Cancer control in the Pacific: big challenges facing small island states

doi:10.1016/S1470-2045(19)30400-0

Review

. 2019 Sep;20(9):e475-e492.

doi: 10.1016/S1470-2045(19)30400-0. Epub 2019 Aug 5.

Cancer control in the Pacific: big challenges facing small island states

Diana Sarfati¹, Rachel Dyer², Filipina Amosa-Lei Sam³, Michael Barton⁴, Freddie Bray⁵, Eka Buadromo⁶, Alec Ekeroma⁷, Sunia Foliaki⁸, James Fong⁹, Josephine Herman¹⁰, Linda Huggins¹¹, Kiki Maoate¹², Ineke Meredith¹³, Glen Mola¹⁴, Neal Palafox¹⁵, Viliami Puloka¹⁶, Hai-Rim Shin¹⁷, Jane Skeen¹⁸, Wendy Snowdon¹⁹, Malama Tafuna'i²⁰, Andrea Teng², David Watters²¹, Paula Vivili²²

Affiliations

¹ Department of Public Health, University of Otago Wellington, Wellington, New Zealand. Electronic address: diana.sarfati@otago.ac.nz.
² Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
³ Pathology Department, Tupua Tamasese Meaole Hospital, Private Bag National Health Services, Apia, Samoa.
⁴ Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia.
⁵ Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France.
⁶ Pathology Department, Vaiola Hospital, Nuku'alofa, Tonga.
⁷ Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa; Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand.
⁸ Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand.
⁹ Obstetrics and Gynaecology Unit, Colonial War Memorial Hospital, Ministry of Health, Suva, Fiji; Department of Obstetrics and Gynaecology, Fiji National University, Suva, Fiji.
¹⁰ Ministry of Health, Rarotonga, Cook Islands.
¹¹ Palliative Care Services, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
¹² Department of Paediatric Surgery, Christchurch Public Hospital, Christchurch, New Zealand.
¹³ Department of Surgery, Capital; Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand.
¹⁴ Department of Obstetrics, Gynaecology and Reproductive Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea; School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea.
¹⁵ Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
¹⁶ Department of Public Health, University of Otago Wellington, Wellington, New Zealand; Health Promotion Forum of New Zealand, Auckland, New Zealand.
¹⁷ Non-communicable Disease and Health Promotion, Western Pacific Regional Office, World Health Organization, Manila, Philippines.
¹⁸ Starship Blood and Cancer Centre, Starship Children's Health, Auckland, New Zealand.
¹⁹ Division of Pacific Technical Support, World Health Organization, Suva, Fiji.
²⁰ Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa.
²¹ Deakin University and Barwon Health, University Hospital Geelong, Geelong, VIC, Australia.
²² Public Health Division, Pacific Community, Noumea, New Caledonia.

PMID: 31395476
PMCID: PMC7746436
DOI: 10.1016/S1470-2045(19)30400-0

Review

Cancer control in the Pacific: big challenges facing small island states

Diana Sarfati et al. Lancet Oncol. 2019 Sep.

. 2019 Sep;20(9):e475-e492.

doi: 10.1016/S1470-2045(19)30400-0. Epub 2019 Aug 5.

Authors

Affiliations

¹ Department of Public Health, University of Otago Wellington, Wellington, New Zealand. Electronic address: diana.sarfati@otago.ac.nz.
² Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
³ Pathology Department, Tupua Tamasese Meaole Hospital, Private Bag National Health Services, Apia, Samoa.
⁴ Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia.
⁵ Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France.
⁶ Pathology Department, Vaiola Hospital, Nuku'alofa, Tonga.
⁷ Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa; Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand.
⁸ Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand.
⁹ Obstetrics and Gynaecology Unit, Colonial War Memorial Hospital, Ministry of Health, Suva, Fiji; Department of Obstetrics and Gynaecology, Fiji National University, Suva, Fiji.
¹⁰ Ministry of Health, Rarotonga, Cook Islands.
¹¹ Palliative Care Services, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
¹² Department of Paediatric Surgery, Christchurch Public Hospital, Christchurch, New Zealand.
¹³ Department of Surgery, Capital; Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand.
¹⁴ Department of Obstetrics, Gynaecology and Reproductive Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea; School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea.
¹⁵ Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
¹⁶ Department of Public Health, University of Otago Wellington, Wellington, New Zealand; Health Promotion Forum of New Zealand, Auckland, New Zealand.
¹⁷ Non-communicable Disease and Health Promotion, Western Pacific Regional Office, World Health Organization, Manila, Philippines.
¹⁸ Starship Blood and Cancer Centre, Starship Children's Health, Auckland, New Zealand.
¹⁹ Division of Pacific Technical Support, World Health Organization, Suva, Fiji.
²⁰ Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa.
²¹ Deakin University and Barwon Health, University Hospital Geelong, Geelong, VIC, Australia.
²² Public Health Division, Pacific Community, Noumea, New Caledonia.

PMID: 31395476
PMCID: PMC7746436
DOI: 10.1016/S1470-2045(19)30400-0

Abstract

This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.

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Figures

**Figure 1:. Map of the Pacific region**
Green islands are part of Melanesia, red islands are part of Polynesia, and yellow islands are part of Micronesia.

**Figure 2:**
Estimated proportion of total cancer incidence and mortality for the top five cancers by gender in selected Pacific island countries and territories (GLOBOCAN 2018)

**Figure 3:. Required travel routes and times taken by patients within selected Pacific Island countries and territories to access cancer care**
Transportation methods and time taken for patients from Kiribati (A), Tokelau (B), Solomon Islands (C), and Papua New Guinea (D) to reach cancer care. NRH=National Referral Hospital of Honiara.

See this image and copyright information in PMC

Comment in

The Commonwealth: an anachronism or a relevant organisation for the future?
Collingridge D. Collingridge D. Lancet Oncol. 2020 Jul;21(7):875-876. doi: 10.1016/S1470-2045(20)30266-7. Lancet Oncol. 2020. PMID: 32615103 Free PMC article. No abstract available.

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[1] Statistics for Development Division. 2018 pocket statistical summary. 2018. https://prism.spc.int/ (accessed Oct 30, 2018).

[2] Statistics for Development Division. 2018 pocket statistical summary. 2018. https://prism.spc.int/ (accessed Oct 30, 2018).

[3] SPC-SDD. National minimum development indicators. 2018. http://www.spc.int/nmdi/ (accessed May 18, 2018).

[4] SPC-SDD. National minimum development indicators. 2018. http://www.spc.int/nmdi/ (accessed May 18, 2018).

[5] World Bank. World Bank open data. 2018. https://data.worldbank.org/ (accessed July 8, 2018).

[6] World Bank. World Bank open data. 2018. https://data.worldbank.org/ (accessed July 8, 2018).

[7] McIver L, Kim R, Woodward A, et al. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 2016; 124: 1707–14. - PMC - PubMed

[8] McIver L, Kim R, Woodward A, et al. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 2016; 124: 1707–14. - PMC - PubMed

[9] Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States (UN-OHRLLS) Small island developing states in numbers: climate change. Edition 2015. https://sustainabledevelopment.un.org/content/documents/2189SIDS-IN-NUMB... (accessed Jul 8, 2019)

[10] Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States (UN-OHRLLS) Small island developing states in numbers: climate change. Edition 2015. https://sustainabledevelopment.un.org/content/documents/2189SIDS-IN-NUMB... (accessed Jul 8, 2019)

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Cancer control in the Pacific: big challenges facing small island states

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Cancer control in the Pacific: big challenges facing small island states

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