On 11 April 2014 The Lancet Oncology published a major new Commission examining the challenges to effective cancer control in China, India, and Russia – which together experience 46% of all new cancers worldwide, and account for more than half (52%) of all cancer deaths globally. The Commission was led by Professor Paul Goss, of Harvard Medical School and Massachusetts General Hospital Cancer Center, USA, in collaboration with over 40 leading cancer experts from the regions studied, and across the world.
At the same time, the journal also published a three part Series on cancer burden and health systems in India, coordinated by Professor Richard Sullivan, of King's College London, UK, and with contributions from many of India's leading cancer experts, including Professor C S Pramesh, of the Tata Memorial Centre, Mumbai, India, and Professor Mohandas Mallath, of the Tata Medical Center, Kolkata, India.
Delivery of cancer care impacted by social, economic, and attitudinal factors
Each of the regions covered by these reports represents an enormous and diverse population, and the obstacles to effective cancer care in these countries are complex and idiosyncratic. According to Professor Goss, "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 which influence the way that cancer care is delivered and received in these countries."
Disparities in access to cancer care
Nonetheless, several common threads emerge from the report's analysis. Disparities in access to cancer care – usually between rich and poor, urban and rural – are pronounced in all three countries, and the report authors urge all governments to ensure that addressing health-care inequity forms a key part of their cancer control strategies. The challenges of preventing cancer – whether through measures to curb risky lifestyle choices, such as tobacco control, or through screening and awareness – are marked in all the countries studied.
Poor quality of data collection on the extent and nature of cancer is also a pressing issue – the sheer size, geographic and human diversity, and lack of infrastructure in each of these countries presents an enormous challenge to scientists trying to evaluate the burden of cancer, which has consequences for policy makers. "Inadequate and unrepresentative cancer data precludes policy makers from having a transparent understanding of the size and trajectory of the problems they face, and this leaves them unable to devise a forward looking, modern, national cancer plan", says Professor Goss.
Importance of embedding effective policies
A further theme arising in all of the countries studied is that the barriers to improving cancer care relate just as much to social, economic, and environmental factors as they do to health resources and financing. Dr David Collingridge, Editor of The Lancet Oncology said in a press release: "Active political engagement is absolutely necessary to ensure that effective policies to fight cancer are embedded in all government departments – not just health ministries. 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."
The Lancet Oncology Commission Challenges to effective cancer control in China, India, and Russia and the Series Cancer burden and health systems in India were presented at the 6th Asian Oncology Summit and 10th Annual Conference of the Organisation for Oncology and Translational Research, held in Kuala Lumpur, Malaysia, on April 11, 2014.
- Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, et al. Challenges to effective cancer control in China, India, and Russia. The Lancet Oncology 2014; 15(5):489-538. doi:10.1016/S1470-2045(14)70029-4
- Varghese C, Shin HR. Strengthening cancer control in China. The Lancet Oncology, 2014; 15(5): 484-485. doi:10.1016/S1470-2045(14)70056-7
- Menabde N. A health-system response to cancer in India. The Lancet Oncology, 2014; 15(5): 485-487. doi:10.1016/S1470-2045(14)70058-0
- Jakab Z, Galea G, Mauer-Stender K, et al. Cancer in Russia: reflections from WHO in Europe. The Lancet Oncology, 2014; 15(5):487-488. doi:10.1016/S1470-2045(14)70057-9