Global Key Message
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Based on the World Cancer Declaration access to quality multimodal treatment, including the availability of affordable essential medicines and technologies is to be provided everywhere.
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Available data show that there is a lack of access to surgical oncology and radiotherapy in low- and middle- income countries (LMIC) with consequent lower rates for cure and quality of life.
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Addressing these gaps in availability of and access to treatment and care are critical to managing the burden of cancer around the world.
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National Cancer plans must include the strengthening of treatment systems trough investment in the public sector infrastructure, education and training.
The Facts
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In 10 years 70% of patients newly diagnosed with cancer will be living in countries that collectively have only 5% of the global resources for cancer control right now.
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It’s further estimated, that approximately 60% of the world’s patients with cancer do not have access to a complete cancer systemic therapy regime.
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Therefore NCCPs should consider the full spectrum of multidisciplinary cancer services and infrastructure across the continuum of care, acknowledging that high quality cancer care is not possible without investment in each of the critical components of a multidisciplinary approach.
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This must include specific efforts to provide supportive care including psychosocial support. Of equal importance is to address affordability of care to protect individuals and families from financial hardship as a consequence of out-of-pocket expenses.
Meeting the challenge
The safe and effective delivery of cancer medicines, surgery and radiotherapy, as part of a team-based approach to cancer care, is achievable in both high- and low-income settings if implemented as part of a national cancer control plan and according to evidence-based clinical guidelines that are appropriate for the level of resources.
Investments in the necessary infrastructure and a skilled and supported health workforce should be priorities. These should include the development of laboratory, pathology, and clinical services for cancer diagnosis, staging, and monitoring of effectiveness and safety of chemotherapy, surgery and radiotherapy equipment. Education and training of healthcare professionals is needed to ensure the safe and proper administration of systemic therapies.
Key Tools
Country example
Ref: Trish Scanlan and Jane Kaijage. 2012. From Denis Burkitt to Dar es Salaam. What happened next in East Africa?- Tanzania’s story. British Journal of Haematology, 156, 704-708.
In high-income countries, survival rates are 80% and higher for some cancers. In Tanzania, a decade ago, survival rates were around 5-10% for all children’s cancers. However, over the last 10 years there have been significant efforts in the country to improve access to early detection and diagnosis and treatment and care. Services are rapidly developing and outcomes have drastically improved with 1 year survival rates of approximately 60% achieved. These changes have been brought about due to the combined efforts and commitments of the Tanzanian Ministry of Health, non-governmental organizations and the participation of the private sector.
Efforts have focused around the following activities- providing high quality local subspeciality medical training, opening of a dedicated 17 bed paediatric oncology ward in the main cancer hospital, modifying and adapting international treatment protocols to the setting and encouraging local ownership of the childhood cancer programme. As part of the national cancer control strategy, the Tanzanian MOH provides all cancer-related services free of charge which has meant that hospital costs including admission fees, costs of various investigations, treatment and supportive care charges are no longer a barrier for adults and children seeking cancer treatment and care. Furthermore, as delayed presentation of early warning signs of childhood cancer are frequently encountered, a national cancer awareness campaign was launched on the signs and symptoms of childhood cancer. This is supported by an emerging national referral network involving regional and primary care facilities around the country so that children with suspected cancer are referred promptly to treatment facilities.
Despite these important developments, challenges still exist particularly around access to essential chemotherapy agents such as asparaginase therapy for acute lymphoblastic leukaemia. While this important agent is readily available in high-income settings leading to cure rates in about 90% of patients, sourcing this therapy at reasonable cost has been challenging in the Tanzanian setting.
1 The Lancet Oncology: Expanding global access to radiotherapie, Vol 16, Issue 10, sept. 2015
2 The Lancet Oncology: Global cancer surgery:delivering safe, affordable, and timely cancer surgery, Vol 16, Issue 10, sept. 2015, p 1193
3 Stewart BW, Kleihues P, (2003) World cancer report (IARC Press, Lyon, France). Google Scholar
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