Fast Cancer Growth In Poorer Countries - Much Can Be Done, With Inexpensive Medications And Equipment

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Main Category: Cancer / Oncology
Also Included In: Aid / Disasters
Article Date: 18 Aug 2010 - 1:00 PDT

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Eminent cancer and public health experts are urging governments and agencies to focus seriously on cancer care and prevention in poorer nations, according to a Health Paper published in The Lancet. A great deal could be done using generic, off-patent medications, educating people, and training physicians and community workers.

In 1970 lower- and middle-income countries (LMICs) accounted for 15% of global cancer cases. In 2008 the figure rose to 56%. Experts estimate that by 2030 the percentage will reach 70%.

With nearly two-thirds of global annual cancer cases occurring in LMICs, it is today a leading cause of death, the authors write. The case fatality from cancer - estimated incidence to mortality ratio - is 75% in low-income countries, compared to 46% in developed nations.

The Health Policy Paper was written by Dr Felicia Knaul, Harvard Global Equity Initiative, with first authors Dr. Paul Farmer, Harvard Medical School, and Drs. Julio Frenk, Harvard School of Public Health and Lawrence Shulman, Dana-Farber Cancer Institute,Boston, MA, USA, as conveners of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC) and co-authored by the members of the GTF.CCC.

Princess Dina Mired of Jordan, Honorary Co-President of the GTF.CCC and co-author of the paper, said:

Our focus is on fixing the harsh inequity and disparity that exists with cancer treatment between the developed and the developing world. Having the chance to live should not be an accident of geography.

According to Dr. Julio Frenk, cancer is a significant cause of premature death in most parts of the world. Unfortunately, it is a neglected health problem in poorer nations.

Dr. Frenk said:

To correct this situation we must address the staggering 5/80 cancer disequilibrium. (referring to the fact that LMIC account for almost 80% of the burden of disease due to cance, yet receive only 5% of global resources devoted to deal with this emerging challenge)

The following initiatives could help address the disparities which currently exist worldwide, without having to use high-priced on-patent medications or other equipment:

• Anti-tobacco campaigns. Smoking is a huge risk factor for cancer. Smoking is still rising in many LMICs, while it is dropping in developed nations. Education via anti-tobacco campaigns would have an enormous impact on cancer rates.
• Education about early detection and screening.
• HPV (human papillomavirus) vaccination programs to prevent cervical cancer.
• Hepatitis B virus vaccination programs to prevent liver cancer.

Vaccination programs are currently too expensive for most LMIC budgets.

GTF.CCC is focusing on supporting current initiatives, and to adapt those that allow synergy between cancer care and control and other diseases through health system strengthening, the authors write.

GTF.CCC will also support the WHO Framework Convention on tobacco control, and programs to improve diet, nutrition, and healthy lifestyles, as well as those reducing exposure to environmental risk factors for cancer.

Palliative drugs to mitigate patients with untreatable cancers should be made available to LMICs, the authors say.

The authors said:

Many of the cancers that pose the greatest burden in low-income and middle-income countries are amenable to treatment with drugs of proven effectiveness that are off-patent and can be manufactured generically at affordable prices. These drugs should be a focus of cancer treatment programmes, rather than expensive on-patent drugs.

Tamoxifen is a good example of an inexpensive, off-patent drug (for breast cancer treatment). The writers add that in Malawi, Cameroon, and Ghana, the total cost of a generic first-line chemotherapy drug with a 50% cure rate for Burkitt's lymphoma costs less than US$50 per patient.

Colombia and Mexico, both LMICs, have fairly comprehensive cancer care programs which are covered by national health insurance policies aimed specifically at poor people, the Health Paper states.

And an international partnership of Partners In Health and the Dana-Farber Cancer Institute, Harvard Medical School, and Brigham and Women's Hospital, working in rural Malawi, Rwanda, and Haiti, is proving that absence of cancer specialists can be surmounted even in the poorest settings. Partners in Health, in partnership with national health ministries, operates health centres and hospitals in rural districts. With support and training from the Harvard-based facilities, these centres and hospitals have begun delivering chemotherapy to patients with a variety of treatable malignant diseases including breast, cervical, rectal, and squamous head and neck cancers, Hodgkin's and non-Hodgkin lymphoma, and Kaposi's sarcoma. Jordan's King Hussein Cancer Centre is another example of what can be achieved in LMIC.

Dr. Farmer said:

There are clearly effective interventions that can prevent or ease suffering due to many malignancies, and that is surely our duty as physicians or policy makers or health advocates.

The authors would like to see cancer care and control become available rapidly and promptly, with a focus on cancers that can be treated or prevented, or, in the case of neither, palliated. More immediately, they propose:

• The implementation of large-scale demonstration programs over the coming years to define and create new infrastructure, train doctors, nurses, and other health care professionals and paraprofessionals, and exploit the opportunities of technology and especially telecommunications to address many on-site limitations in resources.
• Set up a system of regional and global pricing, as well as procurement mechanisms so that countries may participate in collective, multi-country negotiation to secure lower prices for essential medications, vaccines and services.
• Identification and implementation of innovative financing mechanisms, which should decisively expand the financial resources available for prevention, treatment, and palliation of cancer in LMICs.

The authors conclude:

"We can no longer differentiate between diseases of the poor and the rich... Poor people endure a double burden of communicable and non-communicable chronic illness, requiring a response that is well integrated into the health systems of low-income and middle-income countries. Extension of cancer prevention, diagnosis, and treatment to millions of people with or at risk of cancer is an urgent health and ethical priority. A bold research, financing, and implementation agenda is essential for the international community to fill the gaping voids in cancer care and control worldwide.

"Expansion of cancer care and control in countries of low and middle income: a call to action"
Prof Paul Farmer MD, Julio Frenk MD, Dr Felicia M Knaul PhD, Lawrence N Shulman MD, George Alleyne MD, Lance Armstrong, Prof Rifat Atun FFPHM, Douglas Blayney MD, Lincoln Chen MD, Prof Richard Feachem PhD, Mary Gospodarowicz MD, Julie Gralow MD, Sanjay Gupta MD, Ana Langer MD, Julian Lob-Levyt MD, Claire Neal MPH, Anthony Mbewu MD, HRH Dina Mired BSc, Prof Peter Piot MD, K Srinath Reddy MD, Prof Jeffrey D Sachs PhD, Mahmoud Sarhan MD, John R Seffrin PhD
The Lancet, Early Online Publication, 16 August 2010
doi:10.1016/S0140-6736(10)61152-X

Written by Christian Nordqvist
Copyright: Medical News Today
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