Meet Our Team
Q&A with Dr. Simon Sutcliffe
Dr. Simon Sutcliffe – Clinical oncologist and former President and CEO of Princess Margaret Cancer Centre and BC Cancer. Dr. Sutcliffe is founder and president of Two Worlds Cancer Collaboration.
Photo: Chuck Russell/Two Worlds Cancer
What drew you to medicine and particularly oncology when you started your career?
From my earliest memories, I can recall my mother saying, "Oh Simon, he's going to be a doctor." So in a sense I grew up with some sort of conditioning to the context that I was going to be a doctor.
I only really started to concentrate on what it means to be a doctor when I got to medical school. In a sense, I think I horsed around in high school and did what was necessary, but no more. When I got to medical school I realized the triage that had taken place for people who really did want to succeed and I would have to compete with them.
The question as to why I chose oncology is interesting because as you go through your medical training you're exposed to the diseases that people suffer from. Bear in mind I was training in the mid-1960s, so a lot of current treatments were not available. You do your specialties in pulmonary disease, cardiac disease, rheumatology, but it wasn't really until I got to oncology that I got the sense there's something really useful you can do. So that really chose my specialty for me – the ability to do something for patients.
How did you become involved and interested in population cancer control globally? Was there an impetus or was it a gradual process?
It was a gradual process. There comes a time though when you're treating leukemias and other cancers, you start to reflect a lot on this actually shouldn't be happening if in fact one were really paying attention to health risk factors, lifestyles, behaviours, choices, etc. It wasn't until quite late on in my career, when I was leading cancer centres – Princess Margaret Cancer Centre and BC Cancer – that I got to the point where changing cancer control outcomes for the population becomes the priority.
Initially, I was thinking about health systems and the population in Canada. But why would you focus only on Canada? Why wouldn't you think about the bigger picture of the world?
We’ve just completed a strategic planning weekend retreat what was that experience like for you this time?
This time around was more focused. What is it going to take to actually do what we say we want to do? In 2010 when Two Worlds Cancer Collaboration was created, we were a little ‘boutique’ operation – a group of friends and colleagues who were doing things that were very worthwhile. We were extremely happy when we got a $50,000 donation, it made all the difference to the organization and it energized us to start doing more. I think what the 2023 retreat established is a level of ambition and success that can no longer be sustained with uncertain opportunistic funding.
So the 2023 retreat was really to say “We are at a fork in the road” – either live within your existing financial realities, or aspire to the goals that you can achieve. If it is the latter, you better be pretty clear what that's going to look like? What are we going to be to our partners in the future in terms of strategy and development of their programs? And equally, if not more important, how will we actually be a viable, sustainable funded organization to be a partner on that journey?
What do you see as TWCC's biggest success or successes?
I think it has come in different pictures over time. In 2010, it was about the initiation of palliative care activities within an organized system that would support the needs of patients in Hyderabad, India.
Today the Hyderabad Centre for Palliative Care (HCPC) is a centre of excellence that's internationally recognized – the leadership has peer recognition internationally, there are in-patient units for adults and children, out-patient facilities, 11 mobile vans servicing the community, and 31 clinics across Telangana providing palliative and cancer care, and real-time consultation.
We don't take credit for that. We enabled a partner, and I don't minimize the enabling piece, but one has to recognize it's the people on the ground who make the change, not the people in another country.
TWCC’s interest and commitment now is less to “build” the centre. It’s to maintain their ability to host the national and international training that will build capacity throughout India and other regions.
Today, the picture includes the many collaborations that we have in Nepal, Bangladesh, Sri Lanka, the Philippines and Bhutan.
I think COVID-19 also forced us to make the next big innovation which was the evolution of our virtual education – our expanded emphasis on Project ECHO, the WhatsApp mentoring of individuals and groups, which means real time consultation and support.
What is being achieved is education, training and mentoring people in country, in context, and in the time and circumstances of local availability. And I think that's really key because the traditional [teaching and mentoring] in-person is very sporadic. And if you bring people out of country and context [to train], you are running the risk they'll never go back to their country.
I think the other evolution, which is subtle, is we have evolved an understanding of how you work with partners in lesser-resourced countries. What does collaboration actually mean? It’s making that relationship bidirectional, trusted, equal and shared, rather than [an organization in] a high-resourced country, telling it’s partner how to do it. It's that migration away from the old mentality.
There's another concept coming through quite strongly now – ‘Closing the Circle’. We have evolved TWCC as a palliative care organization because palliative care, particularly for children, was so absent from the healthcare environments of the countries in which we partner. My world is really the cancer control world. I'm not a palliative care person, although if you're an oncologist, a large part of your work is palliative care. What we've seen over the last five years is that realization that by bringing in palliative care and clearly changing the quality of life of people who are going to die, you are making their life better, but that isn't changing the number of people who get or die from cancer – so the burden remains high even if you are relieving a component of the burden.
What do you think are the biggest challenges in terms of making that leap to ‘Closing the Circle’ on cancer? What do you see as the biggest challenge that TWCC faces?
The capacity currently doesn't exist. It's not that there isn't medical knowledge or understanding of necessity, it's that the needs are great, but the circumstances to build capacity are limited. So, awareness must be raised, not only of need, but also what it will take to make change happen?
Focus on leaders in the country and how can you help them make those changes in their context. If we use an example, enabling Dr. Gayatri Palat to assume leadership, to develop strategy, and to help build the pieces that enable change to happen – the Pain Relief and Palliative Care Society (Hyderabad NGO that has created a model of sustainable support for the adult and children’s hospices, and home visit teams), the education and training programs, the curriculum development, and the outreach now into 31 districts [in Telangana].
Our greatest challenge is the security of our organization to partner. I don't think our risk is that there aren't volunteers who want to volunteer. It's not that we don't understand how to collaborate. We are aligned in how we do that and I think we do that very well. I think our challenge is if we want to see new capacity, be it in medical oncology, screening or early detection, it requires us to start up that activity and to find how we can embed that in the local environment. Often that needs stipends or some form of structuring the commitment so it's not off the side of everyone’s desk.
Our challenge isn't that we haven't had good and generous donors . We have to move our fundraising from the good graces of a very committed but small number of donors to something that's either much broader i.e more donors, or something that has security about it such as grant money.
It's really changing from a ‘boutique’ operation, as I alluded to earlier, to something that is more substantive in which there is confidence that we can really do the business.
Is there an experience from your visits to India, Nepal or Sri Lanka that really stays with?
There are and they fall into the circumstance that, that could be me, or my children, or my grandchildren, but for the grace of God.
Saathwick was a young boy living with his parents and sister in a tent outside the city [of Hyderabad] with end stage, acute leukemia. How many children in my career have I seen cured of acute leukemia and go on to reach rewarding lives? And yet you have this child and you realize there isn't the awareness of what interventions can do, there aren't the resources in the family to commit to what is necessary. There isn't the circumstance to undertake the intensive treatment and the follow-up that's necessary. And you have a life that disappears. You can provide palliative care and comfort, but the truth is that child actually could have a future were the circumstances different.
You reflect on that. Does it matter where you are born and who your parents are? Well, yes it does, it very greatly does. Within TWCC we are all highly privileged and I think all of us feel some sense of social justice – let’s cause that picture to be better than it is.
What have you learned from our partners or the experiences that you've had that you take away with you when you come back home?
I have seen things in terms of care and compassion by caregivers that could readily be assimilated into what we do in Canada. I've seen commitment and dedication above and beyond the call that we could embrace. I've seen the ability to bring people of different disciplines, including family members, into the concept of care that we could so readily do as opposed to thinking others should be doing that. And I've seen practices that would readily maintain effectiveness while substantially reducing costs here.
Could we change the way care is given? Could more caregiving be within the home or the family, particularly towards the end of life, rather than within an institutional setting? We don't have that because it's not ingrained into the fabric of Canadian thinking.
We advocate for palliative care, for curative care, for screening and prevention, but is there another role of advocacy for TWCC?
I do think we should advocate for countries to have plans to control life-limiting diseases including cancer. People say, " We've got plans," but I mean a plan that is implemented and addresses the comprehensiveness of approach to dealing with a problem.
There are more than 150 national cancer plans posted on the International Cancer Control Partnership website. The majority of plans are on paper, awaiting implementation, often with no business plan, no operating plan and no effective governance. Impressing the necessity to have strategic plans to control the burden of diseases is important – not to react to the diseases but to control them. The other thing of importance is collaboration – organizations working together to achieve more than any organization working by itself.
Do you see Two Worlds Cancer as having an advocacy role in healthcare around the climate crisis?
Most of human illness and loss of wellbeing is really contingent on the social and the environmental determinants of health. And both are being increasingly prejudiced in lesser-resourced countries. So it's difficult to project a future that says, "Don't worry, it's going to get better as you get more affluent," when in fact it doesn't seem likely that either of those circumstances is going to occur soon. Social determinants of health and climate change are very fundamental to health and well-being.
It gets to the issue of what can you do? Some things regarding cancer and life-limiting illnesses you cannot change. You can try and make them better but you cannot change them. Social determinants of health and climate change, can actually be changed. It's a question whether there is a resolve and a commitment to do so. We always need to advocate for and impress their importance. People often don’t realize they're related to health, but they underwrite so much of health and illness.
I don't think we should ever shy away from the advocacy role so long as it is informed advocacy based in knowledge and science about human health and wellbeing.
What do you do when you turn your global health brain off?
The majority of my work is Two Worlds Cancer Collaboration. I also am on a number of boards that require a level of commitment, but you shouldn't be on a board unless you're prepared to rise to that commitment when necessary. I also work with three to four startup, for-profit companies, although none of them is profitable as of yet, but they all have products that have potential clinical importance.
That doesn't leave a tremendous amount of other time, but my other time is for our family. Travel is important. I like travel. Much of my life of traveling has been work mixed with some play. It would be nice in the future to think maybe more of it will be travel for play rather than work.