Global Oncology and Health Equity

Global Oncology and Health Equity: The Beginnings

It has been said that cancer does not discriminate. It cares little if the patient is a toddler or in their 90s. It doesn’t care if the patient is male, female or transgender. And cancer has no geographical boundaries. Yes, cancer is as complex as the various permutations of the 22,000+ coding genes in the body, but the disparities in outcomes we witness in cancer are more often related to socioeconomic or geopolitical factors. These are problems in our own backyard and around the world — this is basis of global oncology.

As a National Cancer Institute-designated Comprehensive Cancer Center, the IU Simon Comprehensive Cancer Center was built on the premise that we want to end the burden of cancer in Indiana and beyond. We have made strong progress in the outcomes of cancer in this country through research, education and clinical care, resulting in a decrease in the mortality of cancer. In limited-resource countries like Kenya, clinical care, research and education are starting from a different baseline than in the West, and they have different challenges which they are addressing.

Patients receive chemotherapy while under a tent

Indiana University School of Medicine has been involved with Moi Teaching and Referral Hospital (MTRH) and Moi University School of Medicine in Eldoret, Kenya, for three decades. This partnership of North American universities led by IU is called the Academic Model Providing Access to Healthcare (or AMPATH). AMPATH’s mission is to Lead with Care.

In the early 2000s, a visit to MTRH by a cancer center oncologist revealed a desperate situation in addressing the emerging cancer problem. As illustrated in the photo above of a chemotherapy “infusion suite,” there was little physical infrastructure, few trained oncologists and limited to no access to chemotherapy or radiotherapy. More than 15 years ago, the cancer center chose to partner with physicians at MTRH to make a difference.

Humanitarian Award Winner Dr. Patrick J. Loehrer Sr.

During the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, Patrick Loehrer, MD, director of the Center for Global Oncology and Health Equities, earned the Humanitarian Award in recognition of his work personifying ASCO’s mission and values as well as providing service and leadership both at home and abroad.

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Leading with Care

Populations in low to middle-income countries (LMICs) like Kenya will see a disproportionate rise in the incidence and mortality from cancer in the next decade. AMPATH-Oncology is well-positioned to face this crisis. To do this well, we need a dedicated and trained workforce, adequate physical infrastructure and broader access to essential medicines that specifically target cancers seen in Sub-Saharan Africa.

Chandaria Cancer and Chronic Disease Center

In the past two decades, we have steadily addressed these issues. We have evolved from treating patients under the cover of a tent to now caring for them in the $5.5 million Chandaria Cancer and Chronic Disease Center.

1,000+ patients are seen each month

80+ patients receive chemotherapy each week

50+ patients are treated with radiation therapy each day

Return on Investment and Global Impact

The Center for Global Oncology and Health Equity at the IU Simon Comprehensive Cancer Center has greatly benefitted from philanthropic support from numerous donors in the private and public sector. This support has resulted in a substantial impact in the care of patients in western Kenya from 150 cancer patients seen yearly in the early 2000s to more than 150 patients now seen daily at the Chandaria Cancer and Chronic Disease Centre. In this same period, the few drugs available to patients (often unaffordable and through local pharmacies) has grown so that virtually all of the 62 cancer agents listed on the WHO Essential Medicines list are available to our patients.

The success of AMPATH upon addressing the HIV/AIDS pandemic in Kenya has served as model for success in the oncology arena. Yet, there is much work to do. We have shown what collaboration can accomplish when focused on a common goal. We have learned what it is like to deal with chronic diseases such as cancer in limited resource settings. This informs those in higher income countries how health care delivery can be more cost effective and more efficiently delivered.

Building the workforce and physical infrastructure through AMPATH-Oncology has helped the often-ignored men, women and children with cancer living in the public sector of western Kenya. These efforts have led to the Ministry of Health to support cancer within the National Hospital Insurance Fund, but many still fall outside this safety net. Fiscal toxicity thus impacts families with cancer as it does for many in our country. The clinical, educational, research pillars of the cancer center and AMPATH-Oncology are intertwined. The success of one is the success of the other. In the end, the world is a bit better for our work.

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IU Simon Comprehensive Cancer Center
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