When Dr. John Miro arrived from the Philippines to begin a Fellowship at UHN’s Princess Margaret Cancer Centre, so much about cancer care in the global north surprised him.
Everything from better access to cancer drugs and clinical trials to cancer prevention initiatives differed from his experience working as an oncologist in the Philippines.
"The medications and practice of medicine are so different here compared to the Philippines," recalls Dr. Miro. “It was almost like I was doing medical school all over again."
He credits the Princess Margaret Global Oncology Leadership Development (GOLD) Program for helping him to broaden his skills and outlook, develop his interpersonal skills, and learn from colleagues and experts.
"We want to create the leaders of tomorrow by giving clinicians formal leadership training as well as an understanding of global health. We are supporting them to make change in their own health systems when they return home," says Dr. Danielle Rodin, Director, Princess Margaret Global Cancer Program, an academic centre of excellence in global oncology.
Running since 2019, the GOLD program is co-directed by Dr. Rodin, and Dr. Meredith Giuliani and Tina Papadakos from Cancer Education. The program has hosted 232 fellows from 54 different countries since its inception.
Fellows continue their clinical work while taking part in in-depth training in self-awareness, lectures and group workshops, formal mentorship, and opportunities to network with global leaders in oncology.
Cancer deaths higher in low, middle-income countries
While one in two Canadians will develop cancer in their lifetime, the greatest number of cancer deaths in the next decade will occur in low and middle-income countries, such as the Philippines.
"In these countries, getting cancer can mean going into major debt for patients," notes Dr. Rodin.
Dr. Miro, who specializes in thoracic, lung and gastrointestinal cancers, says there is a dearth of training positions for sub-specialties in the Philippines, a southeast Asian country of 110 million.
There are about .24 medical oncologists per 100,000 people in the Philippines, according to an article in
JCO Global Oncology, compared with about 1.6 per 100,000 in Canada.
"I have been surprised by the access to expensive drugs here," Dr. Miro said. "Also, research is much more robust as well as molecular testing which is still quite new in the Philippines."
"When I return home, I hope to improve the practice of medical oncology."
In many public hospitals in the Philippines, access to novel and high-value treatments is limited, and many patients have to pay out of pocket.
Dr. Adeline Gonzales, one of four other GOLD fellow from the Philippines, is doing her rotation in geriatric oncology — a growing concern in the Philippines as cancer is predominantly a disease of older age.
"When I return to the Philippines, I will apply what I have learned about knowledge translation and bringing new findings from bench to bedside," says Dr. Gonzalez.
Fellows gain skills to strengthen care for patients globally
Filipinos face significant barriers to accessing clinical trials, including geographic concentration in cities, funding issues and lack of awareness.
Dr. Charles Tan, a third Fellow from the Philippines, is training in the Phase 1 and Drug Development Program, studying how to conduct Phase 1 cancer drug trials, which assess a new drug's safety, including side effects and the proper dosage, in patients.
"In the Philippines, it is hard to live as a pure researcher as there aren’t the financial incentives," says Dr. Tan. "I hope to go back and be a clinician investigator."
Despite the challenges associated with a cancer diagnosis in the Philippines, family and friends typically step in to support their loved ones during treatment, even taking time off work to accompany them to appointments.
"That is one thing Filipinos have: resilience and a strong sense of community," says Dr. Tan.
He sees that empathy reflected in the attitude of many Filipino immigrants who work in health care in Canada.
The Fellows credit the program with helping them understand themselves better and learn how to build successful teams — skills they hope can improve cancer education, research and patient care in their country of origin.
Tina Papadakos says the program’s alumni network is also beneficial.
"We have been impressed by the research partnerships that have developed once fellows return home," she says.
The mission of investing in clinicians helps strengthen care for individual patients globally.
This philosophy aligns closely with the 2026 World Cancer Day theme — United by Unique — which calls for a people-centred approach to cancer care that honours each person’s distinct needs and experiences.
