Presentation 100114 King Hussein Cancer Center 0 Kuwait City, October 25, 2010 October Breast Cancer Program Cancer in the Eastern Mediterranean Region

Presentation 100114

King Hussein Cancer Center1

Kuwait City, October 25, 2010October Breast Cancer Program

Cancer in the Eastern Mediterranean RegionCommon Challenges and Potentials

Mahmoud M. Sarhan, MD, MMM, CPEKing Hussein Cancer Center

Presentation 091026


It is good to know that cancer is not a new disease but the increased life expectancy and improved diagnosis has made it more evident…

77.3Malta

77.5Netherlands

77.5Italy

77.5Cayman Islands

77.7Spain

77.8Norway

78.0Singapore

78.2New Zealand

78.3Canada

78.5Macau

78.6Israel

78.7Sweden

78.9Australia

79.0Switzerland

79.0Japan

79.4Hong Kong

80.2Iceland

80.6Andorra

Improved Life ExpectancyImproved Life Expectancy

Not a Modern DiseaseNot a Modern Disease

Better Clinical DiagnosisBetter Clinical Diagnosis

Diesel engine exhaustAsbestos, Crystalline silica, wood dust

Particles and fibers

Inorganic lead, Cobalt, tungsten carbideArsenic, cadmium, chromium Metals

Petroleum refining, hairdressing

Painting, chimney sweeping, coal mining, coke production,

Occupation

Trichloroethylene benzene, formaldehyde, vinyl chloride

Chemicals

Androgenic steroids, Chloramphenicol

DES, Estrogen, progesterone, tamoxifen, phenacetin

Pharmaceutical

Emissions from high temperature frying Aflatoxins, coal-tar Complex

mixtures

Radon, solar radiation, X-and gamma radiation Radiation

Circadian disruption, household combustion of biomass fuel (primarily wood)

Tobacco, areca nut, alcoholic beverages, household combustion of coal

Life style

Hepatitis B and C, HPV, Helicobacter pylori, HIV, Schistosoma

Biolog-ical gents

Probably Carcinogenic Carcinogenic

IncreasedExposure toCarcinogens

IncreasedExposure toCarcinogens

+

+

+

Presentation 091026


…nevertheless, in the next 10 years, cancer worldwide will be the #1 disease claiming lives and requiring the most investment for prevention, detection, treatment and palliative care

WHO statistical highlights, 2007

Projected global deaths for selected causes (Future Health)

Cancer

Ischemic Heart

Disease

Stroke

HIV/AIDS

OtherInfectiousDiseases

RoadTraffic

Accidents

Malaria

Cancer over time

Mill

ion

peo

ple

42.8%

36.3%

36.3%

Tuberculosis

Presentation 091026


Cancer will impact the developing / low-middle income countries the most…

+64%

+19%

11.94

9.28

8.06

World Cancer Deaths over Time

Year

To

tal C

ance

r D

eath

s in

Mill

ion

s

5.3

5.05.0

Deaths in Low Income Countries

year

Dea

ths

in L

ow

Inco

me

Co

un

trie

s (i

n m

illio

n)

Presentation 091026

King Hussein Cancer Center5Source: Globocan 2000 IARC

>5 million from Asia

Eastern

Southeastern

South Central

Western

Presentation 100114


It is expected that largest increase in cancer deaths within the next 15 years is likely to be in the Eastern Mediterranean region

Rawaf, S. et al. BMJ 2006;333:860-861

projection modelling predicts an increase of between 100%

and 180% [Rastogi et al. 2004]..

Predicted increase in deaths from cancer over the next 15 years (WHO)4

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r (%

)

0

50

100

150

200

Projection modelling predicts an increase of between 100% and 180% in EMR [Rastogiet al. 2004]..

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Presentation 100114


The Eastern Mediterranean region extends from Morocco to Pakistan and has varied income levels, health indicators and geographies

World Bank Income group

Country Population (in thousands)

Expenditure on health per capita in US $

High(Total Pop 8,219,000)

Qatar 656 862

U.A.E 4,210 661

Kuwait 2,645 579

Bahrain 708 555

upper

Middle(Total Pop 35,472,000)

Lebanon 4,370 573

Saudi Arabia

22,608 366

Oman 2,651 278

Libya 5,843 171

World Bank Income group

Country Population (in thousands)

Expenditure on health per capita in US $

lower middle(Total Pop 231,482,000)

Jordan 5,617 177

Palestine 3,827 138

Tunisia 9,911 137

Iran 66,775 131

Morocco 30,509 72

Syria 18,200 59

Egypt 69,323 55

Djibouti 817 47

Iraq 26,503 23

Low(Total Pop 238,627,000)

Yemen 21,003 32

Sudan 34,512 21

Pakistan 151,816 13

Afghanistan 22,998 11

Somalia 8,298 6

GINI index in many countries varies between 28 and 42 indicating inequality

within each country

Presentation 100114


Cancer in the EMRO region is the 4th leading cause of deaths occurring at a younger age than industrialized countries

projection modelling predicts an increase of between 100%

and 180% [Rastogi et al. 2004]..

→ 50% of the cancers in the Region occur before age 55 (10 – 20 years younger than in industrialized countries).

→ The mortality/incidence ratio is 70% indicating significantly lower survival rates from diagnosed cancer (40% in America, 55% in Europe)

.

→ 50% of the cancers in the Region occur before age 55 (10 – 20 years younger than in industrialized countries).

→ The mortality/incidence ratio is 70% indicating significantly lower survival rates from diagnosed cancer (40% in America, 55% in Europe)

.

RemarksRemarks

Presentation 100114


Breast Cancer is the most common cancer in most of the Eastern Mediterranean countries preceded sometimes by lung cancer

Co

un

try

Rank of Disease

Presentation 100114


The 3 leading causes of cancer worldwide are dominantly seen in the region

Cancers due to infections represent 11% of the cancer burden in North Africa and 16% of the cancer burden in west Asia.

70% of the infection‐related cancers in the Region are attributable to four infectious agents: human papilloma virus (HPV) (27%), Helicobacter pylori (23%), and hepatitis B and C virus (20%).

Cancers due to infections represent 11% of the cancer burden in North Africa and 16% of the cancer burden in west Asia.

70% of the infection‐related cancers in the Region are attributable to four infectious agents: human papilloma virus (HPV) (27%), Helicobacter pylori (23%), and hepatitis B and C virus (20%).

InfectionsInfectionsTobaccoTobacco

Prevalence of tobacco consumption is increasing rapidly and is already above 30% in men in 12 countries of the Region

Prevalence of tobacco consumption is increasing rapidly and is already above 30% in men in 12 countries of the Region

Top Countries Ranking (Males) Prevalence of tobacco smoking a (%) > 40%

Country Males > 15 years Females > 15

Yemen 77.0 29.0

Tunisia 61.9 7.7

Djibouti 57.5 4.7

Jordan 48.0 5.7

Syria 48.0 8.9

Lebanon 46.0 35.0

Kuwait 42.0 4.4

Unhealthy Lifestyles

In the Eastern Mediterranean Region obesity is a rapidly growing problem; already more than 50% of the population is overweight in 12 countries.

In the Eastern Mediterranean Region obesity is a rapidly growing problem; already more than 50% of the population is overweight in 12 countries.

Presentation 100114


Jordan and Kuwait are among the smaller populations in the Eastern Mediterranean region with impressive indicators related to health and a growing population that will challenge the current stable situation

PopulationPopulation

Population: =6,198,677 Age Structure: 15-64 = 63.7% Above 65: 4.5% Smokers (m) =48%

Population: =6,198,677 Age Structure: 15-64 = 63.7% Above 65: 4.5% Smokers (m) =48%

Health Indicators

Health Indicators

Life expectancy @ birth years =71/74

Total fertility rate children born/women = 2.47

Life expectancy @ birth years =71/74

Total fertility rate children born/women = 2.47

Socioeconomic Indicators


Unemployment rate: 13.5%

GDP: 4000 USD

Unemployment rate: 13.5%

GDP: 4000 USD

GeographyGeographyDistances: 570 km north to south

Urbanization= 78%

Distances: 570 km north to south

Urbanization= 78%

Population (million) = 2.8 Age Structure: 15-64 = 70.7% Age above 65= 3% Smokers (m): 40%


Area 17,818 square kilometer

Urbanization= 98%


Urbanization= 98%

Life expectancy @ birth years=77/79

Total fertility 2.5

Life expectancy @ birth years=77/79

Total fertility 2.5

Unemployment rate: 2.2% GDP: 48,310 USD


Presentation 100114


Kuwait is among the smaller populations in the Eastern Mediterranean region with impressive indicators related to health and a growing population that will challenge the current situation

PopulationPopulation



Health Indicators

Health Indicators

Life expectancy @ birth in years =77/79

Total fertility 2.5

Life expectancy @ birth in years =77/79

Total fertility 2.5





GeographyGeography


Urbanization= 98%


Urbanization= 98%

Presentation 100114


In Jordan, the National Cancer Registry in 1996 was a major undertaking to identify the most common cancers (breast & lung) as well as register cases

Ten Most Common Cancers Among MalesJordan 1996-2007N=14,445/21,332

Primary Site

Cru

de

Nu

mb

er o

f C

ases

Ten Most Common Cancers Among FemalesJordan 1996-2007N=14,360/21,000

Primary Site

Cru

de N

umbe

r of

Cas

es285

550769

1396

3302 3380 3362 34303591

4198

4606

4332

367834783412

31423354

1126

450

0

1983

1989

1995

1997

1999

2001

2003

2005

2007

Trend of Cancer1980-2007

Years

Can

cer

Cas

es

Sta

rt o

f R

egis

try

Population basedHospital based

2008

Presentation 100114


Despite the growing numbers of cancer cases, it is important to note that Jordan or Kuwait are not worse than other countries in terms of Cancer incidence…

Age Standardized rate compared with different countriesJNCR 2007

Presentation 100114


New cancer cases in Jordan are expected to double by 2020 as the population grows, ages, and lifestyles remain unchanged

Population Growth over Time

Year

Po

pu

lati

on

in M

illio

n

Projected Number of Cancer Cases (by Year) in Jordan

Year

Nu

mb

er o

f C

ases

Presentation 100114


…and as the Jordanian population ages.

Population Growth (in thousands) by gender and ageJordan 2005-2050

Above 50

Above 50

20

05

20

50

2.7 5.516.9

114.5

461.4

0

50

100

150

200

250

300

350

400

450

500

0-14 yrs 15-24 yrs 25-44 yrs 45-64 yrs 65 and above

ASIR by Age Group per 100,000 Population

Age Groups

Pop

ulat

ion

per

100

,000

Presentation 100114


Cancer in Jordan is characterized by late stages diagnosis (similar to the EMR), highest mortality due to lung cancer and 50% of mortality under age 64

Cancer Mortality JNCR 2007

N= 13,298 cases

Primary Site

Per

cen

t o

f D

eath

s

Age in years

Nu

mb

er o

f d

eath

s

Cancer Mortality in Jordan by AgeJNCR 2007

0

5

10

15

Lung Leukemia Breast Colorectal NHL

8 12 37 66

263

644

836

0100200300400500600700800900

< 1 4-Jan 14-May 15-21 25-44 45-64 65 +

Stage Frequency %

0- Insitu 53 1.3

1- Localized 1286 32.7

2- Regional Direct Extension 311 7.9

3- Regional – Lymph Node 326 8.3

4- Regional – (Direct + Lymph node) Extension

265 6.7

5- Regional - NOS 270 6.9

6- Distant Metastasis 1425 36.2

TOTAL 3936 100.0

Distribution of Cancer Cases by StagesBased on SEER Staging

JNCR 2007

Presentation 100114


At the onset of JBCP, breast cancer used to be detected at late stages when the survival rate and treatment success are not promising

Stages of Breast Cancer in Jordanbased on KHCC Experience before JBCP

Direct Correlation of Survival to Stage of Detection

N=550

Stage of disease at Detection

Perc

ent o

f Sur

viva

l

Presentation 100114


ASR ofASR of Breast Cancer ( Females)( Females)

Data for GCC countries 1998-2005, Oman-2007 ,Egypt 2000-2002 , USA-SEER (white population) 1999-2001

Presentation 100114


Median Age at diagnosis of Female Breast cancer in the Arab world

49

53

50

48

47

49

46

45

51

Median Age at diagnosis in Developed Countries 65 years

51

48

Presentation 100114


Breast cancer: proportions by age group in Jordan , Lebanon , KSA and Kuwait

Presentation 100114


The region as been trying to address individually and collectively the burden of cancer but with limited or country specific success

* WHO-EM/NCD/060/E, Towards a strategy for cancer control in Eastern Mediterranean Region, 2009

Presentation 100114


A regional alliance under the guidance of WHO has been working since 2007 and has in 2009 set the crucial need for national cancer control plans as the first step for each country

WHO Regional Office, in association with the Princess Lalla Salma Association against Cancer, nongovernmental organizations and other relevant international organizations in the Region, agreed to establish an alliance against cancer to join forces in order to generate an appropriate and concerted effort to prevent and control cancer.

Membres•Association Lalla Salma de Lutte contre le Cancer (Maroc) •The National Higher Committe for Breast Cancer Control (EAU) •King Hussein Cancer Center (Jordanie) •Lebanese Cancer Society (Liban) •Gulf Federation for Cancer Control (pays du Golfe) •Egyptian Oncology Forum (Egypte) •Fakous Cancer Center (Egypte) •Egyptian Foundation for Cancer Research (Egypte) •Breast Cancer Foundation (Egypte) •The National Association for Cancer Awareness (Oman) •Zahra Association for Breast Cancer (Arabie Saoudite) •Saudi Association for the Fight against Cancer (Arabie Saoudite) •Association Tunisienne de lutte contre le cancer (Tunisie) •Association des Amis de l’Institut National d’Oncologie (AMINO) (Maroc) •Association l’Avenir (Maroc) •Association Coeur de Femmes (Maroc)

Conduct publicity and disseminate information regarding the establishment of the alliance Create an advocacy plan Conduct education and increase public awareness Create a database for cancer in the Region Establish a network of experts, researchers and organizationsPromote the development of highly-qualified well-trained human resources in the field of cancer Mobilize the financial resources needed for the alliance to perform its functions Support research in the field of cancer Conducting monitoring and evaluation

Establishment

Goals

Members

Presentation 100114


Jordan is a model of success that can be presented as a learning experience and center of excellence

Business as Usual

1Data

2Focus

3Quality &

comprehensiveness

4Prevention

5

Stages of Cancer Control Development in Jordan

International Competition

Increasing Readiness

Up to 1996

1996 1997 2003 2006 2010 2020

Equity&

Research

6

Local and International Expansion

Treatment through MOH, RMS, PVS

JNCR established

Amal Hospital for Cancer Care Established

Transforming Al-Amal Hospital to the King Hussein Cancer Center-1st class cancer care

Treatment through MOH, RMS, PVS

JNCR established

Amal Hospital for Cancer Care Established

Transforming Al-Amal Hospital to the King Hussein Cancer Center-1st class cancer care

1

3

Prevention and palliative care initiatives

Increase in clinical capacity is needed for equity in patient care, while infrastructural growth is needed to initiate grade clinical and translational research

Prevention and palliative care initiatives

Increase in clinical capacity is needed for equity in patient care, while infrastructural growth is needed to initiate grade clinical and translational research

4

5

2 6

Treatment

Presentation 100114


Jordan is implementing two models for the early detection and prevention of cancer – a bottom up vs. a top down one

Implementation Plan

Fines, Taxes, Penalty

Quality and Guidelines

Breast Cancer Early Detection and ScreeningAdvocacy and

Awareness

Development of Services

Capacity Building

StableFunding

Legislation – free early detection

1

2

3

4

5

Smoking Control

Bo

tto

m U

pT

op

Do

wn

LegislationImplementation

AlternativesGrace Period

EnforcementSmoke-free

1

2

3

4

5

NationalTarget

NationalTarget

Early Detection& prevention

Presentation 100114


Jordan’s health system is dominated by the public sector that regulates it and provides services as well, followed by the military and private sector providers

Provider

Ministry of

Health(60%)

Ministry of

Health(60%)

Basic Role Description

+

Cancer Control

Royal Medical Service (25%)Royal Medical Service (25%)

Private Sector(XX%)

Private Sector(XX%)

Universities(6%)

Universities(6%)

Non-for-Profit Sector

Non-for-Profit Sector

Law, regulations, budget, health expenditure,

insurance

Law, regulations, budget, health expenditure,

insurance

Reactive vs. Proactive Limited resources Focused on service delivery Public health influenced by Int’l

arena

Reactive vs. Proactive Limited resources Focused on service delivery Public health influenced by Int’l

arena

Closed Military System with

Insurance Scheme

Closed Military System with

Insurance Scheme

Independent budget Serves 25% of populations Quality Services

Independent budget Serves 25% of populations Quality Services

Regulated by MoH from Quality

perspective not pricing

Regulated by MoH from Quality

perspective not pricing

Business driven Varied quality (perceived by

population as a higher quality sector than government)

Business driven Varied quality (perceived by

population as a higher quality sector than government)

Free of charge for enrollees or less

privileged


privileged

Limited budgets Acceptable quality Innovation limited

Limited budgets Acceptable quality Innovation limited


privileged


privileged

Limited budget High expertise and focused

expertise Dependent on Fundraising

Limited budget High expertise and focused

expertise Dependent on Fundraising

Only player to date KHCC Comprehensive 1st class center

(2 accreditations) Outreach, control, diagnosis, Rx

and Palliative care

Only player to date KHCC Comprehensive 1st class center

(2 accreditations) Outreach, control, diagnosis, Rx

and Palliative care

No full plan (under consideration) Divided activities Strong registry Covers all Jordanians Mediocre quality Rx services

No full plan (under consideration) Divided activities Strong registry Covers all Jordanians Mediocre quality Rx services

Prevention without outreach (clinic based)

Rx (not comprehensive)

Prevention without outreach (clinic based)

Rx (not comprehensive)

Rx focused Not driven by unified protocols Very expensive Varied quality

Rx focused Not driven by unified protocols Very expensive Varied quality

No oncology departments Rx available not comprehensive Varied quality (KAH vs. JU)

No oncology departments Rx available not comprehensive Varied quality (KAH vs. JU)

Presentation 100114


Despite the varied quality of treatment, Jordan has been achieving good results comparable to the developed nations

0.53

0.36

0.44

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Male Female All

All Cancers Mortality/Incidence ratios for selected countries

2002

Jordan cancer Mortality/Incidence ratio

2006

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Mor

talit

y/In

cide

nce

Male Female

Diagnosis & Treatment

Presentation 100114


Case in point 1: KHCC’s Department of Pediatrics quality of care has resulted in survival rates equivalent to those in the USA and Europe

Su

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istr

ibu

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un

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Survival Time Month

LEGEND

Product Limit Estimate Curve

Censored Observations

ALL Pediatric - KHCC 2003 – 2007, (N=200)

# Of deaths = 10

3 Years survival = 94%

Kaplan Meier Survival Function

ALL Pediatric - KHCC 2003 – 2007, (N=200)

# of events =19

3 years event free survival =86%

Incidence Free Survival

Overall Survival

Event FreeSurvival Function

Survival Function


Presentation 100114


Case in point 2: KHCC’s Stem Cell Transplantation Program has resulted in survival rates equivalent to those in the USA and Europe

Product-Limit Survival Function Estimate

Su

rviv

al P

rob

abili

ty

Survival Time Month


Presentation 100114


As for palliative care, Jordan has established a national committee to improve provision of services as recommended internationally

GoalGoal

To help alleviate the physical and psychosocial suffering associated with progressive, incurable illnesses throughout Jordan and the region

To increase the availability and access to high-quality hospice and palliative care for patients and families throughout Jordan

To help alleviate the physical and psychosocial suffering associated with progressive, incurable illnesses throughout Jordan and the region

To increase the availability and access to high-quality hospice and palliative care for patients and families throughout Jordan

LeadLead King Hussein Cancer CenterKing Hussein Cancer Center

SupportSupport Ministry of HealthMinistry of Health

Top-Down Activities

Top-Down Activities

Advocacy – change in opiod prescription regulationTen-day policyAuthority with MOH Minister rather than by law

Advocacy – change in opiod prescription regulationTen-day policyAuthority with MOH Minister rather than by law

Bottom-up Activities

Bottom-up Activities

Education – integrate into universities (nursing and medical schools) as a part of the curriculum

Training - Establishment of training programs – KHCC (doctors, nurses, policy makers..etc)

Pharmaceuticals – to develop immediate release morphine tablets

Education – integrate into universities (nursing and medical schools) as a part of the curriculum

Training - Establishment of training programs – KHCC (doctors, nurses, policy makers..etc)

Pharmaceuticals – to develop immediate release morphine tablets

OBJECTIVEOBJECTIVE

Integrate palliative care and hospice principles into the National Health Strategy by shaping governmental policies

Assure availability and easy access to opioid analgesics and adjuvant medications throughout the Kingdom

Establish integrated continuums of palliative care programs, reaching patients in hospital and community settings

Promote Jordan as a model and reference for palliative care practice and education in the region

Integrate palliative care and hospice principles into the National Health Strategy by shaping governmental policies

Assure availability and easy access to opioid analgesics and adjuvant medications throughout the Kingdom

Establish integrated continuums of palliative care programs, reaching patients in hospital and community settings

Promote Jordan as a model and reference for palliative care practice and education in the region

Palliative Care

Emerging Approach

“Decent Care”

Emerging Approach

“Decent Care”

Globalization is putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should … People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in way that correspond to their expectations. Few would disagree that health systems need to respond better – faster – to the challenges of a changing world.

Globalization is putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should … People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in way that correspond to their expectations. Few would disagree that health systems need to respond better – faster – to the challenges of a changing world.

Presentation 100114


With the current and growing cancer burden the region remains extensively challenged

Other primary care issues take priority over cancer care

Funding limitations to prevention, screening and purchase of quality care (including costly drugs)

Other primary care issues take priority over cancer care

Funding limitations to prevention, screening and purchase of quality care (including costly drugs)

Lack of government national supportLack of government national support

Lack of Specific Funds Targeted towards Cancer

High Cost of Drugs and overall treatment

(GDP per capita for most countries in the region is below $ 6000)

(Average cost of treatment is approximately $25,000 without complications)

Major International Funds have not been allocated towards Cancer Control in the region

Lack of Specific Funds Targeted towards Cancer

High Cost of Drugs and overall treatment

(GDP per capita for most countries in the region is below $ 6000)

(Average cost of treatment is approximately $25,000 without complications)

Major International Funds have not been allocated towards Cancer Control in the region

Monetary LimitationsMonetary Limitations

Cultural Barriers

Stigma & myths pertaining to cancer including religious misunderstandings

Social taboos that extend beyond the female herself leading to fears of being ostracized by husband, family, or society

Socioeconomic barriers

Low level of education (ignorance)

Preference to invest in family/children needs rather than self health

Awareness barriers

Cancer as a taboo subject

No health promotion to break myths of hereditary and contagious disease

Do not seek information and action to understand ailment or prevention

Cultural Barriers

Stigma & myths pertaining to cancer including religious misunderstandings

Social taboos that extend beyond the female herself leading to fears of being ostracized by husband, family, or society

Socioeconomic barriers

Low level of education (ignorance)

Preference to invest in family/children needs rather than self health

Awareness barriers

Cancer as a taboo subject

No health promotion to break myths of hereditary and contagious disease

Do not seek information and action to understand ailment or prevention

Social LimitationsSocial Limitations

Presentation 100114


Service limitations

Multidisciplinary approach to treatment is not systematically implemented in some treatment centres

An increasing number of cancers are being treated with combined modality therapy. A major issue in this regard is the cost and availability of cytotoxic drugs.

There are relatively few trained radiation, medical or pediatric oncologists in many countries of the Region, and very few oncology nurses and social workers.

The roles of nursing staff and paramedical could be expanded to reduce the load on specialists

Multidisciplinary approach to treatment is not systematically implemented in some treatment centres

An increasing number of cancers are being treated with combined modality therapy. A major issue in this regard is the cost and availability of cytotoxic drugs.

There are relatively few trained radiation, medical or pediatric oncologists in many countries of the Region, and very few oncology nurses and social workers.

The roles of nursing staff and paramedical could be expanded to reduce the load on specialists

Service LimitationsService Limitations

WHO cites a severe shortage of healthcare professionals in developing countries– Americas: 25 healthcare workers per 1,000 people – Asia: 5 or fewer per 1,000

WHO cites a severe shortage of healthcare professionals in developing countries– Americas: 25 healthcare workers per 1,000 people – Asia: 5 or fewer per 1,000R

em

ark

sR

em

ark

s

Health Care Workers per 1000 population

Presentation 100114


Palliative care for many countries is barely existent

Sources: International Narcotics Control Board; United Nations population dataBy: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2009

Presentation 100114


In Jordan as well, despite the strides to cancer care, some challenges remain to contest the ability to focus on quality and equity

Quality of Services Lack of treatment protocols: No unified protocols are

applied in diagnosis and treatment of cancer but purely based on provider’s academic and on-the-job training

Lack of standard operating procedures: The comprehensive approach to cancer care is not applied in all health care venues except at KHCC

Limited Advanced Experience: The approach and accessibility to tap into advanced resources is non existent

Public Awareness Misinformed public: Due to technological advances in

communication public put pressure on health sector to go for drugs and procedural interventions that are trial based which undermines the sector’s ability to perform and to be trusted

Lack of awareness of risk factors: Except for breast cancer, there is no / minimal work or focused work on the importance of healthy lifestyles

Accessibility to Care Increased prices of drugs: Due to the increased

prices of drugs that make a difference in cancer treatment, many patients are deprived of life saving interventions and the burden on the government is increasing

No primary care focus on Cancer: The focus on maternal & child health, infectious diseases, and cardiovascular diseases remains the core work of the primary health care centers leading to decreased ability to identify cancer early among other drawbacks

No enforcement of Palliative Care: Despite the national consensus on palliative care criteria, there is no enforcement of the agreed approach

Human Resources Lack of health specialized primary care and support

care providers: Especially in support services and early detection, health professionals in Jordan do not receive consistent and focused training for cancer related issues nor have specific academic lines that they can pursue for that purpose

Brain drain : Skilled and educated health providers are solicited by neighboring countries especially those who can offer more competitive packages – this will increase

Presentation 100114


In Jordan, Cancer control is on the right track …

Only population-based data can identify the overall national problem (although institutional data useful)

Only planning at a population level can ensure improved access for all

Only population-based data can identify resources required to control cancer at a national level

Only nation-wide collaboration can assess and make maximal use of all available national resources

Only population-based data can give a clear idea of the overall effect of interventions

Only population-based data can identify the overall national problem (although institutional data useful)

Only planning at a population level can ensure improved access for all

Only population-based data can identify resources required to control cancer at a national level

Only nation-wide collaboration can assess and make maximal use of all available national resources

Only population-based data can give a clear idea of the overall effect of interventions

RemarksRemarks

Presentation 100114


Efforts need to become more streamlined and unified to ensure continued success across all sectors

GOVERMENT

– Legislation relevant to control of risk factors and opioid availability

– Structuring health services

– Supporting establishment of expert committees

– Orchestrating goals

– Monitoring outputs, outcomes and impact

GOVERMENT

– Legislation relevant to control of risk factors and opioid availability

– Structuring health services

– Supporting establishment of expert committees

– Orchestrating goals

– Monitoring outputs, outcomes and impact

ACADEMIC ESTABLISHMENTS

– Education of health care professionals with basic knowledge of cancer

– Leadership in care, epidemiological, public health, clinical and translational research

ACADEMIC ESTABLISHMENTS

– Education of health care professionals with basic knowledge of cancer

– Leadership in care, epidemiological, public health, clinical and translational research

ONCOLOGY SPECIALISTS:

– Expert diagnosis and treatment

– Research: clinical and translational

– Advising government

ONCOLOGY SPECIALISTS:

– Expert diagnosis and treatment

– Research: clinical and translational

– Advising government

PRIMARY CARE PROVIDERS

– Public education, early detection

– Collaboration in care, follow-up and palliation

PRIMARY CARE PROVIDERS

– Public education, early detection

– Collaboration in care, follow-up and palliation

NON-ONCOLOGY SPECIALISTS

– Early detection

– Treatment of early stage disease

– Rapid referral to oncologists

NON-ONCOLOGY SPECIALISTS

– Early detection

– Treatment of early stage disease

– Rapid referral to oncologists

NGOs:

– Education & outreach

– advocacy:

NGOs:

– Education & outreach

– advocacy:

INDUSTRY:

– Access to new innovative products and services

– Research

– Sponsorship

INDUSTRY:

– Access to new innovative products and services

– Research

– Sponsorship

Food for thought: Need for Higher council for Cancer Control ???

Presentation 100114


Thank You

Documents

Presentation 100114 King Hussein Cancer Center 0 Kuwait City, October 25, 2010 October Breast Cancer Program Cancer in the Eastern Mediterranean Region