Cancer rates are increasing around the world, but most low- and middle-income countries still lack effective services to care for patients. As the number of cancer patients grows, governments are increasingly seeking specialist support to build their capacities to meet their cancer control needs.
The Central African Republic is no exception. The country has no radiotherapy unit, with access to very limited diagnostic and treatment capacities. Patients and their families who live far from the capital have to travel great distances at considerable expense to reach care. Limited public awareness of cancer symptoms means that many patients seek help only when they have late-stage cancers, which are uncurable and only limited end-of-life care can be provided.
A team of nine experts from the IAEA, the World Health Organization (WHO), and the International Agency for Research on Cancer (IARC) recently completed a virtual imPACT Review in the Central African Republic at the request of the Government. They examined the country’s capacities and needs across every stage of cancer control – planning, surveillance, prevention, early detection, diagnosis, treatment, and palliative care – and offered a broad range of recommendations which also related to cancer case data collection, specialist training for staff and the development of national cancer control standards and guidelines. The IARC estimates that currently new cancer cases and deaths in the country will rise by almost 30 per cent by 2030.
“The imPACT Review highlighted a number of issues that we must address,” said Raphael Mbailo, Head of Health Directorate at the country’s Ministry of Health and Population. “When we refer cancer patients for treatment outside the country, this can be very costly, and sometimes too late. We want to improve care for cancer patients by supporting consultations with multidisciplinary medical experts, and we need to improve our collection of morbidity and mortality data. Stronger public-private partnerships would help us to work more effectively.”
The Review team paid particular attention to aspects related to breast, cervical and prostate cancers, due to their relatively high prevalence in the country. The team worked with senior medical staff at facilities currently providing cancer services in the capital, Bangui. This included university hospitals, the National Laboratory, the Faculty of Sciences and the National Regulatory Authority for radiation safety. The review also covered relevant aspects of radiation safety and security, with the aim of improving the protection of staff, patients and the environment.
“Our priorities are to increase communication and information about the main cancers and to reinforce the capacity of university hospitals in modern means of cancer diagnosis, training of specialists in medical and surgical oncology and increase the availability of therapeutic services,” said Doui Doumbga, Head of General Surgery Services at Hôpital de l’Amitié in Bangui.
The review also recommended increasing the number of medical professionals dedicated to cancer diagnosis, treatment, and palliative care and building their skills. It recommended developing and implementing national standards and guidelines for the prevention of the most frequent cancers. A further recommendation was for a costed and evidence-based national cancer control plan be developed, as the current Strategic Plan for Non-Communicable Diseases will expire at the end of 2021.
“The comprehensive situation and stakeholder analysis review will help inform future programmes supported by the IAEA, WHO, IARC and other partners to assist in strengthening and increasing equitable access to broader comprehensive cancer services,” said Imen Bentouhami, the IAEA Programme Management Officer in charge of technical cooperation projects with Central African Republic.
“Findings from this imPACT Review underline the importance of incorporating an integrated approach to delivering cancer services as part of the health system, but this is only the beginning”, said Jean-Marie Dangou, Public Health Leader Coordinator for Non-communicable Disease Management at the WHO Regional Office for Africa. “The leadership of the Ministry of Health is key to fight cancer, alongside the support that our organizations provide.”
This imPACT Review, which took place from September 2020 to February 2021, was the third conducted using a partially virtual format adopted because of COVID-19 related travel restrictions. An in-country mission will take place when travel allows, for high-level dialogue and to validate findings.
“Cancer causes patients everywhere great suffering and economic hardship. Continuous action is needed, particularly in low- and middle-income countries, and especially during the COVID-19 pandemic when health resources are being redirected to address these priorities. Maintaining life-saving cancer services at this time is as important ever,” said Lisa Stevens, Director of the Programme of Action for Cancer Therapy at the IAEA.