BOSTON, Mass. (August 12, 2010) ‹Once thought to be a problem primarily inthe developed world, cancer is now a leading cause of death and disabilityin poorer countries. Almost two-thirds of the 7.6 million cancer deaths inthe world occur in low- and middle-income countries.
A paper to be published online in the Lancet on Monday, August 16, assertsthat the international community must now discard the notion that cancer isa 'disease of the rich' and instead approach it as a global health priority.This "call to action" paper is authored by Paul Farmer, chair of the HMSdepartment of global health and social medicine; Julio Frenk, dean of theHarvard School of Public Health (HSPH); Felicia Knaul, Director of theHarvard Global Equity Initiative (HGEI) and HMS associate professor ofsocial medicine; and Lawrence Shulman, chief medical officer at Dana-FarberCancer Institute (DFCI) and HMS associate professor of medicine at DFCI.
Additional authors comprise 19 other leaders from the global health andcancer communities representing the Global Task Force on Expanded Access toCancer Care and Control in Developing Countries (GTF.CCC), includinghonorary co-Presidents Lance Armstrong and HRH Princess Dina Mired ofJordan. GTF.CCC was launched in November of 2009 by HMS, HSPH, HGEI andDFCI.
"The provision of adequate health care in settings of poverty is bydefinition difficult, but the past two decades have taught us that settingour standards high can help bring new resources to bear on old problems,"says Farmer, who is also executive vice president, and cofounder, ofPartners In Health. "The integration of cancer prevention and care whereboth are needed is precisely what we need to do if we are to make theresponse to the challenge as global as cancer itself. There are clearlyeffective interventions that can prevent or ease suffering due to manymalignancies, and that is surely our duty as physicians or policy makers orhealth advocates."
Comparing cancer fatality rates between low- and high-income countriesreveals stark disparities. By some estimates, fatality rates in low-incomecountries are 75 percent, in lower middle-income 72 percent, and in uppermiddle-income 64 percent. In contrast, high-income countries experience a 46percent fatality rate. This enormous difference in survival--particularlylarge for many highly treatable and curable cancers such as cervical,breast, testicular and acute lymphoblastic leukemia in children--denote thescope of action.
"The gaps in access to cancer care and control are one of the greatestchallenges in global health in the world," says Knaul. "As a person livingwith cancer, diagnosed in a developing country, I believe we must addressthis glaring inequity. Evidence shows that this can be done."Many of the more than 4 million deaths from cancer each year in low- andmiddle-income countries can be averted through early detection andtreatment. Millions more people with advanced or untreatable cancer butwithout access to palliative care will die with great and preventablesuffering, often leaving those surviving them impoverished from attemptingto meet even the most basic costs of the disease.
This suffering and needless loss of life will persist without a rapidrecalibration of global and local response. According to Julio Frenk, "Inmost parts of the world cancer is a sorely neglected health problem and asignificant cause of premature death. To correct this situation we mustaddress the staggering '5/80 cancer disequilibrium,' that is, the fact thatlow- and middle-income countries account for almost 80 percent of the burdenof disease due to cancer yet receive only 5 percent of global resourcesdevoted to deal with this emerging challenge." The authors, speaking onbehalf of the GTF.CCC, propose, and are working toward, the following:
- Raise global awareness of the impact of cancer on developingcountries, creating a call to action on both the global and national level.
- Define the packages of essential services and treatments needed toprovide care in low-resource settings for cancers that can be cured orpalliated with currently available therapies.
- Increase access to the best treatment for cancer through theprocurement of affordable drugs and services.
- Reduce human suffering from all cancers through universal access topain control and palliation.
- Develop and evaluate successful service delivery models in differenteconomic and health system settings and share the lessons and evidenceglobally.
- Expand the leadership, stewardship and evidence base for implementingthe most efficient approaches to cancer care and control in developingcountries.
As Princess Dina Mired of Jordan, Honorary Co-President of the GTF.CCC,confirms, "Our focus is on fixing the harsh inequity and disparity thatexists with cancer treatment between the developed and the developing world.Having the chance to live should not be an accident of geography."
The extension of integrated cancer prevention, diagnosis and treatment tomillions of people at risk of or living with cancer is an urgent health andethical priority. The authors argue citing data from resource-constrainedsettings that the unacceptable gap between poor and rich can be reducedthrough a bold research, financing and implementation agenda that combinesglobal and local efforts.
According to Larry Shulman, "Access to life-saving cancer care is a humanright, and must be brought to those in developing countries. We have shownwe can do this in the treatment of other illnesses, and we can and must dothis with cancer care. This should be viewed as an imperative rather than asan option."
Source: Harvard Medical School