Is cancer control in poor countries too high-tech?
- Early detection of cancer too often neglected in developing countries
- Cheap technology boosts survival but expensive treatments take centre stage
- Access to be balanced with ‘competing priorities between stakeholders’, WHO says
Early diagnosis matters, and it can be done using cheap tools that are already widely available in the developing world, said Andre Ibawi, technical officer at the WHO. He said that people have a much better chance of survival if they find out they have cancer at early stages of the disease, so the priority for policy needs to be on promoting early detection and health care.
But developing countries tend to prioritise sophisticated technologies used at advanced stages of the disease, he told delegates at the Royal Society of Medicine’s annual cancer meeting in London earlier this month (2 October), which focused on cancer control in low and middle-income countries.
“No country can afford to treat its way out of the cancer problem.”
A lot of progress can be made “if we take the existing package of services and focus on expanding access, as opposed to expanding the number of interventions in the health service,” Ibawi said in an interview with SciDev.Net.
Major breakthroughs get a lot of attention, he explained, and complex treatments tend to be favoured partly because there is political gain in terms of visibility ‒ governments are then able to say “we have a new cancer intervention, a new pathology test”.
This is driven by a legitimate desire to ensure people have access to care, Ibawi added. “Countries know all the advances are being made in high-income settings, and they also want to offer those services to their population – and appropriately so.”
Globally, one in five men and one in six women will develop cancer before they reach 75 years of age, according to the International Agency for Research on Cancer (IARC). Developing countries already have high mortality rates, and with rapidly changing trends – including population ageing and unhealthy lifestyles – that burden is only expected to rise.
The reality is that "no country can afford to treat its way out of the cancer problem," said IARC director Christopher Wild. A rounded approach is needed, but early detection and prevention are being neglected in developing countries.
The lifesaving potential of simple technologies to monitor patients is being neglected even at advanced stages of the disease, according to Bishal Gyawali, a medical consultant at the Belgium-based foundation Anticancer Fund.
Gyawali told SciDev.Net that studies conducted in the past few years – in lung cancer patients and patients with metastatic cancer, for example – have shown the use of tools such as web-based questionnaires for patient follow-up ‒ where a nurse gets alerted if there is a problem based on the information shared – can do a lot to improve survival.
Prompt intervention can happen cheaply, he said, yet expensive treatments such as chemotherapy still get ‘pushed’.
There are a few reasons why this evidence has not changed diagnostic and treatment practices, according to Gyawali. One is the lack of promotion, which is usually what happens with expensive cancer drugs.
“There is no particular industry involved with a skin in the game to conduct promotional activities of these innovations — versus new drugs which come with lots of ‘educational campaigns’ etc. sponsored by the industry,” said Gyawali.
Patient advocacy groups and policy makers don’t put it at the top of their agenda, he added. And there are no efforts to ensure these technologies are in place in every clinic. “If something comes cheap, probably it’s not sexy enough for us to change practice?”
Demand for expensive machines also comes from countries themselves. Peter Hoskin, a clinical oncologist at University College London, told delegates that colleagues in developing countries are keen on using the “incredibly complex” radiotherapy technologies used in the West, which need maintenance capacity that is generally not available, even though simpler ones will work just as well. Ibawi says the WHO’s approach is to balance access to medicines and technologies with the ‘competing concerns’ over issues such as affordability, intellectual property and safety. “We have to recognise that all partners [involved in health care] have a role to play,” he said. “We also have to minimise any potential conflicts of interest.”
The WHO recognises that “governments have to make decisions that include promotional elements, political elements, financial elements”, said Ibawi. It also recognises that some stakeholders have more influence over others.
At the request of governments, the agency is now producing a report “that provides an objective reference so that we know how to better balance the competing priorities between stakeholders” such as industry, governments and civil society”.