Cancer in the Global South: Tackling challenges in a post-pandemic world

August 2, 2024

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Cancer has long been a leading cause of death worldwide, a global pandemic in itself that transcends borders, affecting millions of lives regardless of nationality, race, or socioeconomic status. According to the World Health Organization (WHO), a pandemic is defined as an epidemic occurring worldwide or across a large area, crossing international boundaries. By that definition, cancer is certainly a pandemic. However, its prevalence and the ability to treat it vary widely across different regions, particularly between developed and developing nations.

The global cancer crisis
As stated by His Excellency Dr Wahid Ali Said Al Kharusi (pix), President and Chairperson of the Oman Cancer Association, cancer presents an unparalleled global challenge. Speaking at the National Cancer Congress in Malaysia, Dr Wahid emphasized that cancer care faces severe limitations, especially in developing countries, which often lack both the resources and infrastructure to adequately manage the disease. "Cancer crosses all international borders and it is not solvable at the moment because it’s either a very expensive disease or the efforts to combat it are limited,” he noted.

This stark disparity is particularly evident in childhood cancer survival rates. In the United States, approximately 80% of children diagnosed with cancer survive, while globally, only 20% of children diagnosed with cancer survive the disease. WHO has committed to increasing this survival rate to 60% by 2030, but this goal highlights the immense challenge of addressing cancer in resource-poor settings.

The genetic complexity of cancer
Cancer is a heterogeneous disease, and this is a significant reason why it is so difficult to treat. Advances in cancer genomics have shown that tumors can have multiple genetic variations, even within the same individual. As Dr Wahid pointed out, "If you take a sample from the top of a tumor and compare it with a sample from the bottom, you may find two different genomes.” This genetic diversity makes it difficult to develop one-size-fits-all treatments, as many standard therapies may not work for every patient. This is also why cancer treatments are often expensive and may not be effective, leading to prolonged suffering for patients.

However, targeted therapies and personalized medicine are emerging as potential game-changers. By understanding the specific genetic makeup of a patient's cancer, doctors can design treatments that are more likely to be effective. This represents a promising avenue for cancer care, but these advanced treatments remain out of reach for many in the Global South due to their high cost and the lack of necessary infrastructure.

Why are some rich countries poor in health outcomes?
The Global South, home to many resource-rich countries, paradoxically struggles with poor health outcomes, especially in cancer care. While some of these countries possess vast natural resources, the wealth generated often does not translate into better healthcare. There are several reasons for this disparity:

Corruption and mismanagement: In many resource-rich countries, wealth is concentrated in the hands of a few, with widespread corruption diverting funds that could have been used for healthcare infrastructure.
Lack of political will: In some nations, the political will to address healthcare challenges, including cancer, is limited. Governments may prioritize other sectors over healthcare, leaving NGOs and international organizations to fill the gap.
Weak healthcare infrastructure: Many countries in the Global South lack the necessary healthcare infrastructure to diagnose and treat cancer early. Facilities for diagnostics, such as mammography and MRI machines, are often scarce, especially in rural areas.
Education and awareness: There is often limited awareness about cancer, particularly about the importance of early detection. Cultural taboos surrounding certain cancers, such as breast cancer, can also prevent people from seeking treatment early on.
High cost of treatment: Cancer treatment, particularly for advanced therapies, is prohibitively expensive. Many governments in the Global South do not have the resources to subsidize these treatments, and patients often cannot afford them out of pocket.

Rebuilding after the pandemic: The way forward
The COVID-19 pandemic further exacerbated existing challenges in cancer care across the Global South. With resources diverted to combat the pandemic, cancer screenings, diagnoses, and treatments were delayed, creating a backlog that healthcare systems are still struggling to address. NGOs and civil societies, which play a crucial role in supporting cancer care in these regions, also faced significant disruptions.

Rebuilding these systems and networks is now one of the most pressing challenges in cancer care. As Dr Wahid explains, “Rebuilding the networks that were destroyed by the pandemic is crucial. Most post-pandemic problems depend on this.”

Key requirements for improved cancer care
Awareness and advocacy: National cancer programs must focus on raising awareness about common cancers such as colorectal, breast, and lung cancer. Data collection should be prioritized to track the effectiveness of these programs and to inform future efforts.

Education for stakeholders: Educating all sectors of society, including government officials, corporate leaders, and community decision-makers, is essential for securing the resources and support needed to tackle cancer effectively.

Empowerment: Empowering patients, particularly women, plays a critical role in their reintegration into society post-treatment. Empowered patients can help raise awareness and advocate for others, creating a ripple effect in their communities.

Early detection and diagnosis: Cancer is not always a death sentence, and early diagnosis can significantly improve survival rates. Public health campaigns must emphasize the importance of regular screenings and early treatment.

Role of NGOs and civil societies: The role of NGOs is complementary to government efforts, especially in healthcare. Strengthening partnerships between these organizations and government bodies is essential to improving cancer care outcomes.

Adapting to digital health: Embracing digital health technologies is another key strategy. Digital platforms can help provide remote care and support for cancer patients, particularly in regions where healthcare infrastructure is limited.

Challenges and solutions for the future
The challenges faced by countries in the Global South are complex, but there are pragmatic solutions that can help improve cancer care in these regions:

Resource allocation and collaboration: NGOs often face stiff competition for funding, but by collaborating with international bodies, they can pool resources and expertise to make a more significant impact.

Addressing backlogs: Clearing the backlogs in cancer screenings and treatments caused by the pandemic will require increased resources and innovative approaches, such as mobile screening units or telemedicine consultations.

Sustainability and mental health support: Many NGOs also face sustainability issues as donor priorities shift. Additionally, addressing the mental health needs of cancer patients, which have been exacerbated by the pandemic, requires specialized training and resources.

Manpower and cultural sensitivity: A significant challenge in cancer care in the Global South is ensuring that healthcare providers are trained not only in clinical care but also in how to communicate with patients in a culturally sensitive manner. As Dr Wahid highlighted, understanding cultural norms is crucial when discussing sensitive topics such as breast cancer, especially in regions where cultural taboos exist.

Policy advocacy: Advocacy for policy changes is necessary to address systemic issues, such as healthcare infrastructure weaknesses and disparities in access to care. Political will is a major factor in improving healthcare outcomes, and stakeholders must be educated to prioritize cancer care.

A global strategy to fight cancer
Dr Wahid calls for a global strategic approach to combating cancer. He stresses the importance of intensifying awareness, education, and research, as well as political will to empower stakeholders. Additionally, strengthening volunteer networks and fostering alliances between NGOs and international organizations is crucial for ensuring that resources are used effectively and that duplication of efforts is avoided.

By sharing knowledge, especially in the field of genetics and targeted therapies, global institutions can help developing countries build their healthcare infrastructure and develop their human resources. This collaboration is essential for reducing the global cancer burden and ensuring that all patients, regardless of where they live, have access to the care they need.

Cancer is a global challenge, but it disproportionately affects those in the Global South, where resources are limited, and healthcare systems are often underfunded. Addressing this crisis requires a multifaceted approach, including awareness, education, empowerment, and collaboration between governments, NGOs, and international bodies. By working together, we can bridge the gaps in cancer care and improve outcomes for patients worldwide.