Regional interventions for Cancer Control: New initiative and the case in IGAD Member States to Strengthen the National Cancer Control Programs and collaboration to establish the Regional Cancer Center of Excellence (RCCE).

Girum Hailu 1 Fathia Alwan 2 Melaku Game 3 Yohannes Jorge 4 Tsion Demeke 4 Abstract Background Cancer is recognized as an enormous global health burden and one of the most common causes of morbidity and mortality today. It accounts for one in every eight deaths worldwide, more than HIV/AIDS, TB, and Malaria combined. Decades ago, cancer was thought to be rare in Africa and was regarded more as a problem of the developed world. Now, more than 60% of all cancer deaths occur in low-and-middle income countries, many of which lack the medical resources and health systems to support the disease burden. Sub-Saharan Africa is faced with a continuing high burden of communicable diseases along with the growing burden of non-communicable diseases (NCDs) such as cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. This results, in a double burden of diseases and needs to be dealt with effectively. The problem of cancer in sub-Saharan Africa is expected to double in the next two decades if no intervention is implemented now. The health and economic consequences as a result of this would therefore be substantial. Problem Statement: The burden and magnitude of the problem from cancer will increase as life expectancy increases; however, the reality is that cancer patients in the IGAD region do not have access to some or all of the essential services. Many breast cancer patients in IGAD region arrive at the Hospital with Advanced disease. Patients whose diseases are curable unnecessarily suffer and die due to lack of resources for early diagnosis and appropriate treatment. The economic shock often includes both the loss of income due to high cost for therapy and expenses associated with payment for costly health care payments within and outside the region. Most unlikely that IGAD member states can immediately take on every aspect of cancer control from prevention to treatment and palliative care, because of acute shortages of trained personnel, treatment facilities (cancer centers, hospitals, health centers, etc.) and reliable communication network and referral systems. Almost all IGAD member states have less than satisfactory infrastructure and facilities for cancer therapy using surgery, chemotherapy and radiotherapy. Furthermore, properly trained personnel able to work in sub-Saharan African environments, adequate drug supplies and replacement of ageing radiotherapy equipment as well as their proper maintenance are in most cases lacking. Conclusions: It is true that early diagnosis and referral is a crucial strategy especially because over 80% of patients in the IGAD region at first presentation have advanced incurable cancer. The establishment of the regional Cancer Center of Excellence will be instrumental to identify and determine the means and mechanisms to mitigate the disease burden, to inform the general public about early symptoms and signs and educating health professionals on cancer prevention & control strategies for quick referral procedure to hospitals and the regional center for better treatment. With prevention strategy, improved cancer services in IGAD region, require the integration of cancer care into the existing health service as well as effective referral system to the regional cancer center of excellence that will be established in collaboration with the member states and the development partners. IGAD and collaborators must closely work to reduce the cancer incidence, morbidity & mortality and to improve the quality of life of patients through the systematic implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, palliative care, and reliable data collection. Recommendations: In line with the above required actions, IGAD must encourage and support its member states to formulate a National Cancer Control Program, to be integrated into existing health systems, and implement the design that will also help facilitate for appropriate referral linkages to the Regional Cancer Center of Excellence. It is therefore recommended that IGAD works to empower each member states, with high political commitment to strengthen and expand cancer prevention and control, as one of the its member states flagship initiative, working on integration of prevention and early detection services at primary health care level, for specific actions that will lessen the impact of cancer among the people in the region. The program can then be expanded with the establishment of the Regional Cancer Center of Excellence (RCCE) and presumably all cancer centers in each member states will be linked to the services, training and research undertakings at the regional level, with the support and ownership by IGAD and its member states. Key words: Regional approach, Cancer Control, Integration, Cancer Center of Excellence _______________________________________________________________ 1 Senior Advisor in IGAD Health and Social Development Program, IGAD/HESAD; 2 Program Manager (PM), IGAD Health and Social Development, IGAD/HESAD 3 Associate clinical Professor, Alberta University, and Representative to IGAD/ HESAD 4 Assistant Professor, Nuclear Medicine, School of Medicine, Addis Ababa University 5 Associate clinical Professor, Alberta University, and Representative to IGAD/HESAD

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