Summary

Excerpt

At the 2012 World Health Assembly, member states agreed to a goal of reducing rates of premature death from noncommunicable diseases (NCDs) by 25 percent by 2025, starting from a 2008 baseline (WHO 2011a, 2011b). The United Nations (UN) Sustainable Development Goals for 2030, announced in September 2015, will include reducing premature death from NCDs, of which cancer is a substantial part (map 1.1).

This chapter summarizes the analyses and conclusions of the 79 authors of this volume on cancer, Disease Control Priorities, 3rd edition (DCP3 Cancer), and analyzes interventions for effectiveness, cost-effectiveness, affordability, and feasibility in low- and middle-income countries (LMICs; see box 1.1 for key messages). The intent is to help governments of LMICs commit to locally appropriate national cancer control strategies that will include a range of cost-effective interventions, customized to local epidemiological patterns and available funding, and to convey this commitment widely to their populations. Where affordable treatment can be provided, conveying this to the public can motivate people to seek treatment when their cancer is at an earlier, much more curable stage. Providing a package of services that addresses a large part of the cancer burden will go a long way toward helping countries reach the new NCD goals. DCP3 Cancer is one of nine planned volumes in the DCP3 series (box 1.2).

The DCP3 package includes prevention strategies, but many cancers cannot be prevented to any great extent by available methods. Some can be treated effectively (breast and childhood cancers, for example), however, and the availability of effective treatment bolsters public confidence in the overall program (Brown and others 2006; Knaul and others 2011; Sloan and Gelband 2007). Cancer control programs can mobilize broad political support, as happened in Mexico with the addition of breast cancer and childhood cancer treatment into expanded national health insurance coverage (Knaul and others 2012).

In high-income countries (HICs), most who develop cancer survive, although survival depends strongly on the type of cancer (table 1.1). In LMICs, less than one-third survive, and in some the proportion is much smaller (Ferlay and others 2015). The differences in survival are due partly to differences in the patterns of cancer incidence; some types of cancer that are common in many LMICs, such as lung, esophagus, stomach, and liver cancers, have a poor prognosis even in HICs (Bray and Soerjomataram 2015, chapter 2 in this volume). The other major contributor to poor outcomes is that many fewer people come for treatment when their cancer is at an early, curable stage than in HICs (Allemani and others 2015; Ferlay and others 2015).

The aim of DCP3 is to identify cost-effective, feasible, and affordable interventions that address significant disease burdens in LMICs (box 1.3). Accordingly, we have examined the following:

1. 1. The avoidable burden of premature death (defined as before age 70, which approximates current global life expectancy) from cancer in LMICs (table 1.1)

2. 2. The main effective interventions for the prevention, early detection, treatment, and palliation of cancer, and their cost-effectiveness

3. 3. The costs and feasibility of developing health system infrastructure that could deliver progressively wider coverage of a set of cost-effective cancer services.

Using these inputs, we define an “essential package” of cost-effective interventions for cancer and discuss their affordability and feasibility, which differ markedly between low-, lower-middle-, and upper-middle-income countries. Even within the same income categories, countries may differ widely in epidemiological patterns and health systems, resulting in different country-specific essential packages. Hence, this is not intended to lead to a common cancer plan for all LMICs, but to identify elements that will be appropriate in many countries and spur discussion within countries about rational cancer control planning and implementation. The result would be national cancer plans that are tailored to local conditions but retain the characteristics of effectiveness, cost-effectiveness, feasibility, and affordability. Finally, we review some ways in which global initiatives could help LMICs to expand cancer control.