Because 44 million U.S. citizens think of themselves as being of Irish descent, it is hardly surprising that various American-Irish collaborations seek to maintain and strengthen trans-Atlantic ties. That effort will now extend to cancer research as investigators and government officials from both the Republic of Ireland and Northern Ireland prepare to join in a milestone agreement with the U.S. National Cancer Institute.
"We are discussing a tripartite cooperation in relation to cancer services and research," said Jim Kiely, M.D., the Republic of Ireland's chief medical officer. Kiely and his colleague from Northern Ireland, Henrietta Campbell, M.D., just returned from a fact-finding visit to the NCI.
The intent now is to craft an official agreement for signing after the first All-Ireland Cancer Conference in October, where the proposed cooperation will be fleshed out.
Good Timing
"Since Northern Ireland and the Republic have both undertaken steps to reform their cancer services, it was about the right time to bring international partners such as the National Cancer Institute on board," said Professor Patrick Johnston, M.D., Ph.D., director of the Cancer Research Program at Queen's University and Belfast City Hospital.
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"I am very excited about this project," said fellow Irishman and co-facilitator Francis Sullivan, M.D., medical director for radiation oncology at Holy Cross Hospital in Silver Spring, Md., and former acting chief at the NCI's Radiation Oncology Branch. "If we manage to get all partners working cooperatively it will be a win-win situation."
Extend Programs
The agreement-to-be is expected to extend existing joint U.S./Ireland training and medical education programs in clinical trials methodology, epidemiology, and teleconferencing.
"This deal might well have a promotional effect and encourage more Irish investigators and patients to participate in cancer treatment studies here," said Adrian Mairs, M.D., senior medical officer at the Department of Health and Social Services in Belfast.
Americans, on the other hand, will benefit from the Irish cancer registries because the data derived stem from populations that are genetically more stable. "That "will allow us to track family histories of cancer patients more easily and increase our knowledge of the disease's genetic progression," said Carmen Allegra, M.D, chief of NCI's Medicine Branch.
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"A lot of groundwork lies ahead of us," conceded Michel Wood, director general of the Ulster Cancer Foundation, a Northern Irish cancer charity located in Belfast. He said that links between the cancer services in the North and the Republic of Ireland have been developing over a long period. "The Ulster Foundation has had close contacts with the Republic's Irish Cancer Society for 30 years and they have just linked their cancer registries.
"The tricky part now is to formalize what has been established informally over the years," Wood said.
Meanwhile, several reports by expert advisory committees on cancer in both countries found that the wide variations in cancer outcomes across both Northern Ireland and the Republic "clearly proved the need for reform."
In Northern Ireland, the centerpiece of reform is the Northern Ireland Cancer Center, a $70 million (U.S.) endeavor. Construction, funded by the British/Northern Ireland government, will begin shortly. It is scheduled to open in 2003.
According to Queen's University's Johnston, the new center will provide centralized services from basic research to clinical investigations and include radiotherapy and chemotherapy as well as training and education.
"In addition to its role as a national cancer center for the North's 1.6 million population, it will also act as a cancer unit to its local catchment population," Johnston said. "Community-based oncology services will be provided through four primarily outpatient cancer units based in specialized clinics throughout the country."
Reorganized
The Republic of Ireland has reorganized its cancer services in a similar way. In order to overcome a lack of special oncology services, three supra-regional cancer centers are now being established in the cities of Dublin, Cork, and Galway.
"Expansion of existing radiotherapy services throughout the Republic will be especially important," noted Sullivan. "At this stage, there is only one full-service radiotherapy facility in Dublin, with a second smaller unit in Cork."
A National Cancer Forum was created to serve as a multidisciplinary advisory board to the Republic's cancer services reform. More than $50 million (U.S.) have been provided by the Republic's Department of Health and Children in Dublin over the past 2 years in order to reshape cancer services. For 1999, an additional $32 million (U.S.) has been allocated.
"We are already making progress, " said Professor Jim Fennelly, M.D., chairman of the Republic's National Cancer Forum and a special advisor on cancer services to the Department of Health and Children. "While in the early '90s the Republic of Ireland with its population of 3.8 million only counted four medical oncologists, we now have eleven and I am optimistic that we will be able to create additional posts for medical oncologists."
Discussions regarding the development of joint services between both Irish countries are already under way, according to Fennelly. "And there is no doubt in my mind that the planned NCI agreement helps to speed up this process," he said.
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