Harnessing a Worldwide Effort to Combat COVID-19 and Cancer
A Conversation With Anil K. D’Cruz, MBBS, MS, DNB, FRCS (Hon), President of the Union for International Cancer Control
This past October, in a virtually held ceremony of the General Assembly of the Union for International Cancer Control (UICC), Anil K. D’Cruz, MBBS, MS, DNB, FRCS (Hon), Director of Oncology at Apollo Hospitals in Mumbai, Chennai, and Delhi, India, began his 2-year tenure as President of the global cancer organization and acknowledged the unprecedented challenges the ongoing COVID-19 pandemic poses for the international cancer community.
Anil K. D’Cruz, MBBS, MS, DNB, FRCS (Hon)
“The current pandemic has had a devastating effect on patient management, screening programs, treatment costs, as well as the financial viability of many organizations and hospitals,” said Dr. D’Cruz. “While we need to support our governments in the control of this pandemic, we must not lose focus and ensure that cancer is firmly on our minds as we seek to adapt to the ‘new normal.’ We must reach out and support each other as we learn more and more each day about the intersection between COVID-19 and cancer. There will be changes in the dynamics of cancer care with modifications in treatment and screening protocols. At UICC, we hope to play a pivotal role as we live up to our mission statement of unity and supporting the global cancer community in our fight against cancer.”
An Illustrious Career in Oncology
The first Indian oncologist to hold the post of President of UICC, which includes 1,200 members from 172 countries, Dr. D’Cruz is well known globally for his research in the treatment of head and neck cancers. In 2015, Dr. D’Cruz presented the results from his landmark phase III study on elective neck dissection in patients with clinically node-negative early oral squamous cell carcinoma during the plenary session at the ASCO Annual Meeting, which was later published in The New England Journal of Medicine. The study found that, among patients with early-stage oral squamous cell cancer, the 3-year overall survival was significantly higher in those treated with elective neck dissection compared with therapeutic neck dissection, 80.0% vs 67.5%, respectively.1
Prior to being named Director of Oncology at Apollo Hospitals, Dr. D’Cruz was Director and Chief of Head and Neck Services at Tata Memorial Hospital in Mumbai. Over his 30-year career, Dr. D’Cruz has published more than 200 peer-reviewed studies and co-edited several oncology textbooks, including Atlas of Operative Surgical Oncology (Jaypee Brothers Medical Publishers, 2017); Hamilton Bailey’s Physical Signs: Demonstrations of Physical Signs in Clinical Surgery, 19th edition (CRC Press, 2016); and UICC Manual of Clinical Oncology, ninth edition (Wiley-Blackwell, 2015).
Dr. D’Cruz has served on the UICC Board of Directors and was Co-Chair of the 2016 World Cancer Congress in Paris and a member of the World Cancer Congress Organizing Committee for the 2014 World Cancer Congress held in Melbourne. He is also a member of several professional organizations in India, including the Indian Society of Surgical Oncology, Association of Surgeons of India, Indian Society for Cancer Research, Indian Association of Surgical Oncology, and the Action Council for Tobacco Control, among others.
The ASCO Post talked with Dr. D’Cruz about the goals he hopes to accomplish during his term as UICC President and the challenges he faces, the impact the COVID-19 pandemic is having on cancer care, and the programs UICC is launching to reduce the global burden of cancer (especially breast and cervical cancers).
Overcoming the Challenges of a Worldwide Pandemic
Your term as President of the UICC will end in 2022. What are the goals you hope to accomplish over the next year-and-a-half, and what are the greatest challenges you face in accomplishing those goals?
Currently, the greatest challenge that UICC faces, as with most involved in the fight against cancer, including patients, their families, caregivers, and organizations, is the COVID-19 pandemic and its impact on cancer control and treatment. At UICC, we are learning, prioritizing, and continuing to adapt each day in a way that allows us to pursue our core priorities in addition to supporting our members through this unprecedented crisis.
While we need to support our governments in the control of this pandemic, we must not lose focus and ensure that cancer is firmly on our minds as we seek to adapt to the ‘new normal.’— Anil K. D’Cruz, MBBS, MS, DNB, FRCS (Hon)
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We have implemented a number of virtual alternatives for our convening and capacity-building activities, including educational opportunities, fellowships, and workshops. A Virtual Dialogues (www.uicc.org/what-we-do/convening/virtual-dialogues) series has been launched to address the challenges of COVID-19, in addition to those areas in which we continue to seek progress in cancer care, such as cervical cancer, breast cancer, and care for older people. This past year, we also initiated the UICC Breast Cancer Program (www.uicc.org/what-we-do/thematic-areas-work/breast-cancer/breast-cancer-programme), which aims to lend support to patients with breast cancer; accelerate the development of breast cancer leaders; strengthen the organizational capacities of breast cancer organizations, including patient groups; support the development of the health workforce in breast cancer; and unite the voice of the breast cancer community to advocate for more effective breast cancer control.
We will continue to emphasize our advocacy work at the international level as we strive for equity in health care, better antitobacco policies, the development of national cancer control plans, universal health coverage, and the implementation of the global strategy to eliminate cervical cancer.
We are also shining a light on the growing problem of antimicrobial resistance and its impact on cancer care, as well as the exciting progress that is being made in cancer treatment and diagnostics, such as immunotherapy, targeted therapies, and liquid biopsies.
Long-Term Impact of the Pandemic
What impact has the COVID-19 pandemic had on global cancer care? What might be the long-term ramifications of the pandemic on cancer care?
COVID-19 is threatening to slow down the progress being made in the fight against cancer on several levels. This is best exemplified by a survey we conducted this past year with our members on the financial impact of the pandemic on health-care systems and on patients with cancer; it found a considerable funding shortfall that had a direct effect on the sustainability of their activities.2 The measures enacted to fight the pandemic, including adopting remote working or greater use of digital delivery of services, while essential, have led to drops in referrals and consultations, delayed treatment and screenings, and impacted prevention programs.
Adding to this are the fears of contagion that keep people away from care centers and, more importantly, the vulnerability of patients with cancer who may become even more isolated during the pandemic. Down the line, we anticipate a noticeable rise in newly detected cancer cases, many being diagnosed at later stages, as well as an increase in cancer-related mortality and mental health issues.
More widely, COVID-19 has revealed significant unpreparedness in many health-care systems, which must be addressed if we wish to reverse current trends in cancer care, particularly in low- and middle-income countries. The problems are further compounded by the financial burden that the pandemic is placing on national budgets.
Improving Global Access to Quality Cancer Care
The City Cancer Challenge (C/Can) Foundation, launched by UICC in 2017, aims to improve access to quality cancer care throughout the world by 2025. How do you envision the foundation achieving these goals?
C/Can is a project that is dear to my heart, having been involved in leading one of the task forces at its inception in 2017. It is a novel, integrated approach to cancer care based on three of the United Nation’s Sustainable Development Goals, notably health, sustainable cities, and public-private partnerships to achieve these goals.
The international community … has a responsibility to break down the barriers that still exist for low-resource countries in accessing essential medicines.— Anil K. D’Cruz, MBBS, MS, DNB, FRCS (Hon)
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C/Can reflects UICC’s desire to regionalize its outreach and support local efforts in fighting the cancer burden, as well as the need to provide greater resources and improved health care in low- and middle-income countries. Since its creation 4 years ago, C/Can now supports community-led cancer care initiatives in nine cities, including Cali, Colombia; Asunción, Paraguay; Porto Alegre, Brazil; Kumasi, Ghana; Yangon, Myanmar; Tbilisi, Georgia; Kigali, Rwanda; León, Mexico; and Greater Petaling, Malaysia; reaching nearly 44 million people, with some 50 partners providing technical assistance.
C/Can is now a standalone foundation and, in the coming years, UICC will support its growth objectives to reach even more cities in lower-resource regions, so that millions more patients have better access to quality cancer care.
The global cancer burden is estimated to grow to more than 29 million cases annually by 2040, assuming global rates in 2018 remain the same, and 16.5 million cancer-related deaths annually. In addition, it is likely to continue to disproportionally affect low- and middle-income countries, where 65% of all global cancer deaths occur, and is expected to increase to 75% by 2030.3 Please talk about the barriers to care in these countries and how initiatives like C/Can and the activities around World Cancer Day on February 4 each year can help mitigate these barriers and achieve the goal to reduce the number of premature deaths from cancer and other noncommunicable diseases by one-third by 2030.
Low- and middle-income countries require huge investments to strengthen their health systems and make them more resilient. Primary health care is nonexistent or rudimentary at best and needs to be strengthened in the majority of these countries. We need to support patient-centered care by expanding community outreach programs and the training of primary care physicians and nurses in identifying early cancer symptoms.
In addition, greater access to research, technology, innovative diagnostics and treatment, education, and specialized cancer care is needed. The number of oncologists per inhabitant in many low- and middle-income countries is often incredibly low. The international community also has a responsibility to break down the barriers that still exist for low-resource countries in accessing essential medicines. Take palliative care, for instance: 75% of the world’s population—mostly concentrated in low- and middle-income countries—lacks access to adequate pain relief medication.4
C/Can is uniquely placed to address issues that can be tackled at the local and regional levels. As for World Cancer Day, it is the ideal global platform, not only for raising awareness about cancer and the challenges faced, but also, importantly, the day enables people to actively get involved and enact change at the local as well as the national and international levels.
‘I Am and I Will’ Campaign
This is the final year of the 3-year “I Am and I Will” theme of World Cancer Day. What has been the impact of this campaign?
As would be expected this year, we highlighted not only the impact that COVID-19 is having on people living with cancer, cancer organizations, and the delivery of cancer services, but, more importantly, the incredible efforts that everyone in the cancer community is making to ensure progress is maintained in fighting this disease. This should inspire people to break down the barriers that exist in reducing the cancer burden.
Individuals and organizations across the globe showed incredible energy and imagination in organizing activities on February 4 to raise awareness about cancer. The day received widespread media coverage and trended early on social media, and more than 100 landmarks were illuminated around the world. UICC initiated a series of Common Ground Conversations (www.worldcancerday.org/common-ground-conversations), which brought together people of different backgrounds and drew a good audience during the daylong broadcast of interviews and book readings on Facebook.
It was inspiring to see how resilient and innovative the cancer community can be, with virtual walks and conferences and other hybrid events that took into account the current situation with the pandemic and proved that together all of our voices matter.
The remedy to improve access to cancer care and reduce cancer mortality in low-resource countries is multifactorial and includes implementation of lifestyle changes to decrease the risk of cancer, such as reducing tobacco and alcohol consumption and maintaining a healthy diet and weight; receiving vaccinations for human papillomavirus (HPV) and other cancer-related viruses; having access to timely cancer screenings and affordable cancer treatment; and increasing the number of clinical oncologists. Please talk about the progress being made in these areas.
There has been a growing awareness in low-resource countries about cancer and effective mitigation policies in terms of prevention and treatment. Countries such as Kenya, Rwanda, and Ethiopia are driving the momentum in Sub-Saharan Africa in developing and implementing national cancer control plans. Tobacco control is getting stronger, probably best illustrated by Jordan’s ban this past year on smoking in public places.
The adoption by the international community of the global strategy to eliminate cervical cancer should also accelerate HPV vaccination in low- and middle-income countries. But, of course, there are still considerable institutional and financial barriers to providing better and more equitable cancer care; a lot of work remains to be done.
Improving Progress in Breast Cancer
This past October, UICC launched a new 5-year Breast Cancer Program to accelerate progress in breast cancer, with the goal of supporting 50,000 patients with breast cancer; mentoring 150 breast cancer organizations; training 170 organizations and 5,000 health-care professionals in advocacy, communications, fundraising, monitoring, and evaluation; and mobilizing 1,500 cancer organizations. How do you plan to accomplish these goals by 2025?
UICC’s Breast Cancer Program leverages existing platforms in convening and mentoring all those involved in the breast cancer community. For example, Project ECHO, which supports 100 individuals over a 6-month period to develop and implement evidence-informed and local relevant breast cancer projects; our online master courses; and our fellowship program. All of these initiatives build on our partnerships with pharma and the National Cancer Institute, as well as our connections with the Breast Health Global Initiative (www.fredhutch.org/en/research/divisions/public-health-sciences-division/research/epidemiology/breast-health-global-initiative.html) and the Breast Cancer Initiative 2.5 (www.fredhutch.org/en/research/divisions/public-health-sciences-division/research/epidemiology/breast-cancer-initiative-2-5/about.html). A primary focus of these efforts is on developing earlier detection, as survival rates for nonmetastatic breast cancer are much higher than they are after the cancer has spread.
We will continue to emphasize our advocacy work at the international level as we strive for equity in health care, better antitobacco policies, the development of national cancer control plans, universal health coverage, and the implementation of the global strategy to eliminate cervical cancer.— Anil K. D’Cruz, MBBS, MS, DNB, FRCS (Hon)
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The program also aims to strengthen local organizations’ advocacy and networks, so they can mobilize their governments to dedicate more resources to fighting breast cancer. In some countries, the Breast Cancer Program also aims to help address cultural, social, religious, and individual barriers that may exist in accessing adequate care.
Finally, the program operates at the multilateral level by connecting cancer organizations, patient groups, health-care providers, foundations, governments, and international agencies for concerted action.
Addressing the Needs of Older Patients With Cancer
What other initiatives are you planning to reduce the global cancer burden?
UICC continues to work with its members, partners, and networks to make sure that patients with cancer are not forgotten as countries seek to strengthen their health systems in the wake of the pandemic. We will continue to develop our virtual offerings through our thematic webinars or virtual dialogues and increase efforts to address inequities in health care.
Several topics remain of particular focus, including tobacco control, breast cancer, the specific needs of older patients with cancer, the growing problem of antimicrobial resistance, supporting governments in developing national cancer control plans, working toward the elimination of cervical cancer, and the implementation of the World Health Organization’s Global Strategy on Diet, Physical Activity, and Health (www.who.int/dietphysicalactivity/goals/en/).
For this, we are fortunate to be able to rely on a large number of partners who are crucial to the success of many of our initiatives. In addition to the Breast Cancer Program, UICC has partnered with Sanofi on the issue of cancer and aging, which is particularly timely given the rapid aging of populations worldwide, which poses significant challenges to health-care systems and how to address the need for a multilayered approach to cancer care for older patients.
UICC has also joined with Unitaid (https://unitaid.org/#en) and Expertise France (www.expertisefrance.fr/web/guest/accueil) on their SUCCESS project (Scale Up Cervical Cancer Elimination With Secondary Prevention Strategy; www.uicc.org/news/unitaid-and-expertise-france-intensify-cervical-cancer-prevention) to intensify cervical cancer prevention in Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines by introducing and promoting the best available screen-and-treat tools for women most at risk.
Finally, we look forward to once again convening the cancer community at the World Cancer Leaders’ Summit in Boston this October, with the theme “Driving Innovation to Advance Cancer Control Equitably.” Of course, we continue to monitor the situation with regard to the COVID-19 pandemic and are working on various hybrid formats that take into account the changing global health and social landscapes.
DISCLOSURE: Dr. D’Cruz has been employed by Apollo Hospitals India and Bombay Hospitals and has received honoraria from Biocon Pharma and Merck Serono.
1. D’Cruz AK, Vaish R, Kapre N, et al: Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521-529, 2015.
2. Union for International Cancer Control: Impact of COVID-19 on UICC’s membership: Pulse survey preliminary report. Available at www.uicc.org/sites/main/files/atoms/files/Impact%20of%20Covid%20Membership%20Survey%20Report.pdf. Accessed April 12, 2021.
3. World Health Organization: WHO report on cancer: Setting priorities, investing wisely and providing care for all. Available at www.who.int/publications/i/item/who-report-on-cancer-setting-priorities-investing-wisely-and-providing-care-for-all. Accessed April 12, 2021.
4. United Nations: International Narcotics Control Board. Availability of internationally controlled drugs: Ensuring adequate access for medical and scientific purposes; indispensable, adequately available and not unduly restricted. Available at www.unodc.org/documents/drug-prevention-and-treatment/INCB_Access_Supplement-AR15_availability_English.pdf. Accessed April 12, 2021.