that setting versus here in Boston. Dana-Farber helped prioritize what cancers to start with, the most common ones in the country, and since then, we have helped grow local capacity at the Butaro Center in a variety of ways. We have helped to train not only physicians but also nurses, pharmacists, pathologists, and technicians. We’ve also created a tumor board for physicians there to meet with Dana-Farber oncologists to provide guidance on complex cases. Most of the physicians in Rwanda who treat patients with cancer are still not oncologists, although many more have been trained since this initiative started in 2012. But the treatment protocols set up with the assistance of Dana-Farber specialists allow these non-specialized doctors to provide resource-appropriate care for many.
Q: What are some of the barriers to care in Rwanda and other lower-income countries?
A: In many countries, cancer care is simply not available and only people with the resources to travel and pay for treatment are able to access it. In Rwanda, where we now have care available and do have some long-term survivors, there are still many barriers patients face.
There can often be a stigma to a cancer diagnosis and treatment, which is something we are currently researching, and there are also transportation and other issues patients face. We recently did a survey, for example, asking patients in Rwanda how long it took them to get to the cancer center and the average was seven hours, because they don’t have their own cars and need to take buses, trains, and other methods to get to treatment. A huge part of getting people the care they need is to create social supports, so they can physically get to the center. Patients may need to come in weekly for care, which can be very challenging to do while holding a job. Medication adherence is also a challenge some patients face, even for oral medications, so we are working on several projects to optimize care and make it easier for patients. These are all issues that exist in America too, where there are many resources, so you can imagine how challenging it can be in a lower-income setting.
Outside of Rwanda, we have a similar program in Haiti, where we have been creating treatment protocols and trainings for physicians and nurses and providing access to tumor boards. Many of the same barriers exist, as well as natural disasters and political instability that can shift people’s priorities away from care and toward just staying afloat or keeping their home, for example. While these outside factors, plus the pandemic, can make it challenging for patients to continue their care, we’ve also seen incredible resilience from patients, staff, and other team members who are working under such difficult circumstances. It’s almost a miracle when you think about what people need to do to complete treatment in lower-income countries.
Q: From your perspective, why is it important for Dana-Farber to be involved in cancer care globally?
A: At Dana-Farber, we are blessed with many resources. In a way, it’s our duty to bring the entire world with us. Even within the United States, there are populations that are underserved—where amazing new treatments are being discovered but only a few people can benefit from them. In Rwanda and Haiti, discoveries that are 10+ years old in America, like targeted therapies, are still not standard practice there.
In lower-income settings, a small number of resources can go a long way. Dana-Farber has the know-how to bring these countries along and help optimize treatments that are inexpensive, available internationally, and that we know work.
My dad died of liver cancer in 1999 and my mom was diagnosed with breast cancer in 2014, when I was living in Rwanda. My mom is a survivor today because she had the resources to travel outside of Nigeria to get treatment. We want to make sure effective treatment is available in-country, in the public health system—everywhere—so we can have more long-term survivors.
Q: What does defying cancer look like to you on a global scale?
A: There has been significant progress in cancer research and treatment over the decades, and even in the past few years, but access to those breakthroughs is unfortunately still limited, even within the U.S. To me, defying cancer means leveling that differential, so the disparities in access and in outcomes are not based on your geography or where you’re from. Even today, patients diagnosed with the same type of early stage breast cancer in a lower-income country are dying at higher rates than the same patient in America. It’s not because we don’t know how to treat the disease, it’s because they don’t have access.
Our work within the Center for Global Cancer Medicine is reducing some of these disparities internationally, similar to how we’re trying to reduce disparities within Boston and around the country. In thinking about Dana-Farber’s role as a global leader, we want to expand this even further to help more patients defy cancer, no matter where they are from.
Learn more about how you can support the Center for Global Cancer Medicine and their important work. Your donations are part of The Dana-Farber Campaign, our ambitious, multi-year fundraising effort to prevent, treat, and defy cancer. The Dana-Farber Campaign will accelerate the Institute’s strategic priorities by supporting revolutionary science, extraordinary care, and exceptional expertise. As a community, we have the power to create a more hopeful, cancer-free future—in Boston and around the world. Together, we can defy cancer at every turn. Learn more about The Dana-Farber Campaign at DefyCancer.org.