Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up

Abstract

Noncommunicable diseases are now recognized by the United Nations and WHO as a major public health crisis. Cancer is a main part of this problem, and health care systems are facing a great challenge to improve cancer care, control costs, and increase systems efficiency. The disparity in access to care and outcomes between high-income countries and low- and middle-income countries is staggering. The reasons for this disparity include cost, access to care, manpower and training deficits, and a lack of awareness in the lay and medical communities. Diagnosis and treatment play an important role in this complex environment. In different regions and countries of the world, a variety of health care systems are in place, but most of them are fragmented or poorly coordinated. The need to scale up cancer care in the low- and middle-income countries is urgent, and this article reviews many of the structural mechanisms of the problem, describes the current situation, and proposes ways for improvement. The organization of cancer services is also included in the analysis.

Fig 1.

Global Human Development Index (HDI). Reproduced with permission from the International Agency for Research on Cancer, Wild CP: Cancer in the global NCD agenda: Is it enough? World Cancer Leaders' Summit, Cape Town, South Africa, November 18-19, 2013.

Fig 2.

Cancer burden by Human Development Index (HDI). Data compiled from Bray F, Jemal A, Grey N, et al: Global cancer transitions according to the Human Development Index (2008-2030): A population based study. Lancet Oncol 13:790-801, 2012.