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Cancer burden by type

Scaling up for treating cancers in LMIC: towards a comprehensive cancer treatment programme Andreas Ullrich MD MPH Geneva Switzerland. Cancer burden by type. Cancer Control Capacity (2011). Population per Radiotherapy Service. http://cancer.iaea.org/agart.asp. Health system for cancer control.

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Cancer burden by type

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  1. Scaling up for treating cancers in LMIC: towards a comprehensive cancer treatment programmeAndreas Ullrich MD MPHGeneva Switzerland

  2. Cancer burden by type

  3. Cancer Control Capacity (2011)

  4. Population per Radiotherapy Service • http://cancer.iaea.org/agart.asp

  5. Health system for cancer control

  6. The “cancer chapter” of the NCD action plan Every country with a national NCD strategy which includes: • Behavioral risk reduction/ HPV/ HBV • Cervical cancer screening • Cancer registry

  7. Projections NCD avoided BAU Business as usual Achieving 6 NCD Targets

  8. What we can learn: • Behavioural Risk Reduction alone will not achieve 25x25 Goal • Infectious /environmental factors are at the forefront in Low and Middle income Countries • Early detection + treatment: key element of additional contribution to 25 x 25 Goal • Strengthen health care systems is at stake

  9. Comprehensive approach Framework TERTIARY PREVENTION SECONDARY PREVENTION PRIMARY PREVENTION

  10. Cancer Screening Cervical cancer Breast Cancer Colorectal cancer Oral cancer

  11. Success criteria • Feasibility in pilot • Governance and leadership. • health system • Validated protocols and guidelines • Quality assurance and information systems • Regular monitoring, • Sufficient organizational and financial

  12. A health system for cancer control • Using a building block framework • Integration into existing health care systems Medicines Workforce Services Governance

  13. Expected outcome Increased access to cancer care Challenges for service integration Services Proposed linkages HIV services Existing services Provincial hospital Almost absent Tertiary care Priority intervention: Prevention / palliative care Community Reproductive Primary Health Care

  14. The cost of cancer • Method (1)* : costs of care ( 53%) + care givers (23%) + productivity loss (24%) *: > 1.16 Trillion US $ = 2% GDP • Method (2)** statistical life approach + variety of individual costs > 2.5 Trillion (1.7 HIC / 0.8 LMIC) * Beaulieu Economist Intelligence (2010) • ** WEF (2011)

  15. Cancer Medicines: Sales & Market Share by region • * $ Million

  16. Cost of Cancer Treatment: Breast Cancer

  17. Fundamental tension(s) over how to solve the ‘cost crisis’:multiple lessons…… Human desire for health services • Accurately measure costs & link to outcomes, Robert Kaplan & Michael Porter, Sept, 2011 Harvard Business Revew • Implement Value Based Pricing • Convergence of ‘regulatory-acceptable’ efficacy & effectiveness: greater hurdles for all domains to demonstrate • Reduce / stop off label use • Mandatory integration of socio-economic studies into clinical research Why do we love medicines so much? EMBO Reports 2010 11: 572-78

  18. The way forward • Political: UN NCD review July 2014: the opportunity for the professional cancer organizations to join the debate • Normative: Expansion of the WHO model essential medicines list for anti neoplastic medicines • Clinical: Collaboration with professional organizations (ESMO ASCO SLACOM): national treatment standards • Research:health system for cancer control, analysis of effectiveness /cost –effectiveness of cancer treatment regimens

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