Could African and Low- and Middle-Income Countries Contribute Scientifically to Global Cancer Care? (original) (raw)
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Evidence-informed frameworks for cost-effective cancer prevention and management are essential for delivering equitable outcomes and tackling the growing burden of cancer in all resource settings. Evidence can help address the demand side pressures (ie, pressures exerted by people who need care) faced by economies with high, middle, and low incomes, particularly in the context of transitioning towards (or sustaining) universal health-care coverage. Strong systems, as opposed to technology-based solutions, can drive the development and implementation of evidence informed frameworks for prevention and management of cancer in an equitable and affordable way. For this to succeed, different stakeholders—including national governments, global donors, the commercial sector, and service delivery institutions—must work together to address the growing burden of cancer across economies of low, middle, and high income.
Building affordable cancer care in low-and middle-income countries
Investments in national health systems, infrastructure capacity and domestic allocations of health care support are crucial for developing quality cancer care in emerging economies. However, it is unlikely that low- and middle-income countries (LMICs) will be able to build the immediate resources required without international development assistance and partnerships. Biomedical innovations in improved diagnostics for screening, vaccines and drug therapies will help in decreasing mortality; however, effective delivery of new innovations must also be adequately managed to achieve impact. Delivery planning not only includes point-of-care procedures between medical personnel and the patient, but also includes pre-delivery training, mass education of cancer facts, prevention guidance and care options. However, as it stands the economics of affordable cancer technologies simply do not add up at the present time with most, if not all therapeutic approaches used in high income countries well above the cost-effectiveness thresholds currently being set for emerging economies. There is an urgent need to innovate on the global financing model for cancer technologies in LMICs.
Delivering affordable cancer care in high-income countries
The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field—eg, the huge development costs for cancer medicines—there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening l...
Addressing cancer care inequities in sub-Saharan Africa: current challenges and proposed solutions
International Journal for Equity in Health
Introduction Cancer is a significant public health challenge globally, with nearly 2000 lives lost daily in Africa alone. Without adequate measures, mortality rates are likely to increase. The major challenge for cancer care in Africa is equity and prioritization, as cancer is not receiving adequate attention from policy-makers and strategic stakeholders in the healthcare space. This neglect is affecting the three primary tiers of cancer care: prevention, diagnosis, and treatment/management. To promote cancer care equity, addressing issues of equity and prioritization is crucial to ensure that everyone has an equal chance at cancer prevention, early detection, and appropriate care and follow-up treatment. Methodology Using available literature, we provide an overview of the current state of cancer care in Africa and recommendations to close the gap. Results We highlight several factors that contribute to cancer care inequity in Africa, including inadequate funding for cancer researc...
Promoting Best Practice in Cancer Care in Sub Saharan Africa
Frontiers in Medicine, 2022
Promoting best practice in the management of a cancer patient is rooted in the application of new knowledge derived through various sources including population science, laboratory advances, and translational research. Ultimately, the impact of these advances depends on their application at the patient's bedside. A close collaboration between the oncologist and the pathologist is critical in underwriting progress in the management of the cancer patient. Recent advancements have shown that more granular characteristics of the tumor and the microenvironment are defining determinants when it comes to disease course and overall outcome. Whereas, histologic features and basic immunohistochemical characterization were previously adequate to define the tumor and establish treatment recommendation, the growing capability of the pathologist to provide molecular characterization of the tumor and its microenvironment, as well as, the availability of novel therapeutic agents have revolutionized cancer treatment paradigms and improved patient-outcomes and survival. While such capacity and capability appear readily available in most developed high-income countries (HIC), it will take a concerted and collaborative effort of all stakeholders to pave the way in the same stride in the low and middle-income countries (LMIC), which bear a disproportionate burden of human illness and cancers. Patients in the LMIC present with disease at advanced stage and often display characteristics unlike those encountered in the developed world. To keep stride and avoid the disenfranchisement of patients in the LMIC will require greater participation of LMIC patients on the global clinical trial platform, and a more equitable and affordable sharing of diagnostic and therapeutic capabilities between the developed and developing world. Key to the success of this progress and improvement of patient outcomes in the developing world is the close collaboration between the oncologist and the pathologist in this new era of precision and personalized medicine.
Perspective, 2018
Cancer burden is increasing day by day in our Low and Middle Income Countries (LMIC) A practicing clinician faces the issue of cost of treatment in almost all patients who approach him or her for clinical consultation . More than often, the clinician has no formal training in cancer service development. Establishment of modern oncological services is dependent on financial resources available to the professionals who sit across an extra-large sized rectangular table and try to get the best out of the money pot. Some skeptics call it beauty out of the junkyard. The allocation of funds is dependent on the feasibility studies done by the healthcare economists .These wise guys seem to know a lot about the health of a nation, but many health care professionals have some reservations about their understanding of the practical knowledge of day to day managerial and clinical problems, faced by the person sitting at the receiving end.
Expansion of cancer care and control in countries of low and middle income: a call to action
The Lancet, 2010
Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the eff ects of the disease on human suff ering. We challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off -patent drugs, and application of regional and global mechanisms for fi nancing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda.