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Focusing Cancer Resources After the Pandemic: Best Practices

This transcript has been edited for clarity.

I’m David Kerr, professor of cancer medicine at University of Oxford.

Today let’s talk a little about a paper that I read recently in the BMJ Global Health. One of the senior co-authors, Professor Ala Alwan, is a dear friend. He’s had a distinguished career as a public health expert, having served as a deputy director general of the WHO, and is a former minister of health and education in his home country of Iraq. He has health policy experience at the very highest level.

He and a group of colleagues have come together to recommend a package of care for low- and middle-income countries who are emerging from the travails of the COVID-19 pandemic. As these countries seek to repair their economies, as they seek to get health back on the front foot, these experts have recommended a series of 120 high-impact health measures across all of medicine that should be the basis for rebuilding health infrastructure.

The process they undertook is one that’s been well validated by the WHO in the past. The things that they consider, the maxims and principles underpinning their recommendations, are to treat people equally and avoid any form of discrimination; to maximize the benefits produced by scarce resources in low- and middle-income countries, ie, saving the most individual lives or the greatest number of life-years by giving priority to patients likely to survive longest after treatment and focusing on those who are likely to benefit most; and finally, giving priority to the worst off in terms of poverty or in terms of health. The sickest are those who will have lived the shortest lives if they die untreated.

These principles, of course, can be merged with other goals and they can be shaped by the health policy framework within individual countries.

It’s a really important guide for the recovery of health. For those wealthier nations who have overseas aid programs, it gives them a focus not of intervention but a focus of support, so that they can actually work with those countries to see what they can pull together.

I thought [Medscape readers] would be interested to see what from across the spectrum of medicine the recommended “best buys” were for cancer. These are the human papillomavirus vaccine and early detection of cancer symptoms.

We know, as I’ve said many times before, that the burden of cancer at first presentation in low- and middle-income countries is always much higher, and the fraction of stage IV patients much greater in those countries than in wealthier countries in the North and in the West.

Regarding early detection and treatment of early-stage cervical cancer, we know this is still the commonest cancer of women in low-income countries. Breast cancer is catching up, but cervical cancer is a terribly important problem.

The list recommends treatment of early-stage breast cancer using multimodal approaches, including genetic chemotherapy with curative intent, as well as treatment of early-stage colorectal cancer, again with multidisciplinary approaches including generic chemotherapy and again focusing on those with curative intent.

It also includes treatment of early-stage childhood cancers — Burkitt non-Hodgkin lymphoma, lymphoblastic leukemia, retinoblastoma, Wilms tumor — all treated with curative intent. Of course, we would include within that the subset of chemocurable adult tumors — the teratomas, rarer dysgerminomas of ovary, and so on.

I think this is an important piece of work because it helps guide the international community in supporting our brothers and sisters in low- and middle-income countries as they emerge from the pandemic with their health services tattered and frayed, and their economies not functioning. The authors provide a clear base on which to start to rebuild those health economies.

I’d be really interested in your comments. Do you feel it’s too direct an approach? Do you think that these guiding principles or frameworks are useful at all? I’d be terribly interested.

For the time being, thanks for listening. As always Medscapers, over and out. Thank you.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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