[UPDATED] Cancer crisis

Based on data up to 2018, the number of cancer cases in the Caribbean is projected to increase significantly in the near future.

According to GLOBOCAN estimates, in men cases will raise to 53,500 with 33,100 deaths – in women, incidents will increase to 50,300 with 27,700 deaths. And adults are not the only ones who will suffer.

Derived from cancer registry data, the number of annual cases of childhood cancer is projected to increase – Trinidad and Tobago to 40, Jamaica to 90, the Bahamas to 14, Cuba to 275, Haiti to 520, and Dominican Republic to 420. Other countries would also see increases although they are expected to remain the single digits.

In addition, using the current rate, the International Agency for Research on Cancer estimated that in 20 years, the number of new cancer cases will increase from approximately 114,000 to 160,000 in 2040. Again at the same rate, mortality due to cancer would increase from 61,000 to 102,000.

These estimates were presented yesterday by Professor Diana Sarfati, of New Zealand – a public health physician and cancer control specialist – and Jamaican Dr Dingle Spence – a consultant in oncology and palliative medicine – at the 64th annual CARPHA Health Research Conference at Hilton Trinidad, St Ann's.

In the feature address, Cancer Control in the Caribbean: Progress and Challenges, Sarfati stressed that cancer could not be managed without planning for it, and it needed to be high on the agenda of governments and policymakers.

“Cancer is the second leading cause of death in the Caribbean. One in five of all deaths are due to cancer. This comes with a mess of economic costs primarily due to premature death but it’s also a huge impediment to meeting sustainable development goals.”

Unfortunately, only seven countries in the region had comprehensive cancer plans and many have incomplete cancer surveillance systems. She noted that NCD prevention strategies were well articulated and they were very important for the prevention of a number of cancers, however she said cancer-specific strategies were necessary. Also most countries had 80 per cent coverage of Hepatitis B vaccinations which were critical for liver cancer prevention.

She noted that cervical cancer was one of the top five killer cancers for women in TT, yet its prevention was under-developed in most Caribbean countries as HPV vaccination coverage remained low or unknown.

According to Sarfati, challenges in cancer diagnosis and treatment include diagnosis at a late stage, variation in diagnostic capacity across countries, difficulties in training and attracting specialists, two thirds of the 70 radiotherapy machines were in two countries and 16 countries had no radiotherapy capacities at all, and less than a third of all countries are able to process all pathology specimens on-island. “Of course that has implications on the timeliness of diagnosis and the cost of diagnosis which is often borne by patients.”

Therefore, she suggested the planning of cancer strategies and the procurement of equipment and medication should be done regionally. She also suggested the health care systems be strengthened including primary care (prevention, treatment, palliative care), health workforce development and support, and innovative approaches to cancer diagnosis and care such as telemedicine, tele-mentoring, and role shifting.

MAKING STRIDES IN CARE

Spence highlighted several deficiencies in health care in the Caribbean including a lack of systematic data in cancer incidence and mortality, appropriate cancer treatment guidelines, strategies for managing paediatric oncology care, and supportive and palliative care.

However, she said strides were being made in these areas. In the case of data, she said less than ten Caribbean countries and territories have a population based cancer registry and only Barbados, Jamaica, Guyana, and TT met international standards. Fortunately, in 2015 the International Agency for Research on Cancer (IARC) Caribbean Regional Cancer Registry Hub was founded to directly support in-country capacity building for cancer registration.

Regarding guidelines she said, “Clinical guidelines are very important especially if you’re working in an area of high specialisation with few specialists. It’s really important to have some guidelines out there for the non-specialists who can at least have an idea of where to channel care, where to refer persons.”

The National Comprehensive Cancer Network (NCCN) and members of the Caribbean Association for Oncology and Haematology (CAOH) adapted the NCCN’s Clinical Practice Guidelines in Oncology to create NCCN Harmonized Guidelines for the Caribbean according to the resources available in the region.

Spence stated that historically the leading cause of deaths in children were infectious diseases, but cancer was becoming more common in the Caribbean. “You can see, in the Eastern Caribbean the numbers (of project future cases of childhood cancer) are small – three per year, five per year, ... but how do you manage those two kids in Antigua and Barbuda who have serious advanced malignancy? Clearly you can not expect an island like that to have a specialist for those two kids. So this is really where it points to regional initiatives. How do we come together and facilitate treatment and care of a high quality standard in such a desperate region?”
One solution, she said, was to create networks between existing paediatric cancer treatment units across the region. The Sick Kids initiative, a collaboration between the Sick Kids hospital in Toronto, Canada, and the University of the West Indies and six Caribbean countries was founded in 2013.

“Where we need to be going is to look at what is the best way in the region to develop a centre or two of excellence and then treat our kids there and then send them back to at least have some decent secondary and primary support in their own island.”

She said access to palliative care and pain management was limited in the Caribbean partly because of poverty, expensive transport, and other issues. Therefore the region needed to think differently, possibly utilising home or community-based care.

Barbados has a community-based system run by NGOs through primary care and public health. The Cayman Islands also had an NGO-ran community palliative care and hospice service that provided free care to approximately 65 patients a year.

She also noted that the NGO, The Jamaica Cancer Care and Research Institute, delivered a two week palliative care training program in palliative medicine in 2017 and 2018 in collaboration with faculty from Massachusetts General Hospital and Harvard Medical School. More than 80 clinicians from six Caribbean countries attended.

“Whilst we are overwhelmed on many days, there are aspects of cancer control out there that are interesting, exciting, moving forward, and I am hopeful.”

This is an updated version of a story earlier published under the headline Cancer cases to rise in Caribbean. The original story is below.

Based on data up to 2018, the number of cancer cases in the Caribbean is projected to increase significantly in the near future.
Using the current rate, the International Agency for Research on Cancer estimated that in 20 years, the number of new cancer cases will increase from approximately 114,000 to 160,000 in 2040. Again at the same rate, mortality due to cancer would increase from 61,000 to 102,000.
These estimates were presented on Saturday by Professor Diana Sarfati, public health physician and cancer control specialist in her feature address, Cancer Control in the Caribbean: Progress and Challenges, at the 64th annual CARPHA Health Research Conference at the Hilton Trinidad, St Ann's.
She said cancer could not be managed without planning for it, and it needed to be high on governments’ agenda. “Cancer is the second leading cause of death in the Caribbean. One in five of all deaths are due to cancer. This comes with a mess of economic costs primarily due to premature death but it’s also a huge impediment to meeting sustainable development goals.”
Unfortunately, only seven countries in the region had comprehensive cancer plans and many have incomplete cancer surveillance systems and these needed to be addressed as soon as possible. However she noted that NCD prevention strategies were well articulated and they were very important for the prevention of a number of cancers. Also most countries had 80 per cent coverage of Hepatitis B vaccinations which were critical for liver cancer prevention.

Based on data up to 2018, the number of cancer cases in the Caribbean is projected to increase significantly in the near future.

Using the current rate, the International Agency for Research on Cancer estimated that in 20 years, the number of new cancer cases will increase from approximately 114,000 to 160,000 in 2040. Again at the same rate, mortality due to cancer would increase from 61,000 to 102,000.

These estimates were presented on Saturday by Professor Diana Sarfati, public health physician and cancer control specialist in her feature address, Cancer Control in the Caribbean: Progress and Challenges, at the 64th annual CARPHA Health Research Conference at the Hilton Trinidad, St Ann's.

She said cancer could not be managed without planning for it, and it needed to be high on governments’ agenda. “Cancer is the second leading cause of death in the Caribbean. One in five of all deaths are due to cancer. This comes with a mess of economic costs primarily due to premature death but it’s also a huge impediment to meeting sustainable development goals.”

Unfortunately, only seven countries in the region had comprehensive cancer plans and many have incomplete cancer surveillance systems and these needed to be addressed as soon as possible. However she noted that NCD prevention strategies were well articulated and they were very important for the prevention of a number of cancers. Also most countries had 80 per cent coverage of Hepatitis B vaccinations which were critical for liver cancer prevention.