David Bayne: Thank you.
Sam Washington: It's a pleasure to be here.
David Bayne: Pleasure to be here.
Zachary Klaassen: So this is really exciting. I know we did a lot of prep to try to get everybody on the same time, so it's great to chat with you guys. I'll just maybe start with David. By way of background for our listeners, what's sort of the global burden of disease? We know there's a lot of underserved areas in the United States, but we need urological oncology expertise across the globe. Can you give us an idea specifically in developing countries what this may look like?
David Bayne: Well, we know that urologic cancers account for 20% of all cancers diagnosed among men, prostate cancer being the most common. And we know specifically in the country where we're operating in Uganda, it has the highest burden of prostate cancer in East Africa with an estimated incidence of about 37.1 per 100,000.
Zachary Klaassen: Wow.
David Bayne: So despite the fact that there's this high urologic cancer burden in Uganda in the Greater East Africa region, there's no real training programs in urologic oncology in the region. So that's kind of what prompted this work.
Zachary Klaassen: No, that's great. I mean, I think we see this in areas of our country, but that's just the United States, which obviously has many resources, not even looking at second or developing world countries. I mean, this is really a burden of disease that doesn't have the people or the training, correct?
David Bayne: Correct.
Zachary Klaassen: Awesome. Sam, why don't you lay out for us how this partnership came together, the timeline, sort of that process of getting this partnership together and maybe the steps for how a program like this is set up.
Sam Washington: Yeah. I think we were lucky in that we were able to leverage existing partnerships, some with IVUmed, other urologists, including Dr. Bayne, other programs. And this really arose from the need for specific urologic oncology training at UCI. We know that there were a lot of fellows and faculty who have been trained in urologic oncology, but that required them to go elsewhere for training and then come back. And there's a lot of barriers to creating that program and training being expensive, really prevented a specialized workforce from being formed there.
So from the existing relationships came this discussion of what could benefit those in that area and address the need in the location in the region. And that's really where we started to have more discussions about a formal program being developed. I would say it's been an interesting year. It feels almost crazy to say it's been a year, less than two years since discussions first started and we've worked together to get this program developed, but thankfully it wasn't just us three.
This program became a program through partnerships with UCSF, our Department of Urologic Oncology, with support from Dr. Ben Breyer, our chair, the Mulago National Specialized Referral Hospital, the College of Health Sciences, McMurry University, Ernest Cook University, as well as collaborations with Dr. Godfrey Nabunwa, Henry Dabanja at UCI, Kit Yuen, who's now at University of Colorado, Dr. Porten, Dr. Bayne who are here, Dr. Eggener, Large, and Dr. Moses who partnered through IVUmed and many others, not only in the hospital, but also Ugandan Medical Council have all been integral and played parts into getting this program up and running.
Zachary Klaassen: No, that's a great outline. I think you mentioned the timeline, almost two years to sort of get this off the ground, which actually seems fast to me, but so congratulations on sort of working through all those details. Sima, what specifically does a curriculum look like? And then we have a very, very broad and specific curriculum for SEO. How do you partner with Uganda Cancer Institute in terms of developing a curriculum that can be followed throughout the whole process?
Sima Porten: Yeah. So when this initiative started, that's where I kind of came in because in my role as the fellowship program director at UCSF, the thought was to see what we can use that we've already sort of outlined as being the highest standard of care or training. Right? Here in the US, which is Society of Urological Oncology, which accredits all of our fellowship programs across US and Canada. And so the thought was, could we use that as a backbone to develop a program in Uganda that aligned with training of urologic oncologists there, that aligned with expectations of the Ugandan Medical Council, as well as also with what Uganda Cancer Institute sort of envisioned for the next steps here. Right?
And so what we used was the backbone of the two-year urologic oncology fellowship with the SUO, and we took that and went through it with a fine-tooth comb and developed a curriculum which consists of didactics and clinical experience, as well as parallel research training, sort of thinking about and creating interesting projects and then coming up with an academic body of work. So that mimics what we require our fellows here in the United States and Canada to do in terms of clinical training, right? Minimum case numbers, graded responsibility toward independence, as well as that kind of scholarship aspect of it, primarily in the form of research.
And so we tried to provide a comprehensive training program using surgical skills, clinical management, and research expertise across the board to sort of meet the needs regionally. Right? And so what does that actually look like? So that looks like Zoom didactics. Right? That we do weekly and we cover all aspects of urologic oncology curriculum. It includes evaluations of both our first two fellows, which are Doctors Godfrey Nabunwa and Henry Dabanja at Uganda Cancer Institute. Those are our two fellows who've also helped us sort of build this program. Right? And so they are participating as the first two fellows here. There will be two every two years, at least that's the plan right now.
And then the second aspect, right? We can do a lot of things via Zoom, but what kind of hands-on teaching are we going to do? And that's in the form of us as educators in the US going over to Uganda and sort of teaching operative skills, supervising and watching our fellows kind of grow to independence. That is where the partnership with IVU has been invaluable.
They already sponsor surgical camps and have a lot of expertise in visas, medical licenses, how you even set up what you need to bring, how do you structure things in another country. And so we've really benefited from their expertise and also from their prior knowledge and setup of doing these surgical camps. So we kind of put together both things, and that's how we came up with the different aspects of this urologic oncology training program.
Zachary Klaassen: I appreciate you laying that out, Sima. That was awesome. I think when we look at this, no pun intended, but on a global scale or a bigger scale, how may this transform into other countries or other programs that may be interested? Is it possible we could have a handful of programs in the United States sort of sponsoring other programs across the globe?
Sima Porten: I mean, I think it's definitely possible, and I can talk about it from three kind of aspects. Right?
Zachary Klaassen: Yeah.
Sima Porten: So the first is you need champions in the country that you're sort of interested in. Right?
Zachary Klaassen: Right.
Sima Porten: And then you need buy-in from their medical councils or governing body to even be able to execute this. Right? In terms of funding and also the ability to have some kind of structure or cohesiveness, kind of like boots on the ground. So you definitely need that. And that usually comes from need, meaning that the importance of cancer care has become paramount because the other public health issues have been adequately addressed or are improving.
So I think you sort of need that sort of milieu to start a program like this. The second part is I do think this is able to be disseminated with other groups in the US and to other countries using kind of a similar structure. And particularly there, I think that's where getting IVU partnership has been really invaluable. And we are always happy to share our learning points and how the curriculum is structured from that aspect. We also have the benefit of CHESA, which is our global health program here at UCSF where, and David, Dr. Bayne is in leadership there. And so they've been really helpful with other aspects and knowledge of just how do you do global surgery. Right? Global health and surgery and make that successful.
And that's how we actually had the pleasure of Kit Yuen joining our team. She was a fellow, SUO oncology fellow at UCSD, but part of the CHESA Fellowship. And so that's how we were able to make contact with her. And she's also been really integral into launching this and continues to play a key role now that she's an attending in Colorado. So I definitely think this is doable and we've learned a lot and I think we would be happy to share our learning points with others, but I do think you need those other two aspects from local environment and infrastructure to really make this successful and get this going.
Zachary Klaassen: No, that's great. To sort of wrap up, I want to do quick round table and just give everybody a chance to sort of maybe just say what you're most excited about this program, what you're excited over the next couple years, and any take home or concluding statements, maybe something we haven't hit on that you want to make sure our listeners here. So maybe start with David, what are your thoughts?
David Bayne: Well, I think what's really exciting about this program, it represents, I think, both where desire to kind of bring high standards of care, to help be a foundational piece to bring high standards of care to patients who otherwise haven't necessarily historically had access. And one of the facts just in the modern world that is making this more of a possibility is the advance of technology.
We have things like improved telecommunication, improvement in technologies, making cost of some aspects of surgery less expensive or at least more disseminatable to people in other countries that historically haven't had access to those things. And I think that the partnership between UCSF and UCI, Uganda Cancer Institute to establish urological oncology fellowship is very timely, context appropriate, and it's a good model for building surgical capacity, not just in East Africa, but other areas that don't have adequate access to advanced surgical care.
Zachary Klaassen: Yeah. Well said. Sam, what are your thoughts?
Sam Washington: Yeah. I think Dr. Porten hit on these as well is that to implement a program like this, it requires that strong institutional partnership, really adapting the framework that we have here from the great training from SUO for the local context, need and populations, and then really dedicated people, especially on the UCI side and here across the many different groups that we work with to bring all of this to fruition. It's an excellent example of kind of showing what is feasible and adaptable at the same time. And I think those as key takeaways show how this could be replicated in different contexts.
Zachary Klaassen: Yeah, absolutely. Well said. Sima, you have the final word.
Sima Porten: I would say this is where I really believe that investing in specialty training in urologic oncology, even in the US and in Canada is really not just about workforce development, but it is a necessary step to improving outcomes for patients with urologic cancers. And this expands this to resource limited settings. And I do believe that institutions, funders, governments, philanthropy should kind of recognize the value of this and hopefully will continue to provide support to build these programs.
Zachary Klaassen: Yeah, absolutely. Thank you all for your time. This was great to break this down. I'm really excited to be able to do this with you guys and to really get the word out there. Congratulations and we'll certainly get the band back together when we have your first couple fellows just to see how things are going. So appreciate you joining us on UroToday.
David Bayne: Thank you.
Sam Washington: Thanks again.