In July 2021, Roxana Sultan, an experienced health sector executive, had the opportunity to serve on a remote TKN assignment with the Aga Khan University (AKU). The primary objective was to support the AKU’s Cancer Center and Brain and Mind Institute to develop its strategic plans within the University's overall integrated framework for the mental health of cancer patients. The six-month assignment culminated in the establishment of a new partnership to enhance cancer care and mental well-being.

Roxana has over 20 years of experience working in the Canadian health system, including the oncology and mental health sectors, with a focus on patient-centred care and the use of data to inform best practices in medicine. She holds an Adjunct Lecturer appointment with the Dalla Lana School of Public Health at the University of Toronto, where she teaches a graduate course on Intelligent Medicine and Machine Learning, and she also serves as the Chief Data Officer and Vice President, Health with the Vector Institute for Artificial Intelligence (AI) in Toronto, Canada.

Roxana’s past role as Director of Strategic Planning and Implementation with the University Health Network (UHN)’s Princess Margaret Cancer Centre (PMCC) in Toronto provided her with exposure to the innovative approaches that are being implemented to deliver the highest quality of care and to treat cancer patients holistically, taking into consideration both physical and mental health needs.

After meeting with AKU’s Dr. Zul Merali (Brain and Mind Institute) and Dr. Mansoor Saleh (Cancer Center), it became evident that PMCC had much to offer AKU at the intersection of physical and mental health services specially dedicated to patients living with cancer. It was clear that there was immense potential to share knowledge and best practices to integrate mental health assessment into cancer care at AKU, as well as to continue to enhance the PMCC's capacity for culturally adaptive care.

Roxana worked closely with Diana MacKay, Global Practice Lead with the Brain and Mind Institute, to shepherd forward a partnership opportunity. With support from the teams at AKU and the PMCC, Roxana and Diana facilitated formal and informal conversations between clinical and administrative leaders, which culminated in the development of a partnership to advance clinical, research, and education programs in cancer care. Meena Merali, Director, Transformation & Strategic Partnerships, PMCC · UHN was also involved in this process.

The memorandum of understanding (MOU) executed between the two organizations states a wide variety of expected outcomes of the collaboration, including:

1. Enhancing and supporting clinical, academic, and research opportunities at both organizations
2. Education and training opportunities, including Fellowship programs, staff education and patient education, which may involve Faculty and trainee exchange visits
3. Exchange of scientific and scholarly research materials, publications, and other information, and
4. Other initiatives aimed at promoting and enabling collaboration, innovation, and knowledge exchange to advance cancer care control in Kenya, Canada and throughout the rest of the world. 

Preliminary activities involve the implementation of a Distress Assessment and Response Tool (DART) developed by Dr. Madeline Li at UHN. DART is an electronic screening tool that supports patients and their care teams in understanding needs for integrated, interprofessional care. AKU is exploring the potential to use the tool with cancer patients to undertake clinical screening for symptoms of physical and mental distress, thereby better understanding prevalence and enhancing treatment pathways.

Because DART is a universal screening process, it aims to remove bias, ensuring that all patients, no matter their age, race, ethnicity or other personal characteristics, have equal access to services and support throughout their cancer experience . In the pilot study of the DART program, 88% of patients said they felt the program improved communication of symptoms and concerns to their health care team . DART is now established as a routine, standard of care at PMCC, where completion of DART has been associated with decreased risk of suicide and increased cancer-related survival.

DART has already been implemented in countries in Asia and the Middle East, and its continued expansion into new geographic areas has the potential to generate a rich source of data on the specific mental health needs of cancer patients from diverse cultural, racial, and sociological backgrounds, which can be used to compare and further improve the quality of patient-centred care internationally.

This new partnership is an illustration of AKU’s Strategic Integrated Framework for Mental Health in action. The Brain and Mind Institute is explicitly adopting a “big tent” approach to co-develop initiatives and programs that recognize intersecting co-morbid conditions, such as cancer and mental well-being.

“Hats off to colleagues in AKU’s Global Engagement Office who helped move this opportunity from concept to signed MOU,” remarked Diana. “Ultimately, it’s the patients admitted to our university hospital in Nairobi who will benefit from this collaboration, and that’s what matters most.”

Beyond the DART program, discussions are now underway between UHN and AKU to explore additional avenues for strategic engagement.

It is Roxana’s and the AKU’s team ambition that this collaboration will drive fruitful knowledge exchange and continuous quality improvement across both partner sites.

“There is often a perception when institutions from the Western world partner with those in the developing world, that the transfer of knowledge and value is unidirectional; however, this partnership is an example of how collaboration of this nature can bring opportunities and advancement in a bilateral fashion,” said Roxana. “Bringing together these two international leaders in healthcare and education – east and west – is an opportunity to drive global impact for cancer patients. I am delighted to have been able to contribute, even in a small way, to the establishment of this initiative through my TKN assignment.”