Building a strategy for 2025: uniting evidence and policy to achieve cancer control for all

Transcription

1 Building a strategy for 2025: uniting evidence and policy to achieve cancer control for all Building on commissions: Latin America in 2015 Diego Touya, MD Number (code): 4-T2 Track 2 Disclosure of interest: No relationships to disclose

2 The Cancer Burden in Latin America

3 Ageing of the population > 100 million people over 60 years by /6 of the total population Statistical yearbook for Latin America and the Caribbean 2014

4 Trends in Tobacco use in Latin American countries (2000, 2010 and 2025) 22% of all cancer deaths

5 Infections and cancer 17% Cancer cases attributable to infection for the region De Martel, Lancet Oncol 2012;

6 2013 Lancet Oncology Commission Universal health care Increase financial resources for cancer control Resource allocation Number of cancer care specialists and redistribution Improve technical resources and services National cancer registries Education

7 Objective To assess evolving cancer policies in Latin America since 2013, and to identify remaining challenges.

8 Content 1. Fragmented health systems 2. Palliative care 3. National cancer plans and cancer registries 4. Financing of cancer care 5. Training in oncology and palliative care 6. Disparities in cancer control 7. Causes of cancer that are of specific concern to Latin America 8. Continuing challenges and remaining questions

9 1. Fragmented Health systems Def. refers to a coexistence of subsystems with different modalities of financing, affiliation, and health-care delivery, specialising in different sectors of the population and often competing with one another. Health systems - Well-funded social security system- employed - Poorly financed public insurance- unemployed Integration of social security and public insurance - Brazil, Cuba, Costa Rica, Uruguay

10 Regional initiatives Health-care packages of interventions for specific diseases (poorest sectors and preventive and primary care) - Increase coverage ( ) from 46 to 60% - ie. Peru, Mexico, Colombia - Avoids large out-of-pocket Unified benefits without a universal health system - ie. Colombia, Chile

11 Country Mexico Cancer packages Scheme Public Health System (Seguro Popular) Social Security (IMSS) Government employees system (ISSSTE, SEDENA, PEMEX, SEMAR) Coverage (population) 45% 44% 7% Covered Cancers Pediatric cancer Cervical cancer Breast cancer Germ cell tumors Non-Hodgkin lymphoma Prostate cancer Colorectal cancer All malignant diseases are covered All malignant diseases are covered

12 Proportion of population covered Covered cancers Drug coverage according to organization Met breast cancer Met prostate cancer Met lung cancer Supportive care

13 1.Fragmented health systems Future Action Profound segregation between the public and the private health-care sector and between social security systems and basic coverage need to be addressed to overcome inequalities in health-care access Efforts towards universal health care with equitable services and coverage including comprehensive care packages for all types of cancer

14 2. Palliative care Publication of the Atlas of Palliative Care in Latin America (first systematic gathering of information on the status of palliative care in Latin America) 1. Increase in the number of palliative care services (922 in 2011 compared to 200 in 2006) 2. Integration of palliative care courses in training programs - ie. Argentina 3. Inadequate opioid availability

15 Indicators of quality in palliative care in Latin America LA: less than 15 mg per capita, DC: mg per capita

16 2.Palliative care Future Action Programs of ambulatory palliative care should be prioritized as they are costeffective and enhance the quality of life of patients with cancer National guidelines, which recommend end-of-life use of strong opioids need to be implemented and monitored to overcome the alarmingly low amounts of strong opioid consumption in Latin America

17 3. National cancer plans and cancer registries 8% increase in the number of countries with NCCP - Suriname, Ecuador, Dominican Republic, Trinidad and Tobago, Puerto Rico, Peru, El Salvador, Colombia Successfully implemented and assessed - ie. Plan Esperanza (Peru)

18 National cancer control policies

19 National obesity control policies

20 National tobacco control policies

21 National alcohol control policies

22 National cancer registries policies 21% 67% Coverage 6% of the total population (US 98%, EU 32%)

23 International cancer control policies Global Action Plan for the Prevention and Control of Non-Communicable Diseases (WHO) Women s Cancer Initiative 2013 (PAHO/WHO) International Cancer Control Planning Partnership to implement NCCP Global Initiative for Cancer Registry Development (IARC)

24 3.National cancer plans and cancer registries Future Action The implementation and success of the numerous newly signed national cancer control plans have to be monitored and this process should be done in cooperation with international organizations Within existing cancer registries, population coverage needs to increase and quality ensured

25 4. Financing of cancer care Average expenditures on health care per person is low - Increase of percentage of GNP spent on health has increased in some countries - ie. Brazil, Argentina Poor access to high-cost drugs - Judicialization of medicine - Establishment of agencies for health technology assessments (Brazil, Argentina, Colombia, Mexico) - Biosimilars Some advancements: HPV vaccination, PET-CT

26 Health Expenditures Indicators GNP spent on health in 2010 (%) GNP spent on health in 2013 (%) Average expenditure per person on health in 2013 (US$) USA Canada Brazil Argentina Mexico Venezuela

27 CONITEC: resolutions by intervention or technology for various cancers (Agency for health technology assessments of Brazil )

28 4.Financing cancer care Future Action Further redistribution of public expenditure towards health care is needed. Health technology assessments allowing for local cost-effectiveness thresholds should be done on drugs, different screening methods, diagnostic and therapeutic procedures.

29 5. Training Implementation of the Red de Institutos Nacionales de Cancer, RINC - Education exchange and training in cervical cancer screening International biobank - to train pathologists, nurses, and technicians Pathological reference training centers - Colombia, Mexico Foundation of the Global Cancer Institute - Networking of oncologist worldwide to improve cancer outcomes

30 Increase in the number of clinical oncologists: Brazil (77%), Mexico (55%) Awareness of shortage of cancer specialists

31 5.Training in oncology and palliative care Future Action Efforts towards increasing the oncology workforce need to continue to reduce the patient-to-oncologist ratio Initiatives to train health-care personnel in screening and care in remote areas should be extended International exchange programmes should continue to be used to improve patterns of practice. Palliative care training needs to be integrated into medical school curricula in all medical schools in Latin America

32 6. Disparities Inequitable geographical distribution of tertiary centers Longest delays to diagnosis and treatment start (median 7 months in Brazil and Mexico) Initiatives - Telemedicine networks (Peru, Ecuador, Colombia) - Relocalization of specialized facilities (Plan Esperanza) - Training to health care providers in remote areas (Colombia- visual inspection for detection of cervical lesions and immediate treatment with cryotherapy). - Incentives and Rewards programs for physicians to practice in rural areas (Brazil, Chile, Argentina)

33 6.Disparities in cancer control Future Action Improvement the health services in rural and remote regions Concentration of cancer services and specialists in urban centers needs to be addressed urgently, eg, through incentive systems or emphasis on primary care training Programs with patient navigators and health workers belonging to indigenous communities to overcome language, organizational, and financial barriers Integration of health services into existing platforms, as done by Pro Mujer with microfinance institutions

34 7. Causes of cancer that are specific concern to Latin America Tobacco Tobacco use declined over past 15 years Implementation of tobacco control policies Increase in cigarette prices (taxes) - Chile, Cuba ( 75%) Coordinated control initiatives (MERCOSUR countries) to regulate cross-border trade between states. Collaborative efforts to understand social and cultural factors an prevention interventions - ASPIRE, COMET

35 22/33 countries raised their tobacco taxes between 2008 and 2012

36 Indoor smoke Awareness Peru-programs to provide cooking stoves ( c.s people) High rates of EGFR mutated lung cancer

37 HPV and cervical cancer 20 countries introduces HPV vaccination (only 4 countries in 2011). - Coverage: 50%-Argentina, 67%- Mexico, 59%- Brazil Screening programs - Access (rural and remote population) and good quality pap smears (Boa Vista, Brazil-86% participate screening but the incidence of cervical cancer remains high) Programs to see-and-treat based on visual inspection with acetic acid (VIA) or screening strategy based on HPV DNA testing could be more effective in the region.

38 7.Causes of cancer of particular concern to Latin America Future Action Implementation of tobacco control policies needs to be optimized and monitored, particularly to reduce the high proportion of adolescent smokers Awareness about the problem of indoor smoke exposure needs to be enhanced and programs to provide nontoxic cooking stoves need to be expanded Identify optimum screening programs per region Screening and vaccination strategies addressing cervical cancer should be monitored for success and shortcomings Timely diagnostic workup and treatment are essential to complement screening, which will otherwise be futile

39 8. Continuing challenges and remaining questions Towards universal health care Redistribution of the health budget - Pharmacoeconomic studies to define priorities Promote palliative care into national agendas Improve prevention programs Biosimilars and generics/access to cancer drugs Insufficient infrastructure and human resources (remotes areas) Most effective and implementable screening strategies/ Education

40

41 RINC-UNASUR (Network of National Institutes and Institutions of Cancer-Union of South American Nations) Cervical Cancer Control Group - "UNASUR Region Plan Cervical Cancer Free". Tumour Bank Group - Contributes to the implantation of tumor banks in institutions of Latin America and Caribbean Cancer Registries Group - Develop a model for the dissemination of information about cancer. Social Communication Group - Communication is an important action in cancer control. Breast Cancer Control Group - It is conducting a survey on the situation of the disease in the region as a basis for the development actions.

42 Global Cancer Institute (GCI) Definition: GCI is the only non-profit completely focused on improving survival rates for underserved cancer patients worldwide. GCI is working to close that gap in cancer control between developed and developing countries. Programs: Patient Navigation Program Online Global Tumor Boards Young Women's Breast and Cervical Cancer Databases.

43 Merci. Thanks. Gracias.