The worldwide oncology community shares a common language based on evidence, clinical trials, and shared anecdotal results of the day-to-day care of patients with cancer. However, diverse political, economic, and cultural issues in different geographic regions present varying challenges to the delivery of oncology services.  This column kicks off an ongoing series of articles, Oncology Worldwide, which will explore those similarities and differences on an occasional basis.

Hatem Azim, MD, an oncologist from Cairo, Egypt, now working in Brussels, Belgium, recently spoke with The ASCO Post about his experience as an international oncologist.

Career Choices

Why did you choose a career in oncology?

In my last 2 years of medical school, I was fortunate enough to be offered an internship at the University of Nebraska Medical Center (UNMC). I worked closely with experts in the field of lymphoma at the UNMC Eppley Institute for Research in Cancer and Allied Diseases and became impressed with the challenges and potential in the field of hematologic malignancies, on the clinical as well as the research side. I believe my experience in the United States was a pivotal point in my decision to become an oncologist. In addition, observing the progress of my father, who is a successful Egyptian oncologist, and being close to him on the personal level, unsurprisingly provided an extra nudge to seal my decision.

Cancer Care in Egypt

Your career choice was influenced by your experience in the United States, a country with vast resources. What challenges did you face as a practicing oncologist in Egypt?

In Cairo, I was working at the National Cancer Institute, which is the largest cancer center in Egypt, seeing around 20,000 newly diagnosed cancer cases per year. I was a resident in the Department of Medical Oncology for 3 years; then I spent 1 year as an assistant lecturer. During this period, I faced several challenges that are endemic in the Egyptian cancer care system, where the number of accumulated patients with cancer represents about three times the amount of new patients, and the patient load is expanding.

Naturally, access to care in Egypt is an issue. We have extremely busy outpatient clinics; at times, I used to see 40 to 50 patients a day! The demand on patient admissions always exceeded the available resources. That shortage was also true in chemotherapy, especially expensive drugs and newer targeted agents. Moreover, we lacked a systematic way of discussing cancer cases in the outpatient clinic, which was compounded by an absence of multidisciplinary meetings and tumor boards. 

Because of a number of cultural awareness and barriers-to-access issues, Egyptian patients with cancer usually present at a relatively advanced stage in their disease, which has a negative impact on treatment results. Adding to that dilemma, patients also face long waiting lists to get basic radiologic and other diagnostic examinations, presenting significant delays in treatment initiation.

Policy Problems

How does the political machine in Egypt affect cancer care?

Health-care policies as they pertain to managing patients with cancer were very poorly addressed at the time I was practicing oncology in Egypt. When someone is diagnosed with cancer, it takes their insurance provider an inordinate amount of time to cover health costs, and in most cases, the coverage did not exceed 20% to 30% of the patient’s real costs.

This situation forces patients to start and stop therapy until they can sort out the problem with the insurance carrier. Consequently, we spent a lot of time writing reports for patients, requesting increased coverage from their insurance provider. This compromises the quality of medical care patients receive and places a huge administrative burden on providers.  It is a major barrier to the delivery of cancer care, especially since many patients in Egypt are resource-challenged.

On to Brussels

You are currently in Brussels. Could you briefly explain your work there?

I moved to Brussels in 2009 to work as a fellow in the Department of Medical Oncology at Institut Jules Bordet, working exclusively in the field of breast cancer. My main task was acting as a medical advisor for large, international phase III clinical trials conducted by the Breast International Group (BIG). In addition, I was involved in writing, discussing, and developing new clinical and translational research protocols in breast cancer.

At the same time, I was enrolled in the PhD program of the Université Libre de Bruxelles. In 2010, I earned a translational research grant from the European Society for Medical Oncology (ESMO) and moved to the Breast Cancer Translational Research Laboratory in the same institute. There I am developing my PhD project on the biology and prognosis of breast cancer diagnosed during pregnancy, using gene expression profiling, while continuing to do my clinical research work as well.

U.S. vs European Practice

What about the European oncology experience is different from how oncology is practiced in the United States?

I have worked in two large cancer institutes in Europe: the European Institute of Oncology in Milan (2008) and where I now work, the Institut Jules Bordet in Brussels. I also had the opportunity to visit a couple of cancer centers in the United States—the University of Nebraska Medical Center and Beth Israel Deaconess Teaching Hospital in Boston. In my opinion, the quality of cancer care is actually quite comparable in the United States and Europe.

In my experience at various institutes, I did not witness significant differences in the quality of the multidisciplinary discussions. Likewise, I found a universal appreciation of the importance of conducting high-quality research that translates into clinical benefits. Any differences in approach between Europe and the United States might be determined more by cultural and political environments, but I found the quality of research and cancer care to be on the same level. ■

Financial Disclosure: Dr. Azim reported no potential conflicts of interest.