Establishing Cancer Treatment Programs in Resource-Limited Settings: Lessons Learned From Guatemala, Rwanda, and Vietnam

Abstract

PurposeThe global burden of cancer is slated to reach 21.4 million new cases in 2030 alone, and the majority of those cases occur in under-resourced settings. Formidable changes to health care delivery systems must occur to meet this demand. Although significant policy advances have been made and documented at the international level, less is known about the efforts to create national systems to combat cancer in such settings.MethodsWith case reports and data from authors who are clinicians and policymakers in three financially constrained countries in different regions of the world—Guatemala, Rwanda, and Vietnam, we examined cancer care programs to identify principles that lead to robust care delivery platforms as well as challenges faced in each setting.ResultsThe findings demonstrate that successful programs derive from equitably constructed and durable interventions focused on advancement of local clinical capacity and the prioritization of geographic and financial accessibility. In addition, a committed local response to the increasing cancer burden facilitates engagement of partners who become vital catalysts for launching treatment cascades. Also, clinical education in each setting was buttressed by international expertise, which aided both professional development and retention of staff.ConclusionAll three countries demonstrate that excellent cancer care can and should be provided to all, including those who are impoverished or marginalized, without acceptance of a double standard. In this article, we call on governments and program leaders to report on successes and challenges in their own settings to allow for informed progression toward the 2025 global policy goals.

Cancer care delivery innovations, experiences and challenges during the COVID-19 pandemic: The Rwanda experience

“…In 2018, 9.6 million lives were lost to cancer of which over 70% occurred in low and middle-income countries (LMICs) where limited access to cancer care and overwhelming late disease presentations negatively impact cancer related survival and quality of life [ 1 ]. Moreover, globally, new cancer cases are expected to increase from 18.1 million in 2018 to 21.4 million by 2030 [ 2 ]. In settings of poor health care systems and impoverished communities, the scarcity of and limited access to diagnostic and treatment modalities negatively impacts health outcomes and undermines achievement of the universal health care coverage (UHC) targets.…”

Cervical cancer prevention and control in women living with human immunodeficiency virus

“…Financing for cancer-specific services and infrastructures, especially in the public sector and with other competing disease priorities, is often a challenge for already severely constrained national health care budgets. External financing efforts, including through multilateral or bilateral donor initiatives 277,278 and philanthropic/nonprofit sector investments, 279 have been critical to augment and expand nascent efforts by in-country agencies, although ensuring the sustainability of such approaches over the long term remains an ongoing challenge. 280 Rwanda is an illustrative example of both the successes and challenges of cervical cancer prevention and control in LMICs.…”

Education and Training

“…The steps involved included training relevant staff in Nepal and allowing for Nepalese providers to receive training at UIC, exchange of standard operating procedures, overseeing construction of HCT unit in a Nepalese hospital, and continued teleconferences between UIC and Nepal. Another example includes enhancing cancer care in low-income limited resource countries such as Guatemala, Vietnam, and Rwanda [6]. Through partnership with established cancer centers and with significant investment, improvements, and development of infrastructure, training of relevant professionals, implementing new cancer screening programs, and developing cancer-specific health policy have improved cancer care in these regions.…”