Special Issue on Global Cancer Medicine
Authors: Lawrence N. Shulman, Tony S.K. Mok
Journal: Journal of Clinical Oncology (2015)

A half century ago, 70 cancer professionals gathered in a conference room in Philadelphia in what would mark the first scientific meeting of the American Society of Clinical Oncology (ASCO). At the time, it would have been impossible to predict the achievements in cancer prevention, care, and treatment that have been made in the United States and other developed countries, resulting in significant improvements in survival from cancer and quality of life. Many of the advances have been cataloged in this journal, now widely read as the predominant oncology publication. Much of the world’s burden of cancermortality occurs not in the developed world, but in the developing world, and in this Special Series of Journal of Clinical Oncology (JCO), the editorial board has granted us the opportunity to focus on the ever-increasing burden of cancer in parts of the world often thought to be plagued only with infectious diseases, or so-called diseases of poverty. What is less well documented, and certainly less frequently at the nucleus of scientific dialogue, is the diversity of cancer biology around the world and the diversity of how countries and partners are responding to the major global burden of cancer. Globally, in 2013, an estimated 15million patientswere newly diagnosed with cancer, and 8.2 million people died. That year alone, almost half amillionwomendiedof breast cancer, a disease that, if caught in early stages, wenowunderstand to be largely treatable andoften curable. Today in theUnited States, despite a consistently high incidence rate, a cancer diagnosis is most often accompanied by a set of therapeutic plans to prolong life or even cure the patient, and approximately 70%of patients with cancer can expect to live for more than 5 years. Sowhere are the 8.2million people dying each year?Many deaths still do occur among patients in developed countries, but two thirds of cancer deaths occur in the developing world. Doubly encumbered by a sparse and overtaxed health care workforce and a high burden of both communicable and noncommunicable diseases, countries in the developing world face extreme barriers to addressing the needs of patients with cancer. Not only are cancer facilities few and far between in low-income countries, but even where they do exist, they are often unaffordable for much of the population. However, as one of our authors, Paul Farmer, has reminded us in many conversations, “We live in one world, not three.” The vast expanse of knowledge, tools, and clinical advances inwealthier countries can have a tremendous impact if applied in partnership with countries currently struggling to establish ormaintain nascent cancer research, prevention, and treatment programs. In this vein, we have solicited articles from authors around the world who are engaged in global cancer care and control across a number of scientific disciplines, including biology, public health, medical education, policy, and delivery science. It is our aim through this Special Series that the cancer community continues to expand its purview to all those in need of cancer care, no matter where a patient happens to live. The series opens with an article on the imperatives of bringing cancer care to the poor, weaving in the history of the HIV treatment access movement two decades ago. Barriers to high-quality cancer care and the resultant poor patient outcomes were examined in low-, middle-, and high-income countries exploring commonalities (the effects of poverty, for instance), and differences in these settings, using Kenya, Brazil, and the United States as examples. Structural barriers to early detection and timely treatment were explored in depth by Cazap et al. The spectrum of services required for cancer care is long, and two articles on pathology and radiation therapy illuminate challenges and practical solutions specific to these points along the care delivery chain in low-income countries. Developing andmaintaining strong cancer care infrastructures require human resource capacity to run, manage, and optimize them. Authors working in Kenya’s rural west describe a medical education and training partnership for cancer care. Delivering cancer care in resource-constrained settings provides a multitude of unique challenges and often nonconventional and innovative approaches. Continuous evaluation of results with identification of gaps, together with targeted interventions to improve the safety and efficacy of care, requires data collection and reporting, and a partnership in Rwanda calls for the integration of implementation science into global cancer medicine. Global pediatric oncology is an area that receives much less attention than it should. Although cancer in childhood is less common than in adults, the potential cure rates are high, and those cured have a long and productive life that will be tragically lost if access to quality cancer care is not available. The series editors asked some of the world’s leading experts to describe their experience of partnership to respond to the needs of children with cancer around the world. Another oft-overlooked area of international cancer control is pain management. Given the late-stage presentation of disease in many low-income countries, authors describe the need for palliative and supportive care. Although some improvements in access to essential cancer medicines have beenmade in recent years, many in the world have little or no access to affordable cancer medicines. Shulman et al share methodologies and outcomes of a collaboration with WHO, which has increased the number of cancer medicines on their Essential Medicines List. ASCO has played an important role in global cancer medicine over many years and more so recently. Chronicling the