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Annual Meeting
INCTR Reports
• Clinical Research Program
The Clinical Trials Office (CTO) coordinates INCTR’s Clinical Research
Program and has the responsibility for managing the clinical research studies
undertaken by disease-specific Strategy Groups and for providing education and
training related to clinical trials and data management.
Four studies are in progress.
A survey of patients of children with retinoblastoma is on-going in eleven institutions
in eight countries - Brazil, Bolivia, Mexico, Nigeria, Zimbabwe, Turkey, India
and Pakistan. The objective of this study is to identify factors contributing
to delays in diagnosis and obtaining treatment. Over 300 parents have been interviewed.
Children from rural areas and older children had higher stages of disease at
diagnosis. The fathers’ education level was associated with the extent
of disease – the less educated the father, the more advanced the stage
of the child’s disease. The children of fathers with lower education levels
experienced longer intervals between the first sign of retinoblastoma and the
time of diagnosis.
Four institutions in India are participating in a study of the treatment and
characterization of acute lymphoblastic leukemia in children, adolescents and
young adults. Patient accrual began in August 2004, and 149 patients have been
enrolled in the study. The principal investigators have formed a study committee
and meet regularly to discuss protocol progress. Data monitoring has been introduced.
A web-based data entry system is used to centralize data collection.
Four institutions in three African countries (Kenya, Nigeria and Tanzania) are
participating in a protocol for the treatment and characterization of Burkitt’s
lymphoma. Over 80 patients have been enrolled in the protocol which consists
of standard therapy for first-line treatment for newly diagnosed patients and
second-line treatment for those who fail first-line treatment. Two secondary
objectives are to improve patient follow-up and data collection. Patient loss
to follow-up, approximately 11%, has been significantly reduced compared to
the era in which a formal protocol was not in use. In November, the CTO provided
a training workshop for the study data managers. The workshop included an overview
of basic data management and practical exercises in data management procedures
relevant to the protocol. Data retrieval for a retrospective survey of the presentation
features of breast cancer and risk factors for treatment outcome is underway
in Peru, India and Pakistan.
In addition to these clinical research studies, the CTO organized and provided
the faculty for a session entitled “Basic Data Management” at the
International Chemotherapy Congress held in Manila, Philippines, in June 2005.
• Education Program 2005
Since its inception, education and training have been central to the ethos of
the INCTR. The aim has been to fulfill actual (and not perceived) needs, to
focus available resources and to support existing INCTR projects. Emphasis is
given to “in-country training”, or “south-south” training,
conducted in a developing country.
Medical Oncology
In 2005, the Education Program focused on: • Workshop Meetings for doctors
and nurses • Proffered papers and poster sessions at the Annual Meeting
• Providing training opportunities for specific individuals • Linking
medical schools.
Workshops (where the emphasis is as much on discussion as on the
formal presentations):
- A Workshop on Research Methodology* entitled "What you always wanted
to know, but were afraid to ask" was held in Lahore in February - in the
context of the 7th Annual Meeting of the Shaukat Khanum Memorial Hospital and
Research Center, (SKMH&RC). Its aim was to give doctors-in-training practical
advice on: writing an abstract, publishing a paper and writing a grant proposal.
There were also presentations on the importance of conducting clinical research
in developing countries, the role of the individuals who make up the clinical
research team, and on study design.
- A Workshop on Lymphoma** was held in collaboration with Dokuz Eylul University
(Izmir, Turkey) and the Middle East Cancer Consortium, with an international
faculty and 125 medical oncologists and hematologists-in-training from Turkey,
the Republic of Cyprus, Jordan, Egypt, Palestine and Israel. The workshop covered
both molecular aspects and recent advances in treatment of Hodgkin’s and
non-Hodgkin’s lymphomas. A nurses’ workshop was held concurrently.
Proffered papers and poster sessions:
73 abstracts were submitted; 9 were chosen for oral and 34 for poster presentation.
On the basis of the data (and their CV), 6 individuals were chosen to participate
in a course in scientific writing to be held in New Delhi, in August 2006.
Training opportunities and visiting experts:
Afghanistan: Dr. Mirwais Malik* > Tata Memorial Hospital (TMH),
Mumbai, for one year, to train in medical oncology - Mr. Hamidulla* > SKMH&RC,
Lahore, for three months, to train in pathology technology.
Nigeria: Dr. K.O. Ajenifuja* > TMH, for one year, for advanced training
in gynecological oncology - Mrs. E.T. Aladekomo, Mrs. O.A. Agboola, Mrs. B.O.
Adebami, Dr. Anorlu* > TMH, for three months to train in screening for cervical
cancer.
Bolivia: Dr. Rocha* > Instituto De Enfermedades Neoplasicas (INEN),
Lima, three months, to train in Colposcopy and CIN management - Dr. Ingrid Hurtado*
> INEN, one month, to train in colposcopy - Mrs. Franco > INEN, one month,
to train in Cancer Registration.
China: A delegation from the Chinese Ministry > to St. Bartholomew’s
Hospital London, to discuss setting up Ethics Committees.
Pakistan: Ms. Murrell and Ms. Stewart and subsequently Ama Rohatiner
> SKMHRC to train nurses and doctors in the delivery of high-dose treatment
with autologous peripheral blood progenitor cell support.
Links between Medical Schools:
Dr. V. Shanta will host two final-year medical students from SBH for an elective
period - Dr. Trajman (Gama Filho University, Rio de Janeiro, Brazil) spent two
weeks at St. Bartholomew’s Hospital with Professor Rohatiner and third-year
medical students to gain experience with an integrated medical curriculum.
* Supported by the Office of International Affairs NCI, USA.
** Supported by the Office of International Affairs NCI, USA and the pharmaceutical
companies Roche and Schering AG.
Acknowledgements: Susanne Radtke and Elisabeth Dupont coordinated the “south-south”
training programs for Afghani, Nigerian and Bolivian health professionals.
Pediatric Oncology
Dr. Aziza Shad, Chairman of the Pediatric Oncology Sub-Committee.
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A number of joint meetings in which INCTR’s pediatric sub-committee had
a major role were held in the course of 2005. The 1st International Conference
on Pediatric Oncology in Karachi, Pakistan, took place in July in collaboration
with the Cancer Society of Pakistan and the Pakistan Society of Pediatric Oncology.
Pre-conference workshops were held on research methodology and oncology nursing.
There were 150 participants from Pakistan and 60 participants from India, Nepal,
Afghanistan, Saudi Arabia, Oman, Jordan, Iraq, Europe and the USA.
The Chinese 5th National Congress in Pediatric Oncology was held in Tianjin
in September in collaboration with the Chinese Society of Pediatric Oncology
and the Children’s Oncology Group (COG). INCTR arranged for several faculty
members to attend.
A Workshop on Palliative Care for the Cancer Patient was held in Larnaca, Cyprus,
in November in collaboration with the Middle East Cancer Consortium. There were
80 participants from Jordan, Israel, Palestine, Turkey, Cyprus, Iraq, Egypt,
Pakistan, India, Canada and the USA. In the course of this meeting a Palliative
Care Steering Committee was formed which includes Drs. Shad and Brown of INCTR.
A program of continuing education for Iraqi pediatric oncologists was initiated
in April 2004 in Amman, Jordan, at the King Hussein Cancer Center (KHCC). Several
subsequent workshops have been held, one during the INCTR Annual Meeting in
Cairo, Egypt, in September 2004, one in Karachi, Pakistan, in July 2005 in conjunction
with the 1st International Conference on Pediatric Oncology, and another at
INCTR’s last Annual Meeting in November 2005 in Chennai, India. These
workshops have been focused on hematological malignancies, supportive care,
transfusion medicine and palliative care.
Three senior fellows from KHCC spent four-month training periods at the Lombardi
Cancer Center (LCC) and gained experience in both laboratory and clinical aspects
of pediatric oncology. Similar fellowship training is envisaged for fellows
from Nepal following Expert Visits undertaken by Dr. Aziza Shad to the Kanti
Children’s Hospital, Katmandu, in January 2005.
A meeting took place at the LCC in August to explore the possibility of collaboration
among a number of organizations involved in pediatric cancer, including the
LCC, the Children’s Oncology Group, INCTR, NCI, CURE and St. Jude Children’s
Research Hospital. The group agreed to share resources, to avoid duplication
of effort, to apply for joint funding and to undertake joint educational activities.
Funding for these events was obtained from a number of sources, but special
thanks are due to the Office of International Affairs, NCI and institutions
and organizations participating in the meetings described above.
Nursing Oncology Report
In most developing countries, nurses undertake relatively menial tasks, and
their training generally does not include cancer care. INCTR (and its French
branch, AMCC) emphasizes in-country training and training in other developing
countries (“south-south” training). Four workshops and training
courses were held in 2005:
- In April, 2005 a three-day workshop entitled “Recent Advances in
Cancer Nursing” was held in Ismir, Turkey. Eighty nurses from Middle
East countries attended.
- In June, a palliative care workshop was carried out in Tanzania in concert
with the INCTR Palliative Care Team and the INCTR Tanzanian office; 20 nurses
were present.
- In October, a training course on “Prevention and Early Diagnosis
of Breast and Cervical Cancer for Health Staff” was held in Niger. For
five days, 75 people (surgeons, doctors, midwifes, nurses and cancer association’s
members) discussed the care of women with cancer.
- In November, a palliative care workshop held in Dakar, Senegal, during
the 5th Aortic Congress brought French, English and Arabic speaking nurses
together from all over Africa.
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