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A continuous "brain drain" of specialists caused by the unrest

and political instability in the region has resulted in serious

challenges to health services continuity and shortcomings

in a region facing an increasing incidence of cancer. Most

countries in the EMR are still challenged by weak public health

systems, fragmentation of services, scarcity of resources,

increased costs, limited access to cancer medicines and an

overdependence on the private sector.

Cancer priorities

Prevention is a priority in the EMR where many of the common

cancers can be prevented by feasible and cost-effective

public health interventions (e.g. the implementation of FCTC

recommendations to reduce lung cancer; increased coverage

of hepatitis-B vaccinations to reduce liver cancer; reducing

exposure to occupational carcinogens through stringent

industrial safety norms to reduce bladder cancer, etc.),the

adoption of healthy lifestyle and improvements in physical

activities alsoneeds to be prioritized in the region.

The early detection of common cancers is another key cancer

control priority in the EMR. Screening for breast, cervical,

colorectal and lung cancer is a complex and resource-intensive

public health initiative. An "Early Diagnosis" approach, which

can be effective for all common cancers and is logistically

simpler to implement, and should be an integral component of

all cancer control programmes in EMR countries

The cost of cancer treatment varies among EMR countries.

The rate of "out of pocket" expenditure (OOP) is lower in highincome countries (25%), where governments

fund more than

65% of the current health expenditures (CHE) of patients. By

comparison, (OOP) is about 70% in low-income countries and

government funding varies from 18% in Sudan to over 40% in

Tunisia, Syria, and Morocco (8).

The generation of robust cancer data is a priority in the EMR

countries where reliable population-based cancer registry

and mortality data are used to monitor cancer incidence

time trends, geographical patterns, and patient's survival

at the population level. There is considerable variation

across the region, both in terms of population-based cancer

registry coverage and quality, reflecting the varying degrees

of developments in the region (9). While more than half of

the 22 countries in the region (64%) have functional cancer

registries in place (both regional and national), about 14% of

EMR countries do not have any type of cancer registration

system (9).

Palliative care in the EMR

When most cancer cases present at advanced stages (10),

the provision of palliative care (PC) services becomes a

necessity to reduce the suffering and improve quality of life . Several initiatives and best practices have been developed

in the region, yet the majority of EMR countries have not yet

considered PC as a public health need and therefore have not

included it in their health agenda. The EMR has a vast variation

in laws, religious affiliations, and access to healthcare. Because

of this, there is a great variability in PC policies and access

to controlled medications; especially i.v. medications such

as morphine or fentanyl. A majority of countries in the EMR

have a much lower consumption of opioids than the global

consumption of opioids which has been on a steady rise. There

are many reasons for this, the most significant reason being

the lack of access to opioids for both patients and healthcare

professionals (11).

Impact of COVID-19

Unfortunately, the COVID-19 pandemic has further

complicated the situation of cancer prevention and control in

the region and has adversely affected all cancer services, from

planning to PC, with the low-income countries being the most

affected. According to the WHO survey in 2020,

cancer services were reported as being disrupted in more

than 40% of countries in EMR (12). These disruptions to cancer

services, including the suspension of screening programmes,

delays in diagnosis and treatment (including palliative care),

are likely to exacerbate the current situation with an increase

in advanced-stage diagnoses and as a result an increase in

potentially preventable cancer mortality. Countries continue

to mitigate the disruption of service; the extent of the effects

of the pandemic are still ongoing and yet to be fully evaluated

and measured.

WHO/EMRO Regional Framework for Action

To help countries scale up their cancer control programmes,

WHO/EMRO has developed a Regional Framework for Action

(RFA) on cancer prevention and control (13).

This RFA aims to support countries in developing a more

systematic approach to cancer control and to reduce mortality

from common cancers. Moreover, WHO has also embarked on

three major global initiatives in the past three years:

J the Global Initiative for Childhood Cancer (GICC);

J the Global Strategy to Accelerate the Elimination of

Cervical Cancer;

J the Global Breast Cancer Initiative.

The adaptation of these strategic interventions, and

prioritization guided by WHO initiatives, will require a far

higher level of political commitment and sustained funding

by EMR governments, and better evaluation of their existing

programmes. n


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