Putting Cancer on the Global Agenda

John Seffrin, PhD, American Cancer Society, Atlanta, Georgia, USA, discussed the historical significance of the United Nations (UN) High-Level Meeting, the outcomes of the May 2013 65^th World Health Assembly, the role of nongovernmental organizations (NGOs), and critical objectives to take advantage of the new global cancer paradigm. “We are seeing the beginning of a tsunami of avoidable, often preventable noncommunicable diseases,” Dr. Seffrin said. “Cancer could become the number one leading cause of death in the not-too-distant future.”

Dr. Seffrin shared that the outcomes document from the UN High-level Meeting essentially says four things: 1) Cancer and noncommunicable disease will be the health, disease, and disability challenge of 21^st century; 2) we have the knowledge and technology to prevent this; 3) economic development and noncommunicable diseases are inextricably linked; and 4) the problem is not one any single sector can solve alone — and the private sector will be particularly crucial. Dr. Seffrin also cited a recent study from the World Economic Forum and the Harvard University School of Public Health that notes the potential for a $47 trillion expected loss in economic output just in the next two decades from noncommunicable disease. The historic UN meeting served as a wake-up call for global leaders, Dr. Seffrin said.

The 65^th World Health Assembly recently called for a 25% global reduction in premature deaths from noncommunicable diseases. The UN political declaration stated the World Health Organization (WHO) must develop targets (specific measures that can be used to hold countries accountable), indicators, and goals by the end of 2012. There is strong support for the four main cancer risk factors: tobacco use, alcohol use, unhealthy diet, and physical inactivity.

NGOs are in a position to provide data and evidence that might not be available in governmental and commercial sectors. They can objectively represent and advocate for patients, engage civil society, and take action without restraints from government or commercial entities. The Noncommunicable Disease (NCD) Alliance is the largest health coalition ever formed, with about 2000 participating organizations.

Three objectives for moving forward include a need to leverage the NCD Alliance, inclusion of noncommunicable diseases in the UN millennial goals, and emphasis on the need for action in this arena to ensure world economic stability, prevent suffering, and save lives.

Perspectives in Cancer Care and Future Strategies

Lawrence N. Shulman, MD, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, related his experience in building cancer care infrastructures in low income countries, with a focus on his work in Rwanda. Dr. Shulman emphasized that partnerships among institutions, governments, and industry are keys to success. The cancer care components on which the program focused were education, prevention, screening, early detection, diagnostics, treatment, palliative care, and survivorship.

Dr. Shulman discussed the principles used to guide development of a cancer care program in low-income countries:

1. Develop a cancer care program within the context of the existing healthcare infrastructure.

2. Develop essential services like pathology, surgery, and chemotherapy, to successfully diagnose and treat patients.

3. Develop a supply chain for affordable drugs, vaccines, and other critical services.

4. Develop cancer care services that can be administered by physicians, nurses, and other healthcare workers, with specialist back up via electronic communication.

5. Develop social support, clean water, and adequate nutrition for successful care.

6. Develop a prioritization plan, directing resources to where they are most needed. Cancers where the greatest impact can be made: 1) diseases amenable to risk reduction; 2) diseases curable with early detection and treatment; 3) diseases curable with affordable chemotherapy; and 4) diseases palliated with systemic treatment (Figure 1).

   

   • Download figure
   • Open in new tab
   • Download powerpoint

   Figure 1.

   Cancers Where An Impact Could Be Made.

   Reproduced with permission from L. Schulman, MD.

7. Develop specific disease-based protocols to direct interventions and care based on principle #5.

8. Expand partnerships with ministries of health, NGOs, academic cancer programs, private sector entities, foundations, and donors.

9. Develop a research agenda and infrastructure specifically designed to address questions applicable to cancer care in these settings. Prospective studies are needed to understand the effectiveness of interventions.

10. Develop ongoing local training in cancer care.

11. Develop a sustainable program.

The program's activities in Rwanda have been conducted in close collaboration with the Ministry of Health. National cancer protocols are being developed and approved by the Ministry. The key to developing a successful program is to integrate prevention, screening, and treatment. Programs need to be developed in parallel with important policy work.