IN36 IS A TWO-SPEED (RICH VS POOR) ONCOLOGY INEVITABLE?

Abstract

is often regarded differently, in different settings: preventable and often curable in developed nations but as a painful death sentence in limited resource countries. A close look at cancer incidence rates according to socio-economic, racial and ethnic groups in 80% of the world population living in developing countries, reveal significant differences; 80% all cancers are in advanced stage and are not curable, and 26% are caused by infectious disease. There is strong evidence that, patients from resource limited countries probably have higher incidence and shorter survival after diagnosis of cancer. In-fact 60% of all cancer patients are in limited resource country, 72% of all deaths from cancer occur in developing countries, and 77% of disability adjusted life years and 78% of years lost. This is due to limited access to medical treatment, un-informed about early detection, as well as the quality of available care. One of the reasons of improved outcomes of care in developed world has been due to use of evidence based clinical practice guidelines. In-fact the improvement of outcome has been due to guidance based cancer care, early detection and awareness with prevention. However the guidelines which have been developed for developed countries are difficult to adopt in limited resource countries. This is mainly because of a) Absence of expertise b) Weak infrastructure c) Costs d) Epidemiological transition and guidelines not integrated in them e) Accessibility f) Data generated is usually not from the region of application Hence very often there is resistance of application. If we are to have an internationally harmonized guideline, then these guidelines will have to have the following characters of validity, reproducibility, cost effective, representative / multi-disciplinary, unambiguous clinical applicability, flexibility, clear, reviewable, amenable to clinical audit. These guidelines should be resource stratified and must be integrable with the existing public health guidelines of the country. The concept of “resource – level appropriateness” recognises that effective intervention have progressed in high income countries through more than one generation. In a situation of insufficient healthcare infrastructure, uneducated public, not covered (out of pocket payment), calls for explicit analysis of effectiveness and cost of alternative approaches, which may help in preventing or countering natural attractions to newest, high technology (and expensive intervention); this thinking although intuitively simple, but filling in the details require systemic analysis of varying complexities.