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7/30/2018 Productive Research Collaborations with Global Partners to Address Challenges in Low-Resource Clinics Kelly Kisling, MS, DABR [email protected] MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 2 Disclosure Research funded by NCI UH2 CA202665 Equipment and technical support provided by: • Varian Medical Systems • Mobius Medical Systems MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 3 Radiotherapy Resources in LMICs Existing Presently required Required by 2020 50000 40000 30000 20000 10000 0 Teletherapy units Radiation Medical Radiotherapy Oncologists Physicists technologists Data from Datta NR, Samiei M, Bodis S. Radiation Therapy Infrastructure and Human Resources in Low- and Middle-Income Countries: Present Status and Projections for 2020. IJROBP. 2014;89(3):448-57. 1 7/30/2018 MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 4 Our Project Create a fully automatic radiation therapy planning system that will be especially targeted for use in LMICs (low and middle income countries) Goal of delivering high quality radiation therapy to a maximum number of patients with minimal training and expenditure Sites: head and neck, breast (chest wall), cervix MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 5 Two Project Phases Funded by an NCI UH2/UH3 grant PIs: Phase 1 (UH2): Exploratory Phase • Laurence Court, PhD • Beth Beadle, MD, PhD • 2 years • System development • Local, non-clinical testing at partner sites Phase 2 (UH3): Validation Phase • 3 years • Full patient testing • Expansion to other LMIC centers MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 6 Our Collaborators Manila, Philippines Santo Tomas Hospital Cape Town, South Africa: Tygerberg Hospital Groote Schuur Hospital 2 7/30/2018 MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 7 Importance of Partnership Insight into the ‘target audience’ Avoid imposing our outsider ideas Understand their clinical challenges Start partnership early and continue through to end MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 8 Different Technologies Healy, BJ, van der Merwe, D, Christaki, KE, and Meghzifene, A. Cobalt-60 Machines and Medical Linear Accelerators: Competing Technologies for External Beam Radiotherapy. Clin Onc. 2017; 29:110-115. Parkes, J. SIOP Africa Congress 2012. MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 9 Huge variation in equipment and approaches Slide courtesy of Laurence Court 3 7/30/2018 MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 10 Cancer Incidence Sub-Saharan More Developed Africa Regions http://globocan.iarc.fr Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 25/07/2018. MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 11 Stage of initial diagnosis of breast cancer Region Country – Population Stage I or Stage III-IV or localized regional-metastatic North America United States 60% 38% South Africa – Blacks 5% 78% Africa South Africa – Whites 31% 31% India – Mumbai 8% 35% Asia India – Trivandrum 4% 53% Latin America Mexico 14% 48% Data from Shulman LN, Willett W, Sievers A, and Knaul FM. Breast Cancer in Developing Countries: Opportunities for Improved Survival. J Oncology. 2010. MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 12 Tygerberg Hospital Groote Schuur Hospital Santo Tomas Hospital Stellenbosch Univ Univ of Cape Town Univ of Santo Tomas 4 7/30/2018 MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 13 Finding and Establishing Partnerships Participate in global health activities Use your institution’s network Cold call or e-mail Talk to colleagues Visit prospective partners Get funding MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 14 Get Funding Our grant: UH2/UH3: Cancer Detection, Diagnosis, and Treatment Technologies for Global Health Open now:PAR-18-802 (R41/42): Cancer Prevention, Diagnosis and Treatment Technologies for low-resource settings (STTR = Small Business grant) Due soon: PAR-18-242 R21 - Mobile health: Technologies and outcomes in LMICs Grants.gov, Industry grants, and more MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 15 Communication Key to success/Potential pitfall Ease of communicating is important Regular meetings at 1st, then as needed Video meetings are best 5 7/30/2018 MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 16 In-Person Visits Focused attention Team building Reinforces commitment Nature of the visits progress along with the projects MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 17 IRB Protocols and Data Transfer Agreements Start early! Inquire early on about human research policies of a particular country • Could be very strict, even a deal- breaker Institutions within a country can vary Great task for in-person visits MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 18 Be Respectful and Aware DO: DON’T • Treat your partners as equals • Have a know-it-all attitude • Respect their expertise • Be a “medical tourist” • Have a long-term commitment • Assume you are the first • Read the literature • Respect their culture 6 7/30/2018 MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 19 In summary… Do global health research! If you want to go fast Establish global partnerships go alone. Share your experience If you want to go far Think about scaling up go together. Make it sustainable African Proverb MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 20 Principal Investigators: Stellenbosch University University of Santo Tomas Laurence Court, PhD Cape Town, South Africa Manila, Philippines Beth Beadle, MD/PhD Hannah Simonds, MD Michael Mejia, MD Komeela Naidoo, MD Maureen Bojador, MS MD Anderson Cancer Center Monique Du Toit Teresa Sy Ortin, MD Houston, USA Chris Trauernicht Joy Zhang, PhD Vikash Sewram, PhD Commercial Partners Rachel McCarroll, PhD Varian Medical Systems Carlos Cardenas, PhD University of Cape Town Mobius Medical Systems Jinzhong Yang, PhD Cape Town, South Africa Peter Balter, PhD Hester Burger, PhD Ann Klopp, MD/PhD David Anderson, MD Anuja Jhingran, MD Tselane Thebe, MD Special thanks to all Simona Shaitelman, MD Julie Wetter, MD David Followill, PhD Sameera Dalvie, MD our collaborators! James Kanke and dosimetry team Jeannette Parkes, MD Kobus Botha MD Anderson Research Collaborations to Address Challenges in Low-Resource Clinics 21 Thank you Contact Kelly Kisling [email protected] 7 .