August 23, 2010

Cancer Care Inequities Between Richer, Poorer Countries

(Ivanhoe Newswire) "“ Experts on cancer and public health are calling for cancer care and prevention in low- and middle-income countries (LMIC) similar to the HIV/AIDS movement that has transformed care in those nations in the past decade.

In many parts of the world cancer is a sorely neglected health problem and a significant cause of premature death. Dr Felicia Knaul, Harvard Global Equity Initiative, with first authors Dr. Paul Farmer, Harvard Medical School, and Drs. Julio Frenk, Harvard School of Public Health and Lawrence Shulman, Dana-Farber Cancer Institute, Boston, all part of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC), point out that much can be done using generic, off-patent drugs, public education, and better training of doctors and community workers.

Cancer is no longer solely the burden of high-income countries. In 1970, 15 percent of newly reported cancers were in LMIC, compared with 56 percent in 2008. That number is expected to reach 70 percent in 2030. Almost two thirds of the 7.6 million annual cancer deaths worldwide occur in LMIC. The case fatality from cancer is 75 percent in low-income countries, compared with 46 percent in high-income countries.
Princess Dina Mired of Jordan, Honorary Co-President of the GTF.CCC and co-author of the paper, was quoted as saying, "Our focus is on fixing the harsh inequity and disparity that exists with cancer treatment between the developed and the developing world. Having the chance to live should not be an accident of geography."

Dr. Frenk was quoted as saying, "To correct this situation we must address the staggering 5/80 cancer disequilibrium," referring to the fact that LMIC account for almost 80 percent of cancer, yet receive only 5 percent of global resources devoted to deal with the disease.

There are ways to address these disparities without expensive on-patent drugs or equipment. As smoking continues to rise in many LMIC, anti-tobacco campaigns could have a huge impact, as could education about the importance of early detection and screening. Vaccinations against human papillomavirus (HPV) could prevent cervical cancer, and immunization against hepatitis B virus could prevent liver cancer.  For those cancers that are not treatable, such as pancreatic cancer, the authors call for entitlement"”often unmet in LMICs"”to palliative drugs to mitigate suffering.

The authors were quoted as saying, "Many of the cancers that pose the greatest burden in low-income and middle-income countries are amenable to treatment with drugs of proven effectiveness that are off-patent and can be manufactured generically at affordable prices. These drugs should be a focus of cancer treatment programs, rather than expensive on-patent drugs."

Tamoxifen for breast cancer is one example of an inexpensive off-patent drug. In some countries, the total cost of a generic first-line chemotherapy drug with a 50 percent cure rate for Burkitt's lymphoma has been reported at less than $50 per patient. Dr. Farmer was quoted as saying, "There are clearly effective interventions that can prevent or ease suffering due to many malignancies, and that is surely our duty as physicians or policy makers or health advocates."

SOURCE:  The Lancet, August 22, 2010.