As is implied in your question, there is tremendous inequity in cancer care all over the world. This is particularly well known in terms of excessive cervical cancer deaths, delayed diagnosis of breast cancer, for example breast cancer survival rates in Africa and Asia are much lower than in developed nations. In paediatric cancer mortality rates for children are above 80% in Africa, for example, whereas the majority of children, the vast majority of children, with cancer in the Western world survive. So inequity is an enormous issue in all parts of healthcare but particularly relevant in cancer.
The opportunity to make a big difference in cervical cancer prevention is enormous. One of the challenges that is existing in low- and middle-income countries all over the world is adoption of the vaccine. There isn’t a trained workforce in communication methodologies to convince mothers to get their children vaccinated with HPV which essentially can be life-saving but there is a lot of taboo against this kind of vaccine. This kind of training can have a huge impact on the world.
Another area of digital is using technologies such as digital technologies to diagnose breast cancer at an earlier stage which can be put in the hands of a workforce and can detect disease early. This is applicable for breast cancer but it’s also applicable for other cancers with the use of portable ultrasounds, which again is a digital technology that can be used with image transfer occurring too.
Another area of use of digital technology is telemedicine. This is somewhat encumbered by the constraint that there is a shortage of specialists even in developed nations. But to the extent there is a geographic divide in expertise, that can be overcome with telemedicine very effectively, that patients don’t have to travel long distances and technology-based solutions can be applied at the front line by allied workforce where the images are transmitted to experts who can then opine on them. This could be mammography, it could be ultrasonography and others.
But the most leveraged way that I have found to use digital technologies to produce equity in the breast cancer space is for workforce training and capacity building which is a project I started called the ECHO project where it is potentially possible to train a community health workforce. So in a country like India, for example, you can train ASHA workers to do mammography, auxiliary nurse midwives to do cervical cancer screening and community health workers to have these conversations with mothers to get HPV vaccination. Similarly, it can be used to train a workforce of nurses in oncology care.
Another area of huge inequity in cancer is the issue of survivorship. So in low- and middle-income countries a lot of patients travel from low resource settings to cities. So they may go from western Kenya to Nairobi to get their cancer care. But when they go back there isn’t any access to a survivorship expert who can help them. Even after the cancer is cured they need care, care to manage their side effects, to prevent the next cancer. We can train a workforce in primary care to do that. Similarly for pain management expertise can be built using digital technologies.
Lastly in the area of palliative care enormous inequity exists. In the continent of Africa, for example, only 1% of patients have access to good palliative care. All of this can be overcome with digital technologies.
