Mary Aiken, I'm the CEO of the IGCS. Thank you for joining our early career network call. I'm going to hand it off to Alex Alawale, who is one of the senior faculty advisors. I know the word senior isn't always very popular, but one of the more senior seasoned faculty advisors, Alex. Thank you, Mary. Good morning, everybody. Nishtha's always stepping away from us. And thank you for joining this meeting. And it's my pleasure to introduce, my name is Alex Alawale. I'm the North American representative. I am very honored to be here and to participate in the early career network program, which is an excellent program of the IGCS. I would like to now introduce our junior faculty members for the early career network. Slide, please. So we have Dr. Gitu Banduria from the Indian Armed Forces in India. We have Dr. Arthur Hsu from the National Taiwan University Hospital, Hsinchu branch in Taiwan. And we have Dr. Arthi Jeraj from Tangham Cancer Center in India. We have Dr. Anisa Mburu from Aga Khan Hospital in Kenya. And we have Dr. Florencia Nol from Sanatorio Alendisero, Argentina. Next slide, please. All right. At this point, I think I'm transitioning to someone else to go through these early career network purpose. Yeah, I think when we first started the early career network, it was proposed to the IGCS board that we have some sort of formalized activity for people who were new and early and young in their careers. So it really is a supportive network to discuss publishing, research projects and different things that might be important for early career professionals within the IGCS globally. So we're excited and I'll hand it over to Nao Suzuki to tell us a little bit about our membership within the early career network. Okay. Hi, everybody. My name is Nao Suzuki from Japan. I'm also one of the senior faculty advisors of early career network and also one of the board members of IGCS, Asia-Oceania-Pacific representative. As you can see in this slide, we have now 339 members of early career network as of May 22nd, 2024. And Asia-Oceania-Pacific region has the most members. Next slide, please. So this slide is detailed by region and countries. I hope to see more early career network members, but please invite your friends to this very nice members. Thank you. So next slide. Hi, everyone. I'm Ashley Johnson-Jones. I am IGCS staff, senior manager of education. I want to talk quickly about our early career network workshop that will be held in Dublin. It's gonna be on October 17th at 7.30 a.m. to 9 a.m. Irish standard time. So it will be before any other session. So it's not gonna be running against anything which we're really excited to offer this year. We had 30 abstracts that were received. Six were accepted for five minute oral presentations. And then we are gonna have a 20 minute expert presentation. We're still working out who that expert's gonna be, but if you have recommendations, please send them my way. And then we're gonna conclude the workshop with some networking time. So you all can have a dedicated time to be amongst each other. Really quickly, I wanna highlight the six abstracts that were accepted for the meeting. You can see them here. Again, these are five minute oral presentations, and then we'll have that expert presentation about midway through the program. Then continue on with additional abstract presentations and conclude with that informal networking time. I'm gonna switch now over to Arthi to discuss what we're all here and gathered for. Hello, everyone. Thank you, Ashley. So I would like to start by saying that what Dr. Sudhakar had said, that the Early Career Network has been started with the aim of supporting each other in terms of advancing care for gynecology. And with this aim in mind, last year we had sent out a survey to our Early Career Network members asking for places where they would like support or help in terms of the support that they would need from IGCS. And we found that five common themes that our members had indicated. And these are the five areas. So it was in the field of statistics, in finding mentors to help them put their projects together, in networking with colleagues in the field of gynecology globally, and in research and publication. Next slide, please, Ashley. So once we understood what the needs and the goals of our ECN members were, we started going through the next steps into making this a reality. And we started doing workshops and webinars for research methods. As you know, IGCS has an Education 360 portal and RedCap where we do regular seminars and webinars on different cancers, evidence-based medicine. And we recently just launched the EBM on the go where we have experts from across the world talking about how to critically appraise manuscripts. And following this, we are now putting together projects by our ECN members and helping them link with mentors and to collaborate within the IGCS community. And hopefully we are going to reach the end of the road where we help our members to design and do quality and meaningful research and publish them at the end. Next slide. So today, and we are going to, sorry. So today we are going to talk about two different projects proposed. The first one is the Global Availability of Resources for Staging and Management of Cervical Cancer, a survey over two time periods. And the second is the ABCD survey. So these two surveys will be conducted under the premise of ECN of the IGCS and our members will be paramount in conducting these surveys and implementing it. Next slide. So coming to the first survey, which is the Global Availability of Resources for Staging and Management of Cervical Cancer. We all know that cervical cancer is a disease of disparity. We have a big burden on the low and low middle income countries, but the resources that are required to successfully stage and manage these cancers are unbalanced with resources more commonly present in the high income countries and the low resource countries still struggling for them. So in order to set up a proper guideline or even staging for cervical cancer, we need information about how these resources are distributed across the globe. So a survey which would focus on the availability of resources such as surgery, lab services, imaging, pathology, radiation, chemotherapy, and other palliation services, which are required to manage and stage cervical cancer would give us an insight into how resources are distributed across the world. With this, the first survey was conducted in 2018 and we plan to conduct another survey just to see how the availability of resources has changed over the six years since the inception of our 2018 cervical cancer staging system to better understand how we can advance care for cervical cancer across the globe. So next slide, please. I'd first be talking about the data that emerged from the 2018 survey. So as we can see, about 30 countries had participated in the survey with major contribution from India, followed by Sweden and Denmark. Next slide. And we saw that the respondents of the survey mostly were working in referral centers, be it national, district, or regional referral hospitals. Next slide. And when we looked at the profile of the people who were answering the survey, we found that about 50% were gynecological oncologists and 20% were general gynecologists with all the contributions from surgical, radiation, medical, and palliation oncology. Next slide, please. Next slide, please. And when we looked at how the manpower resources were distributed, we found that gynecologists were present in about 50%, 55% of the respondents' places of practice, and general gynecologists were present in 20%, which meant about 30% of the places of practice did not have a designated gynecologist or gynae-oncologist at all. Next slide. And when we looked at the type of surgeries that were being performed, we were able to find that in more than 90% of the places of practice of our respondents, surgeries such as radical abdominal hysterectomy, laparoscopy, pelvic and parietal clinical dissections were being performed, but there was a lacuna with radical vaginal hysterectomies and trachelectomies with about 50% of the hospitals not performing these procedures. Next slide. And when we looked at the imaging availability, so we found in most of the countries, x-ray and ultrasound being the basic imaging services were present in more than 97% of the hospitals, but MRI was present in about 80, 85%, and PET scan was only present in about 50% of the hospitals, and interventional radiology in about 75% of the hospitals with 25% lacuna there. Next slide. And apart from this, there was also some waiting time for these imaging modalities with a median waiting time of about two weeks, but it ranged up to 145 days in certain countries, which meant about 20 weeks of waiting time for people with cervical cancer to undergo these imaging tests. Next slide. And when we looked at the waiting, next slide, please. And when we looked at the other resources, so there were pathologists, the pathology laboratory, resources for cytology, histopathology, fine needle aspiration, biopsy, and pap smears happening in about more than 80, 85% of the hospitals, but there was a lacuna with the presence of a pathologist who's dedicated to care of a pathologist who's dedicated to gynecological oncology, and mutational analysis was also present in less than half of the respondents' places of practice. Next slide. And when it came to the major modalities of treating cervical cancer, it was found that radiation therapy, which is one of the biggest pillars of management of cervical cancer, was absent in about 25% of the hospitals, and chemotherapy was not available in 10%, 11% of the hospitals. Next slide. So this is not a part of a survey, but it is a very interesting heat map from 2019 from GlobalCan, which shows the disparity among the resources available with respect to radiotherapy. As we can see, most of the Western countries and the high-income countries are shaded in green or light green, which means they have at least one radiotherapy unit for every five lakh people. But when we looked at Africa, India, the Middle East countries, and the Eastern world, we see that there's a lot of yellow, orange, and red. Red meaning there are no radiotherapy units available, and yellow and orange meaning the radiotherapy units are available, but they are not enough for the population that they serve. And this was the data from 2019, one year after our survey was completed. So it might be interesting to see what the 2024 survey might bring out. Next slide. And again, this was a publication by Phonetius et al in 2021 in Lancet Oncology, where they assessed how chemotherapy was available across the world. And they found that chemotherapy was only available for about one third of the cancer care providers, for the patients of cancer care providers, and two third of the places, the patient had to spend out of their pocket incurring a very big financial toxicity. And in 5% of cases, the providers indicated that these drugs were not available, even if the patient was willing to pay an exorbitant price for this chemotherapy. Again, with respect to our data, it would be very interesting to see what the next survey that's going to be conducted this year would show us. Next slide, please. Coming to palliative care resources. So we found that palliative care resources, including pain and symptom management, psychosocial and spiritual support for the patient was available in more than 85% to 90% of the hospitals. But when it comes to psychosocial or psychosocial support or bereavement care for the family members or home-based palliative care, there was room for improvement with about 40% of the places not providing this kind of care. Next slide. Then we looked at other best practices such as tumor board sessions, which were not available in about 25% of the hospitals and written or official cancer control program or a prevention plan was not available in about another 25% of the hospitals. And when it comes to cancer prevention strategies such as HPV vaccination at the time of survey, which is in 2018, almost 55% of the hospitals or the places of practice did not have a established HPV vaccination program and about 50% did not have an established cervical cancer screening program. Next slide, please. And when it comes to cancer registry, almost 77% of the respondents said that they had a functional and up-to-date cancer registry. But next slide, please. When we look at the collection of data in these cancer registries, routine collection was not available in about 30% of these cases. And even in the places where it was collected, if we see the information collected, complete information was only collected in about 26% of the places, which means that even though cancer registry are present, routine data collection tool is not completely implemented in many of these places. Next slide. So with this data in hand, we are now planning to conduct another survey by the end of mid or end of July. And I will give the virtual mic to Dr. Noll here, who'll be discussing the survey questionnaire for the next upcoming survey. So thank you, Arcee, for concluding the results of the previous survey. And because we are going to conduct a new survey and a lot has been going on in the past few years in cervical cancer. So some of the questions that we'd like to follow up is that because there seems to be some vaccination shortages in different areas. So we'd like to know, what's the vaccination programs going on? Are there any shortages of vaccines? Are there barriers of HPV vaccinations? And also because cervical cancer fertility sparing treatment is, we are having more and more evidence in this area. So we would like to add on, does your institute provide a trachelectomy? Do you do a minimally invasive surgery with such procedures? And also we'd like to follow up other than chemotherapy. Do your institutions have a pevacizumab? Do you have a immunotherapy such as a pembrolizumab? And so on. And other new agents include adjuvant drug conjugates, including tesotumab, vedotin, or trastuzumab, durextacan. And also can your institute provide such companion tests? I think that when we are having more and more evidence of using these new strategies to treat our patients, it's really frustrating to see if we do not have the resources, or if our patients does not have a financial ability to gain such modalities. So these are the questions that we are going to add inside the questionnaire. And this is for our cervical cancer survey project. Can I get the next slide? Thank you. And also other than cervical cancer, we are interested in other barriers in gynecological cancer, such as endometrial cancer or ovarian cancer. And this is a survey that we developed together within the group. And we call it the ABCDIGCS survey, which is the accessibility and barriers of companion tests and new drugs in gynecological cancer around the world. And just as I have said to you, now when these new publications or new evidence comes out, that we have a new modalities to treat gynecological cancers, it's always frustrating that our patients might not have the accessibility or might have some barriers. And so because there is this dramatic shift in landscape of gynecological cancers in recent years, and there are a lot of new emergent promising drugs with companion tests, and there are a lot of areas with limited access to these companion tests or drugs. And most important of all, there is limited data on accessibility of these things so we like to conduct this survey to assess these accessibility and barriers. And can I get the next slide? So for addressing the disparity issues outside cervical cancer, we would like to know, question similar to the previous one, do your institution have these, have bevacizumab, immunotherapy, adjuvant drug conjugate. Can your institute provide such companion tests? And we also like to know what are the barriers in different countries? Is it because that the physicians don't know about the drug? Is there no local pharmaceutical companies? Are physicians too cautious about the side effects? Or is it embarrassment, or probably about the price? And we'd like to know about the accessibility in different areas. Actually, can I get the previous? We'd like to know about the hypothetical usage and the actual usage of such stuff. And this is the IGCS ABCD survey, and we'd really love you to join us to conduct this survey to address the disparities of these conditions around the world. And Flora, would you like to add anything? Thank you, Arthur. Thank you, Arti. A great presentation. So I just want to highlight importance for us that you join the survey. And you know that cervical cancer primarily affects low and middle income countries and settings. So understanding each region's resources is crucial for us to create a collaborative strategies and finally to overcome the management barriers we have in our settings. So please join us. It will be a great survey. I don't know if there is any questions or comments from the audience. Maybe we'll stop sharing and we'll have a little bit of discussion around this and get some feedback from those of you who have joined. I just want to be certain. We're doing one survey and questionnaire initially, correct? And then we will move into the second project over time? That's correct. And just for the general, the entirety of the network who are members who have been able to join us, remember that this project is focused mainly on cervical cancer. In future, there is nothing stopping us from moving on to another gynecologic cancer. All of them are important and doing the same survey. So we have plenty of opportunities to gather data but we want to start along with alignment with the WHO's current move to reduce the burden of cervical cancer. We want to start with cervical cancer. So questions are welcomed. And the one thing though that I wanted to say to you is this survey was done mainly by a consultant, mostly senior faculty members. Our new survey will be done through you guys. So we're hoping for a better response and a much more robust data compared to the 2018 survey. You can either put questions in the chat or mute yourself and ask questions, please. Yes, thank you very much. I need a clarification. I'm Kuduz Lawa. I need a clarification on the second survey, that's the ABCD survey. Is it for all gynecological cancer or for cervical cancer as Dr. Lawa just referred to? Hi, it's mostly for most gynecological cancers. And we will just as we have said that we are going to focus on cervical cancer first and then on other gynecological cancers in the ABCD survey. Thank you. So Kuduz, just to be clear, the first major survey that you'll be involved in and hopefully will be similar to the cervical cancer survey in 2018, but with some new questions around HPV. And then our plan is to analyze that data and compare it to the findings from the 2018 survey where those of you in the Early Career Research Network who are interested can be involved in helping data collection, analyzing the data, using statistical analysis to analyze the data, writing up the results and publishing a paper. And it's really important that you, if you're interested to let us know, as well as helping to collect the data from around the world from early career networks members like yourself being involved in writing up a paper and getting a paper published. So that's the main study we'll focus on first. That would be a great opportunity, thank you. Does anyone else have any other questions about that? We do have a bit of a timeline and we hope the survey will be sent out with IGCS's help on REDCAP, sent out around the end of June, beginning of July and collect the data back after that time to get some results from that. To get some results, we were hoping by the time the IGCS Early Career Network meets in Dublin and that would be our hope, but I suppose it just depends on how quickly we can get the survey out and the response rate. But initially, if you could all help with your colleagues, get them interested in sending back the results of the survey to us, that would be great. Any other questions? Great, well, I think we have just a few more slides. This gets a little bit into the IRB and data collection protocol. So I'll hand that over. Yeah, I'll take that on. So, yeah. So this, as you all heard that these are the two surveys that we are proposing to conduct. Now, surveys may or may not require ethical clearance depending on the institution that you practice. We are going to design IRB protocol, which can be used as a template protocol if you need it from your institution. Although IGCS itself does not have a institutional review board, however, we are going to create this protocol and this can be used for your institutional requirements in case that is needed. Next slide, please. Yeah, so there are different possibilities depending on your work setup. In case you need it for your individual institution, you're free to use it. In case there are more than one of you from the same institution, we would request that one of you take the lead and submit the survey to your own IRB. And in case some of the countries may work on a single IRB from maybe some prominent institution and that single IRB works for the entire country, even that can be, that is also good. So depending on your requirement, you all can use the template that we will be providing. Yeah, next slide. The protocol that we are going to draft will be a standard internationally acceptable protocol wherein there will be some details about the background of the project. We will obviously explain what is the rationale of the study, why is the study important and we'll spell out the exact objectives of the study. Similarly, we would address the gaps in the literature or what exactly are we aiming to answer and then a detailed study methodology. We will be using the REDCap tool for capturing the data of this survey. So all those who would be involved, we would help you getting around the REDCap also when the time comes. Yeah, next slide please. Yeah, actually I'm not sure if I was to carry on from this. Yeah, so just be on the lookout for future steps. As Dr. Farrell mentioned, we're hoping to get the survey out to you for completion in REDCap. More likely it'll be early July to mid-July that we'll get that out to you and hopefully we'll have some data to interpret before we meet each other in Dublin and then we can start working on that manuscript for publication. So we're really excited about this. Be on the lookout for emails, WhatsApp chats. If you're not on the emails or WhatsApp chats, please let us know, reach out to myself and we will make sure that you're included in that. So future communications, that's something you need to be on the lookout for. I'm going to turn it over to Dr. Farrell regarding our junior faculty mentor positions. Yeah. So anyway, that's a great opportunity for you all to be involved in high quality international research and learn some new skills. But just moving on from that, the other opportunity for you all this year is to nominate yourself if you're interested as an early career junior faculty mentor. Two of our current mentors, Gitu and Floor, will be rotating off. And so if you are successful in your application, you'll be in the committee for two years, starting next year, 2025 to 2027, and you'll work alongside senior mentors like us. There's usually three of us to help you together with the current remaining junior faculty. So basically, it's a great opportunity to be involved as a leader of the early career network to provide feedback and support to other members around the world and to learn from and interact with the IGCF staff to learn great skills of leadership, collaboration and research. You'll be guiding the direction of the network into the future. You'll help in planning workshops such as this one and other important webinars. You'll be moderating the network's current successful WhatsApp group so you can communicate with your fellow colleagues around the world, which is a great opportunity for networking. You'll be a resource for discussing new ideas and concepts around research projects with other members and also with more senior members of IGCS. There are faculty mentor calls around every two months, which are usually hopefully at a time that's amenable for you to join in. And basically, it's a fantastic opportunity to develop great relationships with peers, senior and junior, and other professionals from around the world in the area of gynaecological cancer. So there will be a call out for applications. We encourage you to apply, and they'll be opening... Ashley, do you know when that will open? I just seen final approval on it, and once I get that, we're going to open it away. So be on the lookout for emails, like I said. Lots and lots of emails and WhatsApps. Okay. Yeah, so we look forward to all of your applications. It'll be great to have you on board. Yeah, and feel free to reach out to the current junior faculty if you have any questions about it, time commitment, how they've perceived this experience to be within IGCS. So, yeah, we'll definitely use the network and the WhatsApp group to promote it more. So that would be awesome. Okay. Does anyone have any final questions to ask of the junior or senior faculty or of the IGCS staff about any of those topics that we've spoken about tonight? Great. Why don't we, since we have a little bit more time, yeah, we'll stop sharing the screen. If anyone wants to tell us, you know, your name, where you're from, where you practice, it would be nice to hear from some of the people who took the time to participate in the call today. Judas, I recognize your face. We've seen you before. Where are you from again, exactly? Yes, thank you very much. I think I've been in the IGCS Nicaraguan network for a while. We started the WhatsApp group together when it started. And with support of ATSI in particular, I was able to make a presentation last year, do virtually at the L.A. Career Network presentation. I'm a gynecologist in Nigeria with interest in gyne-oncology. I don't have a formal training in gyne-oncology yet, but I intend to have such. Yeah, I've made applications to be part of the junior faculty in the past, but it was unsuccessful. I'm going to be making another one this time around, and I hope that it's going to be successful. I'm happy to be here, and I've learned a lot from this process. I was the first to complete the EBM program, so I'm a full part of the IGCS Nicaraguan community, and I've learned a lot from here. A lot of people on this call have been of help to me. Thank you very much. Fantastic. Thank you. Doctor, can I ask you a question, Dr. Lawa? So there are three programs that IGCS actually runs in Nigeria, one in Zaria, one in Lagos, and one in… You're in CIGS. I participate in all the ECO programs, but I'm not in the training program yet. Okay. Awesome. Just keep it up. Thank you. Masato? Tamate, hello. Where are you from? Good evening. Thank you. Good evening. Let me introduce. My name is Masato Tamate from Japan, and I know this group from Professor Nao Suzuki, and my specialty is oncology, especially vaginal radical tracheotomy is what I usually perform, but now I'm concerned about the oncofartility, and I'm interested in uterus transplantation. So from this month, I will go to Dallas, their medical center, and for six months, I learned about that, but maybe I can go IGCS in Ireland. So I'm looking forward to meet you in Dublin. Thank you. Great, looking forward to meeting you. Nice to meet you. I just wanted to ask, you just said from Japan, which institution, which city are you from in Japan? Sorry, excuse me. My institution is Sapporo Medical University. This is located in Hokkaido, the northern part of Japan. Yeah, very cold city. Yeah, you know. So you must join the Dublin meeting, Tamate. Yeah, thank you. I hope so. Dr. Mustafa? Hello, good day, everyone. I'm Dr. Aisha Mustafa. I am an IGCS fellow from Zaria, northern Nigeria, and I was part of the IGCS Early Career Network. I am very excited. My paper got accepted for oral presentation this time around, and yes, I've met, I think, every mentor here before, and in terms of teaching, training at conferences, and I look forward to even more participation. Thank you very much. All right. You're welcome. Mary, do we have anybody else? My screen doesn't show any other. Shalanki? Shalanki Haldar? No. Dr. Haldar, are you there? Maybe Dr. Al Mustafa? No. No? Yeah. Dr. Fon? You're all shy. Dr. Fon? Oh, there you go. There you go. Dr. Al Mustafa, nice to meet you. Good afternoon, everyone. My name is Dr. Munira Al Mustafa from Nigeria. I'm a gynecologist with special interest in gyne oncology, but I don't have any formal training yet, but wish to have one. I'm a new member. I just joined the IGCS recently. I'm very happy to be with you. Thank you very much. Welcome. There's a big turnout from Nigeria. That's fantastic. Yeah. They are very enthusiastic, aren't they? Yeah, very good. Thank you. That's not a biased statement, Rhonda. Is Dr. Fon there? Sue Fon? Or Dr. Jaya Singh? Or Dr. Shanbag? Speak up. Come and introduce yourselves, if you can hear me. Be nice to meet you. Don't be shy. Maybe next time. Yes, next time for sure. Thank you again for joining. It's been great to get to know you and to see you. Oh, there you go. Dr. Jaya Singh has made an appearance. A late appearance. Nice to meet you. Where are you from? I'm from India, ma'am. I'm in Bangalore. Thank you for coming. Nice to meet you. Thank you. Thank you so much. Well, thank you all again. Thank you to the junior faculty for all of your preparation. Nisi, it's nice to see you. I know you were a little bit stuck in the OR, so thank you for joining. Thanks. Nice to see you all. Sorry again for missing. I hope it went well. Yes. It went well. Yes. We have lots of follow-up to do, so thank you all again. We'll be in touch. And again, any questions, please let us know. Great. Take care, everyone. Thank you. Bye.

IGCS CEO Mary Aiken

Early Career Network meeting

Senior faculty advisor Alex Alawale

Global gynecology discussions

Dublin workshops

Cervical cancer resources survey

Companion tests in gynecological cancers

Junior faculty mentor positions