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| SHORT COMMUNICATION |
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| Year : 2022 | Volume
: 19
| Issue : 4 | Page : 747-749 |
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Bridging the gap in the delivery of cancer care in low- and middle-income nations
Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2
1 Deputy Director—Academics, Sri Balaji Vidyapeeth—Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth—Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
| Date of Submission | 17-May-2022 |
| Date of Acceptance | 31-May-2022 |
| Date of Web Publication | 09-Jan-2023 |
Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV)—Deemed to be University, Thiruporur–Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District 603108, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/MJBL.MJBL_73_22
Cancer continues to be one of the global causes of concern, as each year the number of reported cases continues to rise. The available global trends of cancer are a clear indicator of the fact that people are deprived of cancer care and it is predominantly because of the inequality and inequity, which has become an undeniable aspect. Acknowledging the impact of cancer on the individual, family, and the community in terms of impairment in the quality of life and financial load, it is the responsibility of the policy makers to improve the delivery of cancer care. This calls for the need that international welfare agencies and funding partners should join their hands together with an aim to strengthen the prevention, care, and research and development domain of cancer care, especially in low-resource settings. To conclude, despite being a global cause of concern, the care offered to cancer care patients has not been uniform worldwide and a wide range of disparities have been observed. There arises the need to take concerted actions to ensure the delivery of comprehensive care to cancer patients with an intention to minimize their suffering and improve their prognosis. Keywords: Cancer, COVID-19, low- and middle-income nations, prognosis, radiotherapy, screening
How to cite this article:
Shrivastava SR, Shrivastava PS. Bridging the gap in the delivery of cancer care in low- and middle-income nations. Med J Babylon 2022;19:747-9 |
| Introduction | |  |
Cancer continues to be one of the global causes of concern, as each year the number of reported cases continues to rise.[1] The global estimates depict that in the year 2021, in excess of 20 million people were diagnosed with one or the other kind of cancer, whereas 10 million people eventually succumbed to the potential complications.[2] We cannot ignore the very fact that the emergence of the coronavirus disease-2019 (COVID-19) pandemic has interrupted the delivery of essential services, including services targeting cancer care.[3] Thus, the possibility of under-diagnosis or missing deaths cannot be ruled out. Moreover, considering that most of the cancers can be treated, and many more can be prevented or cured, makes the entire dynamics complicated, as it means that we are falling short in our efforts to deliver quality-assured and timely cancer care.[1],[2]
| Gaps in Cancer Care | | |
The available global trends of cancer are a clear indicator of the fact that people are deprived of cancer care and it is predominantly because of the inequality and inequity which has become an undeniable aspect.[1],[4] The existing gaps can be clearly observed by the finding that 9 out of the 10 developed nations have holistic services available for cancer care, whereas only 15% of low-income nations possess this kind of holistic care.[2] On a similar note, people living in remote or rural settings are significantly deprived of cancer care when compared with the people residing in urban settings.[5] This gap can be explained by the prevailing weaknesses in the primary health care delivery system and the lack of facilities to encourage early diagnosis and delivery of suitable treatment.[5],[6],[7]
Another major cause of concern is the finding that highlights that 4 out of 5 children diagnosed with cancers in high-income nations will survive owing to the availability of diagnostic tools promoting early detection and delivery of timely care.[2] On the contrary, the percentage falls to less than 30% in the case of children diagnosed with cancer in low- and middle-income nations, which is an alarming cause of concern.[2] We all will agree that cancer care can account for a huge amount of financial expenditures by the patient and the family, which can easily push them into poverty. There arises the need for financing the cancer care-related services by the government, which is quite evident in almost 80% of the high-income nations. However, we must note that government-sponsored health financing significantly drops to only 37% in the low- and middle-income nations.[2] All these are alarming estimates suggesting that a wide gap in cancer care exists and we have to take urgent steps to bridge the existing gaps.[2],[5],[6],[7]
| Bridging the Cancer Gap | | |
Acknowledging the impact of cancer on the individual, family, and the community in terms of impairment in the quality of life and financial load, it is the responsibility of the policy makers to improve the delivery of cancer care.[8] As highlighted above, the need of the hour is to focus our attention toward developing nations and the rural settings, wherein the majority of people are deprived of basic services, including screening.[5] This calls for the need that international welfare agencies and funding partners should join their hands together with an aim to strengthen the prevention, care, and research and development domain of cancer care, especially in low-resource settings.[5],[8]
As early diagnosis plays a crucial role in determining the prognosis of the patients, the first priority is to strengthen the screening services and gradually expand to all cancers, starting from the cancers that are most prevalent in the local settings.[1],[4] Any kind of investment in screening will result in huge benefits in terms of reducing out-of-pocket expenditure, the burden on the health system, and impairment of the quality of life.[1],[6] Recognizing the benefits which a tertiary center offers to the patients, it is very much essential that the Government should establish a national cancer center, which eventually ensures that all services pertaining to prevention, diagnosis, and treatment are offered under a single umbrella, and people don’t have to run from one place to another, and thereby minimize their sufferings.[2]
| Radiotherapy and Cancer Care | | |
The experience in the treatment of cancers has shown that the modality of radiotherapy is one of the most cost-effective and predominantly employed treatments of choice in a significant proportion of cancer patients.[9] However, it is quite surprising that regardless of being such an important component of cancer care, access to radiotherapy is very much inadequate in developing nations. We have to rise to the occasion and ensure that people are not deprived of radiotherapy and more centers are established that offer radiotherapy to patients.[2],[9] As already stated, it is high time that we pool our resources and make concerted efforts to eliminate the impact of the COVID-19 pandemic on cancer care, and this will essentially require a collaborative and concerted plan of action.[3],[10] Finally, all these services cannot be delivered, unless the health sector is supported in terms of an adequate infrastructure, resources and logistics, and adequate number of human resources, including healthcare professionals.[7],[8]
| Conclusion | | |
To conclude, despite being a global cause of concern, the care offered to cancer care patients has not been uniform worldwide and a wide range of disparities have been observed. There arises the need to take concerted actions to ensure the delivery of comprehensive care to cancer patients with an intention to minimize their suffering and improve their prognosis.
Contribution details
SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work. PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.
Ethical consideration
Not applicable.
Financial support and sponsorship
Not applicable.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 7. | Sisler J, McCormack-Speak P Bridging the gap between primary care and the cancer system: The UPCON network of Cancercare manitoba. Can Fam Physician 2009;55:273-8. |
| 8. | Graham GL The leadership gap: Supporting new front line leaders in cancer care. J Med Imaging Radiat Sci 2020;51:54-61. |
| 9. | Rodin D, Longo J, Sherertz T, Shah MM, Balagun O, Wendling N, et al. Mobilising expertise and resources to close the radiotherapy gap in cancer care. Clin Oncol (R Coll Radiol) 2017; 29:135-40. |
| 10. | Schmidt AL, Bakouny Z, Bhalla S, Steinharter JA, Tremblay DA, Awad MM, et al. Cancer care disparities during the COVID-19 pandemic: COVID-19 and cancer outcomes study. Cancer Cell 2020;38:769-70. |
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