Nurses constitute the largest category of healthcare personnel in nearly every country of the global community. They are the key professionals who need to be included in the process of setting a worldwide agenda for cancer prevention, early detection, and control initiatives. To be successful across cultures nurse leaders must be essential players in ministries of health and institutions of higher learning.¹ They are critical members of the healthcare team in that they help adapt curriculum to individual experiences and cultural contexts. It follows that nurses already in positions of leadership in universities, healthcare systems, or ministries of health are more likely to be able to apply new knowledge to solve health problems within their countries and to influence the delivery of healthcare services.

The International Society of Nurses in Cancer Care (ISNCC), founded in 1981, is committed to helping nurses through educational programs and networks with the International Council of Nurses (ICN), the International Union Against Cancer (UICC), and the World Health Organization (WHO). As founding members of ISNCC, we were committed to developing and disseminating education programs related to cancer care throughout the world. The purpose of the ISNCC was to establish an international conference for cancer nurses to present the state of the science in cancer nursing. Our dream was to expand the conference to countries that did not have established cancer programs and to provide an opportunity for nurses to attend so they could potentially become the leaders in cancer nursing in their country.

To assist in establishing a model of dissemination for initiating programs in cancer prevention, early detection, and control activities within underdeveloped countries, the United States National Cancer Institute (NCI) funded a series of continuing education (CE) programs for nurse leaders in selected countries. (Table 1 presents a summary of grant support)

Table 1. Grant Support by Year, Number, and Amount*

The CE programs were held biannually between 1986 and 2002. One hundred forty nurses from 71 countries throughout the world were competitively selected to attend (Table 2). The curriculum was designed and offered for 2 days initially, and expanded to 3 days preceding either the conferences of the ISNCC or the UICC meeting. The UICC is the only global cancer organization with members and activities covering all aspects of cancer control. Founded in 1933, the UICC is an independent, international nongovernmental association of 291 cancer-fighting organizations in 87 countries.

Table 2. Location of Conference by Year and International Meeting*

The programs conducted from 1986 to 1996 emphasized cancer prevention education for those cancers most prevalent in the developing world: breast, cervical, esophageal, gastric, liver, and lung. (A comprehensive description of the program and its impact has been previously published.^2,3) As the program evolved over the first decade, participants requested that the content be expanded to include other critical elements. From 1998 to 2002 the curriculum was increased to include risk factors for cancer prevention and emphasized management and supportive care interventions for cancer control.

The goal of the 15 years of the program was to stimulate interest in and facilitate an increase in the knowledge of cancer prevention and control worldwide.

The objectives to accomplish the goal included:

* Increase the number of nurses, globally, prepared to engage in the prevention, early detection, and control of cancer in their countries,

* Incorporate principles of cancer prevention and control in educational programs,

* Design culturally sensitive programs for both professional healthcare workers and the public,

* Influence government policy regarding cancer prevention and control activities, and

* Expand the international cancer nursing network, with program participants ultimately playing a role in the long-term investment of reducing the incidence of cancer in the developing world.

It is difficult to understand fully the status of cancer nursing in parts of the developing world because healthcare delivery systems and the practice of nursing are culturally disparate. Medical practice, which is more comparable worldwide, does not appear as varied as nursing does from country to country. Nurses tend to be more affected by differences in sociocultural factors, and the role of women in individual countries; and, as a result, the roles of nurses have not been well developed or recognized. The differences are extreme between developed and developing countries.

International input into the development of a nursing role in cancer care has, historically, been minimal; thus the contribution that nurses could make to cancer care was underestimated by national cancer organizations and ministries of health. It was not until the first International Conference on Cancer Nursing was held in London in 1978 that nurses around the world came together to learn and share information about the disease and its management. It was the vision, drive, and passion of Robert Tiffany, OBE, Director of Patient Services and Chief Nursing Officer, Royal Marsden Hospital, London, England, that was the catalyst for organizing the first conference.

We believed a nursing role in primary prevention, early detection, and cancer control activities was essential for the health of people everywhere and could have a dramatic effect on healthcare outcomes. We, therefore, proposed an initial 2-day structured training program, later expanded to 3 days, that targeted the specific cancers prevalent in developing countries and the management of patient's response to the disease and its treatment. In addition, program participants attended either the 1-week-long ISNCC or UICC international meeting to encourage collaboration across disciplines and identify cancer care experts in the global community.

The conference registration fee was paid by the grant, and the participants received a small stipend for living expenses. In each city, we were able to arrange for housing accommodations throughout the conference with student housing and local arrangements. The accommodations for the participants were centralized and allowed them to have an opportunity to get to know each other over the 10 days. The success of the program was partially due to the scheduled return of participants to a second conference 2 years later. During the interim they were expected to accomplish goals they had established for themselves. Many returned extremely proud of what they had learned and the activities they had initiated to meet their objective. They were also excited to see each other and the faculty they had met at their first conference. They renewed acquaintances, and this process facilitated personal development and their integration into an international community dedicated to improving cancer care and enhancing health throughout the world.

Faculty participating in the cancer prevention and control workshops are listed in Table 3.

Table 3. Cancer Prevention and Control Workshops Participating Faculty 1986-2002