Cancer- Did you Know? Disproving the Myths About Cancer in Resource-constrained Settings

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

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Cancer- Did you Know? Disproving the Myths About Cancer in Resource-constrained Settings