Cancer control in small island developing states

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Published: 26 Nov 2018
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Prof Diana Sarfati - University of Otogo, Dunedin, New Zealand

Prof Diana Sarfati speaks to ecancer at the CCLMIC meeting at the Royal Society of Medicine in London, UK.

She discusses cancer control in small island developing states which suffer from environmental, economical, and healthcare vulnerabilities.

Prof Sarfati describes the difficulties these states face, and also ways we can build models and interventions to help cancer control in these areas.

I’m speaking today about cancer control in small island developing states. This is a heterogeneous group of 52 countries recognised by the UN that share certain social, economic and environmental vulnerabilities. They’re in three groups – there’s the Pacific group, the group in the Caribbean and then a miscellaneous catch-all group which are scattered around the rest of the world.

How does cancer control in these countries differ from elsewhere?

These countries tend to be countries with relatively small populations, they tend to be very isolated and they tend to be ecologically and economically fragile. The biggest difference for them is trying to manage cancer control with really minimal resources, particularly in terms of just the number of people that they have. So the case loads are very small so it’s very difficult to think of models of cancer control that work in that environment.

How are these models being built?

At the moment there hasn’t been a lot of focus on cancer control in small island developing states from a global perspective. The global cancer agenda has not looked very much at these regions, particularly the Pacific region. If you look at the Pacific region and you look at the challenges that they’re facing in terms of cancer control you can see challenges right throughout the entire cancer control spectrum. So in terms of cancer control planning cancer isn’t really very high on the agenda currently because it seems too hard, it’s really difficult. So there’s not much cancer control planning going on except in a few countries, there’s a few exceptions to that. Then when you look at, for example, screening there’s almost no cervical screening across the Pacific, again with a couple of exceptions. There’s limited diagnostic capacity in the Pacific and in terms of treatment other than if you take out Guam and a couple of French colonies in the Pacific there’s one medical oncologist over the entire Pacific region and there’s no radiation oncologist, there’s no radiotherapy available whatsoever. That’s for a huge region including a country the size of, for example, Papua New Guinea with somewhere between 8-10 million people. So the capacity to manage cancer is really low for many of these countries.

Having said that, there is some really good innovative work going on in the region, for example, one of the few examples where a group of countries have got together and are starting to plan regionally. So that’s the northern Pacific which are the US affiliated states. They’ve got together, they’ve done some really good cancer control planning regionally, they’ve developed a cancer registry for that region and they’ve used the fact that they’ve grouped together to be able to get more resources from the US and to support the development of cancer treatment services, for example. So that’s an example of innovation and using the fact that even though they’re small if they come together they’ve got greater capacity.
There’s also a lot of work going on in terms of cervical cancer control, particularly HPV point of care testing. There’s work going on in terms of improving the outcomes for children with cancer in the Pacific using various approaches, location specific protocols, triaging protocols and twinning with high income countries in the region. And also a lot of really good work from the Royal Australasian College of Surgeons in terms of building up the surgical capacity in the region. So there is a lot of work but at the moment it’s a bit piecemeal. So what we’re working on at the moment is pulling everything together and trying to get a more coordinated approach to cancer control.

Is international collaboration critical?

Collaboration actually at every level is really critical. Clearly if you’ve got very small countries then international collaboration is actually essential. So there’s very good collaboration between Pacific countries, they’re very strongly linked together so there’s international collaboration at that level but it’s also really important to have collaboration, obviously, with the regional high income countries but also the global community which has tended to ignore that region almost entirely. So at each of those levels collaboration is really key.

What have you found from work so far is the most important next step?

We’re still in the process of working on that but the most important thing of the first cab off the rack is to get cancer on the agenda. I’ve been working on a Lancet Oncology series focussed on cancer control in small island developing states and what that has allowed us to do is it has provided a vehicle to have a space on major regional meetings, for example, the Pacific Heads of Health meeting and the Pacific Ministers of Health meeting where we’re talking about cancer, we’ve pulled together information on cancer from around the region that has never been pulled together before, presenting it to the leaders in the region who are recognising the importance of it. That’s a first step in terms of planning and then there’s a whole lot of other things below that that we’re also working on but that’s probably the really key step that we’re taking.