BOSTON – Over 2.4 million cancer deaths could be avoided each year in developing countries using prevention and treatment interventions that are affordable and could be made widely available, according to a new report being released Friday. And deaths due to children’s cancers are among those that could be curtailed most easily. Costs of treatment for certain common cancers are as little as $100 per course of treatment in developing nations.
Even more disturbing, low-cost pain relief medications remain largely inaccessible to patients in developing countries, meaning that most people with cancer worldwide suffer tremendous pain — needlessly — before they die, the report’s authors say.
These findings come from a new report, Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries, being released on October 28 by an international group of experts organized by the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and hosted by a consortium of organizations that includes Harvard School of Public Health, Harvard Global Equity Initiative, Harvard Medical School, Dana Farber Cancer Institute, Brigham and Women’s Hospital and Partners In Health.
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.
The report will be released and discussed on Friday, October 28th at a daylong symposium 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” will be from 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.
LEAD AUTHORS OF THE REPORT:
The report has over 115 contributors from around the world. Lead authors are:
Felicia Knaul, Director, Harvard Global Equity Initiative, Associate Professor, Harvard Medical School,
Secretariat for the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, Founder, Cáncer de Mama: Tómatelo a Pecho
Dr. Julio Frenk, Dean of Harvard School of Public Health and GTF.CCC Co-chair
Dr. Lawrence Shulman, Chief Medical Officer and Sr. Vice-President Medical Affairs, Dana-Farber Cancer Institute, Co-Chair GTF.CCC
Dr. Jonothan Quick, President and Chief Executive Officer, Management Sciences for Health
Rifat Atun, Director of Strategy, Performance and Evaluation Cluster, The Global Fund to Fight AIDS, Tuberculosis and Malaria
Dr. Nancy Keating, Associate Professor of Medicine and Health Care Policy, Department of Health Care Policy, Harvard Medical School
Dr. Peter Piot, Director, London School of Hygiene and Tropical Medicine
Sir George Alleyne, Chancellor of the University of West Indies
Dr. Julie Gralow, Professor of Medical Oncology, University of Washington, School of Medicine
Dr. Paul Farmer, Co-Founder, Partners in Health, Chair of Department of Global Health and Social Medicine, Harvard Medical School
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.
What those associated with the report have to say about cancer care in the developing world:
“The belief that treatment may be reserved for those in wealthy countries whereas prevention is the lot of the poor might be less repugnant if we had highly effective preventive measures.”
Paul Farmer, Partners in Health
“The chance for a cure, the chance to live, should not be an accident of geography.”
Her Royal Highness Princess Dina Mired of Jordan
“Developing countries face a double cancer burden that includes preventable cancers and the emerging challenge of all other cancers that cannot be prevented. Cervical and breast cancer account for almost as many deaths and maternal mortality and most of these deaths could be avoided.”
Harvard Global Equity Initiative
For more information:
photo: Aubrey LaMedica