Access Cancer Care India: affordable, integrated multi-cancer early detection to improve equitable cancer outcomes

印度癌症护理服务：负担得起的、综合的多种癌症早期检测，以改善公平的癌症结果

• 批准号: MR/W023903/1
• 负责人: Richard Sullivan
• 金额: $ 229.84万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FW023903%2F1
• 关键词: Access; Cancer; Care; India; affordable

Of the 1.3 billion population of India more than 70% live in the rural areas. Cancer has a catastrophic impact on the rural men and women of India, the vast majority of whom are socio-economically disadvantaged with one fourth live below national poverty line. Studies have shown that among the rural population in India expenditure on cancer treatment is among the highest for any disease due to the advanced presentation. The cost for treating advanced and metastatic disease are much higher than early stage disease. Treatment is financed mostly through borrowings, sale of assets and contributions from friends and relatives. Over 60% of the households who seek care from the private sector incur catastrophic out of pocket expenditure. Fatality rates are also significantly higher for the common cancers like breast and oral cancers in rural compared to the urban populations.2 Late presentation with more expensive disease coupled to nascent universal health coverage to protect against catastrophic expenditure typifies the 'double burden' not only in India but across the world. Improving the implementation of affordable early detection services to cancer coupled to addressing downstream cancer pathways at provider level is key to reducing such inequalities.A strong and responsive cancer health system is necessary to ensure that the screen positive (in presence of a screening programme) and/or symptomatic individuals have access to prompt diagnosis and those detected with cancer have access to appropriate treatment. Rural population in India are socio-economically disadvantaged and vulnerable to huge inequity in cancer care.3 Our hypothesis is that improving their participation to the cancer early detection pathway through careful investigation into the implementation barriers at the levels of individuals, providers and systems to design strategies and policies that are evidence and context-specific based, will lead to better outcomes.This study focuses on implementation research for a well-validated, integrated early detection interventional approach for cancer (secondary prevention) in the context of a complex lower middle- income country, India. The three states for the study provide different and comparative implementation ecosystems to dissect out critical issues and barriers (logistical, political, social and economic) to support national scale up and inform other comparable countries globally. This intervention targets three site-specific cancers - oral, cervical and breast - that, combined are responsible for 28% of premature mortality in India and 12% globally, in particular for women. Scaling up these proven secondary prevention interventions would significantly address 1/3rd reduction in premature mortality as part of SDG 3.4, and our focus on the most vulnerable populations (the rural populations in some of the hard to reach areas in India) will ensure this approach meets WHO's ambition of expanding Universal Health Coverage to a billion population.

印度13亿人口中70%以上生活在农村地区。癌症对印度农村男女造成灾难性影响，其中绝大多数人在社会经济上处于不利地位，其中四分之一生活在国家贫困线以下。研究表明，由于病情较晚，印度农村人口中癌症治疗的支出是所有疾病中最高的。治疗晚期和转移性疾病的费用远高于早期疾病。治疗费用主要通过借款、出售资产以及朋友和亲戚的捐款来筹集。超过 60% 向私营部门寻求护理的家庭会产生灾难性的自付费用。与城市人口相比，农村地区乳腺癌和口腔癌等常见癌症的死亡率也明显更高。2 较晚就诊的疾病费用更高，加上刚刚开始的全民健康覆盖以防止灾难性支出，不仅在印度，而且在全世界都是“双重负担”的典型代表。改善负担得起的癌症早期检测服务的实施，并在提供者层面解决下游癌症途径，是减少这种不平等的关键。一个强大且反应灵敏的癌症卫生系统是必要的，以确保筛查呈阳性（在存在筛查计划的情况下）和/或有症状的个体能够获得及时诊断，并且那些被检测出患有癌症的人能够获得适当的治疗。印度农村人口在社会经济上处于不利地位，并且容易受到癌症护理方面巨大不平等的影响。3我们的假设是，通过仔细调查个人、提供者和系统层面的实施障碍，设计基于证据和具体情况的战略和政策，提高他们对癌症早期检测途径的参与，将带来更好的结果。本研究重点是实施研究，以建立一个经过充分验证的、综合的早期检测途径。 印度这个复杂的中低收入国家背景下的癌症检测介入方法（二级预防）。该研究的三个州提供了不同的、可比较的实施生态系统，以剖析关键问题和障碍（后勤、政治、社会和经济），以支持国家规模扩大并为全球其他可比国家提供信息。这项干预措施针对三种特定部位的癌症——口腔癌、宫颈癌和乳腺癌——这三种癌症合计导致印度 28% 的过早死亡和全球 12% 的过早死亡，尤其是女性。作为可持续发展目标 3.4 的一部分，扩大这些行之有效的二级预防干预措施将显着减少过早死亡率 1/3，而我们对最弱势群体（印度一些难以到达地区的农村人口）的关注将确保这一方法符合世卫组织将全民健康覆盖范围扩大到 10 亿人口的雄心。

项目成果

Priorities for cancer research in low- and middle-income countries: a global perspective.

• DOI: 10.1038/s41591-022-01738-x
• 发表时间: 2022-04
• 期刊: NATURE MEDICINE
• 影响因子: 82.9
• 作者: Pramesh, C. S.;Badwe, Rajendra A.;Bhoo-Pathy, Nirmala;Booth, Christopher M.;Chinnaswamy, Girish;Dare, Anna J.;de Andrade, Victor Piana;Hunter, David J.;Gopal, Satish;Gospodarowicz, Mary;Gunasekera, Sanjeeva;Ilbawi, Andre;Kapambwe, Sharon;Kingham, Peter;Kutluk, Tezer;Lamichhane, Nirmal;Mutebi, Miriam;Orem, Jackson;Parham, Groesbeck;Ranganathan, Priya;Sengar, Manju;Sullivan, Richard;Swaminathan, Soumya;Tannock, Ian F.;Tomar, Vivek;Vanderpuye, Verna;Varghese, Cherian;Weiderpass, Elisabete
• 通讯作者: Weiderpass, Elisabete

Cancer Medicines: What Is Essential and Affordable in India?

• DOI: 10.1200/go.22.00060
• 发表时间: 2022-07
• 期刊: JCO global oncology
• 影响因子: 4.5

Defining Essential Childhood Cancer Medicines to Inform Prioritization and Access: Results From an International, Cross-Sectional Survey.

• DOI: 10.1200/go.22.00034
• 发表时间: 2022-06
• 期刊: JCO global oncology
• 影响因子: 4.5