Building the Capacity and Infrastructure for Cancer Research and Care
To achieve our goal of eliminating the suffering and death due to cancer, we must build and sustain strong research
environments, support structures, collaborations, and communication channels that will enable us to quickly pursue
new ideas, translate discoveries into innovative interventions, and disseminate evidence-based treatments and
practices worldwide. We must nurture and maintain a cadre of scientists and health care professionals in a variety
of disciplines, and we must strive to eliminate barriers to information, research opportunities, and adequate care.
Therefore, NCI seeks to share its expertise and to facilitate capacity building and infrastructure development to
strengthen cancer research and improve the quality of cancer care around the world. These efforts are especially
important in nations that have limited resources.
The following are several examples of NCI's efforts aimed at increasing the capacity and building the
infrastructure for high-quality cancer research and cancer care worldwide.
In 1999, a historic memorandum of understanding was signed that established the
Ireland-Northern Ireland-NCI Cancer Consortium. The primary goal of this consortium
is to enhance the infrastructure for cancer research and cancer care across all of Ireland.
In addition to facilitating interactions among the three represented research communities,
the consortium has developed a number of joint programs covering the entire continuum
of cancer.
The range of the consortium's activities can be gauged by the focus of its working groups:
Scholar Exchange, Clinical Trials, Cancer Registries, Nursing, Information Technology/
Telecommunications, and Prevention. Several of these activities are discussed elsewhere in
this portfolio, but one program particularly worth mentioning here is the effort to provide
fellowships and training for Irish scientists and nurses at NCI's headquarters in Bethesda,
Maryland (see
Scientist Exchanges and Training Programs).
The Consortium's Prevention Working Group has been particularly active. In addition to
participating in workshops in Ireland on topics such as "Cancer Prevention and Tobacco
Control" and "Obesity and Cancer," the working group has dedicated itself to building
an Ireland-wide community of prevention-oriented scientists and cancer caregivers.
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Dr. Samir Khleif |
In September 2002, the King Hussein Cancer Center (KHCC) in Amman, Jordan forged
a cooperative agreement with NCI for the purpose of enhancing medical sciences and
improving cancer patient care in Jordan and the entire Middle East region. In support of
the agreement, Dr. Samir Khleif, a clinical oncologist at NCI, was named as KHCC
Director General.
One of the notable achievements of this agreement occurred in 2004, when NCI Director
Andrew von Eschenbach and U.S. Department of Health and Human Services Secretary
Tommy Thompson visited KHCC to launch its TELESYNERGY® suite, which will help
foster collaboration between cancer specialists, facilitate professional education and training,
and permit consultation in cancer research protocols and patient care throughout
Jordan and the Middle East, at selected sites in the United States, and throughout Ireland
(see also
A telemedicine technology program to share expert advice and diagnostic input
between the NCI and Ireland to improve patient outcomes).
NCI supported the 5th International Conference on Cancer in Africa, which was held in Dakar, Senegal in
November 2005.
The conference, hosted by the African Organization for Research and Training in Cancer, was designed to develop
a research agenda for dealing with the increasing crisis of cancer in Africa. This research agenda will focus on
screening, prevention, and management of high-incidence cancers, such as breast, cervical, and prostate cancer.
The conference sought to establish global partnerships among oncology care givers and to address health care
disparities, with a focus on early detection and cancer prevention.
The problem of tobacco-related cancers in Africa was one of the issues discussed at the conference. Participants discussed
ways to combat the growing incidence of these cancers as the tobacco industry turns more to the developing
world to find markets for its products.
Also discussed was the problem of how to pay for cancer care for patients who have no resources or health insurance.
Funding adequate cancer care in such resource-poor environments presents monumental challenges. Early
detection and cancer prevention were recommended as ways to minimize both the costs and the risks posed by
cancer. In Africa, most cancer patients do not see health care providers until their disease has progressed to an
advanced stage. Calls were made to encourage women to conduct breast self-examinations and to get Pap smears
at least once every 2 years. Cervical cancer is the most prevalent cancer among African women, despite being the
most preventable of all gynecologic cancers.
Finally, the importance of improving the availability and use of palliative care to relieve cancer symptoms and the
adverse effects of treatment among African cancer patients was stressed.
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NCI, along with other institutes of the National Institutes of Health, cosponsors awards
to establish and maintain Centers for AIDS Research (CFARs) at U.S. institutions that
receive substantial AIDS funding from multiple NIH sources. The mission of each CFAR
is to support a multidisciplinary environment that encourages collaboration across basic
and clinical studies and promotes research in the prevention, detection, and treatment of
HIV infection, AIDS, and AIDS-associated diseases, including cancer. Currently, there are
20 CFARs at U.S. research institutions.
One way in which the CFARs seek to accomplish their mission involves strengthening
the capacity for HIV/AIDS research in developing countries. The Case Western Reserve
University CFAR's activities in the African nation of Uganda serve as an example of these
efforts. Building on its longstanding relationship with Makere University in Kampala,
Uganda, the Case Western CFAR worked to establish the Uganda Laboratory Core in
1997. This laboratory facility created the capacity in Uganda to perform state-of-the-art
immunology and virology research and to provide laboratory services for health care
professionals throughout central Africa. It also provided opportunities to extend the scientific
activities of the Uganda-Case Western Reserve University Research Collaboration
to include studies in AIDS-related malignancies.
In the last four years, the rapid growth and evolution of national cancer control planning
has led to highly visible and successful initiatives by NCI's Cancer Information Service
(NCI CIS) that are designed to improve public health in the United States. In these efforts,
the NCI CIS joined with a U.S.-based group of experts, including the American Cancer
Society, the Centers for Disease Control and Prevention, and the Intercultural Cancer
Council to develop the Comprehensive Cancer Control Leadership Institutes (CCCLIs).
Domestically, CCCLIs provide an opportunity for highly skilled, influential individuals in
the United States to take action together to support implementation efforts for a comprehensive
cancer control approach in their respective states.
With the success of the CCCLIs in the United States, the CIS and its partners began to
address the need for global comprehensive cancer control planning in 2004. The main role
for the CIS in these international efforts is capacity building. In September 2004, the CIS
helped form a new international comprehensive cancer control group that is investigating
the feasibility and the interest in an international version of the CCCLIs. The group consists
of federal and non-federal partners including experts from NCI, the U.S. Centers for
Disease Control and Prevention, the American Cancer Society, and the International Union
Against Cancer (UICC). In 2005, the NCI CIS supported Peruvian cancer leaders in developing
a cancer control plan for that nation. The first pilot of an international CCCLI
workshop took place in Mexico City in June 2006, with participation from Brazil, Mexico,
Peru, and Uruguay. In addition, two workshops on cancer control planning are being held
at the UICC's World Cancer Congress 2006 meeting in Washington, D.C.
The Middle East Cancer Consortium (MECC), which was established in 1996, is a unique partnership involving the
United States and the Ministries of Health of Cyprus, Egypt, Israel, Jordan, the Palestinian Authority (Gaza and the
West Bank), and Turkey. One of the consortium's principal initiatives is its Cancer Registry Project, which supports
the development of high-quality, population-based cancer registries in all MECC jurisdictions.
To facilitate registry training, MECC established an education program and developed a "Manual of Standards for
Cancer Registration." The manual, which is now in its fourth edition (2005), defines requirements for data collection
and coding that are to be followed by all MECC registries. In addition, staff from NCI's Surveillance, Epidemiology,
and End Results (SEER) Program have provided assistance with training, technical support, and quality control.
The first report1 based on MECC-affiliated registry data was published in the European Journal of Cancer Prevention
in 2003. This report contained the first-ever comparison of cancer incidence rates in Israel and one of its Arab
neighbors, Jordan. The report had Israeli, Jordanian, and American authors, including three NCI scientists.
The first monograph from the MECC Cancer Registry Project was
released in 2006. This monograph, entitled Cancer Incidence in Four
Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East
Cancer Consortium (MECC) Compared with U.S. SEER, provides information
about cancer incidence for populations in Cyprus, Egypt (Gharbiah
Region), Israel (Jews and Arabs), and Jordan for the period 1996-2001 in
comparison with data reported by SEER for the United States. This monograph
can be accessed on the Internet at http://seer.cancer.gov/publications/mecc/mecc_monograph.pdf. Alternatively, a print copy can be
ordered from SEER (http://seer.cancer.gov/publications).
1 Freedman L, Barchana M, Al-Kayed S, Qasem M, Young J, Edwards B, Ries L, Roffers S, Harford J, Silberman M. A comparison of population-based cancer incidence
rates in Israel and Jordan. European Journal of Cancer Prevention 12(5):359-365, 2003.
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