International Cancer Expert Corps

Icec twinning programs/mentoring partnershipscancer care - building capacity and capability for low-and-middle-income countries (lmic) through mentorship and innovative technology there are low-middle-income countries (lmics) where there is almost no access to Cancer care leading to unnecessary deaths and immeasurable suffering. What is needed is access to the appropriate expertise built from the local community and treatment with effective technology to ensure sustainable capacity and capability. The International Cancer Expert Corps is addressing the shortage of Cancer care through a two-pronged approach of twinning programs and mentorship to build and sustain expertise and innovative "smart" technology to provide radiation therapy and knowledge-assisted treatment. The icec mentorship Corps is being built with International partners in resource-rich high-income countries (hics) with experts serving as mentors with twinning partnerships among champions in lmics. While there is a good measure of volunteerism, financial support is needed for the twinning partners to have the time and basic resources for education, training and ongoing active partnership. In 2021, icec received an endowment bequest from paul kaplan, the son of the world-renowned radiation oncologist henry kaplan and leah kaplan, to support the norman coleman / paul kaplan endowment fund for mentorship. The endowment continues to grow, receiving additional contributions in 2022. Initial grants will be awarded in 2022-2023. The lack of significant success in addressing the Cancer care shortage requires novel, indeed disruptive change with new paradigms. Icec has carefully crafted a novel systems approach to Cancer care, as a health systems issue requiring Cancer care at the outset rather than a late add-on that often does not happen. The model is called "flex competence" achieving flexible competence: bridging the investment dichotomy between infectious diseases and Cancer (british medical journal global health (2020, dec pmid33303514) that addresses communicable diseases (infectious diseases) and non-communicable diseases (cardiac, metabolic, respiratory, oncologic) while enabling local ready-surge capacity for outbreaks and pandemics. Furthermore, addressing the growing issue of an aging global population in need of healthful and purposeful aging, the icec has a pioneering approach capturing acquired wisdom, enabling healthful aging, and building multinational partnerships through senior global health mentorship that will bring together world-renowned Cancer experts in contact with next generation leaders. It provides a venue for a large range of skilled and determined individuals to "give back and "pay forward" from their life experience and wisdom. Icec's twinning programs and mentoring partnerships bring together Cancer care experts from resource-rich settings with healthcare professionals in resource-poor countries to improve Cancer prevention, screening, diagnosis, treatment and follow-up care with well-defined governance, established policies and procedures, transparency in operations, and the ability to leverage expertise. Icec partners enhance the ongoing activities of governments, professional societies, Cancer centers and other non-governmental organizations. Icec encourages local, regional and national initiatives to develop the sustainable capacity and capability of Cancer care personnel in these countries to battle cancer.icec has established twinning programs/mentoring partnerships with goals to, 1) improve, facilitate and sustain population-directed clinical Cancer care and translational Cancer research at local Cancer centers by multi-disciplinary Expert mentoring teams, 2) train physicians, nurses, scientists, and other healthcare & health policy workers at these centers in public health oncology, 3) evaluate local Cancer care systems and develop model approaches to strengthen them, 4) strengthen local Cancer care programs in low- and middle-income countries (lmic) in order to encourage healthcare professionals to remain at home rather than emigrate to upper income countries and 5) work with professional societies and academic centers of excellence in resource-rich countries to create bona fide and valued career paths in academia and private practice for healthcare service to the underserved by providing an organizational, educational, research and service base to develop and sustain expertise in public health oncology.icec provides support to twinning programs and mentoring relationships in numerous locations including algeria, armenia, botswana, kenya, nigeria (lagos), tanzania, and the united states (e.g., lakota sioux). Twinning programs and mentoring relationships are unique in that they vary in competency levels, but all share the goal of delivering quality Cancer care. Icec scientific staff continue to encourage their lmic colleagues to participate in research studies and foster engagement in publishing articles of significance regarding global Cancer treatment. One area of notable success in 2022 was the continued participation of icec-supported lmic physicians and medical physicists in panels at online International scientific conferences and their contributions to articles published by leading International academic journals. This exchange has provided new insight and respect for the practitioners in regions where support for this type of scientific and career advancement and recognition may be limited. To support and expand icec's efforts, icec fosters established relationships with professional societies and major International agencies, including the International atomic energy agency (iaea), american society of clinical oncology (asco), american society for radiation oncology (astro), association of residents in radiation oncology (arro), royal australian and new zealand college of radiologists (ranzcr), consortium of universities for global health (cugh), ncd alliance, global health council and the union for International Cancer control (uicc). Icec has consultative status with the united nation's department of economic and social affairs (ecosoc) and serves as a board member of the conference of ngos in consultative relationship with the united nations (congo). Icec was invited to join the iaea's practical arrangements on technical professional society partnerships in Cancer with ten of the largest professional oncology-focused societies in Cancer care to help improve access to radiotherapy services and reduce the global inequities in the treatment of the disease. The partnership was signed ten months after the iaea launched the rays of hope initiative, a vehicle through which the agency supports countries to establish or scale up safe, secure and effective radiation medicine capabilities to bridge a significant shortfall in equipment and highly skilled personnel in many developing countries.successfully addressing the Cancer care shortage through a healthcare systems approach with the icec's sustainable mentorship model has immeasurable benefits for health, economic growth, family and community stability and a model of altruism and what will become a long-term partnership among equals. In a world of growing nationalism and schisms, icec's approach of using a common goal of reducing the burden of Cancer is an example of what can be done to solve problems inappropriately labeled "too hard". The number of people who benefit from icec's efforts increases yearly as the capability and capacity of the workforce in lmics increases through icec's ongoing mentoring, training and education programs, thereby improving the quality of Cancer care delivered to all patients with Cancer. Icec board of directors and icec advisory board members contributed over 1,500 service hours with an estimated cash value of $145,000 supporting icec's twinning programs. For additional information, see www.iceccancer.org.

Icec outreach the need for expertise in global oncology is increasing, with approximately 9 million people dying from Cancer annually. Icec engages in various activities that promote healthcare system strengthening, particularly through workforce capacity and capability-building strategies in low- and middle-income countries worldwide. Icec's outreach program leverages its expansive network of experts, including healthcare professionals, educators, economists and others, to raise awareness and promote substantive involvement in efforts to confront the global Cancer crisis. Icec works closely with the research and scientific communities, national and International ngos, governments, regulators, academia, industry, and their regional and International partners in research, presentations at International symposia, and authoring and contributing to a number of peer-reviewed journal articles. In 2022, though the covid-19 pandemic began to lessen its grip on the global healthcare community, it further exposed significant inequities within health systems worldwide. Cancer, like covid-19, disproportionately impacts people of color, the impoverished, and historically marginalized peoples in high-income countries and across all socio-economic groups in low- and middle-income countries. Icec quickly learned lessons from this experience, shifting to provide additional support and access to expertise, leveraging and increasing its telecommunications programs, and engaging with colleagues and partner organizations to increase knowledge transfer and research. Throughout 2022, icec built upon its experience in the icec-authored article, "achieving flexible competence: bridging the investment dichotomy between infectious diseases and Cancer" which was widely shared in the december 2021 issue of bmj global health, 2020 dec. pmid: 33303514; pmcid: pmc7733114.in 2022, icec joined the International atomic energy agency (iaea) and 10 of the largest professional oncology-focused societies in Cancer care to help improve access to radiotherapy services and reduce the global inequities in the treatment of the disease. The practical arrangements on technical professional society partnerships in Cancer care is the iaea's first multilateral partnership on radiation oncology, medical physics and diagnostic imaging that spans the americas, africa, asia, australia and oceania, europe and the middle east. The partnership was signed ten months after the iaea launched the rays of hope initiative, a vehicle through which the agency supports countries to establish or scale up safe, secure and effective radiation medicine capabilities to bridge a significant shortfall in equipment and highly skilled personnel in many developing countries. Icec participated in numerous webinars and online conferences, conducted research, and continued our outreach efforts online to understand, manage and foster the organization's mission and the needs of our constituents and partners. Programs included partnering with professional societies, International governmental and non-governmental agencies and organizations, universities, academic medical centers, think tanks and philanthropic foundations. Icec continued contributing its perspective to the ad hoc working group on alternatives to high-activity radioactive sources, chaired by the governments of france, the united states and germany, sharing information, ideas, views, and experiences on the use of alternatives to technologies that use highly radioactive sources in medical applications. Icec also presented at the world institute for nuclear security meeting, "strengthening the coordination of International stakeholders involved in the adoption of alternative technologies." Icec board of directors and icec advisory board members contributed 1832 service hours with an estimated cash value of $183,000 supporting icec's outreach programs. More information on these efforts can be found at www.iceccancer.org.

Developing novel medical linear accelerators (linacs) for challenging environments in low- and middle-income countries (lmic) there are low-middle income countries (lmics) where there is almost no access to Cancer care leading to unnecessary deaths and immeasurable suffering. What is needed is access to the appropriate expertise built from the local community and treatment with effective technology to ensure sustainable capacity and capability. Radiation therapy is an essential component of Cancer care, critical for the cure and palliation of over half the patients with Cancer. A ready measure for the adequacy of Cancer care is access to the radiation therapy machine called the linear accelerator or linac. In addition to its primary goal of education, training and mentoring of Cancer care teams in lmics, icec's secondary goal is to improve access to technology for radiation therapy treatment. The scope of the shortage of radiation therapy machines or linacs is staggering. In high-income countries, there is approximately one linac for every 125,000 persons; in some lmics, the ratio is one for every 800,000 - 100,000,000. Despite the recognition of this gap decades ago, little has been accomplished. Icec heads an International collaboration to address the current need for approximately 13,000 radiation treatment machines reported by the uicc global task force for radiation therapy for Cancer control, primarily in lmics where the operating environment is often challenging. The linear accelerator program stella - smart technology to extend lives with linear accelerators - is the creation of world-leading physicists from the european organization for nuclear research, cern (in french, conseil europen pour la recherche nuclaire), icec and the science and technology facilities council in the uk. The collaboration, headed by icec and now includes lancaster and oxford universities, is developing an affordable, robust and technologically advanced radiation therapy machine that will be easier to use than existing linacs, and can replace cobalt-60 (co-60) external beam rt machines in lmics. Linacs can deliver more advanced Cancer treatments resulting in better treatment outcomes than co-60 rt machines and reducing reliance on co-60 rt machines will help reduce risks related to the nefarious use of the un- or poorly secured radioactive sources found in cobalt-60 rt machines.project stella has brought together world-renowned engineers, physicists, academicians, scientists, economists and representatives from more than 40 countries, non-governmental organizations, and representatives from agencies and governmental organizations, including the us department of energy's national nuclear security agency, the International atomic energy agency, ministries of health, the world health organization and leading universities and research labs. To gain further insight, in 2022, icec undertook a regional study to understand the level of access to linear accelerator-based radiation therapy (rt) for Cancer patients. Regional countries in this project include armenia, azerbaijan, estonia, Georgia, kazakhstan, kyrgyzstan, latvia, lithuania, moldova, tajikistan, ukraine and uzbekistan.the study's main objective was to determine barriers to and plans for the adoption of medical linear accelerators (linac) for Cancer treatment. The study included participation by regulators of rt equipment as well as physicians, physicists and research scientists in the institutions that utilize those medical devices, and academic, institutional and medical researchers.by leveraging what has been learned from our previous studies and analysis in the use of linac and cobalt-60 (co-60) based technology for rt for Cancer treatment in the south east european countries (the balkan peninsula) and in radiotherapy treatment facilities in all 28 african countries that have experience treating Cancer patients with linacs, icec sought to understand the status of rt and assess the need for training and capacity building for effective and efficient treatment in the selected countries.this effort added critical information to further expand upon the 2021 concept design as the project moves to the technical design report phase. Funding is being sought to launch the stella prototype project. At this time, no people have directly benefited from this program; however, icec's research has contributed significant insight to understanding and addressing the challenges to increasing access to rt. Icec anticipates that once the radiation therapy treatment system is developed and in use, hundreds of thousands of people in lmics and other challenging environments will benefit by having access to effective and safe curative or palliative radiation treatment for their cancers. A report of activity to date is available for interested partners. The report reflects that there are opportunities, ideas, interest and support to continue to pursue this effort to develop a unique radiation therapy treatment system for challenging environments.icec board of directors and icec advisory board members contributed 3430 service hours with an estimated cash value of $340,000 supporting icec's linac program. More information can be found at www.iceccancer.org.