Working summit in Vienna drives forward global guidelines for breast cancer health

Categories: Policy.

When a summit description is preceded by the term “working” – one can expect delegates to roll up their sleeves, combine their brain power and expertise, and leave something tangible for the public health community to grapple with. At the Global Summit on International Breast Health held in Vienna this week, that is precisely what happened.

Delegates worked to put together guidelines for international breast health and cancer control that would shape the way a breast cancer patient, living half way around the world from where the summit was held, might receive care at their local clinic.

From Africa, a small yet significant representation of five African nations included Ethiopia, Ghana, Morocco, South Africa, and Uganda was among the gathering of 132 delegates from the international health community. We asked the delegation from Uganda to share what has been said and by whom. Here’s a culmination of their experiences:

Day one was about survivorship and follow up care for patients with breast cancer. It was indeed interesting to realise that there is a varied understanding of survivorship – what does it mean to have survived a cancer? The debate is still on…

Issues related to fertility were also noted, including the importance of discussing sexuality issues among women with breast cancer. Men need to know that they cannot get breast cancer simply because their wives have breast cancer. By the end of day one, a matrix was developed indicating what should be expected at the basic, limited, enhanced and maximal levels.

Treatment and medication accessibility

The main issue of discussion on day two has been around treatments and medications for breast cancer and for Less Developed Countries (LDCs) the issues of accessibility remain significant. In higher income countries, it is not easier either due to the processes involved. The discussions are pointing to the fact that even for countries where some medications are available, accessibility is still limited due to factors such as costs and transportation, among others.

The summit emphasised the need to have certain basic requirements for any breast cancer patient to be able to access, such as education of the patient and family about their disease, the expected complications, and the means to prevent the complications through regular exercises to help prevent lymphoedema, among others.

Treatment-related supportive care
Day two also focused on treatment-related supportive care, including how to evaluate for treatment -related toxicities and their management. Toxicities from medications have been highlighted as a reality – these can impact the heart, the lungs, the bones and other organs as well as on activities of daily living. A long list of toxicities was discussed, such as GIT side effects (toxicities) fatigue, peripheral neuropathy, skin, the heart, hematological toxicities, etc.

Oncologists and other clinicians were called upon to ensure that the toxicities of cancer treament are well managed in partnership with the patients.

Addressing costs
Costs associated with the treatment and management of side effects (toxicities) increase with advanced stage breast cancer, hence the importance of investing in screening and early diagnosis.

Delegates noted that there are direct and indirect costs such as supportive care, transportation and the cost on human cost among others. “Cancer care and control is an investment not a cost,” said Felicia Knaul from the Harvard Global Equity Initiative.

Managing psychosocial aspects of breast cancer
The psychosocial impact of treatments – anxiety, disfigurement (following a mastectomy, for example) was discussed as well as the alternative and complementary treatment options available for breast cancer patients.

Mrs Ann Steyn, President Reach to Recovery International in South Africa noted that management of psychosocial aspects of breast cancer is critical. Although this may not improve survivorship, it significantly improves quality of life and adherence to treatment. 

Screening for distress using validated tools is essential as distress is recognised as the “6th vital sign.” Mrs Steyn noted that the evidence on the impact of psychosocial interventions is limited and called for more research in this area based on the experiences of patients.

Our response..
Our response as African delegates has been mainly around integration of some of these approaches in the existing system to ensure that the national system makes provision for this. We need to ensure that we set up referrals across the levels in the matrix of guidelines developed and provide for a continuum of care.

We have advocated for the balance between the Western standards in the guidelines and workable solutions for Africa and other LDCs.

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