Global and regional partnerships to build evidence and capacity in supportive care
Authors: Stein Kaasa, Faith Mwangi-Powell, Wendy Lam, Gary Rodin
Journal: The Lancet Global Health (2018)

The challenges in building an evidence base and capacity in supportive care are diverse and vary between countries, regions, and cultures. Differences in economics, expertise, health policy and health systems, and resources often necessitate strategies and solutions that are unique and specific.1Hannon B Zimmermann C Knaul FM Powell RA Mwangi-Powell FN Rodin G Provision of palliative care in low- and middle-income countries: overcoming obstacles for effective treatment delivery.J Clin Oncol. 2016; 34: 62-68Crossref PubMed Scopus (94) Google Scholar However, these differences might obscure powerful and creative opportunities for collaboration and partnership. Combining clinical and scientific expertise, global partnerships could be important and necessary drivers of change in supportive and palliative care. The evidence base on the value of integrating supportive and palliative care into mainstream cancer care is growing,2Temel JS Greer JA Muzikansky A et al.Early palliative care for patients with metastatic non–small-cell lung cancer.N Engl J Med. 2010; 363: 733-742Crossref PubMed Scopus (5026) Google Scholar, 3Zimmermann C Swami N Krzyzanowska M et al.Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial.Lancet. 2014; 383: 1721-1730Summary Full Text Full Text PDF PubMed Scopus (1108) Google Scholar, 4Lo C Hales S Jung J et al.Managing Cancer And Living Meaningfully (CALM): phase 2 trial of a brief individual psychotherapy for patients with advanced cancer.Palliat Med. 2014; 28: 234-242Crossref PubMed Scopus (98) Google Scholar, 5Akechi T Okuyama T Onishi J et al.Psychotherapy for depression among incurable cancer patients.Cochrane Database Syst Rev. 2008; 2 (CD005537.)Google Scholar but greater professional recognition of its value is needed. The Global Institute of Psychosocial, Palliative, and End-of-Life Care (GIPPEC) at the University of Toronto has brought together a wide range of scholars and educators from multiple disciplines to build evidence and advocate for universal access to optimal and timely palliative and supportive care. Global partnerships have been developed to enhance research and the delivery of psychosocial and end-of-life care in diverse geographic and cultural settings. These partnerships have supported combined initiatives in research, advocacy, and education and are representative of global initiatives6Knaul FM Farmer PE Bhadelia A Berman P Horton R Closing the divide: the Harvard Global Equity Initiative–Lancet Commission on global access to pain control and palliative care.Lancet. 2015; 386: 722-724Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar that can be undertaken to advance the access to and quality of supportive care in cancer. Initiatives have been developed to address the following key points. The quality of dying and death and its determinants have been studied in high-income countries (HICs)7Hales S Chiu A Husain A et al.The quality of dying and death in cancer and its relationship to palliative care and place of death.J Pain Symptom Manage. 2014; 48: 839-851Summary Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 8Bekelman JE Halpern SD Blankart CR et al.Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries.JAMA. 2016; 315: 272-283Crossref PubMed Scopus (320) Google Scholar and in low-income and middle-income countries (LMICs), most recently in Africa, in partnership with the African Palliative Care Association and the MWAPO Health Development Group.9Powell RA Harding R Namisango E et al.Palliative care research in Africa: consensus building for a prioritized agenda.J Pain Symptom Manage. 2014; 47: 315-324Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar This collaborative research programme has supported the cultural adaptation of research tools, the building of research capacity, the collection of data to create an evidence base, and the identification of strategies to improve end-of-life care in both HICs and in LMICs.10Fraser BA Powell RA Mwangi-Powell FN et al.Palliative care development in Africa: lessons from Uganda and Kenya.J Global Oncol. 2017; (published online June 30, 2017.)DOI:10.1200/JGO.2017.010090Google Scholar The effectiveness of novel interventions to improve psychosocial, palliative, and end-of-life care in both HICs and LMICs has included partnerships with the European Palliative Care Research Centre and the European Association for Palliative Care Research Network to improve pain and symptom control and to promote advance care planning and end-of-life care. The scope of this network includes clinical, basic, and translational research with partners in Europe, North America, and Australia. The collaboration with GIPPEC was created to identify shared problems and potential interventions to improve palliative and end-of-life care and to support the funding and implementation of multicentre trials. The Movember Foundation is a global charity dedicated to the improvement of men's health. GIPPEC has partnered with the Movember Foundation to disseminate training and delivery of psychosocial care for patients living with metastatic and advanced cancer and to assess its effect. A novel intervention referred to as Managing Cancer and Living Meaningfully (CALM) has been developed to help patients with advanced cancer and their caregivers maintain their quality of life and manage the common and predictable challenges of advanced disease.4Lo C Hales S Jung J et al.Managing Cancer And Living Meaningfully (CALM): phase 2 trial of a brief individual psychotherapy for patients with advanced cancer.Palliat Med. 2014; 28: 234-242Crossref PubMed Scopus (98) Google Scholar The effectiveness of CALM has been shown in randomised controlled trials in Canada4Lo C Hales S Jung J et al.Managing Cancer And Living Meaningfully (CALM): phase 2 trial of a brief individual psychotherapy for patients with advanced cancer.Palliat Med. 2014; 28: 234-242Crossref PubMed Scopus (98) Google Scholar and Europe.11Caruso R Nanni MG Rodin G Lo C Sabato S Grassi L Managing Cancer and Living Meaningfully (CALM) adapted to an Italian cancer care setting.Psycho-Oncol. 2017; 26: 64Google Scholar Centres and regional networks from 19 countries have joined the CALM programme to create a unique global network and community to support research and training and the clinical delivery of the intervention. As the founding members of the Asia Pacific Psycho-oncology Network, the Centre for Psycho-Oncology Research and Training at the University of Hong Kong and the Chinese Psychosocial Oncology Society have joined GIPPEC to identify common needs for research and education in psychosocial, palliative, and end-of-life care in Asia12Lam W Lam TC Fielding R Palliative care in Asian countries: current practices and the future outlook.in: Silbermann M Palliative care: perspectives, practices and impact on quality of life. A global view. volume 1. Nova Science Publishers, Hauppauge, NY2017: 431-480Google Scholar and in other parts of the world. Global cultural shifts have narrowed the cultural divide and created new opportunities for collaboration in research and education and a common agenda for advocacy for supportive care. The feasibility of creating and sustaining global partnerships to advance psychosocial, palliative, and end-of-life care for patients with cancer and their families has created new opportunities to build research capacity and to ensure the quality and universality of access of this essential dimension of cancer care. Their success will be closely linked to their integration with broader global, regional, and local initiatives to improve cancer care. This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on April 11, 2018 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on April 11, 2018 We declare no competing interests. Correction to Lancet Glob Health 2018; 6 (suppl): S23–24Kaasa S, Mwangi-Powell F, Lam W, Rodin G. Global and regional partnerships to build evidence and capacity in supportive care. Lancet Glob Health 2018; 6 (suppl): S23–24—In this Abstract, Faith Mwangi-Powell's affiliation details should have read MWAPO Health Development Group, Nairobi, Kenya. The first sentence of the third paragraph should have ended "in partnership with the African Palliative Care Association and the MWAPO Health Development Group". Reference 11 has been corrected. These corrections have been made as of April 11, 2018. Full-Text PDF Open Access