Global Strategies to Improve Cancer Care and Control

Transcription

1 Women s Empowerment Cancer Advocacy Network (WE CAN) Conference Global Strategies to Improve Cancer Care and Control Tbilisi, Georgia October 15-16, 2013 Julie R. Gralow, M.D. Jill Bennett Endowed Professor of Breast Cancer Director, Breast Medical Oncology Professor, Global Health University of Washington School of Medicine Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance

2 Global Burden of Cancer Mortality: 2008: 7.6 million people worldwide died from cancer 2030: cancer deaths expected to reach 13.2 million Incidence: % of worldwide cancers diagnosed in developing countries % % Ferlay J, et al. GLOBOCAN Lyon: International Agency for Research on Cancer, 2010 Beaulieu N, et al. Breakaway: the global burden of cancer challenges and opportunities. A report from the Economist Intelligence Unit, 2009.

3 Global Burden of Breast Cancer Breast cancer incidence and death rates increasing worldwide 1.2 million new cases of breast cancer reported worldwide annually»45% in low/middle resource countries 55% of deaths from breast cancer occur in low/middle resource countries

4 Percentage Change in Cumulative Mortality of Breast Cancer Forouzanfar H et al, Lancet 2011 # # Positive values show an increase in Cumulative Mortality Rate 4

5 Cumulative mortality of breast cancer from age 20 to 80 years % Cumulative mortality proportion (age 20-80) Australasia Australasia Australasia Europe, Western Europe, Western Latin America, Southern Europe, Western Latin America, Southe North America, High Income North America, High Income Asia Pacific, High Latin America, So Income Asia Europe, Pacific, Central High Income Europe, Europe, North Central Eastern America, H Income Asia, Central Europe, Eastern Latin Europe, America, Central Cent Asia, Central Asia, East Latin Europe, America, Eastern Centra Asia, South Asia, Sub-Saharan East Africa Southern Sub-Saharan Afr Sub-Saharan North Southern Africa Africa, / Middle Southern East

6 Percentage of breast cancer death before age 50 6

7 Cancer Care and Control: A Call to Action Farmer P et al, Lancet, August 2010

8 Evidence for the Feasibility and Effectiveness of Cancer Care and Control in Countries of Low and Middle Income Farmer P et al, Lancet 376, 2010 Much can be done without the latest and most expensive technologies Task and infrastructure shifting could benefit the health systems of even wealthy countries Expansion of treatments for TB and AIDS in poor countries show that new initiatives for care of complex diseases can be effective and strengthen health systems Coordinated financing and procurement can secure reduced prices and increased access to interventions Demonstration programs show that effective cancer diagnosis and treatment can be introduced even in rural areas of low-income countries in which specialized services are absent

9 Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries Task Force report available as free pdf download: Translated into Spanish, Russian, Arabic

10 Global Task Force Report: Core Elements of a Cancer Care and Control Strategy Many cancers are preventable through infection control and lifestyle modifications Accurate cancer diagnosis is critical to determining an appropriate and successful treatment plan Many cancers are highly treatable with affordable therapies that result in the addition of many years of life Denial of therapy for diseases that are highly curable with affordable drugs is unacceptable Palliation of pain and suffering from cancer is a basic human right Reliable data is needed to understand the magnitude of the cancer burden and the potential impact of interventions

11 UN High-level Meeting on Prevention and Control of Non-Communicable Diseases (NCDs) September 19-20, 2011 With Millennium Development Goals expiring in 2015, global health community has unique opportunity to shape framework and priorities for successor agenda NCDs cancer, cardiovascular disease, respiratory disease, diabetes are major challenge to health and development in 21st century Leading cause of death and disability worldwide, exacting heavy & growing toll on physical health and economic security of all countries NCDs a priority for the new UN agenda

12 US NCI Center for Global Health Established November, Goals: Advance global cancer research, build expertise and leverage resources across nations to address challenges of cancer and reduce cancer deaths worldwide

13 US NCI Center for Global Health Primary functions : Develop and implement plans to inform cancer control and provide technical assistance for countries Strengthen U.S. collaboration in global health research, cancer research, and cancer control Train investigators & help develop research capacity in global health across cancer continuum, in U.S. and the developing world Develop and validate new agents and devices for cancer prevention, screening, diagnostics, treatment, and symptom management appropriate for use in developing world Develop scientific initiatives and implement plans relevant to global health and cancer

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15 American Society of Clinical Oncology (ASCO) International Portfolio of education and research opportunities to accelerate collaboration between members, organizations, and countries Multidisciplinary Cancer Management Courses International Clinical Trials Workshops Palliative Care Courses Joint Sessions and Endorsements» Joint Symposia» Best of ASCO International International Development and Education Awards (IDEA) International Innovation Grants

16 Draft WHO Metrics for NCD Action Plan To be finalized at 69 th UN General Assembly September 2014 Primary metric: 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes, chronic respiratory diseases Additional metric: cancer incidence, by type of cancer, per 100,000 population Risk Factors At least 10% relative reduction in harmful use of alcohol, within the national context 10% relative reduction in prevalence of insufficient physical activity 30% relative reduction in prevalence of current tobacco use in persons aged 15+

17 Draft WHO Metrics for NCD Action Plan National Systems Response: 80% availability of affordable basic technologies & essential medicines required to treat major noncommunicable diseases in both public and private facilities Access to palliative care assessed by morphine equivalent consumption of strong opioid analgesics per death from cancer Availability, if cost effective and affordable, of vaccines against human papillomavirus (HPV) Vaccination coverage against HBV monitored by number of 3rd doses of Hep B vaccine administered Proportion of women between screened for cervical cancer at least once

18 Global Alliance for Vaccines and Immunization (GAVI) and HPV Vaccine Pricing: Coordinated Financing and Procurement Innovative public-private partnership launched at World Economic Forum in 2000 Effective May 2013, lowest income countries have access to HPV vaccines for US$ 4.50 per dose Same vaccines cost more than $100 in developed countries Previous lowest public sector price $13 per dose

19 2007 Institute of Medicine Report Cancer Control Opportunities in Lowand Middle-Income Countries Sloan FA, et al, National Academies Press, 2007 Patient advocacy has a key role to play in bringing the public s concerns about cancer to decision makers Summary recommendations: Advocacy Provide active support and assistance of cancer advocacy in low- and middle-resource countries Suggested activities:» Set up advocacy networks within countries, regions, internationally» Identify successful approaches to cancer advocacy and replicate/adapt for use in other settings» Provide hands-on training and technical assistance

20 Promotion of public advocacy for breast cancer prevention, detection, treatment and research Women s Empowerment Cancer Advocacy Network (WE CAN) Goals: To combat breast cancer by building and supporting advocacy groups with skills to address: inadequacy in information inequity in treatment and care injustice in breast cancer early detection, screening, treatment, and prevention

21 WE CAN Eastern Europe/Central Asia Breast Cancer Advocacy Conferences Vilnius, Lithuania 2003 Kiev, Ukraine 2005 Minsk, Belarus 2007 Bishkek, Kyrgyzstan 2009 Vilnius, Lithuania 2011 Tbilisi, Georgia October 2013

22 Global Strategies for Decreasing Cancer Morbidity and Mortality Improve awareness of cancer as a curable (and in some cases preventable) disease Augment cancer registries and data collection Increase early detection - metastatic disease is not treated successfully in ANY country Develop guidelines that are evidence-based, economically feasible, and culturally appropriate Partnerships between community, advocates, governments, nongovernmental organizations and industry