The National Cancer Institute of Egypt: An Influential Tool in the Management of the Nation

1
The National Cancer Institute of Egypt An
Influential Tool in the Management of the
Nations Oncology Issues

• Salah S. Abdel Hadi, M.D.
• Dean, National Cancer Institute
• Cairo University, Egypt

2
Outline

• Descriptive
• Oncology challenges in developing world
  (including Egypt)
• 2. Activities
• NCIs current impact on oncology challenges.
• 3. Prospective
• Renovation procedures Current North South
  buildings
• Multi centric NCI outlets New Hospital addition
• NCI campus Three phase novel project .

3
Global Cancer Burden (WHO)
2000 2020
New cases of cancer 10 million 20 million
No. of cancer related deaths 6 million 12 million
Percentage of new cases in Developing countries 50 70
4
New cancer cases on the rise
16 millionin 2020 a 50 increase!
10 millionin 2000
WHO (2003)
5
Background

• Estimated new cancer cases each year is expected
  to rise from 11 million (2002) to 16 million
  (2020).
• 60 (9.6 million) of all these new cases will
  occur in the less developed world.
• These individuals, their families will face the
  challenge of understanding cancer, and how it
  affects their lives.
• Providing quality current cancer information to
  cancer patients, their families, laymen health
  care givers is a key function of the National
  Cancer Institute, Egypt.

6
Introduction

• Countries with limited resources are defined
  economically as having an average gross national
  product/capita of less than USD 350/year.
• Remarkable advances in treatment of childhood
  cancer have been bitter sweet.
• High incidence of successful cures in developing
  countries who hold a minority of the worlds
  population and a minority of children with
  cancer.
• High rate of patient withdrawal from therapy
  loss to follow up in studies from developing
  countries.

7
Introduction

• The population of developing countries
  represented 78 of the global total in 1990.
• Countries with limited resources accounted for
  86 of the worlds children in 1990.
• Projected to increase to more than 90 by 2030.
• The major killers of children in countries with
  limited resources remain
• a) infections,
• b)malnutrition
• c)diarrhea/dehydration.

8
Issues Facing Developing World

• 1. Patient Load.
• Specialized centers are few and overwhelmed with
  patients.
• 2. Treatment Priorities
• Available agents e.g. chemotherapy and
  radiation facilities impose choice of management.
• 3. Impact of existing health problems
• 4. Hepatitis and nutritional status affect
  management significantly.
• 5. Compliance
• Lack of interest in long term follow up due
  to economic, cultural and educational reasons.

9
Issues Facing de vIssues Facing Developing World

• 6. Lack of communication between regional centers
  in patient follow up management.
• 7. Poor registration and follow up facilities.
• 8. Lack of integrated aproach to
• a)appropriate medical surveillance for late
  effects of treatment.
• b)counseling services.
• c) special needs concerning employment,
  disability, insurance, psychological support.

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EGYPT Country Profile
Damietta
Mansurah
Fakous
Tanta
Alexandria
DEMOGRAPHY Population 78,887,007 (July
2006 est.) Fertility rate 3.3 of
population under 15 32.6 Population
growth 2 Rural / Urban population 58 /
42 Literacy rate 57.7 HDI 0,659 (2003)
(Rank 119)
Port Said
Damanhour
Ismaila
Minufiyah
Cairo
Zagazig
Al Minya
Assiut
Sohag
Aswan
ECONOMY GDP ppp 339,2 billion (2005) GDP
ppp pc 4,400 (2005 est.) Minimum wage 33
(public sector - 2001) Unemployment rate
10 Formal sector 25 of pop. of
population under poverty line 3.1 CIA WHO
2005 PNUD
HEALTH Life expectancy ?68
?72 Malnutrition lt 5 9 Infant mortality
31.3 Epidemiological transition underway
11
Pediatric Oncology Services in Egypt
Damietta
Mansurah
Cancer Institutes Oncology hospitals
university institutions , provide training
program expert care NCI
SECI
Fakous
Tanta
Alexandria
Port Said
Damanhour
Ismaila
Minufiyah
Zagazig
Cairo
Al Minya
Ministry of Health Cancer Centers Comprehensive
CC created by the Ministry of Health and
Population in 1996
Assiut
Sohag
University Hospital departments pediatrics,
hematology, radiotherapy, and other adult services
Aswan
NGO hospitals NGO hospitals located in rural
areas with small activity in PO
12
Cancer Profile - Egypt

• In Egypt today, the number of new cancer patients
  per year is estimated to be 100,000.
• Accumulated patients represent about three times
  the number of new cases.
• This patient load will expand in the future
• Population continues to grow
• Population continues to age,
• Prevalence of known etiological factors increase.

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NCI Egypt

• Largest comprehensive cancer center operative
  since late 60s.
• Serves 18,000 newly diagnosed cancer patients
  (800 peds) and 100,000 patients under treatment.
• Involved in
• Patient service
• Research activities
• Post graduate degrees
• Training and education
• National role

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Most Common Sites in MalesNCI, Egypt
15
Most Common Sites in FemalesNCI, Egypt
16
Most Common Sites in ChildrenNCI, Egypt
17
Number of new cases NCI 2007(total 21181)
82
18
18
18,189 New Cancer Cases by Age Groups and Gender
47
63
51
55
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Cancer Profile - Egypt

• Egyptian patients with cancer usually present at
  a relatively advanced stage in their disease,
  which has a negative impact on treatment results.
• Most common cancers encountered
• A) Male urinary bladder (25 )
• B)Female breast (14)
• C) Childhood ALL (25 )
• Activities directed towards avoidance of risk
  factors, early detection, education and
  awareness.

20
NCIs current impact on oncology challenges.

• Tool 1
• Collaboration

21
NCI Egypt, Collaborative Activities

• National
• Setting up treatment protocols with MOHP
• Providing technical support for comprehensive
  cancer centers nation wide.
• Speer heading early detection activities.
• International
• UICC
• INCTR
• International Atomic Agency
• NCI USA

22
Membership in International Organizations

• European organization for research and treatment
  of cancer (EORTIC).
• International Union Against Cancer (UICC)
• World Health Organization (WHO)
• International Atomic Energy Agency (IAEA)
• International Network for Cancer Treatment and
  Research (INCTR)
• Eastern Mediterannean Regional Office/World
  Health Organization (EMRO)

23
International Available Collaborative
Opportunities

• A) Jordanian Prospect (KHCC)
• Link with Expat. community
• Rotation in US during fellowship program
• Collaborative efforts
• Continutity
• Role of senior staff
• Role of junior staff
• B) French Prospect
• Centre Antoine Lacassagne, Nice
• Radio therapy
• Nutrition
• Tumor bank

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Regional Collaboration NCI/KHCC

• Create larger and stronger professional body
• Learn from each others skills
• Complement each others deficiencies
• Create prototype for regional collaboration
  without intermediaries.
• Allow professionals to work in either institution
  according to developed skills (palliative
  care/clinical pharmacy)

25
Regional Collaboration NCI/KHCC

• Ongoing Collaborative activities
• Epidemiology
• Pain/palliative care
• Nursing
• Laboratory
• Radiation therapy
• Pediatric oncology

26
Regional CollaborationNCI/KAU

• Initiation
• Visit by University president to NCI.
• Visit by Egyptian delegation to KAU.
• Saudi academic delegation attending M.D. exams.

27
Regional Collaboration NCI/KAU

• Prospective
• Training health care team personnel (doctors,
  students, pharmacists, lab techs., physicists,
  nutrition specialists, etc.)
• Sharing in supervision and evaluation of MSc. And
  M.D. dissertations.
• Exchange of post grad students/lecturers in
  various oncology related curriculae.

28
NCIs current impact on oncology challenges

• Tool 2
• Education

.
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ACADEMIC PROGRAM AND RESEARCHNCI, Egypt

• NCI offers academic degrees in various oncology
  specialties, including
• Doctoral degrees in surgical oncology, adult and
  pediatric medical oncology, radiotherapy,
  pathology, clinical pathology, and cancer
  biology.
• Master's degree in surgical oncology, medical
  oncology, pediatric oncology and pain control. 
• The NCI is the nation's first to receive
  international research grants to study cancer
  problems of particular importance to Egypt.

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III- Degree requirements

• Masters degree with a minimum grade of ''Good''.
• Currently, The Masters degree could be either in
  the general field or the oncology specialty.
• After a three year transition period, the Masters
  degree has to be in the oncology specialty field.

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Educational Collaborative EffortsNCI, Egypt

• Team of US educators visiting NCI Egypt 2007.
• Activities
• A) Participation in Cairo University annual post
  graduate conference
• B) Attending a retreat in upper Egypt with NCI
  counterparts to address oncology educational
  aspects.
• C) Assisting in developing a proposal for
  creation of a post graduate medical education
  office at NCI Egypt.

32
Educational Collaborative EffortsNCI, Egypt

• NCI/AUC educational project
• 1) Accreditation
• 2) Development of credit hour system and
  curriculae review
• 3) Partnership activities in computer science, IT
  development, and AV material development.
• Joint committee members working in identifying
  time plan and objectives.
• Success of current effort could lead to MOU
  between both institutions

33
NCIs current
impact on oncology challenges.

• Tool 3
• Research

34
Cancer Research Support

• Cairo University approach to financial research
  support
• Prospective research cancer center with financial
  autonomy and capability planned for NCI, Egypt.
• Development of bilateral channels with research
  centers regionally and internationally.
• Introduction of quality control/incentives to
  centers for policy and procedure development.
• Initiation of workshops to standardize scientific
  rapport.
• Initiation of accreditation activities nation
  wide.

35
Aspects of Research ActivitiesNCI, Egypt

• Translational research
• proper characterization of different types of
  malignancies to define parameters impacting
  treatment and/or prognosis (biological
  differences).
• Role of infectious/parasitic agents in
  carciongenesis
• HCV with Hepatocellular carcinoma,
• HPV with cancer cervix,
• Helicopactor with stomach cancer
• Bilharziasis with bladder cancer.

36
Aspects of Research ActivitiesNCI, Egypt

• Environmental factors and carcinogenesis
• asbestos and mesothelioma,
• intrauterine chemical exposure and infant
  leukemia.
• Genetic/ environmental interaction
• polymorphisms in genes encoding drugs and
  xenobiotic metabolizing enzymes as risk factor
  for cancer development, response to therapy and
  drug toxicity (ALL patients).

37
Obstacles/Barriers to Research

• 1- Financial constraints
• Defies individual motivation when distributed by
  allocation.
• 2- Lack of full time research career path.
• Research combined with patient care and private
  practice.
• 3- Lack of motivation towards research career
  pathway
• Financial constraints, professional satisfaction,
  availability of research tools.
• 4- Variation in research interest/abilities
  within different centers
• Defies ability to initiate multi center studies

38
NCIs current impact on oncology challenges.

• Tool 4
• Training

39
Educational Collaborative EffortsNCI, Egypt

• Training Activities
• I- National a) through post graduate degree
  awarding program
• b) training site for MOHP Board
• c) special programs, clinical pharmacy and
  radiology
• II. Regional Iraq, Yemen and Sudan
• III. International US and France

40
International Collaboration School of Public
Health University of Michigan

• NCI gateway to Egyptian Oncology centers (Assiut,
  Tanta).
• Projects by post graduate American students .
• Projects focused on
• Epidemiology pathology of inflammatory breast
  cancer
• Changing epidemiology of bladder cancer
• Liver cancer and hepatitis viruses
• NCI-Cairo mentors from Epidemiology, pathology,
  and medical, surgical, and radiation oncology.
• International course offered at NCI.
• NCI scientists in Michigan.

41
International Collaboration School of Public
Health University of Michigan

• Learning Experience
• Having the opportunity to work with large patient
  population and large data sets.
• Different laboratory environment (equipment,
  reagents, and work environment).
• Working with incomplete and inconsistent data.
• Communication lessons with local mentors and
  staff during and after the internships.

42
International Collaboration Gustav Ruse
France

• 1. Historical Overview
• 2. Re-initiated by French partner
• 3. Combined with Benha University Cancer Center
  Project (includes local role for NCI in
  community)
• 4. Visit of two French students
• Accommodation at NCI Interaction with residents
  
• 5. Cultural interaction.

43
NCI Prospective

• Renovation procedures
• Current North South buildings
• North Building
• State of the art OR and ICU
• South Building
• Creation of an out patient independent complex

44
NCI Prospective

• Multi centric NCI outlets New Hospital
  addition
• Advancing into complementary health care outlets.
• Hospital planned to impact early detection and
  community service programs in oncology areas.
• Will act as prototype for prospective project in
  areas of management and HR issues.

45
NCI Prospective

• NCI campus Three phase novel project.
• First phase accommodates 350 beds planned to
  function within four years.
• Fund raising campaigns underway through an NGO
  with a board of trustees headed by first lady.
• Aims at further segregating and highlighting
  different avenues of services throughgt
• A) Research institute
• B) Palliative care institute
• C) Specialized clinical hospital settings
• D) Independent academic buildings and activities
• E) Separate out patient facility.

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National Cancer Institute Cairo University
200 years ago
2010