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Global disparities in cancer treatment and recent policies to address cancer care

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By: Nivedita Sengupta, Ph.D.

photo credit: phalinn via photopin cc

According to American Cancer Society more than 8 million people worldwide die from cancer every year. The number of deaths worldwide from communicable diseases like malaria, HIV and AIDS is insignificant compared to the number of global deaths from cancers which is expected to cross the 13 million mark by 2030, making cancer the leading cause of death worldwide. Cancer as a non-communicable disease has long been considered a disease of developed countries, where people are more likely to succumb to long-term chronic diseases rather than dying from infectious diseases. However, according to statistics from the World Health Organization (WHO) and American Cancer Society, of the 14.1 million new cancer cases reported worldwide in 2012, 6.1 million were from developed countries compared to 8 million in developing countries – and these numbers are still rising. The number of new cancer cases in developing countries is predicted to rise to 13.1 million by 2030. These discrepancies between developed and developing countries are also apparent in childhood cancers. Childhood cancers account for less than 1% of the total cases in developed countries but about 4% in developing countries. Considering that reliable data on incidence are only available for a fifth of the world population consisting of people in mostly high-income countries, the actual statistics on cancer in developing countries may be even higher making cancer a significant and growing health burden in developing countries.

Escalation of cancer cases in developing countries over the past years has resulted in an increase in cancer-related health care costs, building up a global financial burden due to cancer. In 2010, $290 billion was spent to treat 13.2 million new cancer cases worldwide and this spending is projected to increase to $458 billion by 2030. Despite a wealth of data on how to diagnose and treat cancer, funding for cancer remains a low priority in context of health spending for both developing countries and for the nations providing donations. Only 5% of global resources devoted to cancer are spent in developing countries. In 2014, total global funding for development assistance for health was $35.9 billion, and only 2% of that amount was allocated for assistance in the area of non-communicable diseases of which cancer is only one aspect. This sets up an untenable situation as developing countries do not have the resources to tackle the rising human cost of cancer within their borders and necessitates significant global interventions and funding.

One potential in-country way to combat and prevent many of the deaths from cancer could be by raising awareness of the signs and symptoms of cancer among the general population, as well of awareness of proven ways to prevent cancer. A 2007 study on breast cancer in Malaysia found that 52.2% of newly diagnosed patients have stage III and IV cancers due to a lack of awareness of the signs and symptoms of cancer leaving them to seek treatment further into the disease progression. Most of these women were from rural Malaysia, with little or no education. Earlier screening for these and other cancers could help prevent cancer deaths. The major cancer types found in the developing countries are breast, cervical and colorectal cancer. Many of these cancers respond to treatment if detected early and treated adequately. However due to lack of cancer diagnosis facilities, by the time cancer is detected in these poor people it progresses to a stage where palliative care becomes the only option. In another example, potentially up to 20% of cancer deaths in developing countries could be prevented by immunization against HBV and HPV infections. Public-private global health partnerships like GAVI Alliance have partly facilitated the availability of HPV vaccines in the poor countries such as Kenya, Ghana, Madagascar, Malawi, Niger, Sierra Leone and the United Republic of Tanzaniato. However, poor people living in the middle income countries like China, Malaysia, India and Brazil are excluded from this initiative due to their country’s slightly higher income.

Another significant problem needing attention is a lack of proper infrastructure (in terms of equipment and people) for cancer treatment in developing countries. Currently, treatment options in developing countries are very limited and expensive. In developed countries people can have better health care coverage and access to up-to-date cancer care facilities and treatment, in addition to dedicated cancer research centers and specialists. Most developing countries have limited treatment centers with proper infrastructure and oncologists. According to the International Atomic Energy Agency (IAEA), even though 85% of the world’s population resides in developing countries, the average number of pieces of therapy radiation equipment in developing countries is only 0.4 units per million inhabitants, compared to more than six units per million inhabitants in developed countries. The few developing countries who are privileged enough to have access to radiotherapy equipment face considerable financial burdens in then providing the necessary training, equipment set-up and maintenance, protocols and quality control for proper usage of these machines for cancer treatment. Oncology and palliative care training is limited in medical schools and very few doctors and nurses can afford to have training outside their country resulting in lack of sufficiently trained staff in developing countries to deal with the increasing load of cancer cases.

Even treating cancer patients at all can be difficult in developing countries. Apart from expensive cancer drugs themselves, pain medications for palliative care like morphine are not easily available in these countries. Statistics show that 99.9% of cancer patients in developing countries are dying with untreated pain. 84% of the morphine used globally goes to the developed countries, leaving just 16% for the rest of the world. This is not because of limited morphine production but rather mainly because of onerously complicated and expensive narcotic supply regulations set by the International Narcotics Control Board (INCB). The structure of surveillance and accountability requirements implemented by INCB makes it almost impossible for poor nations to comply because of poor infrastructure and lack of educated people to handle issues necessary to comply with the regulatory needs. Moreover, country specific regulatory laws make it harder for the doctors to prescribe these medicines. All patients in need of pain relief could be helped if proper laws are implemented to gain access to pain medication and palliative care.

Drug companies themselves can help to address these health disparities in developing countries. On March 31st 2016, GlaxoSmithKline (GSK) CEO Andrew Witty announced a series of new patent policies designed to make innovative GSK medicines available to more people living in under-developed and developing countries. The new polices have a special focus on improving access to cancer drugs specifically. In the policy, GSK plans to stop filing for patents on its molecules in 50 of the least developed and low-income countries. In developing lower-middle-income countries, GSK will continue to file for patents but will grant licenses to generics manufacturers. This will enable easier access to cheaper generic versions of GSK’s drugs in those countries for the treatment of cancer. Furthermore, GSK will submit patents on future cancer drugs it develops to the United Nations-backed Medicines Patent Pool (MPP). The MPP deals in large-scale licensing agreements between drug developing companies and generics manufacturers thus enabling greater access to medicines in up to 127 developing countries. GSK has been applauded for this venture and the initiative also reveals the growing awareness among people regarding the magnitude of disparities in cancer care around the world. However experts says that a lot more still needs to be done in terms of improving access to needed medications. Ironically, most of the world’s poor live in ‘middle income’ countries such as China, India and Brazil that are not included in these polices and therefore will not gain anything from these new measures.

To reduce the death burden due to cancer in developing countries significant funding is needed, and one key challenge is how to obtain that funding. International advocacy is required to mobilize the international community and individual governments to take action. A number of influential international advocates like the UN, WHO and IARC are already active and trying to form partnerships with international health professionals, non-government organizations (NGOs), and funding organizations to bridge the gap between funding and treatment. By taking the necessary steps in proper direction to strengthen cancer prevention, early detection, treatment and palliation, much can be done to help improve cancer control in developing countries.


Written by sciencepolicyforall

May 23, 2016 at 9:00 am

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