Treating cancer in low-income countries

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Kerr DJ, Midgley R. Can we treat cancer for a dollar a day? Guidelines for low-income countries. N Engl J Med. 2010 Aug 26;363(9):801-3. PubMed PMID: 20818843.

Writing from the Sidra Medical and Research Center in Qatar and Department of Clinical Pharmacology, University of Oxford, David Kerr and Rachel Midgley propose a multidisciplinary approach to cancer treatment in low-income countries.

They begin with some revelatory statistics:

“In 2002, approximately 7.6 million people worldwide died of cancer. These deaths accounted for 13% of all deaths worldwide in that year and, perhaps surprisingly, exceeded the number of deaths from HIV–AIDS, tuberculosis, and malaria combined (which totaled approximately 5.6 million). The World Health Organization has estimated that if current trends continue, the global cancer burden will increase from 10 million new cases per year in 2000 to 16 million by 2020. Remarkably, 70% of these cases will be in the developing world, where the number will grow from 5.2 million annually to 8.8 million by 2020.”

Kerr and Midgley note that in low-income countries where the simplest generic treatments are often beyond the reach of the average citizen, oncologists with access to the latest online clinical guidelines can find them frustrating. They find that very little has been done to develop evidence-based guidelines for cost-effective cancer treatments that they can use.

The authors posit that an interdisciplinary task force could adapt existing pharmacoeconomic models to assess the cost-effectiveness of previously established chemotherapy regimens and develop cost-effective cancer-treatment guidelines for low-income countries without establishing a permanent two-tier global system:

“Does this mean that cancer medicine in low-income countries will always be rooted in the past? Not necessarily, for we have seen some innovative and successful projects in which pharmaceutical companies have provided new drugs free of charge to poorer countries — for example, the Glivec International Patient Assistance Program for patients with chronic myeloid leukemia. More could be made of these open access projects, especially if they are sufficiently flexible to answer key research questions about tolerability, efficacy, and pharmacokinetics, to help refine treatment regimens that would be feasible for treatment of people in developing countries who have cancer.”

The full text is freely available via PubMed.