IAEAInternational Atomic Energy Agency

Panel Discussion I: Tackling Cancer

Fifth Session of Islamic Conference of Health Ministers Istanbul, Republic of Turkey, 17 – 19 Nov

2015

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Speakers

Session Programme and Speakers::

No. Name Organization

1. Professor Sanchia Aranda

President-elect of the Union for International Cancer Control;

CEO Cancer Council, Australia

2. Dr Daouda Malle, Principal Operations Specialist, Office of the Vice President of Operaions, Islamic Development Bank

3. Dr Shilpen Patel Board of Directors Radiating Hope; Associate Professor University of Washington, Director of Radiation Oncology RAD-AID Intl.

4. Assoc. Prof Dr Murat Gultekin,.

Director, Cancer Control Department, Presidency of Public Health Institution, Ministry of Health

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Strategic Health Programme-OIC

• The Ministers of Health of the Member States of the OIC at the 4th Conference (Jakarta, October 2013) adopted a Strategic Health Programme of Action 2014 – 2023 (SHPA).

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Strategic Health Programme-OIC

• Under Thematic Area 2: Disease Prevention and Control:

• Action: to enhance cooperation in the area of cancer control in the member countries

• Through establishing networks among the relevant institutions in cancer research, diagnosis, and treatment.

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The Problem

Current coverage of radiotherapy services according to country as determined by global equipment databases, an activity-based operations model, cancer incidence, and

evidenced-based estimates of radiotherapy need. Lancet commission Report

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2012: 14.2 million new cancer cases

8 million cancerdeaths

* Projected :Ferlay J et al Sources, methods and major patterns in GLOBOCAN 2012. 2015; 136(5):E359-E386.

2030 : 24.6 million new cancer cases

13 million cancerdeaths*

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Local Control and Survival Benefit from Radiation

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Radiotherapy utilization rate

(RTU)

RT fractions per course

5-year local control benefit

5-year overall survival benefit

Breast 87% 16 15% 2% Cervix 71% 21 35% 20% Colorectal 19% 23 5% 2% Haematological 48% 8 7% 4% Head and Neck 74% 22 34% 20% Liver 0% 0 0 0 Lung 77% 16 9% 6% Oesophagus 71% 15 5% 2% Prostate 58% 28 25%* 1% Stomach 27% 19 2% 1% ALL TOP 10 CANCERS

50% 18 10% 4%

Top 10 cancers globally by incidence: Radiotherapy utilization rate, average RT fractions and outcome benefits (absolute proportional)**

** personal communication Lancet Commission Report

OpEx – Sensitivity Analysis Relative Cost Savings Automation –

Efficiency Longer Hours

Bulk Purchase

HIC U-MIC L-MIC LIC

X - - -25% -21% -21% -21% - X - -13% -18% -23% -25% - - X -8% -16% -21% -23% X X - -33% -34% -39% -40% - X X -19% -34% -38% -42% X - X -31% -34% -38% -39% X X X -37% -43% -51% -53%

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CT - Transmission Imaging

Structural Information:

Size

Shape

Location

NM - Emission Imaging

Uptake Information

Activity

Function

Localization

CT versus PET/SPECT scans

Images Courtesy D. Paez

DiagnosisStaging

RestagingTherapy planningTherapy response

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Renal Scintigraphy-Tc-99m-MAG3

PET/CT in Use in Neurology

reduced wall motion; scar on bottom

Courtesy D.Paez

Use in Cardiology

Uses of Nuclear Medicine Imaging

Anterior wall ischemia

Most Common NM tests:Bone scansThyroid scintigraphyLung perfusion and ventilation Nuclear cardiologyRenal scansOncologyNeurology and Psychiatry

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Radiation Therapy Techniques

• Radiotherapy has been used for curative or palliative treatment of cancer, alone or combined with chemotherapy or surgery.

Robotic Body Radiosurgery

External Beam 3-D/IMRT

Gamma-knife Radiosurgery

Brachytherapy

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Comparison of Techniques

Radonc.ucla.edu

Courtesy Sua Yu, MD

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IAEA Technical cooperation (TC) programme

Developed and managed jointly by the Member States and the IAEA Secretariat.

The IAEA Technical Departments are responsible for the technical integrity of the TC programme.

IAEA TC Department responsible for the management of the TC programme

Yearly budget of about €120 millionAbout €32 million (~26%) are spent on Human Health

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Cervix Cancer

• Radiotherapy improves the absolute 5-year survival rate by 17% over the contribution of surgery and chemotherapy.

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Cancer Worldwide Burden

• Globally, in 2012 the most common cancers diagnosed were those of the: Lung (1.8 million cases, 13.0% of the total) Breast (1.7 million, 11.9%) Large bowel (1.4 million, 9.7%).

• The most common causes of cancer death were: Cancers of the lung (1.6 million, 19.4% of the total) Liver (0.8 million, 9.1%) Stomach (0.7 million, 8.8%).

*World Cancer Report 2014 launched by the International Agency for Research on Cancer (IARC)

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Cancer Burden in Developing Countries

• Developing countries are disproportionately affected by the increasing numbers of cancers.

• More than 60% of the world’s total cases occur in Africa, Asia, and Central and South America, and these regions account for about 70% of the world’s cancer deaths.

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Comprehensive Cancer Control Approach

Coordinated activities focused around prevention, early detection, diagnosis,

treatment and palliative care.

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Comprehensive Cancer Control Approach

• Improving access, affordability, quality and delivery of cancer services to cancer patients requires a multidisciplinary set of expertise. 

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Panel Objectives

• To address the need for comprehensive cancer control and for implementation of evidence-based interventions tailored to level of resources available with Ministers of Heath.

• To share regional best practices

• Promote regional coordination mechanisms in cancer control planning and implementation in order to strengthen health systems.

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• A high-level panel representing different cancer stakeholders will advocate for :

• Comprehensive cancer control and expand on a number of critical issues that need to be considered to strengthen the health systems to effectively address cancer.

Panel Objectives

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Speakers

Session Programme and Speakers::

No. Name Organization

1. Professor Sanchia Aranda

President-elect of the Union for International Cancer Control;

CEO Cancer Council, Australia

2. Dr Daouda Malle, Principal Operations Specialist, Office of the Vice President of Operaions, Islamic Development Bank

3. Dr Shilpen Patel Board of Directors Radiating Hope; Associate Professor University of Washington, Director of Radiation Oncology RAD-AID Intl.

4. Assoc. Prof Dr Murat Gultekin,.

Director, Cancer Control Department, Presidency of Public Health Institution, Ministry of Health

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Panelist Presentations

• 5 minutes each for presentations

• Followed by questions to the panelists 8-10 minutes each.

• Followed by an open discussion

Human Health 20

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Professor Sanchia Arancha

Human Health 21

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Dr Daouda Malle

Human Health 22

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Dr Shilpen Patel

Human Health 23

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Dr Murat Gultekin

Human Health 24

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QUESTIONS TO THE PANELISTS

Human Health 25

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Professor Sanchia Aranda

• Questions to the speaker:What is the role of NGOs in supporting

governments to implement national cancer control plans?

How could NGO best contribute to raising awareness on the cancer epidemic at national and/or global level?

How could governments support the development of active and collaborative NGOs at national level?

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Dr Daouda Malle What would be the social and economic cost of not

investing in cancer control and can we afford not investing on it?

While cancer services appear to be cost-effective (prevention as well as treatment, including radiotherapy), financing these services may have high initial costs, which may be challenging for low- and middle-income countries. How would you recommend these countries should approach this important issue?

Investing in cancer control would result in an overall strengthening of health systems, which may deliver results also in other health areas, thus maximising the Return on Investment (ROI). How can we factor this aspect in making investment decisions?

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Dr Shilpen Patel

• Questions to the speaker:How can early detection improve treatment

outcome and survival?What key messages have been found effective

in order to raise awareness among the population?

Please comment on the impact of radiation therapy within cancer control?

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Assoc. Prof Dr Murat Gultekin

What kind of access disparities in cancer treatment worldwide and in low and middle income countries in particular do you observe nowadays?

What in your opinion should be done by international community to recognize this equity challenge and, consequently, to address it?

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Assoc. Prof Dr Murat Gultekin

• Questions to the speaker:What are the main challenges normally

experienced in setting up surveillance systems?What are the most effective linkages that need

to be established so that data can actually inform policy and operational decisions?

How can National Cancer Control Plans be developed in the absence of reliable population based data?

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Challenges

• Uncertain energy supply & Lack of control of ambient temperatures in buildings

• Weak health systems with limited laboratory and diagnostic services & medical support.

• An estimated additional 215,000 health professionals will be needed by 2035 to meet the need for radiotherapy services.

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Innovative Coordinated Research Projects (CRP) for Resource Sparing

• Post-mastectomy radiotherapy

• Pre-operative advanced rectal cancer

• Palliative oesophagus cancer

• Glioblastoma multiforme

• Lung cancer

• Painful bone metastasis

• Head and neck cancer (2)

• Cervical cancer (2)

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Innovative Technologic Solutions

• Cloud-based radiotherapy platforms : automated techniques for treatment planning,

quality control, and peer-review

• Resulting in : improved quality, reduced expertise

dependence, and lower operating costs

Human Health 33

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Innovation in Financing

• Innovative financing: offers new opportunities for mobilising, pooling, channelling and funding radiotherapy services .

• Others include Diaspora Bonds and Social Impact Bonds

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CONCLUSIONS

• Strengthen health systems with appropriate laboratory and diagnostic services & medical support.

• Increase education and training opportunities to provide the estimated additional 215,000 health professionals needed by 2035 to meet the need for radiotherapy services.

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CONCLUSIONS

• Accelerated adoption of existing technologies

• Creation of new technologies to address diverse needs

• Development of new processes / models that remove impediments to efficient and effective care delivery

• Financing to address resource shortfalls

• Communication and advocacy to mobilise support and gain confidence of decision makers.

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CONCLUSIONS

• Avoid fragmented approaches –not sustainable.

• Innovative leadership and stewardship models are required to promote multi-national partnerships with those in need.

Human Health 37

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THANK YOU