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Cancer- Did you Know? Disproving the Myths About Cancer in Resource-constrained Settings
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Transcript of Cancer- Did you Know? Disproving the Myths About Cancer in Resource-constrained Settings
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7/29/2019 Cancer- Did you Know? Disproving the Myths About Cancer in Resource-constrained Settings
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Cancer- Did you Know?Disproving the Myths
About Cancer inResource-constrained Settings
Harvard School of Public Health
February 1st, 2013
Felicia Marie Knaul, PhDHarvard Global Equity Initiative, Global Task Force on Expanded Access to
Cancer Care and Control in LMICs
Tmatelo a Pecho A:C. Mxico
Mexican Health FoundationUnion for International Cancer Control
WORLD
CANCER
DAY
Seminar
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Thank you
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Global Task Force on Expanded
Access to Cancer Care and
Control in Developing Countries
= global health + cancer care
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GTF.CCCMembers
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Applies a diagonal
approach to managechronicity and avoid
the false dilemmasbetween disease silos
-CD/NCD- that
continue to plague
global health
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Closing the Cancer Divide:An Equity Imperative
I: Shouldbe doneII: Couldbe done
III: Can be done
M1. UnnecessaryM2. Unaffordabl
e
M3. Impossible
M4: Inappropriate
Expanding access to cancer care and control in LMICs:
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Mirrors the epidemiological transition
LMICs increasingly face both infection-
associated cancers, and all other cancers.
The Cancer Transition
Cancers increasingly only of the poor, are
not the only cancers affecting the poor.
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LMICs account for
>90% of cervical
cancer deaths and>60% of breast
cancer deaths. Both
are leading killers
especially of young
women.
Did you know?????
#2 cause of death in wealthy countries#3 in upper middle-income
#4 in lower middle-income
and # 8 in low-income countries
For children & adolescents
5-14 cancer is:
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Cancer is a disease of both rich and poor but
the poor suffer even more:
1. Exposure to risk factors
2. Preventable cancers (infection)
3. Treatable cancer death and disability4. Stigma and discrimination
5. Avoidable pain and suffering
Closing the Cancer Divide
is an Equity Imperative
Face
ts
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Adults
Leukaemia
All cancers
Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.
Children
LOW
INCOME
HIGH
INCOME
Sur
vival
inequa
lity
gap
LOW
INCOME
HIGH
INCOME
100%
The Opportunity to Survive Should Not,
but Is Defined by Income
In Canada, almost 90% of children with
leukemia survive.
In the poorest countries only 10%.
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The most insidious injustice is lack
of access to pain control
Non-methadone, Morphine Equivalent opioidconsumption per death from HIV or cancer in pain:
Poorest 10%: 54 mg per death
Richest 10%: 97,400 mg per death
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Challenge and disprove the
myths about cancer
M1. Unnecessary NECESSARY
M2. Unaffordable: .for the poorM3. Inappropriate: either/or
Challenging cancer implies taking resources
away from other diseases of the poor
M4: Impossible
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Investing In CCC:
We Cannot Afford Not ToInaction reduces efficacy of health and social investments
Total economic cost of cancer, 2010: 2-4% of global GDP
Tobacco is a huge economic risk: 3.6% lower GDP
Prevention and treatment offers potential
world savings of $ US 130-940 billion
1/3-1/2 of cancer deaths are avoidable:
2.4-3.7 million deaths,
of which 80% are in LIMCs
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The costs to close the cancer divide
may be less than many fear:
All but 3 of 29 LMIC priority cancer chemo and
hormonal agents are off-patent
Pain medication is cheap
Prices drop: HepB and HPV vaccines
Delivery and financing innovations are
underutilized and undeveloped: purchasing is
fragmented and procurement is unstable
Global Paediatric Financing Entity
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Challenge and disprove the
myths about cancer
M1. Unnecessary NECESSARY
M2. Unaffordable: AFFORDABLEM3. Impossible
M4. Inappropriate: either/or
Challenging cancer implies taking resourcesaway from other diseases of the poor
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Women and mothers in LMICs
face many risks through the life cycle
Women 15-59, annual deaths
Diabetes
120,889
Breast
cancer
166,577
Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.
Cervical
cancer
142,744
Mortality
in
childbirth
342,900
- 35%in 30
years
= 430, 210 deaths
Ch i
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Harvard, Breast Cancer in Developing Countries, Nov 4, `09
Champions
Nobel Amartya Sen,
Cancer survivor diagnosed in India50 years ago
Drew G. Faust
President of Harvard University22+ year BC survivor
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PIH Rural Rwanda: 0 oncologists
Source: Paul Farmer., 2009
Burkitts
lymphoma
EmbryonalRhabdomyosarcoma
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The Diagonal Approach to
Health System Strengthening
Rather than focusing on disease-specific vertical
programs or only on horizontal system
constraints, harness synergies that provideopportunities to tackle disease-specific priorities
while addressing systemic gaps.
Optimize available resources so that the whole ismore than the sum of the parts.
Bridge the divide as patients suffer diseases over a
lifetime, most of it chronic.
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Domestic, Diagonal
financing innovations
Integrate CCC into national insurance
programs to express previously suppressed
demand, beginning with cancers of womenand children:
Mexico, Colombia, Dominican
Republic, PeruChina, India, Taiwan
Rwanda, Kenya
M i S P l
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Mxico Seguro Popular:Cancer and the Fund for Protection from
Catastrophic Illness
Accelerated, universal, vertical coverage by disease
with an effective package of interventions
2004: HIV/AIDS
2005: cervical cancer
2006: ALL in children
2007: All pediatric cancers; Breast cancer2011: Testicular and Prostate cancer and NHL
2012: Colorectal cancer
M i S P l d
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Mxico Seguro Popular and
cancer: Evidence of impact
Access to medicines
Since the incorporation of childhood cancers
into the Seguro PopularAdherence to treatment: 70% to 95%
Breast cancer adherence to treatment:2005: 200/6002010: 10/900
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% diagnosed in Stage 4 by state
# 2 killer of
women 30-54
Only 5-10% of
cases in Mexicoare detected in
Stage 1 or in situ
Poor
municipalites:
50% Stage 4; 5x
rich
Delivery failure: Mxico Breast Cancer
Poor/Marginalized
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Juanita:Advanced metastatic breast
cancer, the result of a series of
missed opportunities
S l ti
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Harness platforms by integrating breast and
cervical cancer prevention, screening and
survivorship care into MCH, SRH, HIV/AIDS,
social welfare and anti-poverty programs.
Solution:
Diagonalizing Delivery
Examples:
Integration of breast
and cervical cancerawareness and screening
into the national anti-
poverty program
Oportunidades Results: 000s promoters, nurses, doctors
Harnessing the primary level of care
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Where are the opportunities?
LMICs: not months but rather whole lifetimes to
be gained
Recognize cancer in LMICs as an integral
component of ourcommon search forglobalhealth solutions:
investment in learning, research,
knowledge-sharing and translation, and
ultimately in human beings
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From anecdote
to evidence J 2008
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January, 2008June, 2007
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Be anoptimist
optimalist
Expanding access to cancer care and control in
LMICs: Should Could and Can be done