"While generating LMIC-specific trials is important , it is equally important to fill in our understanding of current standards of care. In LMICs access to antibiotics, transfusions, and other supportive care measures readily available in HICs is not guaranteed, therefore outcomes in LMICs at current standards of care may be less than expectations generated by trials data, and routine care outcomes must be defined  . All of these collaborations recognize this implicitly and have built systems to analyze outcomes in the context of routine clinical care. "
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: Today AIDS-related non-Hodgkin's lymphoma (AR-NHL) is a significant cause of morbidity and mortality in HIV-infected patients the world over, and especially in sub-Saharan Africa. While the overall incidence of AR-NHL since the emergence of combination antiretroviral therapy (cART) era has declined, the occurrence of this disease appears to have stabilized. In regions of the world where access to cART is challenging, the impact on disease incidence is less clear. In the resource-rich environment it is clinically well recognized that it is no longer appropriate to consider AR-NHL as a single disease entity and rather treatment of AIDS lymphoma needs to be tailored to lymphoma subtype. While intensive therapeutic strategies in the resource-rich world are clearly improving outcome, in AIDS epicenters of the world and especially in sub-Saharan Africa there is a paucity of data on treatment and outcomes. In fact, only one prospective study of dose-modified oral chemotherapy and limited retrospective studies with sufficient details provide a window into the natural history and clinical management of this disease. The scarcities and challenges of treatment in this setting provide a backdrop to review the current status and realities of the therapeutic approach to AR-NHL in sub-Saharan Africa. More pragmatic and risk-adapted therapeutic approaches are needed.
[Show abstract][Hide abstract] 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
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