2012 UICC World Cancer Congress

UICC’s important meeting on cancer, which is particularly focused on cancer control in low and middle income countries (LMIC), took place from August 27-30th in Montreal, Canada. The meeting covered a very wide range of topics, and was preceded by a summit meeting of world cancer leaders, which produced some interesting discussion. Of particular importance in the poorer countries in the world is the lack of access to health care, in part resulting from the lack of well trained cancer specialists and the paucity of equipment, such as radiation therapy, as well as the inaccessibility of many chemotherapeutic drugs. It was particularly gratifying, therefore, that INCTR was invited to the summit meeting as well as to a workshop organized by the Swiss Cancer League entitled “Access to cancer treatment: how to achieve equal opportunities” and another meeting organized by the UICC on education. Both are critically important topics that INCTR will focus on much more in the future.

It is a sad reflection on the state of the world that while patients with potentially curable cancers in the LMIC are unable to receive treatment because of cost, late diagnosis and lack of equipment and drugs, the Institute of Medicine recently reported that approximately $750 billion is wasted each year in the USA because of unnecessary services, inefficiently delivered services, unnecessary paperwork and administration, and fraud. To this could be added the high cost of medicines which are of minimal value, but which most patients with terminal cancer are, not surprisingly, willing to go to any lengths to obtain, the expansion of the chronically ill population by the invention of new diseases such as pre-diabetes and pre-hypertension (or “elevated PSA”)and a variety of other issues such as the cost of insurance for doctors against litigation, practicing “safe medicine” (safe, that is, in terms of avoiding litigation) and so-on. Doubtless the same problem exists in many other countries, although to a lesser extent, and even in low income countries, some doctors, particularly in the for profit sector, overcharge patients, and often fail to provide for even the most basic care. Since a large part – sometimes all - of the cost of care, although to a degree subsidized by governments, has generally to be found by the patient (i.e., out of pocket), can be prohibitive for poor patients, the question asked by the symposium was extremely pertinent. While there is no simple answer, a major element must be the lack of human resources, the root causes of which goes back to cultural issues and the slow progress of the industrial/technological revolution across the world. Thus, it was also gratifying to be included in a discussion on education. Building capacity for cancer care must be one of the most important endeavors of the international community as the world’s population continues to age, and risk factors for cancer are progressively transferred to countries with a low index of development.

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