AORTIC: the impact of inequity on cancer care
The 10th AORTIC Conference is being held in
Marrakech, Morocco. This morning started
with round the table discussions: meet the expert. I attended the session on the impact of
inequity on cancer care. It was chaired
by Lyn Denny, Ophira Ginsburg and Renga Sankar.
Prof Lyn Denny opened the discussion and
suggested we should concentrate identifying “outrage points”. She asked us to
consider the downstream effects of premature deaths from cancer. What is the impact of diagnosis of breast
cancer on children? (In Bangladesh:
children have a 25% chance of living to age of 10 if the mother dies before the
child is 10 years old.) Prof Stefan, a
paediatric oncologist, said that history would judge us by how we look after
our children. Childhood cancers are
thought of as being very rare but they can often be successfully treated and as
about half of Africa’s population are children, there are about 50 000 new
cases per annum.
As the discussion opened up, many contributors stressed
the importance of integration of quality resources. It starts at the primary level: the clinic should be clean. Health care workers must be well trained. Centres of excellence have been shown to be essential for improved
outcome from cancer. There is a need to
discuss resource utilization: there was some debate as to whether we need
further specialists or whether competency should be accepted.
There is a need for clear appropiate guidelines for the management of breast cancer.
There is a need for clear appropiate guidelines for the management of breast cancer.
Dr Smith reminded us that alleviation of
poverty must be addressed. There is no
point in having good health care services if patients cannot afford to access
them. Even in countries such as Tanzania
where most of the health care is free, 60 % of women do not get the
chemotherapy they should. Why not? The physical, financial and social toxicity of
the treatment means that the majority of people will not complete their
treatment. On average, one course of
chemotherapy costs 70% of annual income in Tanzania. More discussion has to be had with Pharma
about pricing policies.
Advocacy groups are vital in getting
change. To talk about awareness is not
enough. (How do we measure awareness?) Policy makers have to be committed to
change. In Tanzania, the government
workers are not allowed to leave the country to get medical treatment. This is bound to result in an improvement of
care.
In conclusion, we should not have 3rd
rate care for 3rd world countries.
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