Purpose

The aim of the Center is to develop a program of research and professional education in supportive cancer care for countries in all stages of development, primarily in Latin America and Asia. Center efforts focus on the broad spectrum of supportive cancer care, including those interventions used to support patients who experience adverse effects caused by cancer treatment and those interventions for patients with advanced disease. As in other developing regions, many patients are diagnosed in advanced stages of their disease when they do not respond to curative treatments. The activities of the center will focus on bringing the latest in evidence-based knowledge of supportive care to healthcare providers in these countries and to developing research and demonstration projects with cooperating medical centers. The Center works closely with the Pan American Health Organization, Office of Non-Communicable Diseases, and the World Health Organization Programme on Cancer Control.

Background

In May, 1996, the Pan American Health Organization (PAHO) established the Collaborating Center for Supportive Cancer Care at the Pain Research Group (PRG), The University of Texas M. D. Anderson Cancer Center, Houston, Texas. Dr. Charles Cleeland, McCullough Professor of Cancer Research, and Director, Pain Research Group, directs the Center.

The Center is based in the Pain Research Group. It is guided by a multi-disciplinary advisory committee from the M. D. Anderson community that includes experts in the broad aspects of supportive care, and a five-person staff. The center draws on the diverse expertise at M. D. Anderson in areas that are critical to the survival and quality of life of cancer patients, including symptom control and palliation, the control of infections, the management of bone metastases, rehabilitation, medical decision making, and pharmaco-economics.

The PRG has been involved in international research and training for two decades. In 1987, while at the University of Wisconsin, Madison, the PRG was designated as the WHO Collaborating Center for Symptom Evaluation in Cancer Care. Under this umbrella, the PRG has conducted studies of the prevalence and severity of cancer pain in the US, Asia, Latin America and Europe. These studies have made use of translations of the Brief Pain Inventory (BPI) that was developed by the PRG. The BPI allows for cross-cultural comparisons of pain impact and treatment effectiveness. Together with the French Ministry of Health and French investigators, the PRG has completed a survey of the prevalence, severity and treatment of cancer pain in France with a sample of 600 cancer patients drawn from 20 treatment sites throughout the country. (add ref) A study of prevalence, severity and treatment has been completed in Beijing, with the support of the Ministry of Health, People’s Republic of China.

Goals

• Design and implement international research programs in symptom relief and supportive care for cancer patients.
• Provide a model for international diffusion of the best evidence-based supportive care practice in countries requesting assistance.
• Evaluate and refine national and international training and treatment modalities in supportive care.
• Provide technical support for the WHO Program on Cancer Control and the WHO Regional Offices, particularly with regard to supportive care and symptom management.

World Health Organization Terms of Reference

1. To cooperate with national investigators in the design and implementation of international research programs in supportive care for cancer patients. These programs will be sensitive to the resources and cultural expectations of the areas where they are to be implemented. The Center will offer a multidisciplinary team of supportive care medical specialists and researchers to provide expertise in the clinical practice and research in supportive care.
   
2. To provide a model for international diffusion of the best evidence-based supportive care practice in countries requesting assistance. The existing model uses a multidisciplinary approach with intensive training and protocols, providing didactic, clinical and drug policy components for appropriate use of opioid analgesics. The model also supports the creation of regional or national demonstration projects that utilize the most current and cost-effective symptom management methods. This model would be expanded to encompass the broad objectives of supportive care.
   
3. To develop outcome measures and outcome study designs for the evaluation and refinement of national and international training and treatment modalities in supportive care. Such evaluations might include clinical outcome research, process outcome measures, cost effectiveness studies, and studies of physician practice patterns in supportive care. These evaluations should also include evaluation of changes in supportive care practice as reflected in modifications in health policy and treatment availability.
   
4. To provide technical support for the WHO Program on Cancer Control as well as the WHO Regional Offices, particularly with regard to supportive care and symptom management.