Page 0061

A

ccording to Globocan predictions, cancer incidence

will continue to increase throughout the world for

the foreseeable future.1

Yet countries differ

enormously in socioeconomic status (over a range of several

hundred-fold) and therefore in their capacity to recognize

and overcome obstacles to development. In this article, East

Africa is taken as an example of a small group of countries

with limited development (Table 1) facing many obstacles to

effective care of cancer patients. Demographic changes alone

in the five East African countries combined are projected to

result in 521,240 new cases in 2030, i.e., an increase of 81%

over the 2012 estimate of 287,264.

1 The corresponding

mortality figures are 380,730 and 208,456. Prevention of

cancer is an essential component of cancer control and

vaccination against cancer-causing viruses and tobacco

control will doubtless be components of each national cancer

control plan, but potentially curative treatment cannot be

ignored for patients who develop cancer. This article will deal

exclusively with obstacles faced by the medical community

charged with reducing the number of people who die from

cancer and particularly with the shortage of specialists

involved directly in the treatment of cancer.

Obstacles to increasing the capacity to diagnose and

treat cancer

Socioeconomic development

The major obstacle to reducing the mortality from cancer in

East Africa is the limited socioeconomic development of

these countries. When the components of the Human

Development Index (HDI), namely, longevity, level of

education and income2 are examined separately, it is clear

that they interact strongly. Poor education of health care

providers and the public gives rise to poor health care, whilst

ill-health has an important impact on the ability to learn and

to earn. Health and education are strongly influenced by

poverty, which modifies exposure to risk factors for ill-health

and reduces access to health care. Many factors influence

access, including few primary care providers close to home

(as many as 70% of people in East Africa may first consult

traditional healers) lack of public knowledge about cancer

and concern about the cost of cancer care; loss of income

coupled to the cost of travel and accommodation and fear of

cities (approximately 80% of people in East African live in

rural districts). Transportation is very difficult - journey times

are inordinately long and uncomfortable. While some of

BUILDING CAPACITY FOR CANCER

TREATMENT IN LOW-INCOME

COUNTRIES WITH PARTICULAR

REFERENCE TO EAST AFRICA

IAN MAGRATH (LEFT), PRESIDENT, INCTR AND SIMON SUTCLIFFE (RIGHT), INCTR CANADA

(TWO WORLDS CANCER COLLABORATION)

Cancer rates are presently increasing in low-income countries such as East Africa and are

highly likely to continue to do so. If this ever-increasing burden is to be controlled, it will be

particularly important to address the need for cancer specialists, and to plan for efficient and

widely accessible cancer services. Alternative pathways for training, which are hospital rather

than university-centred should be considered. Teaching would be largely "on-the-job

training" with trainee specialists having patient responsibilities, supervised as necessary, as

well as access to educational materials designed for self-learning, and on-line information.

This approach should increase the number of specialists trained without reducing the number

of doctors available for patient care, although a new accreditation process will be necessary.

In addition, national early diagnosis programmes should be established, thus minimizing the

need for complex surgery, chemotherapy and radiation, while task-shifting and oncologist-led

teams of health professionals will increase the efficiency of care and maximize survival rates.

CANCER MANAGEMENT

60 CANCER CONTROL 2014

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