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.
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.
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.
This PDF provides the majority of my slides from the statewide Minnesota Cancer Summit from February 28, 2019. The presentation focuses on Clinical Cancer Advances as published and released by consensus expert panels from The American Society of Clinical Oncology (@ASCO).
Burden of Cervical Cancer & other HPV Related Diseases : Indian Perspectiv...Lifecare Centre
HPV RELATED DISEASES
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. HPV causes virtually 100% of cervical cancer cases
There is growing evidence of HPV being a relevant factor in other ANOGENITAL CANCERS (anus, vulva, vagina and penis) and head and neck cancers.
HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts
Cancer and US Latinos
Daniel Santibanez, MPH, University of North Florida
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
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...
National Cancer Registry 2014-2018 - UAEAnjalaNizam
Presented on 07/10/2019 by Anjala Nizam & Arshiya Adhnon,
An insightful presentation on the UAE National Cancer Registry 2014-2018 with emphasis on Breast Cancer.
The Highmark Foundation Helps the American Cancer Society Prevent HPV-Relate...Alexandra Houser Vukoder
This project allows the American Cancer Society to access the health care centers, located in Pittsburgh, Pennsylvania and Grafton, West Virginia and identify practice gaps, determine ways to improve tracking screening rates, develop strategies to sustain HPV vaccination efforts and expand existing quality improvement efforts.
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.
This PDF provides the majority of my slides from the statewide Minnesota Cancer Summit from February 28, 2019. The presentation focuses on Clinical Cancer Advances as published and released by consensus expert panels from The American Society of Clinical Oncology (@ASCO).
Burden of Cervical Cancer & other HPV Related Diseases : Indian Perspectiv...Lifecare Centre
HPV RELATED DISEASES
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. HPV causes virtually 100% of cervical cancer cases
There is growing evidence of HPV being a relevant factor in other ANOGENITAL CANCERS (anus, vulva, vagina and penis) and head and neck cancers.
HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts
Cancer and US Latinos
Daniel Santibanez, MPH, University of North Florida
June 24, 2005 - UNF Hispanic Health Issues Seminar
This is part 5 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
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...
National Cancer Registry 2014-2018 - UAEAnjalaNizam
Presented on 07/10/2019 by Anjala Nizam & Arshiya Adhnon,
An insightful presentation on the UAE National Cancer Registry 2014-2018 with emphasis on Breast Cancer.
The Highmark Foundation Helps the American Cancer Society Prevent HPV-Relate...Alexandra Houser Vukoder
This project allows the American Cancer Society to access the health care centers, located in Pittsburgh, Pennsylvania and Grafton, West Virginia and identify practice gaps, determine ways to improve tracking screening rates, develop strategies to sustain HPV vaccination efforts and expand existing quality improvement efforts.
The Canadian Cancer Survivor Network (CCSN) conducted a survey in April 2013 the discover the impact that being involved in volunteer advocacy and/or the development of public policy has on cancer patients, survivors, caregivers and family members. 51 people completed the survey. Findings were that patient advocacy generally has a positive impact on the self-image of those doing it, that many volunteer advocates felt better, prouder, more useful, more hopeful, more effective and more powerful. Still others felt less angry, less anxious, and less sad. But some survey respondents did feel sadder, angrier, less hopeful and less content. CCSN recommends that organizations ensure that cancer patients involved in advocacy activities receive skills to help them and support to deal with the often slow-moving and sometimes frustrating healthcare, cancer care and government systems in Canada.
The patient voice: turning health policy into opportunity - Jan Geissler - ES...patvocates
Presentation on how the patient voice can turn health policy into advocacy opportunities to improve the life of patients. Presented by Jan Geissler, Co-founder of CML Advocates Network, at the Patient Seminar of the European Society of Gynaecological Oncology (ESGO) in Liverpool on 19 Sept 2013
Metastatic Breast Cancer Network (MBCN) - mission and activitiesmbcnetwork
MBCN is a patient led advocacy organization focused on the unique needs of the women and men living with metastatic or advanced breast cancer.
View this introductory slideshow to get to know us better.
Join Dr. Erica Mayer, medical oncologist at Dana-Farber/Brigham and Women's Cancer Center, to learn about exciting metastatic breast cancer developments from the past year. Dr. Mayer presents an overview on metastatic breast cancer and the subgroups, including Hormone Receptive, HER2+, and Triple Negative, and highlights recent advances for each of these subgroups. She also discusses the importance of clinical trials and what it means to participate in a clinical trial.
For more information on the Breast Cancer Treatment Center at Dana-Farber Cancer Institute, please visit:
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Treatment-Centers-and-Clinical-Services/Breast-Cancer-Treatment-Center.aspx
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 is a serious issue across the globe but you can begin helping close to home by volunteering or donating to your local cancer charities. The Foundation of FirstHealth’s Cancer CARE Fund helps FirstHealth Moore Regional Hospital lead the fight against cancer in the mid-Carolinas.
Bridging Clinical Gaps and Disparities in Care in TNBCbkling
This webinar will focuses on racial, ethnic, and socioeconomic disparities with the clinical gaps in treatment for women with triple-negative breast cancer (TNBC). Our guest speaker Shonta Chambers, MSW, is the EVP of Health Equity and Community Engagement at the Patient Advocate Foundation and Principal Investigator for SelfMade Health Network. Come and learn about this complex subtype, barriers to care, address the myths and fears around clinical trials in specific racial and ethnic communities, and help bridge the clinical gaps to improve survival outcomes for patients with TNBC.
Sharad Ghamande, MD, FACOG
Professor and Director of Gynecologic Oncology
Augusta University Cancer Center
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
www.gacommissiononwomen.org
Semana de Seguridad Social. La Reforma de Salud en México: su impacto en los principios de la seguridad social.
Senado de la República, 23 de abril de 2014
- 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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Global Advocacy: From Anecdote to Evidence
1. Felicia Marie Knaul, PhD
Harvard Global Equity Initiative,
Global Task Force on Expanded Access to Cancer Care and Control in LMICs
Union for International Cancer Control
Tómatelo a Pecho A:C. México
Mexican Health Foundation
Pa#ent
Advocacy
Scholar
Seminar
Harvard
Faculty
Club,
Cambridge
April
26th,
2013
Global
Advocacy:
From
Anecdote
to
Evidence:
3. The night of my high school prom visiting my
father, Sigmund Knaul, at Mount Sinai Hospital,
Toronto a few weeks before his death from
cancer. May 1984.
4. In the children’s cancer ward of the Hospital Pediátrico de Sinaloa
promoting Sigamos Aprendiendo en el Hospital. Culiacán, late 2005.
13. International seminar
celebrating the Seguro
Popular and universal
coverage of breast cancer
treatment. October, 2011.
With a patient who traveled
from Guadalajara to share
her story. Mexico City.
14. With Julie Gralow visiting a terminal patient in the Hospital Regional de Ciudad Guzmán.
Jalisco, México. August 2011.
20. Closing the Cancer Divide:
An Equity Imperative
I: Much should be done
II: Much could be done
III: Much can be done
1: Innovative Delivery
2: Access to Affordable Medicines,
Vaccines & Technologies
3: Innovative Financing: Domestic
and Global
4: Evidence for Decision-Making
5: Stewardship and Leadership
21. Challenge and disprove the
myths about cancer
M1. Unnecessary
M2. Unaffordable
M3. Impossible
M4: Inappropriate
• Should,
• Could, and
• Can…..
….be
Expanding access to cancer care and control in
low and middle income countries:
22. " Mirrors the epidemiological transition
" LMICs increasingly face both infection-
associated cancers, and all other cancers.
The Cancer Transition
" Cancers increasingly only of the poor, are
not the only cancers affecting the poor.
23. #2 cause of death in wealthy countries
#3 in upper middle-income
#4 in lower middle-income
and # 8 in low-income countries
More than 85% of pediatric cancer cases and 95% of
deaths occur in developing countries.
For children & adolescents
5-14 cancer is
24. Source: Knaul, Arreola, Mendez. estimates based on IHME, 2011.
The cancer transition in LMICs:
breast and cervical cancer
53%
20%19%
-31%
0%
LMIC’s High
income
% Change in # of deaths
1980-2010LMICs account for
>90% of cervical
cancer deaths and
>60% of breast
cancer deaths.
Both diseases are
leading killers –
especially of young
women.
25. Cancer is a disease of both rich and poor;
yet it is increasingly the poor who suffer:
1. Exposure to risk factors
2. Preventable cancers (infection)
3. Treatable cancer death and disability
4. Stigma and discrimination
5. Avoidable pain and suffering
The Cancer Divide:
An Equity Imperative
Facets
26. Adults
Leukaemia
All cancers
Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.
Children
LOW
INCOME
HIGH
INCOME
Survival
inequalitygap
LOW
INCOME
HIGH
INCOME
100%
Facet 3: The Opportunity to Survive
Should Not, but Is Defined by Income
In Canada, almost 90% of children with
leukemia survive.
In the poorest countries only 10%.
27. Cancer – especially in
women and children - adds a
layer of discrimination onto
ethnicity, poverty, and
gender.
Survivorship
care is non-
existent.
28. Facet 5: The most insidious injustice
is lack of access to pain control
Non-methadone, Morphine Equivalent opioid
consumption per death from HIV or cancer in pain:
Poorest 10%: 54 mg per death
Richest 10%: 97,400 mg per death
30. Investing In CCC:
We Cannot Afford Not To
" Inaction reduces efficacy of health and social investments
" Total economic cost of cancer, 2010: 2-4% of global GDP
" Tobacco is a huge economic risk: 3.6% lower GDP
Prevention and treatment offers potential
world savings of $ US 130-940 billion
1/3-1/2 of cancer deaths are “avoidable”:
2.4-3.7 million deaths,
of which 80% are in LIMCs
✓
31. The costs to close the cancer divide
may be less than many fear:
" All but 3 of 29 LMIC priority cancer chemo and hormonal
agents are off-patent
" Cost of drug treatment: cervical cancer + HL + ALL(kids) in
LMICs / year of incident cases: $US 280 m
" Pain medication is cheap
" Prices drop: HepB and HPV vaccines
" Delivery & financing innovations are underutilized &
undeveloped: purchasing fragmented, procurement unstable
Global
Paediatric
Financing
En#ty
32. Global Paediatric Oncology
Financing Entity
• Opportunity:
– 90% in 25 poorest countries die; 90% in richest live
– Could save >60,000 lives
– Move PedOnc off the GLOBAL list of top killers
• Problem: small, geographically fragmented demand; no
market for drugs; complex delivery (?); many countries
without financing; other countries have $ and yet face
drug shortages
• Delivery solution: innovative global delivery
mechanisms (St. Judes/My Child Matters; Sick Kids;
DFCI etc)
• Financing solution: global opportunity
34. Women and mothers in LMICs
face many risks through the life cycle
Women 15-59, annual deaths
Diabetes
120,889
Breast
cancer
166,577
Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.
Cervical
cancer
142,744
Mortality
in
childbirth
342,900
- 35%
in 30
years
= 430, 210 deaths
35. The Diagonal Approach to
Health System Strengthening
" Rather than focusing on disease-specific vertical
programs or only on horizontal system
constraints, harness synergies that provide
opportunities to tackle disease-specific priorities
while addressing systemic gaps.
" Optimize available resources so that the whole is
more than the sum of the parts.
" Bridge the divide as patients suffer diseases over a
lifetime, most of it chronic.
36. Why diagonal delivery?
" Shared risk factors
" Co-morbidity
" Life cycle approach
" Efficiency: Common need for strong health
system platforms
" Knowledge sharing and inter-institutional
collaboration
" Economic development
" Social justice
37. Diagonal Strategies:
Positive Externalities
" Promoting prevention and healthy lifestyles:
" Reduce risk for cancer and many other diseases
" Reducing stigma around women’s cancers:
" Contributes to reducing gender discrimination
" Introducing cancer treatment for children
" Improves hygiene and reduces intra-hospital infections
" Promoting access to education for children w/ cancer
" Reduces poverty, contributes to social development
" Pain control and palliation
" Reducing barriers to access is essential for cancer as
well as for for other diseases and for surgery.
39. Initial views on MDR-TB
treatment, c. 1996-97
“MDR-TB is too
expensive to treat in
poor countries; it
detracts attention and
resources from treating
drug-susceptible
disease.” WHO 1997
Outcomes in MDR-TB
patients in Lima, Peru
receiving at least four
months of therapy
All patients initiated therapy
between Aug 96 and Feb 99
Abandon
therapy
2%
Failed
therapy
8%
Died
8%
40. Champions
Nobel Amartya Sen,
Cancer survivor diagnosed in India
50 years ago
Drew G. Faust
President of Harvard University
22+ year BC survivor
43. ‘Diagonalizing’ Financing:
Integrate cancer care and control into
national insurance and social security
programs to express previously suppressed
demand beginning with cancers of women
and children:
" Mexico, Colombia, Dom Rep, Peru
" China, India, Thailand
" Rwanda, Ghana, South Africa
44. Universal Health Coverage in Mexico
through Seguro Popular
Horizontal
Coverage:
>
54.6
million
Beneficiaries
Ver9cal
Coverage
Diseases
and
Interven9ons:
Expanded
Benefit
Package
45. Seguro Popular:
Cancer and the Fund for Protection from
Catastrophic Illness
" Accelerated, universal, vertical coverage by disease
with an effective package of interventions
" 2004: HIV/AIDS
" 2005: cervical cancer
" 2006: ALL in children
" 2007: All pediatric cancers; Breast cancer
" 2011: Testicular and Prostate cancer and NHL
" 2012: Colorectal and ovarian cancer
46. Seguro Popular and cancer:
Evidence of impact
" Access to medicines – an anecdote
" Since the incorporation of childhood cancers
into the Seguro Popular
" Adherence to treatment: 70% to 95%
" Breast cancer adherence to treatment:
" 2005: 200/600
" 2010: 10/900
47. % diagnosed in Stage 4 by state
• # 2 killer of women 30-54
• Only 5-10% of cases in Mexico are
detected in Stage 1 or in situ
• Poor municipalites: 50% Stage 4; 5x rich
Delivery failure: Breast Cancer
Juanita
Poor/Marginalized
48. Effective financial coverage:
breast cancer in Mexico
– Primary prevention
– Secondary prevention (early detection)
– Diagnosis
– Treatment
– Survivorship care
– Palliative care
Large and exemplary investment in treatment for women
and the health system, yet a low survival rate.
By applying a diagonal approach,
this can and is being remedied.
49. Harness platforms by integrating breast and
cervical cancer prevention, screening and
survivorship care into MCH, SRH, HIV/AIDS,
social welfare and anti-poverty programs.
Example:
• Mexico: integration of breast and
cervical cancer awareness and screening
into the national anti-poverty program
Oportunidades
Solution:
‘Diagonalizing’ Delivery
50. Including breast cancer awareness for
early detection in Oportunidades
• “Guía de orientación y
capacitación a titulares
beneficiarios del programa
Oportunidades” includes
information on breast cancer
as of 2009/10
• 1.5 million copies to
promoters
• Reaches 5.8 million families =
more than 90% of poor
households
52. Lesson 1:
Duality of advocacy and evidence
• Evidence-Based Passion & Passion inspired Evidence
• Advocacy without evidence is likely to be misguided and
will tend towards error
• The mission of evidence is weakened when neither
inspired by nor applied to the needs of patients and people
• Personal experience has spawned movements
– Fitzhugh Mullan: Seasons of Survival catalyzed the survivorship
movement & area of research
• Methods for merging personal experience and evidence
have not been formally developed – never been rigorously
studied
– HGEI/HSPH/HMS/HGAS Experience-Evidence Seminar Fall- 2014
53. Lesson 2: Diagonal Approach to Evidence-
based, Passionate (Patient) Advocacy
• Rabbi Hillel: “If I am not for myself, who will be for me? If I am only
for myself, what/who am I? If not now, when?”
• Advocating only for ourselves or our own disease, particular disease
limits potential for impact (and is perhaps unethical)
• Huge responsibility for cancer, and especially breast cancer advocates
• The art of patient advocacy is going ‘diagonal’
– Common demands across diseases – i.e. pain control
– Strengthen health and social systems
– Collaboration and cooperation strengthen your message
• ‘Neglected and emerging’ areas for advocacy:
– where patients do not live long enough to advocate for themselves
– Survivorship challenges – long life with disease or symptoms– i.e.
mental health
– Mental health - …and the NCD movement
54. Lesson 3: Local and Global
are inseparable:
Where are the opportunities?
• Address disparities: not months but whole lifetimes to be
gained
• Focus on prevention but do not stop there!
– No prevent/treat dichotomization
• Harness global and national health system platforms
• Innovate in implementation, delivery and financing
– Redefine and reformulate health systems to manage chronicity
– Evaluate, replicate and scale up
– Leapfrog
• Recognize disadvantage groups as part of a global solution
55. Expanding access to cancer care and control in
LMICs: Should, Could, and Can be done
