How ASCO’s Regional Councils Are Having an International Impact on Patients With Cancer
A Conversation With Julie Gralow, MD, FACP, FASCO, and Doug Pyle
In September 2023, ASCO announced the establishment of its fourth regional council, the Central and Eastern European Regional Council, which includes representatives from 17 countries, with the goal of expanding ASCO’s mission globally to “conquer cancer through research, education, and promotion of the highest-quality, equitable patient care.” This latest council has representatives from Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Greece, Hungary, Lithuania, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia, Turkey, and Ukraine.
“Currently, we do not have a representative from every country in Central and Eastern Europe, but I am sure, over time, additional countries will be added,” said Julie Gralow, MD, FACP, FASCO, Chief Medical Officer and Executive Vice President of ASCO.
Julie Gralow, MD, FACP, FASCO
In 2019, ASCO launched the first of its regional councils with the Asia Pacific Regional Council, followed by the Latin America Regional Council in 2021 and the Sub-Saharan Africa Regional Council in 2022. The regional councils are meant to help ASCO understand and respond to its members’ unique challenges in patient care in their region and guide ASCO’s international activities.
Recently, The ASCO Post talked with Dr. Gralow and Doug Pyle, ASCO’s Vice President of International Affairs, to learn more about how ASCO’s regional councils are helping to address the challenges members face in their respective regions and how these members are working with ASCO to adapt programs and services to help mitigate those challenges. Here are excerpts from that conversation.
Bringing ASCO to Where Members Live
Please talk about the impetus for creating the ASCO regional councils.
Mr. Pyle: The idea first came from the recognition that for the vast majority of our international members, ASCO is a remote entity that has a meeting every year in Chicago and publishes journals they can access online or receive in the mail. We wanted to bring ASCO closer to where these members practice and be much more engaged in their regions, so we can understand what their needs are and then work with the council members to adapt or modify ASCO programs to best meet those needs and priorities in their specific regions.
For example, at the first meeting with members of the Asia Pacific Regional Council, they identified the need to support young oncologists across the region and develop the next generation of oncology leaders. They helped us adapt ASCO’s leadership and professional development programs to accomplish that goal.
Understanding the Needs of Each Regional Council
What are the identified needs and goals of the Central and Eastern European Regional Council?
Mr. Pyle: We were originally planning on launching that council in March 2022, but because of Russia’s invasion of Ukraine, we had to put a pause on the launch until September 2023. In the meantime, however, as part of our response to the war in Ukraine, we worked with many of the ASCO members appointed to the council, and they helped us to engage colleagues in the region in our response to the war. The Central and Eastern European Regional Council in place now is building on that good work.
In terms of identifying the needs of this council, as well as the needs of each of the regional councils, one of the first steps is for each council to complete an ASCO Needs Assessment Questionnaire. The survey provides us with detailed information about each region’s challenges and members’ recommendations for their council. We then meet with council members to start identifying priorities for each region.
We are in the beginning phase with the Central and European Regional Council, and I expect to have results in a few months. We have found there are some common priorities among all four councils. For example, many have identified leadership development as a primary interest. When there are common priorities, we then connect the different regional councils with each other, so they can share information and work internally with ASCO departments involved in those areas to engage in those efforts.
But councils also have priorities that are unique to their region. For example, the Sub-Saharan Africa Regional Council is especially interested in improving early-detection screening and early diagnosis, as well as removing barriers to access to cancer treatment. I expect there will be a similar situation with the Central and Eastern European Regional Council. It will likely have some priorities in common with other councils and others that are unique to their region.
Providing Care for Patients During War
Before the Russian invasion of Ukraine, the country was a major site for oncology randomized clinical trials, with 245 underway at the start of the war. Of these trials, 127 were still in active recruitment after the invasion.1 However, most international pharmaceutical companies have stopped launching any new oncology trials in Ukraine, and about 1,100 medical facilities in the country have been damaged or destroyed since the war began.1 What is the current status of oncologists in Ukraine being able to provide care for patients? Are cancer drugs and medical equipment getting into the country?
Mr. Pyle: Soon after the invasion, ASCO and the European Cancer Organization (ECO) launched a special network (https://www.europeancancer.org/topic-networks/20:impact-war-in-ukraine-on-cancer.html) to develop and coordinate a centralized resource center for Ukrainian patients with cancer and for those fleeing to bordering countries to help them continue receiving cancer care. The overall goal was to support a coordinated response to the war in terms of sharing information and developing collective actions.
Our sense from our Ukrainian colleagues is that the situation has improved to the extent that cancer facilities have stabilized. The supply of medicines has also improved, but it is largely funneled through private channels, so although patients are able to access medications, they are very expensive. The public health system is still challenged economically and also logistically, which is impacting the civilian medical supply.
One surprising finding from the ASCO-ECO network is the majority of patients with cancer receiving treatment remained in Ukraine. Many of those patients were internally displaced, so they were not seeing the oncologist they had before the invasion, because they were migrating to other cancer centers. My sense is that situation has now improved.
However, the resumption of clinical trials is a major issue. The Ukrainian community continues to advocate for the resumption of trials in the country, making the argument that some facilities are able to participate in clinical research given the opportunity.
Dr. Gralow: I agree with Doug that there was an initial surge of patients leaving the country to complete their therapy at the start of the invasion. That has died down, and patients are generally being treated in Ukraine. Patients may be displaced, but they are able to get treatment within Ukraine.
One of the reasons Ukraine was such a good clinical trial recruiter is because that is how patients received good quality cancer care, which was paid for by the trial sponsor. It is understandable that Ukraine would very much like to resume the launch of clinical trials, especially since there is such a big inequity in cancer care. Before the invasion, the government funded much of the care for patients with cancer. Now, in most cases, we are told patients have to pay for their drugs. The drugs are available if you can pay for them.
The clinical trials piece is complicated in terms of opening new trials and being able to trust in the integrity of the trial. We want to be prepared to resume the launch of clinical trials once the country is stable and can accrue patients, because that is one proven strategy to get patients access to drugs, even predating the war.
Supporting Oncologists Wherever They Are
How is ASCO adapting its programs and services to address the unique needs of each country, especially during the war in Ukraine, in the new Central and Eastern European Regional Council?
Mr. Pyle: We are in the early development stages with this regional council, and projects and priorities will be identified by the council. However, I imagine there is an opportunity to build on the kind of regional networking and collaboration we saw in response to the invasion of Ukraine: understanding where Ukrainian patients are being treated and determining whether there are ways for the recipient countries to more closely collaborate to help patients with cancer.
“One surprising finding from the ASCO-ECO network is the majority of patients with cancer receiving treatment remained in Ukraine.”— DOUG PYLE
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Adapting patient materials on psychosocial support was another feature of our response to the war. We have been contacted by a group interested in the development of more patient education materials adapted for either patients in Ukraine or in the surrounding region. These scenarios are a few examples.
Currently, the council does not have representation from Russia and Belarus, but ASCO has programs that Russian, Ukrainian, and Belarusian ASCO members can apply to receive. Certainly, ASCO exists to support oncologists caring for patients with cancer regardless of where those oncologists practice. At that level, we hope to keep our focus on our members and the patients they care for.
Productive and Rewarding Experience
In 2019, ASCO launched its first regional council in Asia Pacific, followed by regional councils in Latin America and sub-Saharan Africa. How successful has this effort been in helping ASCO members in these areas respond to their country’s challenges in providing quality cancer care to patients?
Mr. Pyle: I have to say the response has been incredibly positive and gratifying. To begin, in terms of the makeup of the council members, they include senior as well as young oncologists, both male and female, and a good specialty mix of radiologists, surgeons, and palliative care physicians. We consciously brought together diverse communities within these regions, and when ASCO brings these groups together, you could say that magic happens.
Some oncologists on these councils knew each other before they joined the council, and many of them did not know each other. Regardless, they work together and often discover they share the same problems and can offer solutions to overcoming those problems. It has been a very productive and rewarding experience.
For example, I mentioned earlier that the Asia Pacific Regional Council adapted ASCO’s Leadership Development Program for Asia Pacific. This program has already produced its first graduates, and they are getting involved in ASCO and in the societies in their countries. It is based on the Leadership Development Program (https://old-prod.asco.org/career-development/leadership-programs/leadership-development-program), a year-long program that provides early-career oncologists with opportunities to learn valuable leadership skills, receive mentorship from ASCO leaders, and experience ASCO’s mission firsthand.
In Latin America, the Latin America Regional Council identified the need to enhance clinical cancer research and increase research funding in the region. The council is adapting ASCO’s well-established International Clinical Research Course by adding local and international mentors to help investigators develop and implement their research ideas. At the same time, the council was also able to collaborate with Conquer Cancer, the ASCO Foundation, and Pfizer to offer research grants for metastatic breast cancer quality improvement projects. This initiative was so successful, Pfizer is now funding similar research grants for improving the quality of breast cancer treatment in Asia Pacific and in sub-Saharan Africa with those regional councils.
In addition, through open requests for proposals, all these regional councils have selected hospitals in their regions to collaborate with ASCO to improve the quality of care at their institutions. From an ASCO membership perspective, we have seen double-digit growth in each of these regions, so clearly the message is getting out about ASCO’s engagement and the opportunities ASCO offers.
Dr. Gralow: Hopefully, the conclusion we can draw from our membership growth in these regions is members are finding ASCO programs and services to be beneficial to their patients, and we are able to adapt our programs to their country’s oncology needs.
We do not come into a country saying, “This is what we propose for you.” We start the conversation by saying, “We are listening to you. What is going on in your region, and how do you think ASCO can adapt its existing programs and services to better serve you?”
These efforts span across all of ASCO’s programs and departments, and the progress we are seeing is exciting.
DISCLOSURE: Dr. Gralow and Mr. Pyle reported no conflicts of interest.
1. Nuwer R: Operating in the theatre of war. Nature 621:S2-S5, 2023.