Scarce Resources are best Applied to Prevention The Anti Argument

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1 Scarce Resources are best Applied to Prevention The Anti Argument Lawrence N Shulman, MD Director, Center for Global Cancer Medicine Abramson Cancer Center, University of Pennsylvania Senior Oncology Advisor Partners In Health

2 Cancer Treatment in Resource-Constrained Settings? Too expensive, too complex can t be done in resourceconstrained settings you will kill more people than you will help Giving out free cancer drugs would not help the poorest parts of Africa, the head of a pharmaceutical giant has told the BBC. He said "dramatic" progress was being made in treating tumours, and defended the company's pricing policy. And he said that training doctors, not the cost of drugs, was the biggest issue in the world's poorest countries. Access to treatment has been one of the key themes of the world's biggest cancer conference You should focus completely on prevention which is less costly and more feasible and 1/3 of cancers are preventable (real quotes)

3 Prevention versus Treatment A false argument. It is not an either or As was shown with HIV/AIDS prevention and treatment strategies strengthen each other.

4 Do we turn our backs on these children with a potential 80% cure rate? None have preventable cancers.

5 If you want to have the biggest impact on reducing cancer-related mortality world-wide.you need to bring the tools we currently have at our disposal to the many cancer patients who have no access.. But it those tools must be used effectively and safely

6 What is the vision for global cancer care? Patients should expect accessible, high-quality cancer care for treatable and preventable cancers Care should be affordable poverty should not be a barrier to care for many in the world this will mean care must be free Efforts should aim to develop and strengthen incountry capacity for all aspects of cancer care and for the full spectrum of cancer specialists

7 The Continuum of Cancer Care and Services Education Risk Reduction Screening Diagnostics Early Detection Treatment Survivorship Palliative Care

8 Cancers where we could make an impact (not all-inclusive list): Diseases amenable to risk reduction Tobacco control lung, head and neck, bladder HPV vaccine Cervical and H&N Hepatitis vaccine - Hepatocellular Diseases curable with early detection, surgery, and treatment Breast cancer, Cervical cancer, Sarcoma, Colon cancer Diseases curable with affordable chemotherapy Non-Hodgkin s Lymphoma (Burkitt s/large cell) Hodgkin s Lymphoma Testicular cancer Acute Lymphoblastic Leukemia in children Diseases palliated with systemic treatment Chronic Myeloid Leukemia Advanced Breast cancer Kaposi s sarcoma

9 Principles of Cancer Care at PIH Sites Treatment program without on-site oncologists or hematologists but with the back-up of specialists via electronic communication weekly calls between the Dana-Farber Cancer Institute and Rwanda teams There will not be enough oncologists to care for most of the world s cancer patients for decades, and so we need alternate models Now supported by ASCO

10 Journal of Clinical Oncology 2015

11 Benefits of Implementation Science First and foremost improve care for the benefit of our cancer patients Prove to international organizations, governments, and NGOs that safe and effective cancer care is possible in these settings Prove to funders that it is worth supporting cancer care

12 How do we get from this

13 Fabrice, 4 years old Dx Wilms Tumor Inexpensive chemotherapy And Surgery Disease-free Estimated cost - $1,400 USD

14 Journal of Global Oncology 2016

15 59% of children disease-free Journal of Global Oncology 2016

16 Chronic Myeloid Leukemia Imatinib Free from the Max Foundation

17 Journal of Global Oncology 2016

18 95% of patients alive, and 75% in hematologic remission Journal of Global Oncology 2016

19 Linking humility and bold vision to scientific rigor is the surest route to value and equity in global health. Dr. Agnes Binagwaho, Former Minister of Health, Rwanda