Buswell, Lori

PURPOSE The study assesses the current state of global oncology (GO)/hematology training opportunities in US fellowship programs. METHODS We developed a comprehensive survey of 64-Likert multiple-choice and open-ended questions. The survey was electronically distributed to fellowship program leaders at Accreditation Council for Graduate Medical Education-accredited adult hematology/oncology fellowships. Program directors received three reminders after which survey was sent to assistant program directors or division heads for programs not represented. RESULTS A total of 171 programs were eligible for the survey. We received 42 (24.6%) responses; 40 were included in the analysis, and two were excluded for declined consent and incomplete responses. The programs include large academic (81.6%) and community hospitals (10.5%). Of the respondents, 18 (48.6%) reported offering some opportunities for global health training, and half reported interest among current fellows. Most programs (29, 82.9%) had three or fewer faculty engaged in GO research. Institutional training grants were available in 15 (39.5%) programs, of which six (40%) allowed for global health research. Of the 18 programs offering global health training activities, most (15, 83.3%) report less than a quarter of their trainees currently participate in GO experiences. The most commonly perceived barriers to GO opportunities include competing priorities (85.3%) and lack of faculty mentors with GO-related experience (82.4%). Conversely, the most commonly perceived facilitators include established partnerships outside the United States (97.0%) and dedicated institutional funding (93.9%). CONCLUSION Our survey demonstrates that although there is significant interest among fellowship trainees, a minority of the fellowship programs offer GO opportunities. Providing GO opportunities would require programs to establish partnerships with institutions outside the United States and to have systematic approaches of addressing other barriers, including enhancing funding and mentorship.

At the Summit on Cancer Health Disparities held in 2023, the session on Access to Cancer Care in Low- and middle- income countries (LMIC) highlighted several efforts globally. The collaborative efforts of Dana Farber Cancer Institute and the Ministry of Health in spearheading the Butaro Cancer Center of Excellence (BCCOE) in Rwanda was one such initiative. They were able to set up the BCCOE to address the unmet need of cancer care in this area and have trained nurses in East Africa to help establish other similar centers. They also serve as the single radiotherapy center for the entire of the country. Another such collaborative effort between Massachusetts General Hospital and the cancer center in Botswana in setting up sexual health education initiatives for women undergoing pelvic radiation was highlighted. They started with a quality improvement project to demonstrate the benefit of sexual health education and proper vaginal dilator use amongst women in this demographic. They were able to demonstrate that 90% of patients were able to complete an in-person 6-week workshop with clear benefits noted on a long-term basis. To highlight examples of best practice examples of equitable partnerships, examples of partnerships between Instituto Nacional de Cancerologia in Mexico City and UCSF was described. It was emphasized that for successful collaborations, equitable bidirectional partnerships are key. The thought leaders in this field also highlighted challenges associated with global oncology and the need for inclusion of minorities in clinical trials to improve cancer care for all globally.