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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.

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