Globally, Cancer is one of the main causes of sickness and death, and while the mortality rates in some high-income countries such as  Australia, France, Japan the UK and the United States is getting less, this is not so everywhere.
These countries have well-developed economies and broad access to resources, but in developing countries, otherwise known as low- and middle-income countries (LMICs), that do not have the same resources to treat cancer, deaths from cancer are actually rising.
High-income countries have resources for wide-scale cancer prevention programs and modern treatment facilities including   large cancer centres and hospitals, state-of-the-art research facilities, and access to cancer drugs.
Prevention efforts include access to cancer screening programs and public health campaigns which create awareness of cancer risk factors that people can change, including smoking, sun exposure, and obesity.
The sad truth is that 60% of the world’s new cases of cancer are diagnosed in LMICs. An LMIC is a country that has a gross national income of less than $12,235 per person per year, which means that their governments must make difficult decisions about where to use money given their much more limited resources.
The fact that rates of cancer diagnoses and deaths are rising in LMICs is frightening – 11% of the world’s population lives in Sub-Saharan Africa, yet countries in this region carry 25% of the “global burden of disease,” which is a measurement that combines years of life lost due to early death and years spent in poor health.
Countries in Sub-Saharan Africa make up a mere 1% of global health spending. In contrast, the Americas make up 14% of the world population; carry 10% of the global burden of disease and account for more than 50% of global health spending.

Statistics at a Glance: The Burden of Cancer Worldwide
Cancer is among the leading causes of death worldwide. In 2012, there were 14 million new cases and 8.2 million cancer-related deaths worldwide.
The number of new cancer cases will rise to 22 million within the next two decades.
More than 60% of the world’s new cancer cases occur in Africa, Asia, and Central and South America; 70% of the world’s cancer deaths also occur in these regions.

Radiation therapy is the most common way cancer is treated, yet 29 of 52 countries in Africa have no radiation therapy centres whatsoever. There are about 198 million people living in these 29 countries, as opposed to the United States which has over 2,000 radiation therapy centres for its 320 million citizens.
High-income regions spend 5 to 10 times more on health care per person than LMICs, which results in less than 50% of people diagnosed with cancer in high-income countries dying from the disease whereas 66% of people with diagnosed with cancer in LMICs die from the disease.
Low- and middle-income countries face various challenges around controlling cancer, including:

  • Cancer is not seen as a priority public health issue
  • Cost of and access to cancer drugs
  • Patients are already at an advanced stage of the disease at time of diagnosis
  • Small numbers of cancer specialists and other oncology professionals

While there are many governments and international organisations working in collaboration to improve access to cancer prevention and treatment worldwide, money alone is not the solution. Apart from more funding, there also needs to be improved awareness of warning signs of cancer, improved access to surgery, radiation therapy, imaging, and pathology, and the organisation and structure of how cancer care is delivered also needs to improve.
Resource-stratified guidelines can identify treatment options that would provide the best possible outcomes for patients in areas with limited health resources. These guidelines could also recommend ways for LMICs to improve cancer care and advise doctors on how to provide the best possible care with limited resources.
Resource-stratified guidelines work on a levelled system which can ensure that those diagnosed with cancer who live in areas with limited resources get the best possible care.
An example of a Levelled System:

  1. Basic level: Core services that are necessary.
  2. Limited level: Services that will improve health outcomes at a low cost and with limited facility needs.
  3. Enhanced level: Services that are optional but further improve outcomes and increase the number and quality of treatment options for patients.
  4. Maximum level: Services that might be used in high-income countries or are recommended in cancer guidelines that do not account for resource constraints. These services cost more and are usually not within reach for places with limited resources.

Much can be done to help LMICs improve access to cancer treatment and prevention. Improving outcomes does not necessarily mean using the most recently approved drugs or procedures, but utilising the most valuable tool for the option. 

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