Department of radiotherapy. University Hospital Ibn Rochd Casablanca –

Morroco

Cancer Control Resources in Maghreb countries

Pr. BENIDER

Marrakech June 19th 2010

Maghreb map

MAGHREBEpidemiologic transition - Demographic transition

- Transformations of the environment

- Change of the way of life

Non transmissible chronic diseases

Health priorities

Cancer = Major problem of public health

INTRODUCTION

• 1929: Bergonié Centre -Casablanca

Ibn Rochd Oncology Center

Historical •1929-1980

1947: Casablanca Mayor inaugurating the hospitalization of the Bergonié center

Historical •1929-1980

New cases Radium treatments External beam radiotherapy

1939 1940 1941 1942 1943 1944 1945 1946 1947 1948

139 150 228 219 187 170 209 236 336 313

69 58 75 88 59 47 48 44 186 123

88 85 189 89 140 182 204 396 308 384

total 2187 797 2075

•Treated cancers in Cancer Centre bergonié

• 1980: First two radiotherapy specialists (Pr.Gueddari -

Pr.Kahlain)

• 1985: National Institute of Oncology-Rabat

• 1989: First private center - Casablanca

Historical •1980-2005

• 2005: Lalla Salma Association Against Cancer

• 2010: Cancer Plan (2010 - 2019)

•After 2005

Epidemiological Data

Cancer Standardized Incidence In Maghreb

All SitesMale FemaleMOROCCO (Casablanca*) 100,3 104,2

ALGERIA (Alger**) 148,6

151,3

TUNISIA (Tunis***) 133,2 101,4

LYBIA (Benghazi****) 116,92 95,11

•* Registre des Cancers de la région du Grand Casablanca Edition 2004

•** Registre des tumeurs d’Alger Edition 2003

•*** Registre des Cancers de Nord Tunisie 1999-2003

•**** Benghazi Cancer Registry 2004

Cancer Standardized Incidence In Maghreb

All SitesMale FemaleMOROCCO (Casablanca*) 100,3 104,2

ALGERIA (Alger**) 148,6

151,3

TUNISIA (Tunis***) 133,2 101,4

LYBIA (Benghazi****) 116,92 95,11

USA (New Jersey) 566,2 439,2

France (Loire) 422,7 256

CANADA 398,5 308,3

COMMONLY CANCERS IN MALE

MOROCCO(Casablanca

*)

ALGERIA(Alger**)

TUNISIA(Tunis***)

LYBIA(Benghazi****

)

Lung Lung Lung Lung

Prostate Colon/Rectum

Bladder Colon/Rectum

Colon/Rectum

Bladder Colon/Rectum

Head Neck

NHL Stomach Prostate Bladder

Larynx Prostate Skin Prostate

•* Registre des Cancers de la région du Grand Casablanca Edition 2004

•** Registre des tumeurs d’Alger Edition 2003

•*** Registre des Cancers de Nord Tunisie 1999-2003

•**** Benghazi Cancer Registry 2004

COMMONLY CANCERS IN FEMALE

MOROCCO(Casablanca

*)

ALGERIA(Alger**)

TUNISIA(Tunis***)

LYBIA(Benghazi****

)

Breast Breast Breast Breast

Cervix uteri Colon/Rectum

Colon/Rectum

Colon/Rectum

Thyroid Cervix uteri Skin Corpus uteri

Colon/Rectum

Thyroid Cervix uteri NHL

Ovaries Ovaries Thyroid Cervix uteri

•* Registre des Cancers de la région du Grand Casablanca Edition 2004

•** Registre des tumeurs d’Alger Edition 2003

•*** Registre des Cancers de Nord Tunisie 1999-2003

•**** Benghazi Cancer Registry 2004

Breast CancerComparison of standardized

incidence of other countries

Country Incidence

MOROCCO (Casablanca)

35,04

ALGERIA (Alger) 44,5

TUNISIA (Tunis) 29,6

USA (New Jersey) 129,4

FRANCE (Loire) 109,8

CANADA 95,5

Health facilities

Cancer facilities in Morocco

• Casablanca Public (1)

Private (2)

• Rabat Public (1) Military (1)

Private (2)

• Oujda Public (1)

• Total: 8 cancer centers

Al houceima

•Before 2005

Cancer facilities in Morocco

Functional• Casablanca (4)• Rabat (4)• Agadir (1)• Oujda (1)• Al Houceima (1)• Marrakech (2*)• Fes (1/1*)• Total: 12 (3*) cancer

centersPlanned• Tanger• Meknes (2)• Safi• Laayoune

Al houceima

•After 2005

*Functional soon

Cancer facilities in Algeria

•ALGERIA

•Constantine•Algiers

•Ain-Naadja•BlidaAin

Misserghin

Oran

•6 centers

... . ..

Cancer facilities in Tunisia

•- 3 functional centers:

Tunis

Sousse

Sfax

•Jendouba

- 3 planned centers:

Gafsa

Gabes

Jendouba

Radiation Therapy Equipment in Morocco Before 2005

Linac 10

Cobalt 7

Simulator (CT) 3

Brachy LDR 16

Brachy HDR 2

TPS 10

After 2005

22 (2*)

6

5 (7*)

16

7

28 (14*)

•* Planned

Radiation Therapy Equipment in Algeria

Linac 9

Cobalt 6

Brachy 4

Radiation Therapy Equipment in Tunisia

  Public Private Total

LINAC 1/4* 1/1* 2/5*

Cobalt 4 5 9

Simulator 3 2/1* 5/1*

TPS 3 3

•* Planned

Comparison of Radiation Therapy Equipment in Maghreb countries

Morocco Algeria Tunisia

Linac 22(2*) 9 2(5*)

Cobalt 6 6 9

Simulator (CT)

5(7*) - 5(1*)

Brachy LDR 16 4 -

Brachy HDR 7 - -

TPS 28(14*) - 3

•* Planned - No data available

2222

Human resources in cancer centers in Morocco

•Radiotherapy

Specialists: 82

Residents: 61

Medical Oncology

Specialists: 20

Residents: 51

Surgical Oncology

Specialists: 16

Total:

Specialists: 118

Residents : 112

2323

Human resources in cancer centers in Algeria

Medical Oncologists: 250

Radiation Oncologists: 50

Surgeons: 100

2424

  Public Private Total

Surgical Oncology      

Specialists 11 4 15

Residents 13  - 13

Radiotherapy      

Specialists 15 4 19

Residents 19 -  19

Medical Oncology      

Specialists 20 12 32

Residents 32 -  32

Total      

Specialists 46 18 64

Residents 64  - 64

Human resources in cancer centers in Tunisia

2525

  Morocco Algeria Tunisia

Surgical Oncology      

Specialists 16 100 15

Residents -  - 13

Radiotherapy      

Specialists 82 50 19

Residents 61 -  19

Medical Oncology      

Specialists 20 250 32

Residents 51 -  32

Comparison of Human resources in cancer centers in Maghreb countries

- No data available

Moroccan cancer Plan 2010-2019Conceptual Framework

National and international mobilization

Prevention

Early diagnosisDetection

Diagnosis and treatment

Palliative cares

Legislation

Research / TrainingSocial support

Communication

Moroccan cancer Plan 2010-2019Health facilities organization

•Level 1: Basic health centers,

General practionners

•Level 2: Provincial hospitals Diagnosis centers

Clinics

•Level 3: University hospitals, Regional cancer centers Private cancer centers

Tunisian cancer Plan 2006-2010

In collaboration with the Institut National Français du Cancer (INCa)

Piloting comittee and sub-commissions :

- Formation/Research

- Epidemiology

- Primary Prevention

- Screening/Early Diagnosis

- Management

Recommendations

International Resources Standards in Radiotherapy

EQUIPMENT

• 1 device / 250 000 - 500 000 inhabitants.

OMS/AIEA recommendations for developing

countries :

1 device for 1 million inhabitants.

International Resources Standards in Radiotherapy

HUMAN RESOURCES

• 1 Radiation Oncologist / 300 - 400 annual treatments

• 1 Radiation Physicist / 350 - 500 annual treatments

• 2 therapy radiographers / each treatment device

• At least 1 therapy radiographer / simulator

• At least 1 dosimetrist.

Moroccan equipment Requirement in Radiotherapy (cancer Plan 2010-

2019) For each cancer center

2 LINACs with MLC

1 Simulation system (standard or CT)

1 TPS with network link

HDR Brachytherapy

Moroccan Human Resources Requirement in Radiotherapy

(cancer Plan 2010-2019) For each cancer center

At least 2 radiation oncologists, and above depending on the

center activity: 1 radiation oncologist / 400 - 500 patients treated

per year

At least 2 Radiation Physicists , and above depending on the center

activity: 1 radiation Physicist / 600 - 700 patients treated per year

At least 12 radiation therapy radiographers

At least 2 Brachytherapy radiographers

At least 1 dosimetrist, and above depending on the center activity

Conclusion

Cooperation Governments - NGOs would

allow:

* Cancer prevention

* Cancer treatment

* Palliative care

* Better quality of life