NCI leads the Nation's efforts to develop new and better methods for cancer prevention, treatment, and symptom management. The Institute also strives to improve the quality and delivery of cancer care throughout the world by sharing best practices with the doctors, nurses, and other health care providers who interact directly with cancer patients and their families.

A diagnosis of cancer presents a challenge to patients and their families - a challenge that is best met with highquality care from a team of health care providers who have access to the latest tools and techniques of cancer care. Should their cancer progress despite the best available care, patients will need help to reduce their pain and suffering and to understand and face the challenges associated with the end of life. The need to improve end-of-life care is especially urgent in developing nations, where cancer patients are often diagnosed with more advanced, less curable disease.

The international projects described in this section highlight some of the efforts that NCI has made to improve the quality of cancer care around the world.

Workshops to provide cancer training to clinicians in developing nations
Most new cancer interventions and new ways of caring for cancer patients are generated in the industrialized world, while many of the world's cancer patients live in developing nations. Oncologists and other health care providers in these countries have limited opportunities to learn about the latest tools and techniques in the treatment and palliation (symptom relief) of cancer. As a step toward addressing this dissemination problem, NCI has cosponsored, in collaboration with the International Network for Cancer Treatment and Research (INCTR), a set of workshops for health care providers in the Middle East and China.

In 2003, NCI sponsored a 3-day symposium on lymphomas in Cairo, Egypt, featuring both local and international lecturers. Concurrent with this meeting, NCI helped support a 3-day training course for Egyptian and Palestinian oncology nurses on new developments in cancer nursing.

Also under the framework of INCTR, NCI sponsored two pediatric oncology workshops, one in the United Arab Emirates and one in Chongqing, China. These workshops, both held in 2003, featured presentations on the treatment, management, and palliative care of common childhood cancers. In addition, NCI held a workshop in Amman, Jordan for Iraqi pediatric oncologists in 2004 to help them devise solutions for treating and caring for pediatric patients in Iraq.

More information about INCTR can be found in Improving Cancer Communications.

A conference on Traditional Chinese Medicine (TCM) oncology research to explore various TCM approaches to cancer prevention, treatment, and symptom management
NCI sponsored the first TCM Oncology Research Meeting in 2006. The conference provided an opportunity to educate NCI staff about the application of various TCM methods (e.g., herbs and other plant remedies, acupuncture) to prevent and treat cancer, as well as manage symptoms. Conference organizers created a collegial environment to engage Chinese clinical investigators and other practitioners of TCM and to facilitate discussion about the role that NCI should take in furthering research in this area.

Presenters from China included investigators from Guang An Men Hospital of the China Academy of TCM in Beijing, Guangzhou University of TCM in Guangzhou, and Xiyuan Hospital of the China Academy of TCM in Beijing. Other presenters from China were identified from a review of the relevant literature and recommendations of experts in the field, including NCI grantees working in TCM. Invited guests included grantees in the field of complementary and alternative medicine, NCI extramural program staff, interested NCI intramural investigators, other National Institutes of Health program staff working on related topics (for example, the Office of Dietary Supplements), and other TCM investigators working in the field of oncology in the United States and elsewhere.

A telemedicine technology program to share expert advice and diagnostic input between the NCI and Ireland to improve patient outcomes
The Ireland-Northern Ireland-NCI Cancer Consortium has instituted numerous collaborative programs to enhance patient outcomes in Ireland (see Building the Capacity and Infrastructure for Cancer Research and Care for more information about this consortium). One notable achievement of the consortium has been the ongoing implementation of the TELESYNERGY® system. This integrated telecommunications system of computers, microscopes, cameras, and other equipment can transmit X-rays and other medical images or a live examination of a patient to distant sites, where clinicians can discuss the case as if they were in the same room.

To date, five TELESYNERGY® suites have been installed on the island of Ireland under the auspices of the All-Ireland Cancer Consortium. These suites are hosted by Belfast City Hospital in Belfast, Northern Ireland; St. Luke's Hospital and St. James' Hospital in Dublin, Republic of Ireland; Cork University Hospital in Cork, Republic of Ireland; and University College Hospital Galway in Galway, Republic of Ireland.

A series of reports on palliative and end-of-life care in the Middle East, produced in collaboration with the International Observatory on End of Life Care
In 2003, NCI commissioned the International Observatory on End of Life Care (IOELC) in the United Kingdom to conduct a pilot survey of palliative and end-of-life care in the six geographic regions represented in the Middle East Cancer Consortium (MECC) (More information about MECC can be found below and in Building the Capacity and Infrastructure for Cancer Research and Care). These regions include Cyprus, Egypt, Israel, Jordan, Turkey, and the territory administered by the Palestinian Authority. The survey's results were presented at a MECC palliative care workshop in Cyprus in 2004.

Subsequently, NCI provided funding for IOELC to collect more information and to prepare detailed reports on the palliative and hospice care provided in each MECC jurisdiction. These reports were completed as part of the observatory's global analysis of palliative and hospice care, which is intended to provide reports on palliative care services and issues for countries and territories throughout the world in a common template to facilitate comparative analysis.

Each IOELC report examines the current provision of palliative care, history and development, public health context, and ethics of providing palliative care for that country or territory. The reports for the six MECC jurisdictions are available on the observatory's Web site at http://www.eolc-observatory.net/global_analysis/mecc.htm.

A palliative care training program for health care providers in the Middle East
Health care providers in developing nations, including those in the Middle East, need access to the latest tools and techniques for palliative cancer care. To help ensure broad access to quality palliative care, NCI has worked with the Middle East Cancer Consortium (MECC) to deliver training on palliative care to health care providers in the Middle East and India. See above and also Building the Capacity and Infrastructure for Cancer Research and Care for more information on MECC.

In November 2005, NCI helped sponsor a second MECC palliative care workshop in Cyprus. Researchers and clinicians from the United States, Canada, India, Pakistan, Iraq, and the six MECC jurisdictions participated in the workshop. The topics included pain control, psychosocial concerns, grief and bereavement, nursing issues in palliative and home care, practical aspects of managing palliative care, and the current practice of palliative care.

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