Cancer in Africa

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Cancer in Africa

• Professor David Kerr

www.afrox.org ... to enable the delivery of
comprehensive cancer care to Africa
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Millions of deaths in 2002
WHO (2003)
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Worldwide annual new cases of cancer
16 millionin 2020 a 50 increase! 70 will be in
the developing world 1 million / yr in Africa
10 millionin 2000
WHO (2003)
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Important Cancer Types

• Kaposis sarcoma
• Cervical cancer
• Hepatocellular carcinoma (HCC)
• Breast cancer

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Cervical Cancer

• Related to HPV
• Some serotypes more important (16,18)
• Serotypes vary between countries
• Screening availability and uptake poor in Africa
• HPV vaccines would prevent 70-80 Ca (125)
• Costs would be a problem (?large trial)
• Radiation availability
• Effective Palliation

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Download the London Declaration on Cancer Care in
Africa from www.afrox.org

• Gathering the troops
• A two-day meeting in London in May 2007.
• Chaired by the Rt. Hon. Alan Milburn
• Over 130 leaders in all aspects of World
  Health and Cancer
• Control present and 23 African Health
  Ministers.

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• AfrOx aims to deliver comprehensive cancer care
  to African countries where it is most needed
• Most Africans live in a rural areas with little
  access to cancer screening, early diagnosis,
  treatment or palliative care (est. gt 250 million
  people). Differential survival between blacks and
  whites
• Life-saving radiotherapy is available in only 21
  of Africa's 53
• countries, or to less than a max 20 the total
  population
• Over 1/3 of cancer deaths are due to preventable
  causes such as
• viral infection, poor nutrition and widespread
  tobacco use
• In Africa 5 childhood cancers cured compared to
  80 in developed world
• In Africa, combination of cancer, poverty,
  deprivation and ID hinder development of
  sustainable population and consequently a
  sustainable future

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The economic perspective

• Starting point Scarce (health care) resources
• Objective Use these to maximise health gain
• Method Compare health interventions
• Assess their net costs
• Assess their health benefits
• Implement interventions with highest benefits in
  relation to cost
• This is the cost-effectiveness approach

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Resource constraints (Int. s)
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Kenya Country Profile
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Ministry of Health Priority List byExpenditure-
2005/2006
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What is good value for money?

• Support for breastfeeding mothers 11 per DALY
  averted
• Community newborn care package 9 per DALY
  averted
• Measles vaccination (80 cover) 33 per DALY
  averted
• Treat smear tuberculosis 7 per
  DALY averted
• Cataract extraction lens implant 89 per
  DALY averted
• Insecticide-treated bed nets (ITN) 29 per
  DALY averted
• 2) What resources are available
• Level of national income
• Priority given to health care
• 1) What else could be done with resources

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What are the general priorities for AfrOx?
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Cancer Intelligence Units

• Partnership with IARC world leaders in the
• field
• Build on hospital based registries
• Training fellowships supported by WHO

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Tobacco Control

• Partnership with Gates Foundation
• Consider health economic and legal matters

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Cancer Prevention

• Major development on HPV vaccine
• Current cost 125 per jab
• Will be reviewed by GAVI Summer, 2008
• Coalition of Pharma, Gates, World Bank,
• WHO, AfrOx and African Health Ministries

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Cancer Treatment

• Focus on curable childhood cancer
• Partner with International Society of Paeditric
• Oncology
• Training fellowships
• Simplify treatment regime

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Nephroblastoma in Nigeria

• n 42, 5 year survival 38
• late presentation late referral, ignorance,
• recourse to orthodox medicine after
  traditional
• practitioners and prayer houses have failed.
• Resource deficiency 5 patients could not
  afford
• chemotherapeutic drugs, operation was delayed
  
• on 7 children because, they could not afford
• blood and antibiotics. Poverty was largely
• responsible for default from treatment.
• Poor compliance to treatment regimen 17
• children could not comply. Chemotherapeutic
• drugs were given only when available.
• Lack of collaboration amongst clinical
• community.

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The cost-effectiveness plane
New treatment more costly
New treatment more effective but more costly
Maximum acceptable cost-effectiveness ratio?
Costly not very effective
Not costly very effective
New treatment more effective
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• Is it ethically justifiable to develop low
• cost, moderately effective cancer
• treatments?
• Modulated-dose oral chemo regimes for BC?
• Tamoxifen for breast lumps clinically described
  as cancer?

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Palliative Care

• Introduction of opiates despite cultural and
• religious barriers
• Training fellowships in partnership with
• Global Palliative Care fund

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Afrox in Ghana

• The combination of Ghanas historic ties with
  Britain, its record of good governance and the
  commitment of local policy-makers and clinicians
  to control cancer make Ghana an excellent
  starting point for AfrOx to develop its work in
  Sub-Saharan Africa.
• Ghana has a population of 23 million which is
  served by only two oncology centres, one in the
  capital Accra and one in Kumasi. There are only 4
  oncologists in the country and no specialist
  cancer nurses.
• Our 5 year programme covers the spectrum of
  cancer control
• Policy support for national cancer plan.
• Raising public awareness of cancer.
• Cancer prevention through screening and
  vaccination.
• The early diagnosis and treatment of children's
  cancer.
• Improvement in palliative care.
• Training and education of healthcare staff.
• Our programmes in Ghana will serve as a template
  that could be adapted for other African
  countries.

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Major Achievements (1)

• Public Policy Projects
• African Cancer Reform Convention, London, 2007
  (Sierra Leone, Rwanda, Uganda, Nigeria, Burkina
  Faso, Cote DIvoire, Gambia, Egypt, Yemen, Ghana
  ,Tanzania, India, Cameroon, Morocco, Mozambique,
  Libya, Benin, Malawi, Botswana, South Africa,
  Congo, Kenya, Zimbabwe, Mauritius, Zambia,
  Lesotho and Tunisia).
• Towards the Prevention of Cervical Cancer in
  Africa Conference, Oxford 2009.
• Early Diagnosis and Prevention Projects
• Cancer Awareness in Ghana AfrOx supported the
  Cancer Society of Ghana (CSG) with a capacity
  building grant in 2008. 
• Developing a Cancer Code for Africa
  (collaboration with ESMO and WHO).

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Major Achievements (2)

• Cure the Curable Projects
• Improving Paediatric Oncology Services in Ghana
  AfrOx is funding a 5-year twinning programme
  between the Paediatric Cancer Unit at the Korle
  Bu Teaching Hospital, Accra, Ghana and the Royal
  Hospital for Sick Children, Edinburgh.
• Palliative Care Projects
• Palliative Care Training Two workshops held in
  January and October 2009, attended by over 100
  doctors, nurses, pharmacists and other
  health-workers, resulted in significant
  improvement in end of life care in Ghanas
  teaching hospitals.
•  
• Training and Education
• Public lectures, Radio and TV appearances
  raising cancer awareness in Accra and Kumasi
  Milburn, Arbuthnott, Kerr and Roddan 2007- 2009.
• Clinician training and education workshops in
  Ghana, May 2009 (Sharma and Kerr)
• Workshop on Health Economics of Cancer Control,
  Africa Cancer Conference, 2009 (Kerr).
• E-Cancer Filming Project, Africa Cancer
  Conference, 2009 (Kerr).
• Practical workshop on bone marrow aspirates for
  children, SIOP conference, Ghana 2010 (Eden and
  Sharma).

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AfrOx Projects

• Childhood cancer Twinning project
• HPV vaccination pilot programme
• AfrOx/ AORTIC wider twinning with NHS
• AfrOx/ESMO Cancer code and poster campaign

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Extend the ESMO Community

• Extend ESMOs place in the world by working to
  improve cancer services in developing countries
• ESMO Developing Countries Task Force
• ESMO Cancer Prevention Working Group
• ESMO Guidelines Working Group
• ESMO Palliative Care Working Group
• ESMO National Representatives
• ESMO Educational Committee, etc.

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The Way Forward

• The time for taking concerted action against
  cancer in African
• and the rest of the developing world has come
• No one government, organisation or charity can
  tackle the
• looming cancer epidemic on its own
• If the international community acts now, we have
  the chance
• to make an extraordinary difference by
  preventing a major
• tragedy unfolding and saving countless lives
• Only by combining our resources and skills, will
  we be able to
• make an impact!
• We hope that you will work together with us to
  achieve the goal of improving cancer care in
  Africa.

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