Five Questions With: Dr. Scott Triedman

Radiation oncologist Dr. Scott Triedman works to cure cancer here in Rhode Island and in Rwanda. He talked with Providence Business News about his experiences in Rwanda, his collaborations with colleagues and the progress they are making toward providing high-quality care for those in need.

PBN: Can you describe the work you are doing with the Dana Farber Center for Global Cancer Medicine and Partners In Health?

TRIEDMAN: Partners In Health was founded in 1987 as a nonprofit dedicated to alleviating the suffering of the poor through long-term partnerships dedicated to health care delivery, equity and social justice. Over the last five years, oncologists and practitioners at Dana-Farber Cancer Institute have formally joined PIH with the specific mission of supporting expanded access to cancer care in the low-income countries where PIH works.

In the past decade, world cancer incidence rates appear to be catapulting over other diseases; we believe there are two reasons for this. First, infectious diseases’ incidences and mortality rates have been dropping precipitously in many poor places, given a massive influx of global funding for HIV, malaria and tuberculosis and the overall strengthening of health systems. As such, cancer’s proportional burden among all-cause mortality increased. Further, people are living long enough to get cancer, as cancer is largely a disease of late adulthood. Second, as my Rwanda’s Ministry of Health colleagues say: “If you don’t count, you don’t count.” Another reason for the increase may be due to our lack of knowledge – until we started to measure and then treat cancer, we had no grasp of cancer’s real burden in places like East Africa. That is really key – would you seek care for a lump or discoloration if you knew it was a death sentence either way? To purposefully misquote one of my favorite movies, “If you don’t build it, they won’t come.” The option of cure or years gained must be offered; that’s what PIH and Dana-Farber decided to do.

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Most of my recent work supports Rwanda’s Ministry of Health to develop a skilled cancer care workforce and build quality treatment centers. With a long-standing partnership with the ministry and a strong track record in health care delivery, PIH is expanding lessons learned from those experiences to cancer medicine, including adult and pediatric chemotherapy, surgery and radiation therapy. Cancers that are often highly curable in the United States and Europe often go untreated in places like sub-Saharan Africa, with limited or no cancer care resources.

In 2012, the Rwandan Ministry of Health, Partners In Health and Dana-Farber opened the Butaro Cancer Center of Excellence, which now sees more than 1,000 patients a year. Before the center opened, Rwanda had no system for cancer care. The facility is staffed almost entirely by Rwandan clinicians and providers, with support from a few American physicians and nurses. This multidisciplinary team is designing low-cost and high impact cancer care for those who need it most.

The most enriching part of this work has been collaborating with colleagues in Rwanda. The tireless pursuit of health equity by physicians, nurses, policy-makers, pharmacists, community health workers and many others … is beyond inspirational.

PBN: You’re a partner at North Main Radiation Oncology and a clinical assistant professor of radiation oncology at Brown University’s Warren Alpert School of Medicine. What inspired you to add this international assignment, and how do you juggle and coordinate those multiple responsibilities?

TRIEDMAN: I’ve travelled globally since I was a child, often to off-the-beaten track places. I took a few months off from work in 2013 and travelled to New Zealand – a country so geographically remote that [it has] a … global perspective. That time away prompted me to become more aware of new challenges in global oncology. When I returned to Providence, I reached out to colleagues at Brown and The Miriam Hospital who have been involved at Moi Hospital in Eldoret, Kenya, for many years. Timing is everything; they were ready to build a radiation oncology program and I offered to help design the operation. Then, I reconnected with Dr. Lawrence Shulman at Dana-Farber, whom I knew from my residency at Harvard. Dr. Shulman, a longtime leader in global oncology efforts, asked me to work with his group.

Juggling multiple responsibilities is an ongoing challenge but it’s part of the new way of work. Fortunately, current technologies enable us to be part of global teams. Finding time to international travel is hard, yet it’s also critical to really understanding the needs and being a thoughtful contributor to any project. I’m grateful that my clinical practice supports me to carve out this time. I have never felt more engaged in my direct patient care and clinical teaching here than I do now, with this global perspective. As a lifelong Rhode Islander, I continue to love caring for patients in my own community.

PBN: You’ve been engaged in this international work for a few years now; what progress have you seen?

TRIEDMAN: It’s a very exciting time to be involved in global oncology work; in spite of the many challenges, there’s a clear recognition that this growing problem will require major investment. There is consensus that diseases like breast cancer and childhood leukemia, often highly curable in the United States and Europe, should not continue to be a death sentence in low-income countries without access to cancer care. Clearly, one’s birthplace should not determine one’s chances of surviving a treatable illness.

With many successful and sustained collaborations between academic medical centers in the United States and partners in Africa, Asia and Central and South America, cancer centers are being built, people are getting trained and access to quality cancer care is improving.

One striking example of success is Rwanda’s human papilloma virus (HPV) vaccination program. These vaccines will likely prevent the development of a huge number of cervical cancer cases in generations to come. Rwanda’s HPV immunization campaign started in 2011 and targeted girls between 11 and 15 years of age. In the first year, coverage rates exceeded 93 percent for both in-school and out-of-school girls, and that percentage has increased. This is the highest vaccination rate in the world; in contrast, Rhode Island’s HPV vaccination rate – the nation’s highest – is 76 percent, and our current national average hovers around 30 to 40 percent.

PBN: What are the greatest obstacles to more progress?

TRIEDMAN: It’s always easy to focus on obstacles to progress, but it’s more practical and exciting to focus on opportunities. We are now beginning to clearly recognize the scope of the global cancer burden, and health systems’ limitations in integrating cancer care. Some of the best and brightest experts are working to create new therapies. Our own leaders, including President Barack Obama (in his final State of the Union address) have recently confirmed a renewed and significant commitment to cure cancer. I think a similar commitment is required from the international community and policy makers, as well. On a positive note, the growing call to action to develop a global cancer fund is positive, and I am privileged to be part of that chorus.

PBN: Have these international experiences informed or transformed how you teach or practice medicine, or live your life?

TRIEDMAN: For 30 years, I have had the privilege to take care of one patient at a time in my clinical practice. My global work has given me an opportunity to help improve access to cancer care for very large numbers of patients, many with treatable diseases. I have come to appreciate the extraordinary layers of expertise and infrastructure that contribute to the quality of care we have in the United States. Health care is often criticized in the press, but we often take for granted a system that offers some of the best care in the world.

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