In Latin America, cancer and its control present often stark contrasts—or, in the words of one expert interviewed for this study, “light and shadow”. Rapid change occurs next to stubborn stasis, and substantial progress in some areas is intermingled with still unmet, pressing needs in others.
It is also an issue with growing political salience within the region: past success in the control of communicable diseases has increased the relative profile of non-communicable ones.
This study looks in detail at both the bright spots and the ongoing gaps for Latin American governments as they wrestle with cancer and seek to provide accessible prevention and care to their populations. Its particular focus is on 12 countries in Central and South America chosen for various factors, including their size and level of economic development. These states, referred to as “study countries”, are Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Paraguay, Peru and Uruguay. Together they accounted for 92% of cancer incidence and 91% of mortality in Central and South America in 2012.
The study also introduces a major tool for stakeholders seeking to understand this field: the Latin America Cancer Control Scorecard (LACCS). The LACCS relies on significant desk research to rank the 12 study countries on their performance in different areas of direct relevance to cancer-control access. In addition to the scorecard, the report also draws on its own, separate substantial research as well as 20 interviews with experts on cancer in the region and worldwide. Its key findings include the following.
This Presentation provides information about the segmentation of oncology market worldwide, Global Oncology market analysis along with Indian Oncology market.
This presentation covers the following information - Indian Government initiatives,Market Challenges,Market Drivers and SWOT Analysis.
The presentation begins with a brief history of how cancer epidemiology evolved, and what is the status at present. After describing the burden of the disease of cancer globally and in India, the presentation includes a brief description of Cancer causes and prevention including screening activities. It also talks about the national Cancer Registry Program, NPCDCS and NCCP.
US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)Innovara, Inc.
A presentation on cancer and ethnicity in the United States, and how the US can learn from other countries in regards to cancer control. - by Barri Blauvelt, CEO, Innovara, Inc.
In Latin America, cancer and its control present often stark contrasts—or, in the words of one expert interviewed for this study, “light and shadow”. Rapid change occurs next to stubborn stasis, and substantial progress in some areas is intermingled with still unmet, pressing needs in others.
It is also an issue with growing political salience within the region: past success in the control of communicable diseases has increased the relative profile of non-communicable ones.
This study looks in detail at both the bright spots and the ongoing gaps for Latin American governments as they wrestle with cancer and seek to provide accessible prevention and care to their populations. Its particular focus is on 12 countries in Central and South America chosen for various factors, including their size and level of economic development. These states, referred to as “study countries”, are Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Paraguay, Peru and Uruguay. Together they accounted for 92% of cancer incidence and 91% of mortality in Central and South America in 2012.
The study also introduces a major tool for stakeholders seeking to understand this field: the Latin America Cancer Control Scorecard (LACCS). The LACCS relies on significant desk research to rank the 12 study countries on their performance in different areas of direct relevance to cancer-control access. In addition to the scorecard, the report also draws on its own, separate substantial research as well as 20 interviews with experts on cancer in the region and worldwide. Its key findings include the following.
This Presentation provides information about the segmentation of oncology market worldwide, Global Oncology market analysis along with Indian Oncology market.
This presentation covers the following information - Indian Government initiatives,Market Challenges,Market Drivers and SWOT Analysis.
The presentation begins with a brief history of how cancer epidemiology evolved, and what is the status at present. After describing the burden of the disease of cancer globally and in India, the presentation includes a brief description of Cancer causes and prevention including screening activities. It also talks about the national Cancer Registry Program, NPCDCS and NCCP.
US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)Innovara, Inc.
A presentation on cancer and ethnicity in the United States, and how the US can learn from other countries in regards to cancer control. - by Barri Blauvelt, CEO, Innovara, Inc.
World Cancer Day, established by the Union for International Cancer Control (UICC) in 2000, is observed every year on February 4th. Over 10 million people die each year from cancer, more than HIV/AIDS, malaria, and tuberculosis combined. This makes cancer a leading cause of death with a global impact; cancer is not specific to any one geographic region or any one demographic. Cancer can affect anyone of any age, but we are moving towards extraordinary medical breakthroughs in the fight against cancer...
Cost-Effectiveness of Contralateral Prophylactic
Mastectomy Versus Routine Surveillance in Patients
With Unilateral Breast Cancer
Benjamin Zendejas, James P. Moriarty, Jamie O’Byrne, Amy C. Degnim, David R. Farley, and Judy C. Boughey
Cancer de mama
Clinica Ruber
Dr Juan Carlos Meneu
Cancer Epidemiology, Risk factors for most common types, mortality, prevention and yeild of cancer prevention. gender, geography, infections, tobacco, environmental riskk factors.
Different types of diseases and infections have always threatened man.However, one disease that is considered almost deadly and has a very high rate of recurrence is cancer.
Medooc is a search engine for researching medical information.It has been built by medical
professionals to help others in the community to research and share credible health information.
Doctors, Physcials and medical professionals participate in Medooc.com on day to day basis to help
each other.
For more information you can visit:-http://www.medooc.com/
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
World Cancer Day, established by the Union for International Cancer Control (UICC) in 2000, is observed every year on February 4th. Over 10 million people die each year from cancer, more than HIV/AIDS, malaria, and tuberculosis combined. This makes cancer a leading cause of death with a global impact; cancer is not specific to any one geographic region or any one demographic. Cancer can affect anyone of any age, but we are moving towards extraordinary medical breakthroughs in the fight against cancer...
Cost-Effectiveness of Contralateral Prophylactic
Mastectomy Versus Routine Surveillance in Patients
With Unilateral Breast Cancer
Benjamin Zendejas, James P. Moriarty, Jamie O’Byrne, Amy C. Degnim, David R. Farley, and Judy C. Boughey
Cancer de mama
Clinica Ruber
Dr Juan Carlos Meneu
Cancer Epidemiology, Risk factors for most common types, mortality, prevention and yeild of cancer prevention. gender, geography, infections, tobacco, environmental riskk factors.
Different types of diseases and infections have always threatened man.However, one disease that is considered almost deadly and has a very high rate of recurrence is cancer.
Medooc is a search engine for researching medical information.It has been built by medical
professionals to help others in the community to research and share credible health information.
Doctors, Physcials and medical professionals participate in Medooc.com on day to day basis to help
each other.
For more information you can visit:-http://www.medooc.com/
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
Become a data driven organisation, and turn your KPIs into Euro's. Through monetization you are able to measure the real value of each digital channel, each online behavior and each audience segment.
Roteiro para contribuição da paciente para a Consulta Pública do uso do medicamento Bevacizumabe para pacientes com câncer de colo de útero metastático, persistente ou recorrente.
Según la Ley de Transparencia, los Organismos garantes, serán los responsables de desarrollar, administrar, implementar y poner en funcionamiento la plataforma electrónica, atendiendo a las necesidades de accesibilidad de los usuarios.
[OPERAÇÃO UNIFORME] Fase 1: Meu SUS é igual ao seu SUS?Oncoguia
Iniciativa do Instituto Oncoguia para identificar se há ou não uniformidade na oferta de tratamentos nos cerca de 300 hospitais habilitados em oncologia no SUS
Running head INEFFECTIVE CANCER TREATMENTS LEADING TO DEATHS1.docxcowinhelen
Running head: INEFFECTIVE CANCER TREATMENTS LEADING TO DEATHS 1
INEFFECTIVE CANCER TREATMENTS LEADING TO DEATHS 18
Ineffective Cancer treatments leading to deaths
Name
Course
Tutor
Date
Abstract
The main focus of the report will be to research on the various methods through which cancer can be treated with a keen eye on why some methods are ineffective and lead to death. A discussion on different cancer treatment will be done followed by the types of cancer that cause millions of death today. Presentation of answers to the research questions will be done in line with ineffective cancer treatment methods. Relevant literature review will be conducted and used to support the claims of ineffective cancer treatments. Lastly, recommendations on the best cancer treatment will be done.
Introduction
Cancer is an ailment caused by the unrestrained division of abnormal cells in the body. The cancer cells are malignant meaning they can spread from the origin to distant organs and tissues. The disease can be genetically hereditary hence can be crossed over from one generation to another. Some of the forms of cancer treatment include targeted therapy, hormone therapy, chemotherapy, precision medicine, surgery, immunotherapy, and stem cell transplant. Some of the common types of this disease include lung, liver, stomach, and bowel cancers.
Cancer is also called as malignancy which means abnormal cells growth. More than 100 types of cancer are found in this world today, including breast cancer (widely spread among women), skin cancer (found in the person of almost every age), lung cancer (common among smokers), colon cancer, lymphoma and prostate cancer. Each kind of cancer has varying symptoms. Cancer differs with respect to the cell it affects first. The uncontrollable division of cells harm the body and form lumps and the masses of tissues which are known as tumors. The tumor grows in size and sometimes even intervene the digestive system, circulatory system, excretory system and nervous system. In the case of leukemia, cancer inhibits the normal blood functioning which is caused due to the abnormal cell division into the blood stream. Cancer also causes the systems of the body to secrete hormones that alter the body functioning. Tumors that do not grow and remain limited to one spot are considered to slightly less harmful and benign. The sign of the more dangerous and malignant cells is:
1. The harmful cancerous cells move from one spot to another throughout the body using blood as a medium and invade the organs and the healthy tissues of the body.
2. These cells grow and divide rapidly, they make blood vessels of their own which are used by them in the process of feeding, called as angiogenesis.
Then comes a stage is known as metastasized in which the tumor spread successfully to the other parts of the body, penetrating into the healthy tissues of the body and damaging them badly. The process is known as metastasis. It cause ...
Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
Analysing Research on Cancer Prevention and Survival: Recommendationsnzhempfoods
World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) champions the latest and most authoritative scientific research from around the world on cancer prevention and survival through diet, nutrition and physical activity to help people make informed lifestyle choices to reduce their cancer risk.
It is a core aspect of global health to control cancer because the cases of cancer patients increasing rapidly in low-resource countries. Around 411,000 deaths due to breast cancer in 2002
were recorded and out of which 221,000 deaths due to breast cancer occur in low- and middle-income countries. Early detection, Diagnosis, and Treatment are the guidelines for breast health. It is curable in 70-80% of patients diagnosed in the early-stage and non-metastatic stage of this cancer. Inadequate access to optimal care increases the mortality rate of breast cancer in low- and middle-income countries. Public health education and breast cancer awareness are key strategies that can play role in decreasing its incidence. By using a consensus, evidence-based approach that explains the step-by-step improvement in quality of life and also the health care delivery system.
Breast cancer is one of the leading cause of death in women and only treatment is the early detection of it.
Professor Alan Jackson’s presentation, The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer, at the African Organisation for Research & Training in Cancer (AORTIC) conference, 18-22 November 2015, Marrakech, Morocco.
Developing a cancer survivorship research agenda - Prof Patricia GanzIrish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
Developing a cancer survivorship research agenda: challenges & opportunities - Prof Patricia Ganz, UCLA Fielding School of Public Health
Survival Analysis of Determinants of Breast Cancer Patients at Hossana Queen ...Premier Publishers
Breast cancer is one of the most severe diseases in the world and become the public’s ever day’s agenda in both developed and developing countries. The primary goal of this study was to identify the determinants of survival time of breast cancer patients at Hossana hospital, south Ethiopia. Kaplan-Meier estimation method and a new two-parameter probability distribution called hypertabastic are introduced to model the survival time of the data. A simulation study was carried out to evaluate the performance of the hypertabastic distribution in comparison with popular distribution with the help of R and SAS statistical software Packages. One-fourth (25%) of the total patients survived for only 2 days. 31(35.2%) were censored, and 55(62.5%) were died. Hypertabastic survival model was found to be best fitting to the breast cancer data and age, level of education, family history, breast problem before, High fat diet, child late age, early menarche, late menopause were significant risk factors for the death of breast cancer patients. Awareness has to be given for the society on causes of breast cancer and screening test and early detection policies for most risky groups has to be established.
Similar to Câncer, uma prioridade global - Gilberto Lopes (20)
Relatório de atividades do Instituto Oncoguia2022Oncoguia
Apresentamos o nosso relatório anual, onde divulgamos os principais resultados e atividades de 2021, reforçando nosso comprometimento com a transparência e a ética.
Feelings about Radiotherapy: the Brazilian Cancer Patients' PerspectiveOncoguia
Study presented at XXIII CBOC- SBOC, Nov 3-5, 2022, using data from a Oncoguia's national survey about Brazilian Cancer
Patients' Perspective of Radiotherapy
Return to work after breast cancer: disparities among patients treated in pub...Oncoguia
Study presented at SABCS, Dec 7-10, 2021 using data from an Oncoguia's national survey to better understand return to work after breast cancer diagnosis
Pesquisas do Oncoguia mostra visão sobre câncer por quem mora na favelaOncoguia
Sem assistência e informação, população tem ‘muito medo’ da doença; 13o Fórum Nacional Oncoguia debate os desafios para reduzir desigualdades e ampliar acesso à saúde
Consultas Públicas do SUS / Paciente oncológico: informe-se e participe!Oncoguia
Consulta pública é o espaço de contribuição da população em um processo de avaliação sobre o que deve ou não estar disponível para tratamento no SUS ou nos planos de saúde.
Relatório de atividades do Instituto Oncoguia / 2021Oncoguia
Apresentamos o nosso relatório anual, onde divulgamos os principais resultados e atividades de 2021, reforçando nosso comprometimento com a transparência e a ética.
How can we help: The needs of those seeking breast cancer information and sup...Oncoguia
Esta pesquisa foi desenvolvida pelo time de Pesquisa do Oncoguia com o objetivo de analisar o perfil e as principais necessidades de pacientes com câncer de mama e seus familiares. Foi desenvolvida análise retrospectiva de dados de 11.137 atendimentos do Ligue Câncer realizados entre 2013 e 2019
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
1. Global Challenges and Opportunities in
Cancer Control and Access to Cancer
Medications
Gilberto de Lima Lopes, Jr., M.D., M.B.A, F.A.M.S.
Volunteer Physician, Oncoguia Institute
Chief Medical and Scientific Officer, Oncoclinicas Group
Assistant Professor of Oncology, Johns Hopkins University
Associate Editor, ASCO University and Journal of Global Oncology
2.
3. In Adults in the US
In Men cancer death
rates have dropped
21%
In Women 12%
Overall 2/3 of patients live
for 5 years or longer
compared to less than
50% several decades ago
American Cancer Society 2009-2012
Photo Credit: G Lopes, Chicago 2013
4. For those of us who treat patients in low and
middle income countries most of these
advances are an inspiration and represent
hope for the future...
...but not our current reality
5. Cancer mortality to incidence ratios
USA Europe LMICs
0.36 0.48 0.68
Lopes [Senior Author]: Global Health Equity: Cancer Care Outcomes Disparities in High,
Middle and Low Income Countries. J Clin Oncol special issue on Global Oncology, in press.
Based on Data from GLOBOCAN
Photo Credit: G Lopes, Copacabana Beach, Rio de Janeiro 2013
6. Example:
Latin
America
Lopes [co-author] in Goss et al, Planning Cancer Control in Latin America and the Caribbean Lancet Oncology 2013
Copyright: Elsevier, used with permission
7. Low and Middle Income Countries Spend
Less in Cancer Control
Lopes. Access to Cancer Medications in Low and Middle Income Countries.
Nature Rev Clin Oncol 2013. Copyright: Nature Publishing, used with permission
Numbers represent economic
burden per cancer patient in
US$ (and as a percentage of
GDP/Capita)
8. Low and Middle Income countries represent
more than half of cancer cases, 6.2% of global
cancer costs and 89% of the cancer global
expenditure gap
Lopes. Investing in Cancer Prevention and Control to Reduce Global Economic Burden. ASCO Connection 2015
9. The implementation of prevention, early
detection, and treatment strategies could
potentially save 2.4 million-3.7 million lives
every year—the vast majority of them in low-
and middle-income countries—yielding an
economic benefit in excess of $400 billion.
Lopes. Investing in Cancer Prevention and Control to Reduce Global Economic Burden. ASCO Connection 2015
10. Moreover, it has been estimated that an
investment of $11.4 billion in a set of core
prevention strategies in less wealthy regions of
the world can lead to savings of up to $100
billion in future cancer treatment costs
Lopes. Investing in Cancer Prevention and Control to Reduce Global Economic Burden. ASCO Connection 2015
11. Dificuldades Atuais no Diagnóstico e
Tratamento do Câncer
Culturais
Diagnostico
Tratamento: Cirurgia
Radioterapia
Tratamentos Sistemicos
17. Infra-Estrutura Para o Tratamento do Câncer
Leitos Cirúrgicos teriam que aumentar em
até 4x para atender à demanda calculada
18. Disparidades Regionais
57.000 Cirurgias p/ Tumores de SNC no SUS
Media de Mortalidade 7%
O Estado com a menor Taxa: 6%
O Estado com a maior Taxa: 17%
Lopes et al, ASCO 2014, Journal of Global Oncology 2016
24. UN Resolution 61/225 on Diabetes (2006)
Political Recognition
UN Political Declaration on NCDs
• Historic political commitment for cancer
and the other NCDs
• 22 action orientated commitments
covering prevention, treatment and care
• A springboard to set a new Global NCD
Framework
26. What is the WHO model EML?
Definition
“Essential medicines are those that satisfy the priority health care needs of the
population. They are selected with due regard to public health relevance,
evidence on efficacy and safety, and comparative cost-effectiveness.”
Former WHO Model List had 30 cancer medicines
• Full reviews of the cancer medicines on the WHO EML list had been carried in
1984, 1994 and 1999
References:
www.who.int/medicines/publications/essentialmedicines
Shulman, Wagner, Barr, Lopes, Torode, Magrini et al. Proposing Essential Medicines to Treat Cancer:
Methodologies, Processes, and Outcomes. J Clin Oncol 2015, special issue on Global Oncology. In Press.
27. What opportunity does the model EML
provide for national advocacy?
At least 156 out of 194 Member States have national EMLs
Model list is a response to MS requests – since 1977
Guide the definition of national EMLs: identify priority
medicines for procurement and prioritization at the
institutional level
A central component of Universal Health Coverage
28. 2012-2013 WHO EML cycle
Applications for the addition of trastuzumab and imatinib submitted jointly by
DFCI and UICC in November 2012
Campaign to secure support: 20 letters of support received and posted on WHO
website from ASCO, ESMO, BHGI, PIH, SLACOM, Ministry of Health of
Rwanda, Max Foundation and others
Presentation at the Expert Committee meeting in April 2013 to defend the two
applications and section review proposal
Thanks to the financial support of LIVESTRONG
29. The request for a section review
Report of the 19th Expert Committee (oct. 2013)
Acknowledgement of the growing public health importance of
cancer and the need for countries to consider the addition of
highly effective but high cost cancer drugs in the context of
evidence-based treatment regimens;
Urgent need for a review of sub-section 8.2 in terms of
structure and medicines included – decision on
trastuzumab and imatinib reported until the review is
completed;
30. UICC Task Team
The UICC-convened task force was charged with creating a
new framework for evaluation of drugs for inclusion in the
WHO Essentials Medicines List
Members of the Task team include:
DFCI, UICC, ASCO, NCCN International, NCI, ESMO -
working in collaboration with the WHO EML Secretariat
For a detailed account of the process, email me at glopes.md@gmail.com for a
copy of our JCO article on the WHO Essential Medicines List
31. Proposed EML Framework
Four Main Dimensions with Three Levels Each:
Efficacy and Safety of Therapy
Cure, Near Cure, Prolongation of Survival/Palliation of Symptoms
Adequate Safety
Burden of Disease
Low, Mid and High Incidence
Cost Effectiveness of Drug/Regimen
Highly Cost Effective, Cost Effective and Not Cost Effective
Resource Requirements for Drug Use
Low, Middle and High requirement levels
32. Low Medium High
Incidence of Disease
Treatment Goal
Cure or “near cure”
Significant
prolongation of
survival
Palliation of
symptoms with
small benefit in
survival
Leukemia and
Lymphomas in Children
HIGHEST PRIORITY
Adjuvant Breast Cancer
CML
Adjuvant Colon Cancer
Lymphomas
in Adults
Stage III Ovarian Cancer
Metastatic Breast Cancer
HIGH
PRIORITY
Metastatic
Pancreatic Cancer
Metastatic
Lung Cancer
LOWEST PRIORITY
GIST
Metastatic Prostate Cancer
Metastatic
Bladder Cancer
LOW PRIORITY
Low priority could become High Priority if Highly Cost Effective
33. Highly Cost Effective
[Cost/QALY equal or less than GDP/capita]
Cost Effective
[Cost/QALY up to 3x GDP/Capita]
Not Cost Effective
[Cost/QALY > 3x GDP/Capita]
P
R
I
O
R
I
T
Y
1. Different levels for low income, low middle income and high middle income countries.
2. Health systems should see the CE evaluation as a tool to discuss/negotiate prices of priority medications
not as a rigid recommendation.
FOR EACH CATEGORY
34. BHGI-Like Approach: Metastatic Colon Cancer
Level Drugs
Basic BSC Alone
Limited 5FU Alone
Enhanced + Oxaliplatin, Irinotecan
Maximal + Cetuximab/Panitumumab,
Bevacizumab
DecreasingCE
ICER
US$
450
44,500
80,000
Source: Management of colon cancer: resource-stratified guidelines from the Asian
Oncology Summit 2012. Lopes [Senior Author] in Ku et al, Lancet Oncology Vol 13
November 2012
35. Disease-based Briefings Prepared for 29 Types of Cancer
• AML and APL (Adult and Pediatric)
• Chronic Lymphocytic Leukemia
• Chronic Myelogenous Leukemia (Adult and Pediatric)
• Diffuse Large B-Cell Lymphoma
• Early Stage Breast Cancer
• Early Stage Cervical Cancer
• Early Stage Colon Cancer
• Early Stage Rectal Cancer
• Epithelial Ovarian Cancer
• Follicular Lymphoma
• Gastrointestinal Stromal Tumor
• Gestational Trophoblastic Neoplasia
• Locally Advanced Sq Carcinoma of the Head and Neck
• Hodgkin Lymphoma
• Kaposi Sarcoma
• Metastatic Breast Cancer
• Metastatic Colorectal Cancer
• Metastatic Prostate Cancer
• Nasopharyngeal Carcinoma
• Non-small Cell Lung Cancer
• Ovarian Germ Cell Tumors (Adult and
Pediatric)
• Testicular Germ Cell Tumors (Adult and
Pediatric)
Pediatric-Specific
• Acute Lymphoblastic Leukemia
• Burkitt Lymphoma
• Ewing Sarcoma
• Hodgkin Lymphoma
• Osteosarcoma
• Retinoblastoma
• Rhabdomyosarcoma
• Wilms Tumor
39. The Task Force Suggested the
Inclusion of 22 Medications
40. 16 Were Approved
“Following a review requested by the previous Expert Committee in
2013, the Committee recommended the addition of 16 new
medicines and endorsed the use of 30 medicines listed currently
as part of proven clinically effective treatment regimens. These
medicines will be included on the complementary list of the EML
for the treatment of specific cancers. The Committee
recommended that the Model Lists should specify the cancers for
which use of each medicine is recommended.”
WHO, May 2015
45. Cost Implications of Adding Trastuzumab
UICC WHO EML Task Force. http://www.who.int/selection_medicines/committees/expert/20/applications/cancer/en/
46. Cost Implications of Adding Rituximab
UICC WHO EML Task Force. http://www.who.int/selection_medicines/committees/expert/20/applications/cancer/en/
47. Birth of a Drug
1
Approved
Drug
10,000
Compounds
in Drug
Discovery
250 drug
candidates in
pre-clinical
testing
5 drugs in
Phase I-III trials
IND
Submission
10-15 years
Munos. Lessons from 60 years of pharmaceutical innovation. Nat Rev Drug Disc 2009
Pammolli. The productivity crisis in phrmaceutical R&D. Nat Rev Drug Disc 2011
48. The Cost of Developing New Drugs Has Escalated
US$ 138 Million
1975
DiMasi et al. The Price of Innovation: New Estimates of Drug Development Costs. J Heath Econ 2003 and press release from the
Tufts group in 2015
US$ 318 Million
1987
US$ 802 Million
2000
US$ 2.6 billion
2015
49. Current Access to Innovative
Cancer Drugs in SE Asia
Summary of the First South East Asia Cancer Care
Access Network Meeting and Survey
Lopes et al. 2011. Available at
http://www.ispor.org/regional_chapters/Singapore/documents/presentation%20of-the-SE-
Asia-Cancer-Care-Access-Network.pdf
50. Access to Innovative Cancer Drugs
in SE Asia: Overall Index
0
0,1
0,2
0,3
0,4
0,5
0,6
51. How to Improve Cost Effectiveness?
Decreasing Cost and Increasing Value of Cancer
Medications
Making Drug Development Cheaper and More Effective
Using Biomarkers
Using Generics, Biosimilars, Price Discrimination and
Access programs
52. Biomarkers Improve Cost-Effectiveness
Sorafenib in HCC (No biomarker): 1.6 LY at a Cost of US$ 80k/LY
Trastuzumab (Her2Neu): 1.44 QALY at US$ 19 k/QALY
and generates societal income
in the adjuvant setting
Oncotype Dx in Adjuvant Breast: Generates Cost Savings
EGFR Mutation Testing and EGFR TKI: Generates Cost Savings
Lopes, JCO 2007, ASCO GI 2009, BMC Cancer 2010, ASCO and WCLC 2011, Cancer 2012
53. Biomarkers Decrease Clinical Trial Risk and
Cost of Drug Development
In Breast Cancer, the use of Her2 increases the rate
of success by 50% and decreases cost by 30%
In Lung Cancer, the use of biomarkers increases trial
success rates from 11 to 60% and decreases
development cost by 27%
Parker, Lopes et al, Breast Cancer Res Treat 2012
Falconi, Lopes et al, ASCO 2013, WCLC 2013, JTO 2014
55. Options to Increase Access
Copyright Nature Publishing, used with permission
56. How to Increase Access
Most Important and Effective Options:
Quality generics (and Compulsory Licensing?)
Price Discrimination, aka, Affordable Pricing
Adequate Healthcare Funding:
Universal Coverage
Value-Based Insurance Design
PPP - Global Fund to fight cancer in LMIC
Lopes. Access to Cancer Medications in Low and Middle Income Countries. Nature Rev Clin Oncol 2013
57. Generics
Generic medicines account for 69% of all prescriptions
dispensed in the United States, yet only 16% of all
dollars spent on prescriptions. (source: IMS Health)
Cost of Medication my drop by 80% after introduction
of a generic
In the US the use of generics has saved greater than
US$ 734 billion over a decade
58. Potential Savings with Generics in
Low and Middle Income Countries Are Significant
Generic substitution for four commonly used drugs can
amount to savings in excess of US$800 million in India
every year
In one small retrospective study and one small prospective
registry, efficacy and safety of commonly used drugs was
equivalent with generic or originator drug in India
Lopes G. Ann Oncol 2013 and BMC Cancer 2016 (submitted)
59. Generics and Biosimilars: Challenges
Patient and Health Care Workers Perception
Quality Issues
Except for growth factors such as G-CSF and EPO only
India has had significant experience with Biosimilars
in Oncology
Lopes. Access to Cancer Medications in Low and Middle Income Countries. Nature Rev Clin Oncol 2013
60. >$1000 /gram Existing Innovative
Products
$ 500-$1000 /gram Indian Players
Therapy yet to reach
affordable /
accessible rates
Manufacturing Costs Patient Access
< $100 /gram
ONE NEW
player in the
market!
NOT TARGETED
UNTIL RECENTLY
A “NEED GAP” THAT
WILL BE EXPLOITED
IN THE NEXT FEW
YEARS
CAN WE GET BIOSIMILARS FOR US$ 1 a day?
Annual Cost of
Therapy (patient)
> $ 30000 or
> $ 400 / day
$ 7000 or
$ 20 / day
$ 1200 or
$ 3 / day
61. Compulsory Licensing
WTO – TRIPS Agreement went into effect in January 1995
Allows countries to produce/import generics while medications
are still protected by patent on grounds of public interest
Widely used for AIDS medications
Occasionally used for cancer medications
The US threatened its use to create stockpiles of ciprofloxacin
during Anthrax scare
Lopes. ASCO Connection 2014 + Manuscript under preparation for the Journal of Global Oncology.
Compulsory Licensing: A Double Edged Sword in the fight for access to cancer medications in low- and middle-income countries.
62. Compulsory Licensing in Oncology
Thailand in 2008
Docetaxel, Letrozole, Erlotinib, [Imatinib]
Savings in excess of US$ 140 million
India in 2012
Sorafenib
Lopes. ASCO Connection 2014.
Compulsory Licensing: A Double Edged Sword in the fight for access to cancer medications in low- and middle-income countries.
63. Compulsory Licensing: Challenges
Decrease in investment
In Egypt, Pfizer pulled out of a new planned factory when
the country issued a compulsory license for Sildenafil
Office of the US Trade Representative withdrew duty-free
status of three Thai products
Lopes. ASCO Connection 2014.
Compulsory Licensing: A Double Edged Sword in the fight for access to cancer medications in low- and middle-income countries.
64. Price Discrimination
[including Access Programs]
Important concept in Economics and Business
Companies charge different prices in different markets or
segments, increasing number of consumers able to
afford a product or service
Widely used outside of health care[Think of discounts and
rebates in electronics, for instance]
65. Price Discrimination
IMS data: Little Variation in Average Unit Price (USD)
per Country for all drugs combined [Lopes, 2011]
0
50
100
150
200
Index
Singapore
Malaysia
Thailand
Indonesia
Philippines
Vietnam
66. Price Discrimination
[including Access Programs]
Many pilot projects have led to an increase in access and,
in some cases, revenue
Some companies now have specific policies to provide
medications at a different cost in low and middle income
countries [GSK in all emerging markets, ROCHE in India]
67. Price Discrimination: Challenges
Parallel Imports
Political Backlash in higher income countries,
especially in times of economic difficulties
Lower prices might still not be low enough in the
absence of Universal Coverage and Economic
Development
72. Public Private Partnerships:
The GAVI Alliance and The International
Finance Facility for Immunization
The global alliance for vaccines and immunization receives
funding from donors such as the Bill and Melinda Gates
foundation and the World Bank combined with technical
assistance from the WHO and UNICEF
73. GAVI and IFFI
Additional 325 million children immunized
5.5 million premature deaths averted
In cancer prevention, GAVI has created a market for low
cost interventions and has helped decrease the cost of
each dose of hepatitis B vaccine to US$0.50 and of HPV
vaccine to US$5
74. Proposal:
A Global Fund and Alliance
to Fight Cancer in LMIC
A Global Fund to Fight Cancer would—through
engagement, goal setting and multiple-stakeholder
involvement—provide recipient countries with incentives
to create and develop their health and human capital
infrastructures with adequate technical support.
75. Global Fund to Fight Cancer in LMIC
The alliance of funding and technical partners would unify
efforts, support the creation and implementation of cancer
control plans and make available cancer interventions in
a stepwise fashion, led in the most cost-effective way
76. Global Fund to Fight Cancer in LMIC
The alliance could also help create a functioning market for
the provision of low-cost interventions where none exists
today, fostering innovation and lowering costs.
Furthermore, we envisage that the alliance would support
negotiations with industry to facilitate the implementation
of tiered pricing schemes in low-income countries.
78. What we saw today
Cancer is a major global health care issue
Access is or will be a major issue in ALL countries
The WHO Essential Medicines List helps set a starting point,
not the final destination and is a major victory in our global
public health fight against cancer
Low Income Countries in particular will need help accessing
all of the drugs on the list
A Series of Policy Options exist that could help them do so
79. How to do it!
It will take the whole world to control cancer
in low and middle income countries
80. We need the creation of a global fund to fight
cancer, a cancer alliance and international
finance facility bringing together donors, the
world bank, WHO, IAEA, UICC, NGOs,
Industry and other stakeholders to effectively
tackle cancer control in low income countries