presentation 100114 king hussein cancer center 0 kuwait city, october 25, 2010 october breast cancer...
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Presentation 100114
King Hussein Cancer Center1
Kuwait City, October 25, 2010October Breast Cancer Program
Cancer in the Eastern Mediterranean RegionCommon Challenges and Potentials
Mahmoud M. Sarhan, MD, MMM, CPEKing Hussein Cancer Center
Presentation 091026
King Hussein Cancer Center2
It is good to know that cancer is not a new disease but the increased life expectancy and improved diagnosis has made it more evident…
77.3Malta
77.5Netherlands
77.5Italy
77.5Cayman Islands
77.7Spain
77.8Norway
78.0Singapore
78.2New Zealand
78.3Canada
78.5Macau
78.6Israel
78.7Sweden
78.9Australia
79.0Switzerland
79.0Japan
79.4Hong Kong
80.2Iceland
80.6Andorra
Improved Life ExpectancyImproved Life Expectancy
Not a Modern DiseaseNot a Modern Disease
Better Clinical DiagnosisBetter Clinical Diagnosis
Diesel engine exhaustAsbestos, Crystalline silica, wood dust
Particles and fibers
Inorganic lead, Cobalt, tungsten carbideArsenic, cadmium, chromium Metals
Petroleum refining, hairdressing
Painting, chimney sweeping, coal mining, coke production,
Occupation
Trichloroethylene benzene, formaldehyde, vinyl chloride
Chemicals
Androgenic steroids, Chloramphenicol
DES, Estrogen, progesterone, tamoxifen, phenacetin
Pharmaceutical
Emissions from high temperature frying Aflatoxins, coal-tar Complex
mixtures
Radon, solar radiation, X-and gamma radiation Radiation
Circadian disruption, household combustion of biomass fuel (primarily wood)
Tobacco, areca nut, alcoholic beverages, household combustion of coal
Life style
Hepatitis B and C, HPV, Helicobacter pylori, HIV, Schistosoma
Biolog-ical gents
Probably Carcinogenic Carcinogenic
IncreasedExposure toCarcinogens
IncreasedExposure toCarcinogens
+
+
+
Presentation 091026
King Hussein Cancer Center3
…nevertheless, in the next 10 years, cancer worldwide will be the #1 disease claiming lives and requiring the most investment for prevention, detection, treatment and palliative care
WHO statistical highlights, 2007
Projected global deaths for selected causes (Future Health)
Cancer
Ischemic Heart
Disease
Stroke
HIV/AIDS
OtherInfectiousDiseases
RoadTraffic
Accidents
Malaria
Cancer over time
Mill
ion
peo
ple
42.8%
36.3%
36.3%
Tuberculosis
Presentation 091026
King Hussein Cancer Center4
Cancer will impact the developing / low-middle income countries the most…
+64%
+19%
11.94
9.28
8.06
World Cancer Deaths over Time
Year
To
tal C
ance
r D
eath
s in
Mill
ion
s
5.3
5.05.0
Deaths in Low Income Countries
year
Dea
ths
in L
ow
Inco
me
Co
un
trie
s (i
n m
illio
n)
Presentation 091026
King Hussein Cancer Center5Source: Globocan 2000 IARC
>5 million from Asia
Eastern
Southeastern
South Central
Western
Presentation 100114
King Hussein Cancer Center6
It is expected that largest increase in cancer deaths within the next 15 years is likely to be in the Eastern Mediterranean region
Rawaf, S. et al. BMJ 2006;333:860-861
projection modelling predicts an increase of between 100%
and 180% [Rastogi et al. 2004]..
Predicted increase in deaths from cancer over the next 15 years (WHO)4
Wo
rld
Es
tab
lis
he
d M
ark
et
ec
on
om
y
Fo
rme
r s
oc
iali
st
ec
on
om
y
La
tin
Am
eri
ca
&
Ca
rib
be
an
Ch
ina
Su
b-s
ah
ara
n A
fric
a
Oth
er
pa
rts
of
As
ia
& I
sla
nd
s
Ind
ia
Inc
rea
se
in
de
ath
fro
m C
an
ce
r (%
)
0
50
100
150
200
Projection modelling predicts an increase of between 100% and 180% in EMR [Rastogiet al. 2004]..
Ea
ste
rn
Me
dit
err
an
ea
n R
eg
ion
Presentation 100114
King Hussein Cancer Center7
The Eastern Mediterranean region extends from Morocco to Pakistan and has varied income levels, health indicators and geographies
World Bank Income group
Country Population (in thousands)
Expenditure on health per capita in US $
High(Total Pop 8,219,000)
Qatar 656 862
U.A.E 4,210 661
Kuwait 2,645 579
Bahrain 708 555
upper
Middle(Total Pop 35,472,000)
Lebanon 4,370 573
Saudi Arabia
22,608 366
Oman 2,651 278
Libya 5,843 171
World Bank Income group
Country Population (in thousands)
Expenditure on health per capita in US $
lower middle(Total Pop 231,482,000)
Jordan 5,617 177
Palestine 3,827 138
Tunisia 9,911 137
Iran 66,775 131
Morocco 30,509 72
Syria 18,200 59
Egypt 69,323 55
Djibouti 817 47
Iraq 26,503 23
Low(Total Pop 238,627,000)
Yemen 21,003 32
Sudan 34,512 21
Pakistan 151,816 13
Afghanistan 22,998 11
Somalia 8,298 6
GINI index in many countries varies between 28 and 42 indicating inequality
within each country
Presentation 100114
King Hussein Cancer Center8
Cancer in the EMRO region is the 4th leading cause of deaths occurring at a younger age than industrialized countries
projection modelling predicts an increase of between 100%
and 180% [Rastogi et al. 2004]..
→ 50% of the cancers in the Region occur before age 55 (10 – 20 years younger than in industrialized countries).
→ The mortality/incidence ratio is 70% indicating significantly lower survival rates from diagnosed cancer (40% in America, 55% in Europe)
.
→ 50% of the cancers in the Region occur before age 55 (10 – 20 years younger than in industrialized countries).
→ The mortality/incidence ratio is 70% indicating significantly lower survival rates from diagnosed cancer (40% in America, 55% in Europe)
.
RemarksRemarks
Presentation 100114
King Hussein Cancer Center9
Breast Cancer is the most common cancer in most of the Eastern Mediterranean countries preceded sometimes by lung cancer
Co
un
try
Rank of Disease
Presentation 100114
King Hussein Cancer Center10
The 3 leading causes of cancer worldwide are dominantly seen in the region
Cancers due to infections represent 11% of the cancer burden in North Africa and 16% of the cancer burden in west Asia.
70% of the infection‐related cancers in the Region are attributable to four infectious agents: human papilloma virus (HPV) (27%), Helicobacter pylori (23%), and hepatitis B and C virus (20%).
Cancers due to infections represent 11% of the cancer burden in North Africa and 16% of the cancer burden in west Asia.
70% of the infection‐related cancers in the Region are attributable to four infectious agents: human papilloma virus (HPV) (27%), Helicobacter pylori (23%), and hepatitis B and C virus (20%).
InfectionsInfectionsTobaccoTobacco
Prevalence of tobacco consumption is increasing rapidly and is already above 30% in men in 12 countries of the Region
Prevalence of tobacco consumption is increasing rapidly and is already above 30% in men in 12 countries of the Region
Top Countries Ranking (Males) Prevalence of tobacco smoking a (%) > 40%
Country Males > 15 years Females > 15
Yemen 77.0 29.0
Tunisia 61.9 7.7
Djibouti 57.5 4.7
Jordan 48.0 5.7
Syria 48.0 8.9
Lebanon 46.0 35.0
Kuwait 42.0 4.4
Unhealthy Lifestyles
In the Eastern Mediterranean Region obesity is a rapidly growing problem; already more than 50% of the population is overweight in 12 countries.
In the Eastern Mediterranean Region obesity is a rapidly growing problem; already more than 50% of the population is overweight in 12 countries.
Presentation 100114
King Hussein Cancer Center11
Jordan and Kuwait are among the smaller populations in the Eastern Mediterranean region with impressive indicators related to health and a growing population that will challenge the current stable situation
PopulationPopulation
Population: =6,198,677 Age Structure: 15-64 = 63.7% Above 65: 4.5% Smokers (m) =48%
Population: =6,198,677 Age Structure: 15-64 = 63.7% Above 65: 4.5% Smokers (m) =48%
Health Indicators
Health Indicators
Life expectancy @ birth years =71/74
Total fertility rate children born/women = 2.47
Life expectancy @ birth years =71/74
Total fertility rate children born/women = 2.47
Socioeconomic Indicators
Socioeconomic Indicators
Unemployment rate: 13.5%
GDP: 4000 USD
Unemployment rate: 13.5%
GDP: 4000 USD
GeographyGeographyDistances: 570 km north to south
Urbanization= 78%
Distances: 570 km north to south
Urbanization= 78%
Population (million) = 2.8 Age Structure: 15-64 = 70.7% Age above 65= 3% Smokers (m): 40%
Population (million) = 2.8 Age Structure: 15-64 = 70.7% Age above 65= 3% Smokers (m): 40%
Area 17,818 square kilometer
Urbanization= 98%
Area 17,818 square kilometer
Urbanization= 98%
Life expectancy @ birth years=77/79
Total fertility 2.5
Life expectancy @ birth years=77/79
Total fertility 2.5
Unemployment rate: 2.2% GDP: 48,310 USD
Unemployment rate: 2.2% GDP: 48,310 USD
Presentation 100114
King Hussein Cancer Center12
Kuwait is among the smaller populations in the Eastern Mediterranean region with impressive indicators related to health and a growing population that will challenge the current situation
PopulationPopulation
Population (million) = 2.8 Age Structure: 15-64 = 70.7% Age above 65= 3% Smokers (m): 40%
Population (million) = 2.8 Age Structure: 15-64 = 70.7% Age above 65= 3% Smokers (m): 40%
Health Indicators
Health Indicators
Life expectancy @ birth in years =77/79
Total fertility 2.5
Life expectancy @ birth in years =77/79
Total fertility 2.5
Socioeconomic Indicators
Socioeconomic Indicators
Unemployment rate: 2.2% GDP: 48,310 USD
Unemployment rate: 2.2% GDP: 48,310 USD
GeographyGeography
Area 17,818 square kilometer
Urbanization= 98%
Area 17,818 square kilometer
Urbanization= 98%
Presentation 100114
King Hussein Cancer Center13
In Jordan, the National Cancer Registry in 1996 was a major undertaking to identify the most common cancers (breast & lung) as well as register cases
Ten Most Common Cancers Among MalesJordan 1996-2007N=14,445/21,332
Primary Site
Cru
de
Nu
mb
er o
f C
ases
Ten Most Common Cancers Among FemalesJordan 1996-2007N=14,360/21,000
Primary Site
Cru
de N
umbe
r of
Cas
es285
550769
1396
3302 3380 3362 34303591
4198
4606
4332
367834783412
31423354
1126
450
0
1983
1989
1995
1997
1999
2001
2003
2005
2007
Trend of Cancer1980-2007
Years
Can
cer
Cas
es
Sta
rt o
f R
egis
try
Population basedHospital based
2008
Presentation 100114
King Hussein Cancer Center14
Despite the growing numbers of cancer cases, it is important to note that Jordan or Kuwait are not worse than other countries in terms of Cancer incidence…
Age Standardized rate compared with different countriesJNCR 2007
Presentation 100114
King Hussein Cancer Center15
New cancer cases in Jordan are expected to double by 2020 as the population grows, ages, and lifestyles remain unchanged
Population Growth over Time
Year
Po
pu
lati
on
in M
illio
n
Projected Number of Cancer Cases (by Year) in Jordan
Year
Nu
mb
er o
f C
ases
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King Hussein Cancer Center16
…and as the Jordanian population ages.
Population Growth (in thousands) by gender and ageJordan 2005-2050
Above 50
Above 50
20
05
20
50
2.7 5.516.9
114.5
461.4
0
50
100
150
200
250
300
350
400
450
500
0-14 yrs 15-24 yrs 25-44 yrs 45-64 yrs 65 and above
ASIR by Age Group per 100,000 Population
Age Groups
Pop
ulat
ion
per
100
,000
Presentation 100114
King Hussein Cancer Center17
Cancer in Jordan is characterized by late stages diagnosis (similar to the EMR), highest mortality due to lung cancer and 50% of mortality under age 64
Cancer Mortality JNCR 2007
N= 13,298 cases
Primary Site
Per
cen
t o
f D
eath
s
Age in years
Nu
mb
er o
f d
eath
s
Cancer Mortality in Jordan by AgeJNCR 2007
0
5
10
15
Lung Leukemia Breast Colorectal NHL
8 12 37 66
263
644
836
0100200300400500600700800900
< 1 4-Jan 14-May 15-21 25-44 45-64 65 +
Stage Frequency %
0- Insitu 53 1.3
1- Localized 1286 32.7
2- Regional Direct Extension 311 7.9
3- Regional – Lymph Node 326 8.3
4- Regional – (Direct + Lymph node) Extension
265 6.7
5- Regional - NOS 270 6.9
6- Distant Metastasis 1425 36.2
TOTAL 3936 100.0
Distribution of Cancer Cases by StagesBased on SEER Staging
JNCR 2007
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King Hussein Cancer Center18
At the onset of JBCP, breast cancer used to be detected at late stages when the survival rate and treatment success are not promising
Stages of Breast Cancer in Jordanbased on KHCC Experience before JBCP
Direct Correlation of Survival to Stage of Detection
N=550
Stage of disease at Detection
Perc
ent o
f Sur
viva
l
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King Hussein Cancer Center19
ASR ofASR of Breast Cancer ( Females)( Females)
Data for GCC countries 1998-2005, Oman-2007 ,Egypt 2000-2002 , USA-SEER (white population) 1999-2001
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King Hussein Cancer Center20
Median Age at diagnosis of Female Breast cancer in the Arab world
49
53
50
48
47
49
46
45
51
Median Age at diagnosis in Developed Countries 65 years
51
48
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King Hussein Cancer Center21
Breast cancer: proportions by age group in Jordan , Lebanon , KSA and Kuwait
Presentation 100114
King Hussein Cancer Center22
The region as been trying to address individually and collectively the burden of cancer but with limited or country specific success
* WHO-EM/NCD/060/E, Towards a strategy for cancer control in Eastern Mediterranean Region, 2009
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King Hussein Cancer Center23
A regional alliance under the guidance of WHO has been working since 2007 and has in 2009 set the crucial need for national cancer control plans as the first step for each country
WHO Regional Office, in association with the Princess Lalla Salma Association against Cancer, nongovernmental organizations and other relevant international organizations in the Region, agreed to establish an alliance against cancer to join forces in order to generate an appropriate and concerted effort to prevent and control cancer.
Membres•Association Lalla Salma de Lutte contre le Cancer (Maroc) •The National Higher Committe for Breast Cancer Control (EAU) •King Hussein Cancer Center (Jordanie) •Lebanese Cancer Society (Liban) •Gulf Federation for Cancer Control (pays du Golfe) •Egyptian Oncology Forum (Egypte) •Fakous Cancer Center (Egypte) •Egyptian Foundation for Cancer Research (Egypte) •Breast Cancer Foundation (Egypte) •The National Association for Cancer Awareness (Oman) •Zahra Association for Breast Cancer (Arabie Saoudite) •Saudi Association for the Fight against Cancer (Arabie Saoudite) •Association Tunisienne de lutte contre le cancer (Tunisie) •Association des Amis de l’Institut National d’Oncologie (AMINO) (Maroc) •Association l’Avenir (Maroc) •Association Coeur de Femmes (Maroc)
Conduct publicity and disseminate information regarding the establishment of the alliance Create an advocacy plan Conduct education and increase public awareness Create a database for cancer in the Region Establish a network of experts, researchers and organizationsPromote the development of highly-qualified well-trained human resources in the field of cancer Mobilize the financial resources needed for the alliance to perform its functions Support research in the field of cancer Conducting monitoring and evaluation
Establishment
Goals
Members
Presentation 100114
King Hussein Cancer Center24
Jordan is a model of success that can be presented as a learning experience and center of excellence
Business as Usual
1Data
2Focus
3Quality &
comprehensiveness
4Prevention
5
Stages of Cancer Control Development in Jordan
International Competition
Increasing Readiness
Up to 1996
1996 1997 2003 2006 2010 2020
Equity&
Research
6
Local and International Expansion
Treatment through MOH, RMS, PVS
JNCR established
Amal Hospital for Cancer Care Established
Transforming Al-Amal Hospital to the King Hussein Cancer Center-1st class cancer care
Treatment through MOH, RMS, PVS
JNCR established
Amal Hospital for Cancer Care Established
Transforming Al-Amal Hospital to the King Hussein Cancer Center-1st class cancer care
1
3
Prevention and palliative care initiatives
Increase in clinical capacity is needed for equity in patient care, while infrastructural growth is needed to initiate grade clinical and translational research
Prevention and palliative care initiatives
Increase in clinical capacity is needed for equity in patient care, while infrastructural growth is needed to initiate grade clinical and translational research
4
5
2 6
Treatment
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King Hussein Cancer Center25
Jordan is implementing two models for the early detection and prevention of cancer – a bottom up vs. a top down one
Implementation Plan
Fines, Taxes, Penalty
Quality and Guidelines
Breast Cancer Early Detection and ScreeningAdvocacy and
Awareness
Development of Services
Capacity Building
StableFunding
Legislation – free early detection
1
2
3
4
5
Smoking Control
Bo
tto
m U
pT
op
Do
wn
LegislationImplementation
AlternativesGrace Period
EnforcementSmoke-free
1
2
3
4
5
NationalTarget
NationalTarget
Early Detection& prevention
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King Hussein Cancer Center26
Jordan’s health system is dominated by the public sector that regulates it and provides services as well, followed by the military and private sector providers
Provider
Ministry of
Health(60%)
Ministry of
Health(60%)
Basic Role Description
+
Cancer Control
Royal Medical Service (25%)Royal Medical Service (25%)
Private Sector(XX%)
Private Sector(XX%)
Universities(6%)
Universities(6%)
Non-for-Profit Sector
Non-for-Profit Sector
Law, regulations, budget, health expenditure,
insurance
Law, regulations, budget, health expenditure,
insurance
Reactive vs. Proactive Limited resources Focused on service delivery Public health influenced by Int’l
arena
Reactive vs. Proactive Limited resources Focused on service delivery Public health influenced by Int’l
arena
Closed Military System with
Insurance Scheme
Closed Military System with
Insurance Scheme
Independent budget Serves 25% of populations Quality Services
Independent budget Serves 25% of populations Quality Services
Regulated by MoH from Quality
perspective not pricing
Regulated by MoH from Quality
perspective not pricing
Business driven Varied quality (perceived by
population as a higher quality sector than government)
Business driven Varied quality (perceived by
population as a higher quality sector than government)
Free of charge for enrollees or less
privileged
Free of charge for enrollees or less
privileged
Limited budgets Acceptable quality Innovation limited
Limited budgets Acceptable quality Innovation limited
Free of charge for enrollees or less
privileged
Free of charge for enrollees or less
privileged
Limited budget High expertise and focused
expertise Dependent on Fundraising
Limited budget High expertise and focused
expertise Dependent on Fundraising
Only player to date KHCC Comprehensive 1st class center
(2 accreditations) Outreach, control, diagnosis, Rx
and Palliative care
Only player to date KHCC Comprehensive 1st class center
(2 accreditations) Outreach, control, diagnosis, Rx
and Palliative care
No full plan (under consideration) Divided activities Strong registry Covers all Jordanians Mediocre quality Rx services
No full plan (under consideration) Divided activities Strong registry Covers all Jordanians Mediocre quality Rx services
Prevention without outreach (clinic based)
Rx (not comprehensive)
Prevention without outreach (clinic based)
Rx (not comprehensive)
Rx focused Not driven by unified protocols Very expensive Varied quality
Rx focused Not driven by unified protocols Very expensive Varied quality
No oncology departments Rx available not comprehensive Varied quality (KAH vs. JU)
No oncology departments Rx available not comprehensive Varied quality (KAH vs. JU)
Presentation 100114
King Hussein Cancer Center27
Despite the varied quality of treatment, Jordan has been achieving good results comparable to the developed nations
0.53
0.36
0.44
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Male Female All
All Cancers Mortality/Incidence ratios for selected countries
2002
Jordan cancer Mortality/Incidence ratio
2006
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Mor
talit
y/In
cide
nce
Male Female
Diagnosis & Treatment
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King Hussein Cancer Center28
Case in point 1: KHCC’s Department of Pediatrics quality of care has resulted in survival rates equivalent to those in the USA and Europe
Su
rviv
al D
istr
ibu
tio
n F
un
ctio
n
Survival Time Month
LEGEND
Product Limit Estimate Curve
Censored Observations
ALL Pediatric - KHCC 2003 – 2007, (N=200)
# Of deaths = 10
3 Years survival = 94%
Kaplan Meier Survival Function
ALL Pediatric - KHCC 2003 – 2007, (N=200)
# of events =19
3 years event free survival =86%
Incidence Free Survival
Overall Survival
Event FreeSurvival Function
Survival Function
Diagnosis & Treatment
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King Hussein Cancer Center29
Case in point 2: KHCC’s Stem Cell Transplantation Program has resulted in survival rates equivalent to those in the USA and Europe
Product-Limit Survival Function Estimate
Su
rviv
al P
rob
abili
ty
Survival Time Month
Diagnosis & Treatment
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King Hussein Cancer Center30
As for palliative care, Jordan has established a national committee to improve provision of services as recommended internationally
GoalGoal
To help alleviate the physical and psychosocial suffering associated with progressive, incurable illnesses throughout Jordan and the region
To increase the availability and access to high-quality hospice and palliative care for patients and families throughout Jordan
To help alleviate the physical and psychosocial suffering associated with progressive, incurable illnesses throughout Jordan and the region
To increase the availability and access to high-quality hospice and palliative care for patients and families throughout Jordan
LeadLead King Hussein Cancer CenterKing Hussein Cancer Center
SupportSupport Ministry of HealthMinistry of Health
Top-Down Activities
Top-Down Activities
Advocacy – change in opiod prescription regulationTen-day policyAuthority with MOH Minister rather than by law
Advocacy – change in opiod prescription regulationTen-day policyAuthority with MOH Minister rather than by law
Bottom-up Activities
Bottom-up Activities
Education – integrate into universities (nursing and medical schools) as a part of the curriculum
Training - Establishment of training programs – KHCC (doctors, nurses, policy makers..etc)
Pharmaceuticals – to develop immediate release morphine tablets
Education – integrate into universities (nursing and medical schools) as a part of the curriculum
Training - Establishment of training programs – KHCC (doctors, nurses, policy makers..etc)
Pharmaceuticals – to develop immediate release morphine tablets
OBJECTIVEOBJECTIVE
Integrate palliative care and hospice principles into the National Health Strategy by shaping governmental policies
Assure availability and easy access to opioid analgesics and adjuvant medications throughout the Kingdom
Establish integrated continuums of palliative care programs, reaching patients in hospital and community settings
Promote Jordan as a model and reference for palliative care practice and education in the region
Integrate palliative care and hospice principles into the National Health Strategy by shaping governmental policies
Assure availability and easy access to opioid analgesics and adjuvant medications throughout the Kingdom
Establish integrated continuums of palliative care programs, reaching patients in hospital and community settings
Promote Jordan as a model and reference for palliative care practice and education in the region
Palliative Care
Emerging Approach
“Decent Care”
Emerging Approach
“Decent Care”
Globalization is putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should … People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in way that correspond to their expectations. Few would disagree that health systems need to respond better – faster – to the challenges of a changing world.
Globalization is putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should … People are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and changing needs, and with their failure to provide services in way that correspond to their expectations. Few would disagree that health systems need to respond better – faster – to the challenges of a changing world.
Presentation 100114
King Hussein Cancer Center31
With the current and growing cancer burden the region remains extensively challenged
Other primary care issues take priority over cancer care
Funding limitations to prevention, screening and purchase of quality care (including costly drugs)
Other primary care issues take priority over cancer care
Funding limitations to prevention, screening and purchase of quality care (including costly drugs)
Lack of government national supportLack of government national support
Lack of Specific Funds Targeted towards Cancer
High Cost of Drugs and overall treatment
(GDP per capita for most countries in the region is below $ 6000)
(Average cost of treatment is approximately $25,000 without complications)
Major International Funds have not been allocated towards Cancer Control in the region
Lack of Specific Funds Targeted towards Cancer
High Cost of Drugs and overall treatment
(GDP per capita for most countries in the region is below $ 6000)
(Average cost of treatment is approximately $25,000 without complications)
Major International Funds have not been allocated towards Cancer Control in the region
Monetary LimitationsMonetary Limitations
Cultural Barriers
Stigma & myths pertaining to cancer including religious misunderstandings
Social taboos that extend beyond the female herself leading to fears of being ostracized by husband, family, or society
Socioeconomic barriers
Low level of education (ignorance)
Preference to invest in family/children needs rather than self health
Awareness barriers
Cancer as a taboo subject
No health promotion to break myths of hereditary and contagious disease
Do not seek information and action to understand ailment or prevention
Cultural Barriers
Stigma & myths pertaining to cancer including religious misunderstandings
Social taboos that extend beyond the female herself leading to fears of being ostracized by husband, family, or society
Socioeconomic barriers
Low level of education (ignorance)
Preference to invest in family/children needs rather than self health
Awareness barriers
Cancer as a taboo subject
No health promotion to break myths of hereditary and contagious disease
Do not seek information and action to understand ailment or prevention
Social LimitationsSocial Limitations
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King Hussein Cancer Center32
Service limitations
Multidisciplinary approach to treatment is not systematically implemented in some treatment centres
An increasing number of cancers are being treated with combined modality therapy. A major issue in this regard is the cost and availability of cytotoxic drugs.
There are relatively few trained radiation, medical or pediatric oncologists in many countries of the Region, and very few oncology nurses and social workers.
The roles of nursing staff and paramedical could be expanded to reduce the load on specialists
Multidisciplinary approach to treatment is not systematically implemented in some treatment centres
An increasing number of cancers are being treated with combined modality therapy. A major issue in this regard is the cost and availability of cytotoxic drugs.
There are relatively few trained radiation, medical or pediatric oncologists in many countries of the Region, and very few oncology nurses and social workers.
The roles of nursing staff and paramedical could be expanded to reduce the load on specialists
Service LimitationsService Limitations
WHO cites a severe shortage of healthcare professionals in developing countries– Americas: 25 healthcare workers per 1,000 people – Asia: 5 or fewer per 1,000
WHO cites a severe shortage of healthcare professionals in developing countries– Americas: 25 healthcare workers per 1,000 people – Asia: 5 or fewer per 1,000R
em
ark
sR
em
ark
s
Health Care Workers per 1000 population
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King Hussein Cancer Center33
Palliative care for many countries is barely existent
Sources: International Narcotics Control Board; United Nations population dataBy: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2009
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King Hussein Cancer Center34
In Jordan as well, despite the strides to cancer care, some challenges remain to contest the ability to focus on quality and equity
Quality of Services Lack of treatment protocols: No unified protocols are
applied in diagnosis and treatment of cancer but purely based on provider’s academic and on-the-job training
Lack of standard operating procedures: The comprehensive approach to cancer care is not applied in all health care venues except at KHCC
Limited Advanced Experience: The approach and accessibility to tap into advanced resources is non existent
Public Awareness Misinformed public: Due to technological advances in
communication public put pressure on health sector to go for drugs and procedural interventions that are trial based which undermines the sector’s ability to perform and to be trusted
Lack of awareness of risk factors: Except for breast cancer, there is no / minimal work or focused work on the importance of healthy lifestyles
Accessibility to Care Increased prices of drugs: Due to the increased
prices of drugs that make a difference in cancer treatment, many patients are deprived of life saving interventions and the burden on the government is increasing
No primary care focus on Cancer: The focus on maternal & child health, infectious diseases, and cardiovascular diseases remains the core work of the primary health care centers leading to decreased ability to identify cancer early among other drawbacks
No enforcement of Palliative Care: Despite the national consensus on palliative care criteria, there is no enforcement of the agreed approach
Human Resources Lack of health specialized primary care and support
care providers: Especially in support services and early detection, health professionals in Jordan do not receive consistent and focused training for cancer related issues nor have specific academic lines that they can pursue for that purpose
Brain drain : Skilled and educated health providers are solicited by neighboring countries especially those who can offer more competitive packages – this will increase
Presentation 100114
King Hussein Cancer Center35
In Jordan, Cancer control is on the right track …
Only population-based data can identify the overall national problem (although institutional data useful)
Only planning at a population level can ensure improved access for all
Only population-based data can identify resources required to control cancer at a national level
Only nation-wide collaboration can assess and make maximal use of all available national resources
Only population-based data can give a clear idea of the overall effect of interventions
Only population-based data can identify the overall national problem (although institutional data useful)
Only planning at a population level can ensure improved access for all
Only population-based data can identify resources required to control cancer at a national level
Only nation-wide collaboration can assess and make maximal use of all available national resources
Only population-based data can give a clear idea of the overall effect of interventions
RemarksRemarks
Presentation 100114
King Hussein Cancer Center36
Efforts need to become more streamlined and unified to ensure continued success across all sectors
GOVERMENT
– Legislation relevant to control of risk factors and opioid availability
– Structuring health services
– Supporting establishment of expert committees
– Orchestrating goals
– Monitoring outputs, outcomes and impact
GOVERMENT
– Legislation relevant to control of risk factors and opioid availability
– Structuring health services
– Supporting establishment of expert committees
– Orchestrating goals
– Monitoring outputs, outcomes and impact
ACADEMIC ESTABLISHMENTS
– Education of health care professionals with basic knowledge of cancer
– Leadership in care, epidemiological, public health, clinical and translational research
ACADEMIC ESTABLISHMENTS
– Education of health care professionals with basic knowledge of cancer
– Leadership in care, epidemiological, public health, clinical and translational research
ONCOLOGY SPECIALISTS:
– Expert diagnosis and treatment
– Research: clinical and translational
– Advising government
ONCOLOGY SPECIALISTS:
– Expert diagnosis and treatment
– Research: clinical and translational
– Advising government
PRIMARY CARE PROVIDERS
– Public education, early detection
– Collaboration in care, follow-up and palliation
PRIMARY CARE PROVIDERS
– Public education, early detection
– Collaboration in care, follow-up and palliation
NON-ONCOLOGY SPECIALISTS
– Early detection
– Treatment of early stage disease
– Rapid referral to oncologists
NON-ONCOLOGY SPECIALISTS
– Early detection
– Treatment of early stage disease
– Rapid referral to oncologists
NGOs:
– Education & outreach
– advocacy:
NGOs:
– Education & outreach
– advocacy:
INDUSTRY:
– Access to new innovative products and services
– Research
– Sponsorship
INDUSTRY:
– Access to new innovative products and services
– Research
– Sponsorship
Food for thought: Need for Higher council for Cancer Control ???