TOGETHER, INDIA, CHINA and Russia experience almost half of all new cancers worldwide and see more than half of all cancer deaths globally.

What are the three countries doing to combat the disease?

Not enough, according to a major new study.

Medical journal, the Lancet Oncology, has just published a number of articles on the topic, to be published at a Commission examining the challenges to effective cancer control across the three nations this weekend.

Pollution issues in China, extreme shortages of doctors and cancer fatalism in India and tobacco and alcohol use in Russia were all cited as obstacles to cancer prevention and treatment.

The Commission recommends that more “specific attention” needs to be given to the disease, as well as more funding and study.

According to the 40 experts involved, the obstacles to good treatment and care are “complex and idiosyncratic”.

“It is impossible to understand the issues that affect delivery of cancer care in China, India, and Russia, without first understanding the social, economic, and attitudinal factors which influence the way that cancer care is delivered and received in these countries,” said lead author Professor Paul Goss.

However, there are some common threads within the three countries.

Across all three nations, pronounced disparities in access to care were seen between rich and poor and between rural and urban citizens.

Cancer experts have urged government to address the inequities that have formed.

Other challenges of preventing cancer are marked across the three countries. These include changing risky lifestyle choices, such as smoking.

Poor quality of data collection on the nature and extent of cancer is also a pressing issue.

“The sheer size, geographic and human diversity, and lack of infrastructure in each of these countries presents an enormous challenge to scientists trying to evaluate the burden of cancer, which has consequences for policy makers.”

It leaves them “unable to devise a forward looking, modern, national cancer plan,” says Professor Goss.

Social, economic and environmental factors are just as important for improving cancer care as health resources and financing across the three countries.

“Active political engagement is absolutely necessary to ensure that effective policies to fight cancer are embedded in all government departments – not just health ministries,” explained Dr David Collingridge.

“Departments charged with protecting the environment, provision of social services, and the delivery of education, science, and technology, all have key roles in these challenges.”

Key Findings: China

• Cancer accounts for 21 per cent of all-cause mortality in China, the most populous and the largest low-middle income country in the world.
• Urgent and ongoing attempts to combat environmental pollution of air, water and soil are needed.
• Integration of traditional Chinese medicine to create acceptance and compliance with anti-cancer strategies are needed.
• China has built more than 200 cancer hospitals, with more than 30 tertiary-level hospitals for cancer that provide the highest level of care.
• The number of beds for cancer care doubled between 2005 to 2010 but they remain unevenly distributed across the country, with twice as many beds available in urban areas.

Key Findings: India

• Affordability and an extreme shortage of doctors and healthcare workers are major obstacles to progress.
  
• Socio-cultural factors such as castes, gender inequality, low regard for health as a priority, cancer fatalism, blind faith in traditional methods of healing, religious dynamics, and widespread superstitions all impede anti-cancer progress and need widespread education to be addressed.
• Novel approaches that are simple, affordable, safe, and with a minimum need for monitoring is needed to improve cancer outcomes for a large sub-section of the population.
• Development of cancer registries and a prospective national cancer plan including a focus on prevention (particularly anti-tobacco measures), screening, early diagnosis and the most cost-effective therapies are urgently needed.
• Data from the registry have enabled government policy makers to recognize the effect of cancer on the nation’s health, resulting in the formation of 27 regional cancer centers in India. Additional funding has been provided to more than 80 public hospitals to establish oncology services. At a local level, programmes for cancer control are now operational in 21 states throughout the country.

Key Findings: Russia

• There are extreme economic disparities and health care expenditure on the poorer population remains very low by high-income country standards.
  
• Nationally, life expectancies have not risen commensurate with increasing wealth, and are much lower among men than women. Cancer accounts for 15% of all deaths in Russia.
• The risk of dying from cancer is 0·60 in Russia, almost double that in the US (0·33) and much higher than in the UK (0·40).
• Although measures against tobacco and alcohol use have been attempted, significant improvement in enforcement and monitoring of these policies is needed to translate into improved outcomes as these are two leading causes of cancer and early mortality.

The Lancet Oncology Commission Challenges to effective cancer control in China, India, and Russia and the Series Cancer burden and health systems in India will be presented at the 6th Asian Oncology Summit and 10th Annual Conference of the Organisation for Oncology and Translational Research, being held in Kuala Lumpur, Malaysia this weekend. 

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