A Decade of INCTR: Challenges and Opportunities

INCTR’s Structure and Strategies

Background

INCTR was established in 1998 as an international not-for-profit organization (NGO) under Belgian law and dedicated to building capacity for cancer treatment and research in developing countries. Its founder members are the International Union Against Cancer (UICC) and the (former) Institute Pasteur. INCTR located its offices in Brussels, where activities commenced in April 2000. In March 2010 a special expanded Annual General Meeting was held to take stock of INCTR’s strategies and activities. This report provides a brief overview of developments during this period as reported during the meeting.

From its small beginning, INCTR has developed to the point where it has branches or offices in ten countries (Canada, USA, Brazil, Cameroon, Egypt, India, Tanzania, UK, France and Nepal) in addition to its Head Offices in Belgium. This represents one component of its overall strategy – the continued enlargement of its international network. Secondly, since cancer is a complex set of diseases which require, for their control (reduction in morbidity and mortality), a broad range of both health workers and managers, INCTR has developed a series of organization-wide programs that cover various disciplines. At present there are seven programs. Five have existed for some time: Foundational Programs, Clinical Research, Pathology, Pediatric Oncology and Palliative Care (PAX), while Cancer Registration and Cancer Nursing are in the process of being launched. A psychosocial program was discussed during the 2010 meeting and this will probably be initiated in the context of the pediatric oncology program.

New branches in Europe (e.g., Sweden) are being considered to expand INCTR’s access to resources, and this is likely to be associated with the creation of new programs in adult oncology and cancer surgery and a considerable expansion of INCTR’s ability to develop training and education programs, particularly in relationship to cancer treatment, although INCTR recognizes the importance of a combined public health/clinical care approach coupled to education of policy makers and the public.

INCTR’s Mission, Philosophy and Strategies

INCTR’s mission is to build capacity for cancer treatment and research with the vision of creating an international network dedicated to education and training and emphasizing a scientific approach. INCTR believes that working together with colleagues from developing countries “in the field” is the most efficient way to transfer knowledge to health professionals involved in the care of cancer patients. The latter are then in a position to educate their colleagues, particularly primary health care providers, who have a major role in ensuring that cancer is diagnosed as early as possible and that patients have access to existing treatment facilities.

INCTR’s objectives are:

• To build capacity for cancer treatment and research in countries with limited resources through long-term collaborative projects coupled to training and education.
• To promote international collaboration directed towards cancer control between technologically advanced countries and countries with limited resources.
• To take advantage of unique research opportunities.

The importance of research can never be underemphasized. It is essential if national priorities are to be addressed and relevant evidence in the local context created. It leads to a more analytical and disciplined approach to all aspects of health care. It allows advantage to be taken of unique scientific opportunities and will lead to greater independence of developing countries from high-income countries while playing a role in economic development. 

In the creation of an international network, it was recognized that “local” ownership of programs and projects was essential, yet resources from high-income countries were necessary. Offices and branches in high income countries such as the USA, UK, France and Canada have access to regional and national resources that include both human and financial components. Offices and branches in LMIC provide regional or national coordination of INCTR programs and projects and participate in regional capacity building. The guiding principles of INCTR offices and branches are its Charter.  

Developing Human Capacity

To achieve its mission INCTR must confront many challenges. While all countries have specialists and institutions dedicated to cancer care or who care for cancer patients, care in LMIC is rarely up to the standards of high-income countries. Minimal in-country research frequently results in ill-disciplined approaches to care and there is little or no surveillance of treatment quality. INCTR seeks to improve human resources within low- and middle-income countries (LMIC) for the delivery of effective care and recognizes the need for well trained specialists from the LMIC or high-income countries (HIC) to undertake this (although they need to be familiar with the challenges of cancer care in resource-limited settings). Accordingly, it is in the process of developing an INCTR “faculty” from partnerships with academic institutions that is comprised of health care professionals representing a variety of disciplines required for the optimal delivery of cancer care. The INCTR “faculty” has performed on-site assessments, conducted training workshops and supported long term assignments of INCTR experts (months to years) to work with local staff at institutions in LMIC in order to provide training and education. Partnerships with academic institutions will enable INCTR to take advantage of their professional expertise in education, training and research and make it available to institutions in LMIC. Standard training approaches are coupled to web-based approaches (e.g., e-learning, or the provision of on-line information as in the INCTR/MERLOT partnership (see p.24), which gives access to a broad variety of educational materials (www.http://oerc.merlot.org/about/index.html).

Up-Scaling

A strategy that INCTR strives to accomplish in the context of its projects “in the field” is to develop centers of excellence in care, education and research that can help spawn centers in other parts of the country or region. This should help convert small demonstration projects to interventions with a population impact – essential if a real difference is to be made to cancer control, and if that difference is to be sustainable. This does mean, however, that funding from within the country, or essentially permanent external funding, must be found. This is much more likely if an impact on national cancer control can be achieved and the success brought to the attention of policy makers and particularly ministries of health and finance.

INCTR Programs

INCTR identifies and initiates activities through its programs that are briefly described below.

Foundational Programs:

to create the necessary human resources and infrastructure to manage cancer treatment in LMIC.

Clinical Research Program:

to develop the evidence on which to base interventions while providing care and training to health professionals.

Pathology Program:

to improve the accuracy of diagnosis essential to treatment and research.

Pediatric Oncology Program:

to ensure access to care for highly curable diseases in patients with a potentially long life span and to incorporate psychosocial support for patients and their families in the overall management of children with cancer.

Palliative Care Program (PAX):

to train health professionals in the provision of care in the context of regional training centers; to work with governmental authorities to improve opioid availability and to include palliative care in medical and nursing curricula.

Cancer Registration Program:

to help develop a cancer registration program initially focused on Africa through the provision of necessary training and surveillance.

Oncology Nursing Program:

to focus on training and education of oncology nurses.

Partnerships

INCTR partners with other organizations and institutions that have overlapping interests and activities. Partnerships may entail the joint conduct of projects and takes advantage of complementary skills or experience that exists in other organizations. 

Because of its internal structure and the origin of its initial support as well as its ongoing support, INCTR has strong links with the National Cancer Institute (NCI) of the USA. It continues to extend its professional network with other governmental agencies, including the World Health Organization (WHO), the Program for Action for Cancer Therapy (PACT) of the International Atomic Energy Agency (IAEA), the European School of Oncology (ESO), MERLOT and other non-governmental organizations. It also works closely with university departments and seeks sponsorships and, occasionally, joint projects (although not product related) with the corporate world. 

In 2010, INCTR was approved as a non-governmental organization in official relations with WHO.