118IN - Overcoming cancer in developing countries; how to improve cancer care

Date 27 September 2014
Event ESMO 2014
Session ESMO Emerging Countries Committee (ECC) - AORTIC-SLACOM-UICC: Personalised medicine with limited resources: Myth or reality?
Topics Bioethics, Legal, and Economic Issues
Presenter Ian Magrath
Citation Annals of Oncology (2014) 25 (suppl_4): iv40-iv40. 10.1093/annonc/mdu316
Authors I.T. Magrath1, M.A. Adde2
  • 1Director's Office, International Network for CancerTreatment and Research (INCTR), BE-1180 - Brussels/BE
  • 2Clinical Trials, International Network for CancerTreatment and Research (INCTR), 1640 - Brussels/BE




In order to improve the quality of cancer care the obstacles to care must first be identified. Poverty often inhibits health-care seeking behavior, since care may be unaffordable, while stigma also contribute to late diagnosis. Low GDP inhibits public spending on health-care as well as on factors that impact upon access to care, e.g., transportation, too few health-care facilities, and on the purchase of necessary equipment for imaging, diagnostic reagents, radiotherapy, chemotherapeutic drugs, trained cancer specialists and specialist surgeons as well as oncology nurses, pharmacists and social workers. Although some Low and Middle Income countries (LMIC) are able to provide transportation and treatment costs, sometimes by insurance schemes, the latter may not cover cancer and payment for diagnosis and treatment is usually “out-of-pocket.” With respect to expertise in cancer care, the obstacles begin at the level of secondary education, which is still insufficient in the poorest countries to educate students to the level required for university entrance. University teachers, similarly, are few. Although cancer has a higher incidence in high income countries, mortality to incidence ratios are significantly lower (0.47) than in LMIC (0.64). In the lowest income countries, the majority of patients with cancer die, generally without end-of-life care. What can be done? It is critical to increase the pool of young people eligible for university and the number of university places. Lack of universities can be compensated for by distance learning and webinars (from anywhere in the world) as well as tutors for knowledge transfer; but more hospitals will be required as well as at least one specialist cancer center to act as a nuclear site for skills training and delivery of cancer services. Campaigns via the media, posters, meetings, etc, should acquaint the population, including primary-care providers, with the signs of potential cancer to ensure earlier diagnosis and promote referral networks. Additional radiation machines, radiation oncologists and physicists are sorely needed. Treatment of diseases not requiring radiation or major surgery is presently the most feasible and cure is already possible.


All authors have declared no conflicts of interest.