China, India, and Russia account for 46% of all new cancer cases globally, as well as 52% of cancer-related mortality per 4/2014 Lancet Oncology article
Reporter: Aviva Lev-Ari, PhD, RN
Challenges to effective cancer control in China, India, and Russia Paul E Goss, Kathrin Strasser-Weippl, Brittany L Lee-Bychkovsky, Lei Fan, Junjie Li, Yanin Chavarri-Guerra, Pedro E R Liedke, C S Pramesh, Tanja Badovinac-Crnjevic, Yuri Sheikine, Zhu Chen, You-lin Qiao, Zhiming Shao, Yi-Long Wu, Daiming Fan, Louis W C Chow, Jun Wang, Qiong Zhang, Shiying Yu, Gordon Shen, Jie He, Arnie Purushotham, Richard Sullivan, Rajendra Badwe, Shripad D Banavali, Reena Nair, Lalit Kumar, Purvish Parikh, Somasundarum Subramanian, Pankaj Chaturvedi, Subramania Iyer, Surendra Srinivas Shastri, Raghunadhrao Digumarti, Enrique Soto-Perez-de-Celis, Dauren Adilbay, Vladimir Semiglazov, Sergey Orlov, Dilyara Kaidarova, Ilya Tsimafeyeu, Sergei Tatishchev, Kirill D Danishevskiy, Marc Hurlbert, Caroline Vail, Jessica St Louis, Arlene Chan
The Lancet Oncology 1 April 2014 (Volume 15 Issue 5 Pages 489-538 DOI: 10.1016/S1470-2045(14)70029-4)
Three Countries Account for Half of All New Cancers
China, India, and Russia account for 46% of all new cancer cases globally, as well as 52% of cancer-related mortality. The populations in these regions are large and diverse, and the obstacles to providing effective cancer care are complex and idiosyncratic, according to a report published in the April issue of the Lancet Oncology.
Effective cancer control in China, India, and Russia is a burgeoning problem, but paying attention to the issue now will have “tremendous socioeconomic benefits in the future,” write the authors, led by Paul E. Goss, MB BCh, PhD, professor of medicine at Harvard Medical School and director of breast cancer research at the Massachusetts General Cancer Center in Boston.
“It is impossible to understand the issues that affect delivery of cancer care in China, India, and Russia without first understanding the social, economic, and attitudinal factors that influence the way cancer care is delivered and received in these countries,” Dr. Goss said in a statement.
The report is the result of a collaboration of more than 40 leading cancer experts from around the world, including China, India, and Russia.
Data from the report were presented earlier this month at the 6th Asian Oncology Summit and 10th Annual Conference of the Organisation for Oncology and Translational Research, held in Kuala Lumpur, Malaysia,
High Mortality Burden
The incidence of most cancers in China, India, and Russia is low, but the mortality burden is much higher than in the United States or the United Kingdom (whereas the financial burden per patient is much lower).
Table. Mortality and Financial Burden of Cancer
|Region||Mortality to Incidence Ratio||Financial Burden per Patient ($)|
The populations of China (1.35 billion), India (1.24 billion), and Russia (144 million) account for almost 40% of the world’s population.
Although diverse, these regions have much in common with each other, such as their vast geographies, rapidly improving economies, increasing population of elderly people, adoption of Westernized lifestyles (e.g., changes in diet and decreased physical activity), suboptimum healthcare for people in rural regions and of low socioeconomic status, serious environmental contamination, and a rising incidence of oncogenic communicable infections, the report notes.
In addition, in all 3 countries, there has been inadequate data on cancer. The lack of information on demographics and outcomes makes it difficult for policymakers to clearly see the size and trajectory of the problem they are dealing with, and therefore unable to devise a forward-looking modern national cancer plan.
In all 3 countries, financial and human resources need to be improved and equitably allocated to reduce the high mortality rates from cancer.
Policymakers need to be encouraged to invest more of their resources into healthcare, and specifically cancer care, so that they can study current and future trends of cancer and change policy and investment toward cancer prevention, early detection, and treatment.
“Active political engagement is absolutely necessary to ensure that effective policies to fight cancer are embedded in all government departments, not just health ministries,” said David Collingridge, MD, editor of the Lancet Oncology. “Departments charged with protecting the environment, provision of social services, and the delivery of education, science, and technology, all have key roles in these challenges,” he said in a statement.
The “magnitudes of the cancer burden and problems facing these 3 huge countries drive home many messages for smaller low- to middle-income countries: adequate and representative cancer data are required through investment in cancer registries.”
In addition, the development of a “forward-looking prospective national cancer plan is inexpensive and mandatory.”
The report evaluates the situation in each of the 3 countries and offers country-specific recommendations to improve cancer care.
In China, cancer accounts for about 20% of all-cause mortality, and the burden of this disease — driven by socioeconomic growth, an aging population, and environmental pollution — is increasing.
To address this issue, China urgently needs ongoing methods of combating air, water, and soil pollution, according to the report.
There is also a shortage of healthcare workers, especially in rural areas, which limits availability of optimum care. Training more healthcare workers would address this shortage, and could improve prevention and screening education.
Although traditional medical practices are widespread, cancer programs need to integrate traditional Chinese medicine to create acceptance and compliance.
China has had some success in cancer control. The country has built more than 200 cancer hospitals, 30 of which are tertiary-level hospitals for cancer that provide the highest level of care. In addition, many general facilities have established oncology departments, and the number of beds for cancer care doubled from 2005 to 2010. However, these hospitals are unevenly distributed, with twice as many in urban as in rural areas.
The dissolution of the Soviet Union in 1991 created social and economic instability, but since 2000, the economy has improved because of key economic reforms in several sectors. Russia is classified as a high-income nation and an emerging economy. Although expenditure on healthcare has dramatically increased over the past 2 decades, substantial socioeconomic disparities remain. Healthcare expenditure on the poorer population is very low, compared with other high-income countries.
Life expectancies, which have not risen along with increasing wealth, are much lower in men than in women. Cancer is responsible for 15% of all deaths. The risk of dying from cancer in Russia is nearly double that of the risk in the United States. An increase in the percentage of the healthcare budget directed toward cancer care is needed, according to the report.
The risk of dying from cancer in Russia is nearly double that of the risk in the United States.
Also needed are improvements in the quality of the data, a national cancer plan, a national cancer screening program that takes local needs and resources into account, and a comprehensive national prevention plan that includes campaigns to reduce tobacco and alcohol consumption.
Currently, an estimated 44 million Russians smoke (60.2% of men and 21.7% of women).
On the positive side, new forward-looking anticancer policies have been implemented to reduce the incidence of the disease and improve outcomes. Examples include public health initiatives directed at alcohol and tobacco control and at disease prevention, with the goal of lowering cancer mortality. Unfortunately, the effects of these strategies have been limited by inadequate enforcement and monitoring, according to the report.
Cancer now accounts for approximately 6% of all deaths (55 million) in India. This number is expected to grow substantially because of changing population demographics and lifestyle factors. There are significant socioeconomic disparities in India, and about 55% of the population (660 million) lacks sufficient resources for basic survival. Conversely, about 15% (180 million) of the population is wealthy and can afford the best healthcare. India is therefore considered a lower- to middle-income nation; as in China, it has a growing economy and environmental pollution.
India is also highly diverse, with a broad range of cultural and social traditions throughout the separate states and regions of the country. There are several major sociocultural issues that affect approaches to healthcare, including social taboos, castes, gender inequality, healthcare not being a priority, nihilistic approaches to cancer diagnosis (i.e., cancer fatalism), and religious dynamics.
Affordability and an extreme shortage of doctors and other healthcare workers are major obstacles to progress in cancer care, according to the report. Simple, affordable, and safe approaches that require minimal monitoring are needed to improve cancer outcomes for a large subset of the population.
Also needed are prevention and screening programs and the integration of traditional medicine into cancer care.
As in China and Russia, headway has been made in cancer care. A National Cancer Control Programme was launched in India in 1975. It led to the development of a cancer registry program, which enabled government policymakers to recognize the effect of cancer on the nation’s health, and to the development of 27 regional cancer centers.
More than 80 public hospitals have received funding to establish oncology services, and programs for cancer control are now operational in 21 Indian states.
Coauthor Pedro E.R. Liedke, MD, from Clínicas de Porto Alegre, Instituto do Câncer Hospital Mãe de Deus, in Brazil, reports receiving travel grants from Roche, sanofi-aventis, and Novartis, and consulting for Novartis.
Lancet Oncol. 2014;15:489-538. Abstract