05:49am Monday 11 December 2017

Report Brings Cancer in Developing Countries to Light

 This and more detailed information about cancer care in the developing world is shared in a new report released Friday, Oct. 28, by an international group of experts organized by the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. The report is called Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries. Joining Brigham and Women’s Hospital in this consortium of organizations is Partners in Health, Harvard School of Public Health, Harvard Global Equity Initiative, Harvard Medical School, and Dana Farber Cancer Institute.

Once considered a problem only in wealthy countries, cancer is now a leading cause of death in low and middle-income countries. About 55 percent of the world’s 12.7 million new cases and 65 percent of the 7.6 million cancer deaths each year occur in these nations.

“Acknowledging the impact cancer has in the developing world is a vital first step in addressing this global issue,” said Elizabeth Nabel, MD, president of Brigham and Women’s Hospital. “This report is a crucial step in determining the current status of cancer in developing countries and outlining a practical strategy   and recommendations for improving cancer treatment and prevention on a global scale.” 

The report will be discussed at a daylong symposium on Oct. 28, to be attended by representatives from national governments from low and middle income countries, global and national civil society organizations, private sector, academia and donors.

The symposium, “Closing the Cancer Divide: The Global Equity Imperative of Expanding Access in Low and Middle Income Countries”  is 8 a.m. to 6 p.m. at the Joseph B. Martin Conference Center on the campus of Harvard Medical School, 77 Avenue Louis Pasteur, Boston MA. It is open to the public.

BACKGROUND
Much of the most needed cancer treatment in the developing world is inexpensive
According to the report’s authors, 26 of the 29 key agents for treating many of the most prevalent, treatable cancers in the low and middle income countries are off-patent, making drug treatment relatively low cost at less than US $100 per course of treatment for most drugs. The total cost of covering drug treatments for unmet needs for cervical cancer, Hodgkin’s lymphoma, and acute lymphoblastic leukemia in children in low and middle income countries is about US $115 million.

Vast disparities in pain medication use exist in rich and poor countries alike

  • Vast disparities exist between rich and poor countries in access and use of pain medication as part of cancer treatment. When comparing the 20 percent of countries that have the lowest incomes with the 20 percent of countries that have the highest incomes, there is an almost 580-fold difference in the consumption of morphine-equivalent opioids per death from HIV and cancer.
  • Yet, this huge variation is only partially explained by income, and must also be related to health system weaknesses and cultural barriers. In several low, and a few lower-middle income countries, milligrams of pain medication consumed per death from HIV or cancer is extremely low — less than 100. In these cases, there is likely to be almost no access to pain control for patients, and even surgical pain control is often lacking.
  • China has a higher per capita income, yet a consumption level of just below 1300 mg. Botswana, Mexico, Chile, and Turkey are all upper-middle income countries with similar levels of per capita income, yet there is a 10, 25, and 50 fold difference in use of pain control medication – approximately 250 milograms in Botswana, versus 2400, 6200, and 12000 milograms respectively in Mexico, Chile and Turkey.

Failure to offer prevention and treatment for cancers threatens economies as well as individual wellbeing

  • Failure to protect people in low and middle income countries from preventable health risks associated with cancer and other chronic illness is detracting from efforts to improve economic development, placing countries at risk of failing to meet many Millennium Development Goals, the authors warn.
  • The global value of lost productivity from cancer outstrips the estimated cost of prevention and treatment.  In addition, cancer is a disease that drives families into poverty.
  • Tobacco use is a huge and preventable economic risk that reduces gross domestic product by as much as 3.6 percent  per year in LMICs, according to the American Cancer Society.
  • The economic cost of productivity losses combined with treatment costs for cancer is approximately 2 percent of total global GDP.
  • The economic value of productivity lost due to preventable cancer deaths exceeds the cost of cancer care and control by more than $US 130 billion. Potential savings are much higher– between $ US 540 billion and $2010 US 850 billion– taking into account the individual perception of the value of lost income and suffering

Report dispels common myths about cancer in the developing world

  • The report, which will be released at the symposium, uses a combination of new and existing data to dispel the four common myths that thus far have slowed efforts to improve cancer care in developing countries:
  • Cancer care and control is not necessary in the developing world because the burden of cancer is not large there
  • Cancer care and control is not attainable because low and middle income countries do not have adequate treatment, human or physical resources to provide treatment
  • Cancer care is unaffordable in most low and middle income countries
  • Focusing on cancer care and control in low and middle income countries should not be attempted because it takes resources away from high burden diseases that have proven treatments and interventions.
  • The report provides a road map for improving cancer care in low and middle income countries, including practical, country-specific and disease-specific recommendations.

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