Elsevier

The Lancet Oncology

Volume 16, Issue 14, October 2015, Pages 1405-1438
The Lancet Oncology

The Lancet Oncology Commission
Progress and remaining challenges for cancer control in Latin America and the Caribbean

https://doi.org/10.1016/S1470-2045(15)00218-1Get rights and content

Summary

Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.

Section snippets

Part 1: Introduction

Our previous 2013 Commission1 on cancer care in Latin America showed the existing and increasing burden of cancer in the region and identified several obstacles to providing optimum cancer services. Although some cancer incidences are lower in developed countries than in Latin American countries, overall cancer mortality in Latin American countries is about twice that of more developed countries. Ageing of the Latin American population, which will include more than 100 million people by 2020

Part 2: Fragmented health systems

Originally, Latin American health systems sought to enrol salaried workers.23 With this scenario, universal health care would hopefully be gradually achieved through economic, professional, and social development. Unfortunately, this situation has not been the case in most of Latin America, where development did not create enough employment opportunities in the formal sector.24 Health system fragmentation refers to a coexistence of subsystems with different modalities of financing, affiliation,

Part 3: Palliative care

Since 2013, a major advance in the specialty of palliative care in Latin America has been the publication of the Atlas of Palliative Care in Latin America by the Latin American Association for Palliative Care (Asociación Latinoamericana de Cuidados Paliativos).5 The Atlas is the first systematic gathering of information on the status of palliative care in Latin America, and it represents cooperation between different institutions worldwide including the International Association for Hospice and

Part 4: National cancer plans and cancer registries

In the 2011 country profiles for non-communicable diseases, WHO reported that 52% of Latin American and Caribbean countries had an integrated policy, or programme, or action plan for cancer.70 For 2014, WHO reported an 8% increase in the number of countries (60% of the whole region) with an NCCP,71 with these countries having newly adopted plans: Suriname, Ecuador, Dominican Republic, Trinidad and Tobago, Puerto Rico, Peru, El Salvador, and Colombia (figure 1). Belize has established the plan

Part 5: Financing of cancer care

The IMS Institute for Healthcare and Informatics forecasts that for 2016, worldwide expenditure for medicines will be US$1·2 trillion ($615–645 billion spent on branded drugs and $400–430 billion spent on generics); 30% of this expenditure will be from pharmerging markets (in 2012 this amount was 20%).12 Thus, although the USA is expected to increase its spending on drugs by 1–4%, pharmerging countries are expected to increase their expenditures by 12–15%, primarily on cancer care.12

Between

Part 6: Training in oncology and palliative care

Since our previous Commission, awareness about the shortage of cancer specialists has increased in Latin American countries, driven partly by meetings such as the PAHO-initiated conference entitled “Innovative cervical and breast cancer control strategies”, in which increases in oncological training for medical and non-medical personnel in both screening and diagnostic testing was strongly recommended.120

Subsequently, the number of oncologists across Latin America has steadily increased, most

Part 7: Disparities in cancer control

Although numerous efforts to overcome cancer inequalities have been undertaken in the Latin American region in the past few years, inequities in cancer care persist, which have been discussed in several studies published since 2012 (table 6).139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154 We report on several initiatives to overcome these inequalities.

Part 8: Causes of cancer that are of specific concern to Latin America

Among behavioural and environmental risk factors that have a role in the cause of cancer in Latin American populations, several are of special importance because they cause a large proportion of cancer-associated morbidity, particularly in less developed countries in the region. These risk factors include: (1) tobacco use causing lung cancer, which is anticipated to emerge as the main killer in the region if smoking rates do not decrease;187 (2) indoor smoke (panel 3), which is the leading

Part 9: Continuing challenges and remaining questions

Although progress has been made, obstacles to Latin American health systems identified by our 2013 Commission remain. There has been progress towards universal health care, but the number of people with a minimum benefit scheme covering short-term interventions has continued segregating social groups into health-system fragments: a well-funded social security system for employed workers and their families; and a public system providing only basic, poor quality services for the unemployed or the

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