GLOBAL CANCER INITIATIVES
18 CANCER CONTROL 2021
been fully achieved in several LMICs. Evidence from the SIOP
Global Mapping Programme undertaken in Africa showed that
only a third of the respondents from 47 countries affirmed full
treatment cover by the state or donors (see Table 1). Fifty-eight
percent had partial cover or families having to pay solely out of
pocket. This is a reality, for example, from personal experience
in Ghana, families have to pay out of pocket to access lifesaving
treatment for their child who has cancer. Countries
have committed to UHC but advocacy at the local level is still
required for childhood cancer care to become a priority and for
adequate health financing. There is strong evidence to support
advocacy efforts showing the cost-effectiveness of childhood
cancer treatment in LMIC globally and in Africa in particular
(10,13,14).
Importance of active paediatric oncology clinical
research programmes
Kathy Pritchard-Jones, President of SIOP, Professor of Paediatric
Oncology, University College London (UCL) and Great Ormond
Street Institute of Child Health, London, UK
It is widely accepted that improvements in childhood cancer
survival rates go hand in hand with active participation in
clinical research, including observational studies and registries
(15-17). However, most of the evidence supporting 'best
practice' treatment recommendations for children and young
people with cancer living in resource-limited countries comes
from research studies performed in HIC (18). Yet, there are
many other determinants of outcomes in LMICs including
treatment toxicity and abandonment, drug shortages, suboptimal diagnostic
facilities, poor access to specific treatments
such as radiotherapy. Therefore, clinical research performed
in LMICs, which deal with these context-specific issues and
constraints, is essential to define the optimal therapeutic
strategies to improve cure rates and decrease short- and longterm toxicities
(19).
The SIOP Global Mapping Programme survey for Africa
investigated the current status of clinical research activity
across the continent, with 23 low-income countries (LIC),
23 lower-middle-income countries (L-MIC), 7 upper-middleincome countries (UMIC) and one HIC. It is encouraging
that
31% (34/109 units) and 49% (23/47 countries) reported
in general especially noncommunicable diseases, underappreciation of the essential role of imaging in treatment
outcome should also be noted. Imaging is important at every
step in the continuum of cancer management - detection,
diagnosis, staging, treatment planning, assessment of
treatment response and long-term follow up. Moreover,
the authors of the Lancet Commission on Imaging and Nuclear
Medicine (2021) showed significant cost saving advantages
with good imaging services overall (11). On its own, purchase
of expensive imaging equipment will not have the desired
effect on cancer treatment outcome. There must be a robust
maintenance plan for the equipment, continuous availability
of consumables such as films, reagents etc., and skilled human
resource to deliver the service holistically. Otherwise, the
expensive equipment will sit in facilities unused.
The SIOP Global Mapping Programme in Africa showed
significant disparities in access to imaging both between
countries and within countries. Not surprisingly, for basic
imaging, at least one respondent in 44 (94%) of 47 countries
reported having access to X-Ray, and 45 (96%) have access
to ultrasound. More advanced technologies (e.g., computed
tomography) were only reported as available in 79% (37) of 47
countries. Still, at this point in Africa, models referred to in the
Lancet Commission on Imaging and Nuclear Medicine suggest
that the largest survival advantage may be brought about by
scaling up access to conservative imaging rather than to newer
modalities like PET.
Access and importance of universal health coverage
Lorna Renner, Associate Professor, Department of Child Health,
University of Ghana
In order to achieve the target of the WHO GICC, countries will
have to make all efforts to improve outcomes by, amongst other
strategies, ensuring access to effective treatment and reducing
treatment abandonment. The implementation of Universal
Health Coverage (UHC), which should include childhood
cancer care, would be an important approach to achieve this.
According to the WHO, "Universal health coverage means that
all people have access to the health services they need, when
and where they need them, without financial hardship" (12).
Unfortunately, with regards to childhood cancer, this has not
Table 1: Major antibiotic resistance in Iran between 2013-2014 (WHO, 2014)
Payment of care Responses
in your setting at
facility level
Fully subsidised Partially subsidised Paid for by the family No answer
by state/donors by state/donors of the patient
Answers 36 (33%) 39 (36%) 24 (22%) 10 (9%)
Note: Totals may not add up to 100% due to rounding.