2022’s World Cancer Day theme is “Close the Care Gap”1 and is focused on raising awareness of the cancer care equity gap that affects almost everyone, in high as well as low- and middle-income countries, and costs lives. DDW’s Megan Thomas comments on the crisis as well as initiatives that are working to close this gap.
World Cancer Day is a global initiative is led by the Union for International Cancer Control (UICC), an organisation that believes that by raising worldwide awareness, improving education and catalysing personal, collective and government action, “we are all working together to reimagine a world where millions of preventable cancer deaths are saved and access to life-saving cancer treatment and care is equitable for all – no matter who you are or where you live”1.
Consider the stats
According to UICC: “People who seek cancer care hit barriers at every turn. Income, education, geographical location and discrimination based on ethnicity, race, gender, sexual orientation, age, disability and lifestyle are just a few of the factors that can negatively affect care. The most disadvantaged groups are also more likely to have increased exposures to a host of other risk factors, like tobacco, unhealthy diet or environmental hazards.”
This is reflected across studies. For instance, the five-year survival rate for cervical cancer is 71% for white women in the US, compared with 58% for black women2. Similarly, New Zealand’s Māori population have double the chance of dying from cancer as non-Māori people3. Childhood cancer survival rates are as low as 20% in low-income countries while over 80% in high-income countries4, and more than 90% of cervical cancer mortality occurs in low- and middle-income countries5. Cancer kills nearly 10 million people a year and some 70% of those are aged 65 or older, yet older populations face disproportionate barriers to effective treatment6. In refugee populations, cancer is more likely to be diagnosed at an advanced stage, leading to worse outcomes7. Due in part to discrimination from healthcare practitioners, cancer screening among transgender people is lower than in the rest of the population8. There are notable differences in cancer-related outcomes for rural and nonrural patients, even in high-income settings such as the US9.
Patient and public involvement
According to commentary by Jim Elliott (HRA Public Involvement Lead) provided by the UK’s NHS, research, including all types of cancer research, needs input and involvement from a more diverse range of people to successfully address the inequalities in outcomes for cancer in the UK.
Elliott said: “Many different types of studies need the people who take part to continue to do so for many months or even years. If we want people to do this, we need to understand what the potential barriers might be and what people need to help them to help others through research. Involving people who understand what it is like to live with cancer can help researchers to make it easier for people to take part in research, and to continue to do so for the whole of the study.”
National cancer centres
In a recent survey by the World Health Organization (WHO), researchers found that cancer services are covered by a country’s largest, government health financing scheme in an estimated 37% of low- and middle-income countries, compared to at least 78% of high-income countries. WHO said: “This means that a cancer diagnosis has the potential to push families into poverty, particularly in lower-income countries, an effect that has been exacerbated during the Covid-19 pandemic”.
WHO shared the importance of national cancer centres in ensuring a comprehensive approach to cancer treatment. They said: “Bringing services for prevention, diagnosis, multidisciplinary treatment and supportive care together in one place makes it easier for patients to navigate services and leads to a greater concentration of expertise, and subsequently better health outcomes. Furthermore, cancer centres serve as training and research hubs, and in this way, help build country capacity and expertise”.
Setting Up a Cancer Centre: a WHO-IAEA Framework is an initiative set up by WHO and the International Atomic Energy Agency for World Cancer Day. Intended for policy-makers, programme managers and health professionals, it provides details of the infrastructure, human resources and equipment required for essential services, taking into consideration local context and resources available10.
According to WHO, screening is another important element of comprehensive cancer prevention and control10. However, decisions on what to include in a cancer programme require consideration of a number of complex factors. To support this decision-making process, WHO has released A short guide to cancer screening. Increase effectiveness, maximize benefits and minimize harm10.
In Nigeria, the Sebeccly Cancer Care and Support Centre has helped patients navigate and access earlier cancer diagnosis and treatment with the launch of the digital tool Oncopadi11. The company are a digital patient navigation platform that helps cancer patients and their loved ones to organise their journey by providing accurate information and a supportive community12.
In Canada, several organisations have collaborated across sectors on a series of measures aimed at closing the gap in healthcare for indigenous populations11. One such organisation is Closing the Gap Healthcare, which strives towards increased accountability and transparency for those providing healthcare services in the community.
Around the world, governments raised $8.817 billion in 2021 for Gavi, a global health partnership, to provide 84 million girls in low-resourced regions with HPV vaccinations to protect them from cervical cancer11.
In South Africa, a collaborative organisation called CANSA aims to promote and support innovative, effective and relevant approaches to the prevention, diagnosis, and treatment of cancer, in order to address the high cancer burden in South Africa. Researchers include scientists, social scientists, clinicians, epidemiologists, health professionals, and students13.