CANCER CONTROL OPPORTUNITIES IN LOW- AND MIDDLE-INCOME COUNTRIES

By Dr. Cosmas Mugambi. Follow this Author on Twitter

The cancer burden is still on an upward trajectory globally. At the moment, there seems to be no greater disease burden. More people have actually died from cancer than HIV, Malaria and Tuberculosis combined.

In 2018 alone, 9.6 million people died due to cancer, while another 18.1 million new cases were confirmed. This is according to the International Agency for Research on Cancer (IARC).

Cancers of the breast, colorectum, lungs, cervix uteri and thyroid, are the most prevalent among females. Those of the lungs, prostate, colorectum, stomach and liver, are top among males.

Further, this disease burden is greatest in low-income and middle-income countries (LMICs), where 70% of all the cancer deaths occur. Worse still, the sub-Saharan Africa region is projected to have more than an 85% increase in cancer incidences by 2030.

This sharp increase is being attributed to demographic changes such as ageing and population growth, urbanization, increased unsafe food and water consumption, and increased alcohol and tobacco use, among others.

The good news however, is that most cancers can be prevented. If diagnosed early, others can even be treated and cured. Even for late stage cancers, the pain can be reduced, the progression slowed, and patients and their families helped to cope.

Effective prevention efforts have been shown to reduce the number of new cases, while early interventions have been shown to improve treatment outcomes and survival rates.

Nevertheless, the utmost hinderance to the fight against cancer continues to be the limited public awareness on cancer symptoms, benefits of early diagnosis and treatment.

In addition, geographically induced inaccessibility of health services, the cost of treatment, underlying socio-cultural factors, and poor referral and post referral follow ups, continue to add salt to an already growing wound.

The effect is thus continuous physical, financial and emotional strain, on both cancer patients and their families. Ultimately, prolonged strains coupled with premature mortalities due to cancer have substantial socio-economic impact on LMICs.

In May 2017, world governments made a commitment to further invest in cancer control as a public health priority, thereby passing the World Health Assembly Resolution 70.12 on cancer prevention and control.

However, historically, the fight against cancer in LMICs has received little attention from global policymakers and donors. Only 1% of global health financing is directed to Non-Communicable Diseases (NCDs), within which cancer falls. Worse still, only 5% of the global spending on cancer is directed to LMICs.

LMICs are thus finding it increasingly difficult to respond to the cancer challenge on their national health systems. Despite all that, the opportunities for cancer control still continue to be available.

Governments must understand that they cannot win the war against cancer alone. There is therefore, need for well curved out Public-Private-Partnerships (PPPs).

This way, pre-existing investments or assets such as public outreach programmes can be leveraged upon to create and maintain public awareness on cancer, even as other investments are sought.

Secondly, as with all wars, we are only as strong as our weakest links. The war against cancer will either be won or lost at the individual level first. Citizens must thus take personal responsibility.

This calls for disciplined adoption and maintenance of healthy living. For example, proper dieting, moderated alcohol intake, avoidance of tobacco, safe sex practices, regular exercising and recommended vaccinations, go a long way in preventing cancer.

Third, it is wise to employ regular medical check-ups. These increase your chances of ‘catching’ cancer early. Ask your doctor about the best cancer screening schedule for you and go for it.

In the event of a confirmed diagnosis, the first step should be to find the right doctor for that specific type of cancer. This ought to be followed by the designing of a treatment plan and thereafter, creation of a social support system. These processes have been observed to improve the quality of life for both cancer patients and their families.

In the case of structural interventions by government, the primary role should be investments on prevention. Aside from public awareness, there needs to be focus on eliminating or controlling the causes of cancer. This includes ensuring safe food and water, and limiting the adverse effects of urbanization, among others.

Further, all cancer control plans need to be tailored to fit both national and regional priorities. This would then help address the challenge more holistically. In addition, it would then set the platform for cancer registries to aid in informed and evidence-based interventions, as well as integration of cancer control interventions with other related health interventions (such as reproductive health, HIV and AIDS etc.), at the primary health level.

Governments also need to strengthen regional and sub-regional partnerships in order to improve geographic accessibility to healthcare. This could be coupled with improving national road networks that connect rural practices to specialized cancer centers.

Last but not least, research on oncology in LMICs needs to focus on two key areas, the first one being risk reduction and early detection. This ought to be aimed at determining specific genetic, biological, and behavioral risk factors for cancer, and evaluating innovative models to improve screening and early diagnosis.

The second research focus needs to be on survivorship and symptom science, aimed at reducing treatment-related symptoms and enhancing survivorship.

The Author is A Public Health Specialist Based in Nairobi, Kenya.

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