Global Health Cancer
Cancer is an emerging epidemic with profound ramifications for global health both in terms of the burden of morbidity and the strain it will place on healthcare systems around the world. As the global population ages the incidence of cancer is rising, the relative burden of each cancer changing and critically the relative proportion of burden placed on low and middle income countries is increasing rapidly (LMICs).
The problem in LMICs is particularly worrisome as healthcare systems often have insufficient resources to deal with existing threats, let alone deal with the emerging burden of protracted chronic diseases. Moreover the evidence base (both for the effectiveness of treatments and the importance of risk factors) as well as the capacity to conduct research in LMICs is grossly inadequate. However, there is increased resolve to tackle the challenge of NCDs by building capacity for clinical research through infrastructure and expertise in clinical research in LMICs.
The prevention, identification and treatment of cancer represent perhaps the most rapidly changing landscape in medical science. Resource rich countries struggle increasingly to cope with the burden of ever more expensive drugs; with ever decreasing returns on quality-adjusted life years and an ever-shrinking market share as therapies become progressively more personalized. Meanwhile resource poor countries deal with the new burden of disease, the dilemma of comprehensive care for the few versus cheaper care for a greater number and the challenge of health systems and political contexts which are also in more systemic flux.
Whilst health systems are strengthened and the global health community work towards the provision of more equitable access to comprehensive cancer care, rational decisions need to be made about the way forward for in the interim. Decisions are required about how to deliver the optimal cancer care with available resources and with patient safety at the forefront of decision making. There are optimists who have proposed that basic cancer care can be delivered for less than a dollar day. Such innovation could take the form of existing therapeutic modalities implemented in new ways, such as the identification of breast cancer on palpation from community health workers and subsequent treatment with Tamoxifen. Alternatively old therapies may find a revival in new contexts. Furthermore policy research to identify the levers for improving access to medicines. Over and above all of this is the importance of local biological variation which impacts on the results of basic research. Any such developments will require local biomedical research which in turn will be expedited by global collaboration and research capacity building.
This context highlights the importance of locally conducted research according to locally identified priorities and in consideration of locally available resources. Environmental and genetic risk factors identified in mainly European populations may differ markedly with risk factors in the local population. The resultant impact on preventative public health measures and healthcare planning for country specific disease prevalence indicates the seminal importance of locally conducted epidemiologic research. Differential funding and reimbursement and country specific organization of health systems necessitate the exploration of locally generated health economic and health policy research. Furthermore clinical trials are often conducted in special trial conditions in Western Healthcare systems, and although the number of clinical research studies conducted in LMICs has increased rapidly over the last ten years, the vast majority of these had been commissioned and designed outside of these countries with little or no input from local investigators and are not designed to answer research questions of primary relevance to the local population. Clearly, in order for research to have maximal benefits to the local population, it is essential that local investigators are involved in the design and conduct of studies from the outset.
Global Health Cancer has been started to create a research capacity building community in the field of Oncology research. Global health Cancer provides a platform for sharing of expertise in the design and execution of clinical trials in a variety of contexts around the world. It will create communities of practice in order to reduce redundancy in expertise, leverage global institutional partnerships and drive efficiency in building capacity in LMICs. Global Health Cancer provides a conduit for the Global Oncology research community to connect remotely and provides the tools to facilitate distance learning and mentoring of clinical researchers. In so doing Global Health Cancer aspires to support others in training a cadre of clinical researchers in LMICs who can themselves begin to tackle the challenges that lie ahead.
The video below, from Global Health Videos by Greg Martin, shared with permission. You can follow more videos from him at his YouTube channel.
10 Facts about cancer:
Published on 4th of Feb 2015: This video looks at Global Health and Cancer in observance of World Cancer Day. We talk about the burden of cancer in both developed and developing countries and take a look at what needs to be done to prevent cancer. For more of This Week in Global Health, go to TWiGH