David Kerr, Professor of Cancer Medicine at the Radcliffe Department of Medicine, discusses his research and the importance of international collaboration to support cancer care across Africa.
I have been, and still am, a cancer researcher and practising physician who has developed a sort of side line in health policy support, based on the idea of ‘amplified good’. I see the enormous importance of individual consultation with the patients we see in our clinic, and this is magnified by our research which is carried into clinical practice around the world.
But the benefits of this are eclipsed by the potential population benefits of delivering health policy plans which will have an impact on cancer control for many millions of citizens: the good of an individual consultation is amplified many fold by effective health policy.
My friend Twalib Ngoma and I were Fellows together 35 years ago in Glasgow. I visited his cancer centre all those years ago and found that 80-90% of cancer patients presented with advanced, Stage 4 disease - well beyond the capacity of any healthcare system to offer anything other than palliative care. When we attended clinic together much more recently in Dar es Salaam, nothing had changed – all the patients that we saw carried massive tumour burdens.
Now, in sub-Saharan Africa , urgent action is needed to stem a growing crisis in cancer incidence and mortality. Without interventions, data estimates show a major increase in cancer deaths reaching about 1 million deaths per year by 2030. The growing cancer crisis is attributable to external and internal factors, including infections with viruses, changing population demographics, behavioural changes, environmental exposures, genetics, and weak healthcare systems.
Under the auspices of a Lancet Commission, we have drawn on the wisdom and practical experience of widely acknowledged leaders, representing the spectrum of cancer control, with expertise in prevention, early detection, treatment, education and research to provide a clear set of practical policy recommendations for Sub Saharan African nations.
To some extent, we are cancer lobbyists in that we aim to influence public officials, especially members of legislative bodies and sway public opinion, but we do so from a position of professional expertise, of evidence offered and a profound sense of timeliness. We have seen too many reports, too many words, too many good intentions, too many families torn apart, too many excruciatingly painful deaths to feel that we can brook any further delays in taking collective action to accelerate Sub Saharan African cancer control.
The President of Ghana, Nana Addo Dankwa Akufo-Addo and the President of the House of Chiefs, Ogyeahohoo Yaw Gyebi II preside over the launch of the Commission which calls for the following actions:
- Cross governmental cost effective cancer planning
- Equity by expanding Universal Health Coverage to reduce out of pocket expenditures for essential therapy for citizens with cancer, with a view to avoiding catastrophic bankruptcies and abandonment of treatment
- Invest in cancer registration in order to provide that data upon which rational cancer planning will be undertaken
- pilot early cancer screening and detection programmes which make use of point of care technology
- Gap analysis of existing versus optimal services (staff, equipment, infrastructure) will be undertaken as a main component of the NCCP and a realistic investment plan constructed in 5 year cycles
- Improve access to opiate analgesics, available to less than 10% of African cancer patients, which, again, needs a joined up government response, spanning health, justice, police and finance section
- Education and training will be the mainspring of any cancer plan and has enormous partnership potential – North-South; South-South; public-private; NGO-professional societies-governments
- Research and innovation underpins rational delivery of cancer care. African cancer researchers are keen to contribute to global cancer knowledge and to focus the wider research community on African cancer problems
Let me repeat our call to action and urge politicians, policy makers, healthcare professionals, NGOs, professional societies and citizens to unite and chart a collective (and individual) response to the increasing burden of cancer in Africa. The amplified good of collaborative action to shape the actions of health systems and health policies is vital now, as the prospect of a million deaths every year from cancer looms.
David Kerr is Professor of Cancer Medicine at the Radcliffe Department of Medicine, University of Oxford. He is also a consultant physician within the NHS.