GHF2008 – PS03 – Oncology: Only for the Rich?

Session Outline

Parallel session PS03, Tuesday, May 27 2008, 11:00-12:30, Room 16
Chair(s): André-Pascal Sappino, Head of Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland, Alexandre Bodmer, Chief Resident, Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland
Cancer in Developing Countries 
Paolo Hartmann, Medical Officer, Chronic Diseases and Health Promotion, WHO, Switzerland 
Cancer Control in Developing Countries: Meeting the Challenge
Ketayun Dinshaw, Director, Tata Memorial Centre, India
PACT: Using Radiotherapy as an Anchor to Build Self-Sustaining Cancer Cure and Care Capacity in Low and Middle Income Countries
Massoud Samiei, Programme Director, Programme for Action for Cancer Therapy, and Head of Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Austria 
The Role of the Global Community in Cancer Control 
Isabel Mortara, Executive Director, International Union against Cancer, Switzerland

Session Documents

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Session Report

Submitted by: Reem Ibrahim (ICVolunteers)

4 February is World Cancer Day. This year, the campaign poster focused on smoking: "I love my smoke-free childhood". Image: www.uicc.org

The global incidence of cancer is on a rise with over 10 million new cancer cases diagnosed per year. More than 6 million annual deaths are attributable to cancer with over 20 million people considered to be living cases of the disease. It is predicted that over the next 20 years, there will be an approximate 200% increase in death rates due to cancer in low-middle income countries. Although the global incidence in high income countries is also rising, the mortality rate is at a slight decline. It is the first time that cancer is on the agenda of this forum, and as the speeches illustrate, the global community has an important role to act upon cancer control.

Chair André-Pascal Sappino, Head of Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland & Alexandre Bodmer, Chief Resident, Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland opened the session with statistics reflecting the need to address cancer, the second-leading cause of death, at a global scale and raise awareness to the misconception that it is a disease of the rich.

Key points presented by Paulo Hartmann, Medical Officer of Chronic Diseases and Health Promotion at the WHO, Switzerland, include:

  1. Increased prevalence of cancer in developing countries
  2. The major role the WHO and Member states can play in prevention and control
  3. Complexity of cancer as a health problem that requires substantial human and financial resources and strong political commitments

Hartmann highlighted the problem of available and accurate data, especially in developing countries, where less-than-optimal infrastructures and limited human and financial resources pose constraints. Cancer and non-communicable diseases are replacing infectious diseases as the main cause of death, with an evident burden shift on low-middle income countries. Failure to immediately address these issues will increase the current number of cancer deaths from approximating to 7.6 million to at least 11.5 million by 2030.

Furthermore, the types of cancers dominating in developing countries differ from those in developed countries, raising greater need for knowledge sharing and development. Lung, breast and colon cancers have greater incidence in developed countries, in contrast to developing countries, where one fourth of all cancers are associated with chronic diseases (dominant cancers include liver cancer, linked to Heptatis B and cervical cancer, due to the pulmonary virus).

Isabel Mortara, Executive Director for the International Union against Cancer, Switzerland, underlined the fact that if current trends continue, there will be a 50% increase in death from cancer by 2020. Cancer differs in demographics and geographic regions, requiring different tailored approaches. There is significant importance in both the surveillance and collection of accumulated data. One must build on local expertise and knowledge, and the transfer of knowledge remains an essential global challenge.

Core concepts in cancer prevention include awareness, advocacy, scientific exchange and mobilisation, capacity building, and partnerships. The leadership of UICC in increasing cancer awareness is evident in its launch of the World Cancer Campaign on February 4th, 2006. Furthermore, it held a world summit in 2006, where 50 world leaders launched a call for action. A second summit is scheduled to take place in August 2008 to access progress and develop a new set of milestones.

Ketayun Dinshaw, Director at Tata Memorial Centre, drew upon cancer statistics in India to demonstrate the prevalence of cancer in a developing country. Approximately 2.5 million cases exist with over 70% being advanced t3-t4 diseases. It summons a clear objective: to downsize deadly cases. Moreover, goals of cancer care include:

  1. Decreasing mortality and lifestyle related cancers
  2. Decreasing morbidity and increasing quality of life
  3. Increasing the cost effectiveness of treatment (emphasizing effective resource utilization and innovative and adaptive technology)

The main issues governing health care professionals in developing countries entail resource constraints and limited access, accessibility to cost-effective protocols, applicability of evidence based solutions, and the ability to deliver acceptable levels of contemporary clinical care. The decisive factors for cancer treatment progress will include: prevention and screening, early detection, randomized clinical trails, multi-modality therapy, and translation research and novel drug developments.

A contributing factor to treatment success is efficacy versus cost for different treatment modalities. Radiotherapy is the most cost effective method of treatment in late stage presentation of disease. However, low-middle income countries have limited access. The high initial investments needed to setup radiotherapy facilities and demand for human resources hinder progress development and stipulate a call for action.

Program Director of Programme for Action for Cancer Therapy and Head of Department of Nuclear Sciences and Applications for the International Atomic Energy Agency in Austria, Massoud Samiei made the link in his presentation: "Cancer kills more than tuberculosis, AIDS and malaria put together" he pointed out, stressing the need for cost-effective modalities. He then went on to highlight key goals of IAEA:

  1. Introducing and expanding on radiotherapy infrastructure and capacity
  2. Promoting effective use of services
  3. Delivering adequate training and education

The objectives of IAEA are illustrated by the establishment of radiotherapy centres in Tanzania with various achievements:

  1. Effective and sustainable transfer of radiation technology
  2. Suitable, appropriate and affordable technology
  3. Compliance at national level with safety, security and quality standards

A clear discrepancy is apparent in cost-effective cancer treatment access between developing and industrialized nations. For example Switzerland has one radiotherapy machine per 100,000 persons, in comparision with Tanzania, which has one machine to cover a population of 20 million persons.

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