Addressing cancer care inequities in sub-Saharan Africa: current challenges and proposed solutions (original) (raw)
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Cancer now ranks as the leading cause of death globally, outpacing mortality rates for HIV/AIDS, malaria, and tuberculosis combined. Cancers and other noncommunicable diseases (NCDs), in particular, are quietly taking center stage in many lowand middle-income countries in sub-Saharan Africa and worldwide, and these countries are projected to carry as much as 80 percent or more of the global cancer burden by 2030. Yet, there are severe inequities in the response to this burden, and many patients diagnosed with cancer are unable to access comprehensive cancer care simply because of where they live. In policy and advocacy circles, cancer is often seen as too challenging and expensive to treat in low resource settings, and funding and priority-setting for cancer has fallen substantially behind the current disease burden in sub-Saharan Africa. This is an often repeated narrative in global health, with the HIV/AIDS epidemic serving as an especially telling example of how inaction can fuel...
Cancer in Africa: the way forward
ecancer, 2019
While progress in oncology has been remarkable in recent decades, not every cancer patient is benefitting from the advances made in treating their disease. The contrast in diagnosis, treatment and its outcome between high-resource and low-resource countries is dramatic. Africa presents an enormous challenge with population growth and life expectancy increasing in many countries as the toll of AIDS and other communicable diseases declines. However, there has been little investment in capacity of any sort to deal with the current cancer problem, never mind the rapid increase in incidence which is underway. This is a critical area for investment and not only of a purely financial nature. It is bad to have cancer and worse to have cancer if you are poor. The gap between rich and poor, highly educated and less educated and the North-South divide is substantial and continuing to grow. Radical solutions are urgently needed: the status quo is not an appropriate response to the current situation. Recognising that no single government or source of philanthropy has the means to solve this problem, new models are needed to cope with and improve this situation.
Cancer in sub-Saharan Africa: a Lancet Oncology Commission
Lancet Oncology, 2022
In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.
The Lancet Oncology, 2013
Sub-Saharan Africa has a disproportionate burden of disease and faces a major public-health challenge from noncommunicable diseases. Although infectious diseases continue to affl ict Africa, the proportion of the overall disease burden in sub-Saharan Africa attributable to cancer is rising. The region is predicted to have a greater than 85% increase in cancer burden by 2030. Approaches to minimise the burden of cancer in sub-Saharan Africa in the past few years have had little success because of low awareness of the cancer burden and a poor understanding of the potential for cancer prevention. Success will not be easy, and will need partnerships and bridges to be built across countries, economies, and professions. A strategic approach to cancer control in sub-Saharan Africa is needed to build on what works there and what is unique to the region. It should ideally be situated within strong, robust, and sustainable health-care systems that off er quality health care to all people, irrespective of their social or economic standing. However, to achieve this will need new leadership, critical thinking, investment, and understanding. We discuss the present situation in sub-Saharan Africa and propose ideas to advance cancer control in the region, including the areas of cancer awareness, advocacy, research, workforce, care, training, and funding.
JCO Global Oncology
PURPOSE Standard treatment guidelines improve patient outcomes, including disease-specific survival, in cancer care. The African Cancer Coalition was formed in 2016 to harmonize cancer treatment guidelines for sub-Saharan Africa. METHODS The African Cancer Coalition collaborated with the National Comprehensive Cancer Network (NCCN) and the American Cancer Society to harmonize 46 cancer treatment guidelines for use in sub-Saharan Africa. Harmonization for each guideline was completed by a group of approximately 6-10 African cancer experts from a range of specialties and with representation across resource levels. Each working group was chaired by an African oncologist and included a member of the appropriate NCCN guidelines panel. Treatment recommendations from the parent guidelines were distinguished as options that are generally available and should be considered standard care in most of the region or as highly advanced options for which cost or other resources may limit widespread...
Treatment of cancer in sub-Saharan Africa
The Lancet. Oncology, 2013
Cancer is rapidly becoming a public health crisis in low-income and middle-income countries. In sub-Saharan Africa, patients often present with advanced disease. Little health-care infrastructure exists, and few personnel are available for the care of patients. Surgeons are often central to cancer care in the region, since they can be the only physician a patient sees for diagnosis, treatment (including chemotherapy), and palliative care. Poor access to surgical care is a major impediment to cancer care in sub-Saharan Africa. Additional obstacles include the cost of oncological care, poor infrastructure, and the scarcity of medical oncologists, pathologists, radiation oncologists, and other health-care workers who are needed for cancer care. We describe treatment options for patients with cancer in sub-Saharan Africa, with a focus on the role of surgery in relation to medical and radiation oncology, and argue that surgery must be included in public health efforts to improve cancer c...
Building Modern Cancer Care Services in Sub-Saharan Africa Based on a Clinical-Research Care Model
American Society of Clinical Oncology Educational Book
Cancer is as old as humankind; there are examples of cancer treatment in ancient Egyptian civilizations. Globally, there has been rapid evolution of oncologic practices over many decades using different modalities, their complexities notwithstanding. These developments have resulted in visible improvements in outcomes for a complex medical condition.
Cancer Management in Africa: The Burden of Late Presentation and the Case for Cancer Awareness
2014
4 Abstract: Cancer was at a time thought to be rare in Africa because of lack of the necessary personnel, hospitals and equipments to manage the cases which, for different reasons, also rarely got to the few existing health centers. Presently cancer, which is a global epidemic and is not limited to any category of people, is not only present in Africa but generally gets to health centres at advanced stages due mainly to lack of cancer awareness. Its frequency is even expected to rise rapidly within the next few years if adequate precautions, based on current knowledge in oncology, are not taken presently. This rise in a continent which already has many problems making cancer management very difficult necessitates satisfactory measures in order to mitigate what some are already considering as an impending tragedy or catastrophe. This paper analyses some of the elements of this impending difficult prevision and some of the possible solutions of the problem.
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BackgroundDespite rising incidence and mortality rates in Africa, cancer has been given low priority in the research field and in healthcare services. Indeed, 57% of all new cancer cases around the world occur in low income countries exacerbated by lack of awareness, lack of preventive strategies, and increased life expectancies. Despite recent efforts devoted to cancer epidemiology, statistics on cancer rates in Africa are often dispersed across different registries. In this study our goal included identifying the most promising prevention and treatment approaches available in Africa. To do this, we collated and analyzed the incidence and fatality rates for the 10 most common and fatal cancers in 56 African countries grouped into 5 different regions (North, West, East, Central and South) over 16-years (2002–2018). We examined temporal and regional trends by investigating the most important risk factors associated to each cancer type. Data were analyzed by cancer type, African regio...
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