Cancer in Resource-Limited Settings

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 04/2011; 56(4):297-9. DOI: 10.1097/QAI.0b013e31820c0b0f
Source: PubMed
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    ABSTRACT: Increased awareness of cancer as a health crisis facing less developed healthcare systems has led to recent calls for increased investment in cancer care infrastructure in low resource settings. However, operational descriptions of well-functioning cancer care systems in resource-constrained settings are limited. AMPATH-Oncology is the result of collaboration between North American, European, and Kenyan partners to develop a comprehensive cancer care model that supports screening services, cancer treatment, and palliative care. This article describes the approach taken by the AMPATH-Oncology program to deliver cancer care in a resource-constrained setting. A review of other ‘high-income – low-income’ collaborative models identifies successful strategies to implement cancer care in low resource environments.
    Journal of Cancer Policy 09/2013; 1(s 3–4):e42–e48. DOI:10.1016/j.jcpo.2013.06.002
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    ABSTRACT: : Cancers associated with immunosuppression and infections have long been recognized as a major complication of HIV/AIDS. More recently, persons living with HIV are increasingly diagnosed with a wider spectrum of HIV-associated malignancies (HIVAM) as they live longer on combination antiretroviral therapy. This has spurred research to characterize the epidemiology and determine the optimal management of HIVAM with a focus on low-and middle-income countries (LMICs). Given background coinfections, environmental exposures, host genetic profiles, antiretroviral therapy usage, and varying capacities for early diagnosis and treatment, one can expect the biology of cancers in HIV-infected persons in LMICs to have a significant impact on chronic HIV care, as is now the case in high-income countries. Thus, new strategies must be developed to effectively prevent, diagnose, and treat HIVAM in LMICs; provide physical/clinical infrastructures; train the cancer and HIV workforce; and expand research capacity-particularly given the challenges posed by the limitations on available transportation and financial resources and the population's general rural concentration. Opportunities exist to extend resources supported by the President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria to improve the health-care infrastructure and train the personnel required to prevent and manage cancers in persons living with HIV. These HIV chronic care infrastructures could also serve cancer patients regardless of their HIV status, facilitating long-term care and treatment for persons who do not live near cancer centers, so that they receive the same degree of care as those receiving chronic HIV care today.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2014; 67 Suppl 1:S17-26. DOI:10.1097/QAI.0000000000000255 · 4.39 Impact Factor
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    ABSTRACT: In the next 20 years, it is expected that 70% of incident cancers will be diagnosed in the developing world. There exist very few models of cancer care delivery in resource constrained settings. We present a model of cancer care delivery that developed as a result of a multi-institutional collaboration between high-income country academic medical centers and a Kenyan medical school and governmental referral hospital. Based on the infrastructure provided by a successful HIV care program, AMPATH-Oncology presently offers a range of clinical services across the continuum of care, including cervical cancer and breast cancer screening, palliative care, and oncology clinics in pediatric, adult, and gynecology oncology. This program grew from 346 patient visits amongst a few dozen patients in 2004 to over 30,000 visits by 2012 between screening programs and treatment programs. This paper describes the development of the program over a 7-year period.
    Journal of Cancer Policy 03/2013; 1(s 1–2):e25–e30. DOI:10.1016/j.jcpo.2013.04.001