The International Agency for Research on Cancer forecasts over 35 million new cancer cases in 2050 globally. The growing burden of cancer reflects the urgent need for global collaboration by academic medical centers to drive innovation and improve access to cancer care. International collaborations by AMCs have the potential to expedite research on new treatment options, improve access to care and enhance their global presence.
While the success of screening programs has reduced the incidence of advanced-stage disease for certain cancer types in high income countries, there remains the need to evaluate treatments for early-stage disease necessitating global collaboration. Large sample sizes are critical to detect potential benefits of new treatments or similar efficacy of less toxic regimes, while diverse samples from global populations can enhance identification of molecular markers to better define patient cohorts based on tumor biology and genomics. Broad applicability of collaborative research findings will facilitate the uptake of improvements in cancer treatment into standard practice internationally.
Rare tumor types also benefit from global collaboration to provide adequate sample sizes for identification of targeted therapies. Rapid conduct of phase III trials is needed to integrate new cancer therapies into existing treatment regimens.
Global clinical care extension by major U.S. cancer centers can increase overall revenue through patient volumes and higher reimbursement rates, which can subsidize domestic operations while promoting their own global brand recognition.
Current Global Landscape
The 2021 Global Oncology Survey of NCI-Designated Cancer Centers identified that 91% of U.S. cancer centers reported global oncology involvement. Leading cancer centers often follow a four-stage development path beginning with educational programs, consulting or advisory services, expanding to management services to hospitals or research centers, and finally owning overseas facilities.
Another 2022 study of worldwide hospital or satellite clinics of U.S. cancer centers identified 53 offshore entities. Over 70% of these cancer centers rank in the top 20 cancer hospitals in the U.S. Offshore entities can facilitate care extension both virtually and in-person.
For example, Cleveland Clinic’s Fatima bint Mubarak Center in Abu Dhabi offers comprehensive cancer care services while Pittsburgh-based UPMC Hillman Cancer Center has the largest overseas clinic network. New York Memorial Sloan Kettering Cancer Center offers a global telemedicine platform and operates the MSK India Center.
(adapted from V. Prasad et al 2022)
China is the most prevalent location for collaborations. The U.S. has the highest incidence cancer rate while China has the highest cancer volume and mortality rate. Hence, clinical trial cooperation could have a significant impact. Regulatory bodies in China have made it easier to approve cancer therapies based on international data, allowing potentially simultaneous regulatory approvals of new therapies.
Memorial Sloan Kettering’s collaboration with The Chinese Thoracic Oncology Group has been successful. Since established in 2018, the MSK-CTONG collaboration has worked with partners to successfully launch the first U.S.-China multicenter clinical trial in late 2020 (NCT04611776).
Cedars-Sinai Medical Center’s research partnership with Korea’s Seoul National University Hospital focuses on genomic profiles and the tumor microenvironment of breast cancer between native Koreans and Korean Americans to better understand the disease and enhance treatment.
In the U.S., the FDA’s Oncology Center of Excellence initiated Project Orbis in 2019 to provide a framework for the concurrent submission and review of cancer treatments across several countries. Its first success story came in 2019 when two drugs were simultaneously approved for the treatment of endometrial cancer in the U.S., Canada and Australia. Such efforts facilitate learning and consistency among regulators, strengthens international ties and allows earlier access to new treatment options across multiple countries.
More than half of cancer centers involved in global oncology offer training in oncology, which can take many forms including lectures, seminars, and courses. University of California, San Francisco’s Global Cancer Program provides education, research training and mentorship for trainees in several low- and middle-income countries. Its Vietnam Pediatric Hematology Oncology Fellowship program provides training to become a physician-scientist, while its grant supports cancer research training in Tanzania across multiple tiers, from short-term programs to master’s and doctoral degree levels.
Other examples include MD Anderson’s Cancer Center’s Project Echo partnership with Africa Emerging Hospitals and the Mayo Clinic Network, which offers access to educational content for members worldwide. Cedars-Sinai’s Global Healthcare Grand Rounds and Healthcare Diplomacy program invites experts to share their knowledge with an international audience. Other centers such as Stanford have established collaborative tumor board discussions.
Summary
Global oncological collaboration improves clinical research and expands applicability of results, which, when paired with streamlined regulatory frameworks, could revolutionize the pace of cancer care improvement. Clinical care extension by major cancer centers can increase revenues, subsidize domestic operations and promote global branding. The growing global collaboration among leading academic medical centers in cancer care represents promising opportunities to enhance access and promote global health equity — an especially prescient effort given the global rise in cancer incidence.
Author information:
Waqas Haque, MD, is an oncology fellow at the University of Chicago.
Isurujith Herath, MD, is an administrative fellow at Cedars-Sinai International in Los Angeles.
Heitham Hassoun, MD, is chief executive of Cedars-Sinai International.
References:
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