Transcript Presentation - 5th Session of the Islamic Conference of Health

Panel Discussion I: Tackling Cancer
Fifth Session of Islamic Conference of Health
Ministers Istanbul, Republic of Turkey, 17 – 19 Nov
2015
IAEA
International Atomic Energy Agency
Speakers
Session Programme and Speakers::
No. Name
1.
Professor
Aranda
Organization
Sanchia President-elect of the Union for International Cancer Control;
CEO Cancer Council, Australia
2.
Dr Daouda Malle,
Principal Operations Specialist, Office of the Vice President of
Operaions, Islamic Development Bank
3.
Dr Shilpen Patel
Board of Directors Radiating Hope; Associate Professor University
of Washington, Director of Radiation Oncology RAD-AID Intl.
4.
Assoc. Prof Dr Murat Director, Cancer Control Department, Presidency of Public Health
Institution, Ministry of Health
Gultekin,.
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Strategic Health Programme-OIC
• The Ministers of Health of the Member
States of the OIC at the 4th Conference
(Jakarta, October 2013) adopted a
Strategic Health Programme of Action
2014 – 2023 (SHPA).
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Strategic Health Programme-OIC
• Under Thematic Area 2: Disease Prevention and
Control:
• Action: to enhance cooperation in the area of
cancer control in the member countries
• Through establishing networks among the relevant
institutions in cancer research, diagnosis, and
treatment.
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The Problem
2012:
14.2
million
new
cancer
cases
8
million
cancer
deaths
Current coverage of radiotherapy services according to country as determined by global
equipment databases, an activity-based operations model, cancer incidence, and evidencedbased estimates of radiotherapy need. Lancet commission Report
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2030
: 24.6
million
new
cancer
cases
13
million
cancer
deaths*
* Projected :Ferlay J et al Sources, methods and major patterns in GLOBOCAN 2012. 2015; 136(5):E359-E386
.
5
Local Control and Survival Benefit
from Radiation
Radiotherapy
5-year local
5-year overall
utilization rate RT fractions per
course
control benefit survival benefit
(RTU)
Breast
Cervix
Colorectal
Haematological
Head and Neck
Liver
Lung
Oesophagus
Prostate
Stomach
ALL TOP 10
CANCERS
87%
71%
19%
48%
74%
0%
77%
71%
58%
27%
50%
16
21
23
8
22
0
16
15
28
19
18
15%
35%
5%
7%
34%
0
9%
5%
25%*
2%
10%
Top 10 cancers globally by incidence: Radiotherapy utilization
rate, average RT fractions and outcome benefits (absolute
proportional)**
** personal communication Lancet Commission Report
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2%
20%
2%
4%
20%
0
6%
2%
1%
1%
4%
OpEx – Sensitivity Analysis
Automation – Longer
Bulk
Efficiency
Hours
Purchase
X
X
X
X
X
X
X
X
X
X
X
X
HIC
-25%
-13%
-8%
-33%
-19%
-31%
-37%
Relative Cost Savings
U-MIC
L-MIC
-21%
-18%
-16%
-34%
-34%
-34%
-43%
-21%
-23%
-21%
-39%
-38%
-38%
-51%
LIC
-21%
-25%
-23%
-40%
-42%
-39%
-53%
6
CT versus PET/SPECT scans
CT - Transmission Imaging
NM - Emission Imaging
Structural Information:
Uptake Information
Size
Activity
Shape
Function
Location
Localization
Diagnosis
Staging
Restaging
Therapy planning
Therapy response
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Images Courtesy D. Paez
Uses of Nuclear Medicine Imaging
Renal Scintigraphy-Tc-99m-MAG3
Use in Cardiology
PET/CT in Use in Neurology
Anterior wall ischemia
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Most Common NM tests:
Bone scans
Thyroid scintigraphy
Lung perfusion and ventilation
Nuclear cardiology
Renal scans
Oncology
Neurology and Psychiatry
reduced wall motion; scar on bottom
Courtesy D.Paez
Radiation Therapy Techniques
Robotic Body Radiosurgery
Gamma-knife Radiosurgery
• Radiotherapy has been used for
curative or palliative treatment of
cancer, alone or combined with
chemotherapy or surgery.
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External Beam 3-D/IMRT
Brachytherapy
Comparison of Techniques
Radonc.ucla.edu
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Courtesy Sua Yu, MD
IAEA Technical cooperation (TC) programme
Developed and managed jointly by the Member
States and the IAEA Secretariat.
The IAEA Technical Departments are responsible
for the technical integrity of the TC programme.
IAEA TC Department responsible for the
management of the TC programme
Yearly budget of about €120 million
About €32 million (~26%) are spent on Human
Health
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Cervix Cancer
• Radiotherapy improves the absolute 5-year
survival rate by 17% over the contribution of
surgery and chemotherapy.
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12
Cancer Worldwide Burden
• Globally, in 2012 the most common cancers
diagnosed were those of the:
 Lung (1.8 million cases, 13.0% of the total)
 Breast (1.7 million, 11.9%)
 Large bowel (1.4 million, 9.7%).
• The most common causes of cancer death were:
 Cancers of the lung (1.6 million, 19.4% of the total)
 Liver (0.8 million, 9.1%)
 Stomach (0.7 million, 8.8%).
*World Cancer Report 2014 launched by the International Agency for Research on Cancer (IARC)
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Cancer Burden in Developing Countries
• Developing countries are disproportionately
affected by the increasing numbers of
cancers.
• More than 60% of the world’s total cases
occur in Africa, Asia, and Central and South
America, and these regions account for
about 70% of the world’s cancer deaths.
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Comprehensive Cancer Control Approach
Coordinated activities focused around
prevention, early detection, diagnosis,
treatment and palliative care.
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Comprehensive Cancer Control Approach
• Improving access, affordability, quality and
delivery of cancer services to cancer
patients requires a multidisciplinary set of
expertise.
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Panel Objectives
• To address the need for comprehensive cancer
control and for implementation of evidencebased interventions tailored to level of
resources available with Ministers of Heath.
• To share regional best practices
• Promote regional coordination mechanisms in
cancer control planning and implementation in
order to strengthen health systems.
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Panel Objectives
• A high-level panel representing different
cancer stakeholders will advocate for :
• Comprehensive cancer control and
expand on a number of critical issues that
need to be considered to strengthen the
health systems to effectively address
cancer.
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Speakers
Session Programme and Speakers::
No. Name
1.
Professor
Aranda
Organization
Sanchia President-elect of the Union for International Cancer Control;
CEO Cancer Council, Australia
2.
Dr Daouda Malle,
Principal Operations Specialist, Office of the Vice President of
Operaions, Islamic Development Bank
3.
Dr Shilpen Patel
Board of Directors Radiating Hope; Associate Professor University
of Washington, Director of Radiation Oncology RAD-AID Intl.
4.
Assoc. Prof Dr Murat Director, Cancer Control Department, Presidency of Public Health
Institution, Ministry of Health
Gultekin,.
IAEA
Panelist Presentations
• 5 minutes each for presentations
• Followed by questions to the panelists 8-10
minutes each.
• Followed by an open discussion
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Human Health
20
Professor Sanchia Arancha
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Human Health
21
Dr Daouda Malle
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Human Health
22
Dr Shilpen Patel
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Human Health
23
Dr Murat Gultekin
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Human Health
24
QUESTIONS TO THE PANELISTS
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Human Health
25
Professor Sanchia Aranda
• Questions to the speaker:
 What is the role of NGOs in supporting
governments to implement national cancer
control plans?
 How could NGO best contribute to raising
awareness on the cancer epidemic at national
and/or global level?
 How could governments support the
development of active and collaborative NGOs
at national level?
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Dr Daouda Malle
 What would be the social and economic cost of not
investing in cancer control and can we afford not investing
on it?
 While cancer services appear to be cost-effective
(prevention as well as treatment, including radiotherapy),
financing these services may have high initial costs, which
may be challenging for low- and middle-income countries.
How would you recommend these countries should
approach this important issue?
 Investing in cancer control would result in an overall
strengthening of health systems, which may deliver results
also in other health areas, thus maximising the Return on
Investment (ROI). How can we factor this aspect in making
investment decisions?
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Dr Shilpen Patel
• Questions to the speaker:
 How can early detection improve treatment
outcome and survival?
 What key messages have been found effective
in order to raise awareness among the
population?
 Please comment on the impact of radiation
therapy within cancer control?
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Assoc. Prof Dr Murat Gultekin
 What kind of access disparities in cancer
treatment worldwide and in low and middle
income countries in particular do you observe
nowadays?
 What in your opinion should be done by
international community to recognize this equity
challenge and, consequently, to address it?
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Assoc. Prof Dr Murat Gultekin
• Questions to the speaker:
 What are the main challenges normally
experienced in setting up surveillance systems?
 What are the most effective linkages that need
to be established so that data can actually
inform policy and operational decisions?
 How can National Cancer Control Plans be
developed in the absence of reliable population
based data?
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Challenges
• Uncertain energy supply & Lack of control of
ambient temperatures in buildings
• Weak health systems with limited laboratory
and diagnostic services & medical support.
• An estimated additional 215,000 health
professionals will be needed by 2035 to
meet the need for radiotherapy services.
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Human Health
31
Innovative Coordinated Research
Projects (CRP) for Resource Sparing
• Post-mastectomy
•
•
•
•
•
•
•
radiotherapy
Pre-operative advanced
rectal cancer
Palliative oesophagus
cancer
Glioblastoma multiforme
Lung cancer
Painful bone metastasis
Head and neck cancer (2)
Cervical cancer (2)
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Innovative Technologic Solutions
• Cloud-based radiotherapy platforms :
 automated techniques for treatment planning,
quality control, and peer-review
• Resulting in :
 improved quality, reduced expertise
dependence, and lower operating costs
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Human Health
33
Innovation in Financing
• Innovative financing: offers new
opportunities for mobilising, pooling,
channelling and funding radiotherapy
services .
• Others include Diaspora Bonds and Social
Impact Bonds
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CONCLUSIONS
• Strengthen health systems with appropriate
laboratory and diagnostic services & medical
support.
• Increase education and training
opportunities to provide the estimated
additional 215,000 health professionals
needed by 2035 to meet the need for
radiotherapy services.
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CONCLUSIONS
• Accelerated adoption of existing technologies
• Creation of new technologies to address diverse
needs
• Development of new processes / models that
remove impediments to efficient and effective care
delivery
• Financing to address resource shortfalls
• Communication and advocacy to mobilise support
and gain confidence of decision makers.
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36
CONCLUSIONS
• Avoid fragmented approaches –not
sustainable.
• Innovative leadership and stewardship
models are required to promote multinational partnerships with those in need.
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Human Health
37
THANK YOU
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Human Health
38