Hundreds of people lined the streets to see a cancer doctor, a common phenomenon in many low- and middle-income countries such as Nigeria, Malaysia and India.Chemotherapy is commonly used in cancer patients in these areas, with little use of radiation or surgery.In fact, 90 percent of patients in low-income countries do not have access to the most basic radiation treatments.
In rich countries, new drugs, procedures and radiotherapy techniques for treating cancer are emerging, but they are not sustainable.Between 2011 and 2015, there were 277 clinical trials of anti-cancer drugs, and only 15% were found to extend life and quality of life for patients.Even more remarkable, recent research has found that the more expensive the treatment, the less effective the treatment is. Del Paggio, J. C. et al.Lancet Oncol. 18, 887–894 (2017)。In low- and middle-income countries, technology-centric cancer treatment strategies are harmful and unhelpful.
Over the past 15 years, three clinical researchers, Richard Sullivan, C. S. Pramesh和Christopher M. Booth is involved in cancer control programs in more than 40 countries. Richard Sullivan is a Professor of Cancer at King's College, C. S. Pramesh is Professor of Thoracic Surgery at Tower of India Memorial Centre, Christopher M. Booth is a professor and principal investigator at Queen's University Cancer Institute in Canada.
Look beyond technology in cancer care. Nature. 549(7672):325-328
The results of a study by the three of them and a large number of epidemiologists suggest that the more important factors leading to cancer deaths in low-income countries are political, economic and social issues.To improve the survival and well-being of 16 million cancer patients worldwide, scientists, doctors, policymakers, and patient organizations must focus on education, stigma, and training to ensure that patients who really need it get the right care at the right time.In a recent article in Nature, three scholars called for avoiding tall new cancer technologies and investing limited funds in the most basic care and treatments.
I. The problem is getting worse
The number of cancer patients is increasing, and by 2007, there were 12.7 million cancer patients worldwide, with an economic impact of nearly $290 billion.Mainly due to population growth, aging and lifestyle changes, 21.7 million cancer patients are expected by 2030, at an estimated cost of $458 billion.
According to UROCARE-5 data, the survival rates of breast cancer patients in 2014 were 14.5% different from those in Denmark and Lithuania, and the survival rates for rectal cancer were as high as 32% different from countries.The situation is even worse in Asia, where a 2012 study showed that patients diagnosed with solid tumors such as breast or colorectal cancer had a one-year mortality rate ranging from 12% in Malaysia to 45% in Myanmar.The proportion of patients suffering from poverty due to high treatment costs ranges from one-quarter in Thailand to two-thirds in Vietnam.
In many hospitals in low-income countries and emerging economies, the most lacking are infrastructure and technicians to treat a variety of cancers.Mumbai's Tata Memorial Centre is India's oldest and largest cancer research centre, with 164 staff and about 40,000 cancer patients a year, compared to 33,000 a year at MD Anderson Cancer Center in Houston.In sub-Saharan Africa, only 16 countries have basic pathology services, trained staff and cancer diagnostic equipment.Most African regions have an average of one pathologist for every 2.3 million people, and high-income countries have one pathologist for every 15,000 to 20,000 people.
Even in well-resourced urban areas, lack of guidance and regulation has led to many clinical laboratories failing to function effectively.In 2011, only 5% of 954 pathology laboratories in Kampala and Uganda met the WHO Regional Office's minimum tissue processing and analytical reporting capacity.Lack of trained staff often fails to make the correct pathological diagnosis.
Another factor affecting the effectiveness of cancer treatment is the lack of early medical treatment, with Tunisia's five-year survival rate for breast cancer being only 68.4 per cent.Part of the reason is that many women in low- and middle-income countries suffer from cancer is disgraceful, and seeing a doctor requires their husband's consent first, and women are worried that a cancer diagnosis will lead to divorce.
Given the lack of education and awareness, treatment levels and conditions that prevent patients from getting an early diagnosis, many low- and middle-income countries should control modest investments in technology.