Closing the Cancer Divide: A Blueprint to Expand - NCD Alliance

286 Pages·2011·29.12 MB·English

The mandate of The Global Task Force on Expanded Access to Cancer Care and
Control in Developing Countries (GTF.CCC) is to design, promote, and evaluate
innovative strategies involving multiple stakeholders. The GTF.CCC supports the
work of partners in low and middle income countries to test and scale-up new
approaches to service delivery that can increase access to cancer care and control
and, at the same time, strengthen health systems.
This Report provides a blueprint for expanding acess in low and middle income
Closing the Cancer Divide:
countries to reduce the immense disparities in outcomes that constitute the cancer
divide. In three sections, the Report outlines what should, what could, and what
can be done to close this divide. The proposed strategies can strengthen health A BLUEPRINT TO EXPAND ACCESS
systems in ways that will benefit all countries.
IN LOW AND MIDDLE INCOME COUNTRIES
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The GTF.CCC logo is a multicolor ribbon-of-ribbons that represents both all cancers,
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and the links between cancer and other diseases. It symbolizes the importance of
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building strong health systems to meet the challenge of cancer and, at the same i
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time, of the potential contributions of expanding cancer care and control to i
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strengthen health systems in ways that benefit all patients. The ribbon is trans-

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Boston, MA 02115
gtfccc.harvard.edu [email protected]

Closing the Cancer Divide:
A BLUEPRINT TO EXPAND ACCESS
IN LOW AND MIDDLE INCOME COUNTRIES
A REPORT OF THE GLOBAL TASK FORCE ON EXPANDED ACCESS
TO CANCER CARE AND CONTROL
Global Task Force on Expanded Access
to Cancer Care and Control
in Developing Countries
Closing the Cancer Divide:
A Blueprint to Expand Access in Low and Middle Income Countries.
First published in October 2011 by President and Fellows of Harvard College
acting through the Harvard Global Equity Initiative.
Copyright © 2011
President and Fellows of Harvard College.
All rights reserved.
SUGGESTED CITATION
Knaul, Felicia Marie, Frenk, Julio and Shulman, Lawrence for the Global Task Force
on Expanded Access to Cancer Care and Control in Developing Countries. Closing the
Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.
Harvard Global Equity Initiative, Boston, MA, October 2011.
http://gtfccc.harvard.edu
*See Table of Contents for authorship of specific sections and text boxes.
This publication is copyrighted. It may be reproduced by any method without fee,
for teaching or non-profit purposes with written permission from the Harvard
Global Equity Initiative (HGEI). Under any other circumstances for copying, reuse
in other publications, or translation or adaptation, prior written permission must be
obtained from the publisher and a fee may apply. An electronic version is available
as a free download from http://gtfccc.harvard.edu.
Cover Design and Layout: Oliver Gantner and Marycarmen Vázquez, arte i diseño.
The views expressed in this publication are those of the GTF.CCC and do not
necessarily represent the views of HGEI or the President and Fellows of Harvard
College. The authors have made every effort to ensure accuracy of the information
within this publication; however, all errors remain our own.
GLOBAL TASK FORCE ON EXPANDED ACCESS TO
CANCER CARE AND CONTROL IN DEVELOPING COUNTRIES
Harvard Global Equity Initiative, Secretariat
651 Huntington Avenue
FXB Building, Room 632
Boston, MA 02115
Email: [email protected]
T C
ABLE OF ONTENTS
GLOBAL TASK FORCE ON EXPANDED ACCESS TO CANCER CARE AND CONTROL
IN DEVELOPING COUNTRIES i
!!Membership iii
!!Technical Advisory Committee v
ACKNOWLEDGEMENTS ix
MESSAGES FROM HONORARY CO-PRESIDENTS xv
!!HRH Princess Dina Mired xvii
!!Lance Armstrong xix
FOREWORDS xxi
!!Claudine Humure xxiii
!!Abish Romero Juarez xxv
!!Harvey Fineberg xxviii
!!Amartya Sen xxix
PREFACE xxxi
!!Global Task Force on Expanded Access to Cancer Care and Control
in Developing Countries xxxiii
!!History of the Report xxxiv
!!Organization of the Report xxxv
P I:
ART MUCH SHOULD BE DONE 1
SECTION 1: OVERVIEW 3
Felicia Marie Knaul, Paul Farmer
SECTION 2: THE GLOBAL CANCER DIVIDE: AN EQUITY IMPERATIVE 33
Felicia Marie Knaul, Hector Arreola-Ornelas, Hans-Olov Adami, Nancy Keating,
David Hunter, Megan O´Brien, Jim Cleary, Julio Frenk
Text Box 2.1: The cancer transition 36
Felicia Marie Knaul, Hector Arreola-Ornelas
Text Box 2.2: Cancer care and control in high income countries: elements of progress 39
David Hunter, Hans-Olov Adami, Felicia Marie Knaul
Anite: A woman in search of care will spend all she has and more 44
Paul Farmer
Text Box 2.3: Understanding and combating stigma: A LIVESTRONG research
and outreach program 51
Claire Neal
SECTION 3: INVESTING IN CANCER CARE AND CONTROL 63
Felicia Marie Knaul, Hector Arreola-Ornelas, Ramiro Guerrero
Text Box 3.1: The economic benefit of early detection and prevention:
cervical, breast and colorectal cancer 70
Janice Seinfeld, Arlette Beltrán, Edmundo Morocho
P II:
ART MUCH COULD BE DONE 77
SECTION 4: HEALTH SYSTEM STRENGTHENING AND CANCER:
A DIAGONAL RESPONSE TO THE CHALLENGE OF CHRONICITY 79
Julio Frenk, George Alleyne, Rifat Atun, Peter Piot, Felicia Marie Knaul
Text Box 4.1: The diagonal approach 84
Juanita Part 1: A hypothetical case study of late diagnosis turned into lessons
for implementing a diagonal response 86
Felicia Marie Knaul, Hector Arreola-Ornelas, Oscar Méndez
Text Box 4.2: Rwanda: Partners in Health chronic care integration
for endemic non-communicable disease 89
Julia Lu, Gloria Sangiwa, Agnes Binagwaho
Text Box 4.3: Survivorship 90
Claire Neal, Felicia Marie Knaul
SECTION 5: CORE ELEMENTS FOR PROVISION OF CANCER CARE AND CONTROL IN
LOW AND MIDDLE INCOME COUNTRIES 97
Lawrence Shulman, Julie Gralow, Eric Krakauer, Benjamin O Anderson,
Peggy Porter, Mary Gospodarowicz, Sarah Feldman, Carlos Rodriguez-Galindo,
Lindsay Frazier, Leslie Lehmann
Text Box 5.1: Analysis and recommendations around core elements of a CCC strategy 100
Text Box 5.2: Jordan: Creating a regional center of excellence for cancer care as
a focus for a national program on cancer care and control 102
Afsan Bhadelia, Imad Treish, Zaid Bitar, Ruba Anastas, Mahmoud Sarhan
P III:
ART MUCH CAN BE DONE 125
SECTION 6: INNOVATIVE DELIVERY OF CANCER CARE AND CONTROL
IN LOW-RESOURCE SCENARIOS 125
Author: Felicia Marie Knaul, Afsan Bhadelia, Julie Gralow, Ana Langer
Text Box 6.1: Optimal tasking: A partial review of literature 131
Juanita Part 2: Lessons for innovating in delivery 132
Felicia Marie Knaul, Hector Arreola-Ornelas, Oscar Méndez
Text Box 6.2: Applications of innovative delivery: Breast cancer 136
Case 1: PIH-DFCI-BWH Partnership: nnovative Delivery Strategies
for Cancer Care in Rural Rwanda, Malawi and Haiti 137
Luke Messac, Megan McLaughlin, Kelly Bogaert, Jarred Mcateer, David Shulman,
Amy Sievers and Amy Judd
Case 2: Uganda Program on Cancer and Infectious Diseases:
a collaboration between FHCRC and Uganda Cancer Institute 139
Corey Casper, Erica Sessle, Warren Phipps, Jessica Yager,
Lawrence Corey, Jackson Orem
Case 3: Expanding access to gynecological CCC in Peru through
an MOH-PATH collaboration 140
Vivien Tsu
Case 4: Twinning in pediatric oncology: Models for the innovative use
of technology to bridge distance 141
Felicia Marie Knaul, Afsan Bhadelia, Carlos Rodriguez-Galindo, Lindsay Frazier
Case 5: International training and exchanges: American Society
of Clinical Oncology 142
Doug Pyle
Case 6: Satellite cancer care in high income countries for peri-urban
and rural communities 143
Afsan Bhadelia, Amanda Berger
SECTION 7: ACCESS TO AFFORDABLE MEDICINES, VACCINES, AND HEALTH TECHNOLOGIES
FOR CANCER: OVERCOMING PRICE AND NON-PRICE BARRIERS TO ACCESS 149
Jonathan Quick, Niranjan Konduri, Julie Gralow
Text Box 7.1: Working towards affordable pricing for HPV vaccines
for developing countries: the role of GAVI 159
Aurélia Nguyen, S. Deblina Datta, Nina Schwalbe,
Diane Summers, Geoff Adlide
Text Box 7.2: Partnership and pooled procurement for a life-saving
health technology 160
Text Box 7.3: Estimating the global unmet need for cancer medicines:
Hodgkin’s lymphoma, cervical cancer, childhood acute
lymphoblastic leukemia, and breast cancer 164
Ramiro Guerrero, Jaime Andrés Giraldo, Héctor Arreola-Ornelas, Felicia Marie Knaul
SECTION 8: INNOVATIVE FINANCING: LOCAL AND GLOBAL OPPORTUNITIES 175
Rifat Atun, Felicia Marie Knaul, Yoko Akachi

Text Box 8.1: Current ODA for NCDs and cancer 177
Text Box 8.2: Innovative financing along the financing value chain 179
Case 1: Mexico 186
Felicia Marie Knaul, Salómon Chertorivski Woldenberg, Hector Arreola-Ornelas
Case 2: Colombia 187
Ramiro Guerrero, Ana Maria Amaris
Case 3: The Dominican Republic 188
Magdalena Rathe
Case 4: Peru 189
Janice Seinfeld
Case 5: Taiwan 189
May Tsung-Mei Cheng
Case 6: China 190
Jing Ma
Case 7: India 191
Maja Pleic, Suneeta Krishnan
Case 8: Rwanda 192
Agnes Binagwaho, Afsan Bhadelia
SECTION 9: EVIDENCE FOR DECISION-MAKING 199
Nancy Keating, Felicia Marie Knaul
Text Box 9.1: Leveraging collaboration to establish cancer registries in LMICs:
Examples from Colombia and Uganda 203
Elena Kouri
Text Box 9.2: Evidence-based approaches to identifying barriers and designing
multifaceted education and intervention projects: Increasing
awareness and enhancing early detection of breast cancer
in Gaza strip 207
Rola Shaheen
Text Box 9.3: Strengthening collaboration for implementation
and evaluation research 209
Elena Kouri, Felicia Marie Knaul
Text Box 9.4: International multi-institutional partnerships for capacity-building
in cancer research: Uganda Program on Cancer
and Infectious Disease 211
Corey Casper
SECTION 10: STRENGTHENING STEWARDSHIP AND LEADERSHIP TO EXPAND ACCESS
TO CANCER CARE AND CONTROL 217
Felicia Marie Knaul, George Alleyne, Rifat Atun, Julio Frenk, Peter Piot
Text Box 10.1: Stewardship 219
Text Box 10.2: National cancer plans 220
Afsan Bhadelia, Kathy Cahill
Text Box 10.3: Mapping national actors: the Jordan case 222
Afsan Bhadelia, Imad Treish, Zaid Bitar
Text Box 10.4: IARC 225
Text Box 10.5: Femama: Promoting policy change in Brazil through civil society 228
Maira Caleffi
Text Box 10.6: The Union for International Cancer Control 228
Text Box 10.7: ASCO’s evolving engagement in global cancer control 230
Doug Pyle
Text Box 10.8: Research and publications on cancer in LMICs 231
Ana Mylena Aguilar
Text Box 10.9: An integrated partnership in Rwanda: Comprehensive National
Cervical Cancer Prevention Program and the Rwanda Task Force
on Expanded Access to Cancer Care and Control 233
Agnes Binagwaho, Afsan Bhadelia
Global Task Force
on Expanded Access
to Cancer Care and Control
in Developing Countries