Monthly Archives: November 2015

Closing the 40% survival gap in Gaza

 

shayma wahaidi cropped

Shaymaa Al Wahaidi is a pharmacist trained in public health who is about to return to Gaza to support efforts to improve diagnosis and care of breast cancer patients

In Gaza, only around 50% of women diagnosed with breast cancer will still be alive five years down the line, compared to almost 90% in countries like the UK and USA.

 

I’m a Palestinian pharmacist from Gaza, and I’m about to return there after completing a Public Health course in Oxford, with a view to becoming a public health researcher. My current interest is the lack of support for early diagnosis for women with breast cancer in Gaza. I used to work with breast cancer patients, and I’ve noticed that women in Gaza often present late for diagnosis and have many fears associated with the disease.

 

The poor rate of breast cancer survival partly reflects cultural attitudes about breast cancer. Some women, for instance, worry about being divorced if they were to be diagnosed with the breast cancer. As result, even if they suspect that they have breast cancer, they sometimes prefer to keep silent and die waiting.

 

But women can also be deterred from seeking a diagnosis because they know how hard it can be to get access to treatment. Once diagnosed with breast cancer, women face many challenges, and it has been suggested that their treatment in Gaza is below acceptable standards. A few years ago, the Ministry of Health had to appeal to international bodies after stocks of almost 15% of essential chemotherapy drugs ran out, and adherence to scheduled treatments for breast cancer was impossible due to the erratic supply of medicines.

 

This problem has not been resolved. Last December, breast cancer patients in Gaza organised a demonstration in protest that the medication they need is still not available, and even when it is available, it is unaffordable.

 

Part of the problem is poor use of meagre resources. There’s only one histopathological laboratory, and there are no facilities for radiotherapy. And yet there are currently four mammography units in Gaza, despite the evidence-based research that challenges whether women in general derive any benefit from mammographic screening. Most of the time hospitals cannot import the chemicals used for the mammography X-rays anyway. Considering Gaza’s disastrous economy – half the population lives on less than $3 per day – spending money on mammography facilities, which charge around $27 per appointment, is not justifiable.

 

It is my hope that we can start to improve the situation for women and for breast cancer patients in Gaza if we start to direct research attention to how we can improve our healthcare facilities, train up personnel in breast cancer investigation and treatment, and improve adherence to treatment guidelines.

 

We also need to conduct detailed investigations to understand more, for instance, about women’s experiences and perceptions regarding adherence to treatment, and about their quality of life and their experiences after mastectomy.

 

As long as health services in Gaza are unable to offer adequate treatments for breast cancer patients, Palestinian women will continue to die from a disease which in many countries is seeing increasingly high survival rates. In addition, until significant steps are taken in early diagnosis, women will continue to present at a late stage of the disease, when the chances of prolonging their lives are reduced.

 

I hope that when I return home in a few weeks’ time, I will be able to use what I’ve learned to start to make a real difference.

Breast cancer patients and survivors help other patients by sewing prosthetic breasts that are distributed free

Breast cancer patients and survivors help other patients by sewing prosthetic breasts that are distributed free

The multiple problems women with breast cancer face in Gaza have been captured in a moving animation, “Fatenah”, which follows the journey of one woman from her delayed diagnosis to the multiple delays, stress and humiliation involved in getting access to the right treatment 

Fatenah

 

We welcome contributions to this blog. If you have a topic you would like to write about, please send your post to Corinne Hall – chall@eso.net You can find our guidelines here – How to write a blog

It’s not a war on cancer that we need, it’s a revolution

anna portrait  pic

Anna Wagstaff

The influential Economist magazine describes its mission as “to take part in a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress”.

So when it turned its attention to organising a conference on the “War on Cancer”, I registered for a press pass. I was familiar with most of the speakers, and I wasn’t expecting to hear anything I didn’t already know. But I thought The Economist might attract an interesting and diverse audience, and I was interested to hear how the discussion would go.

It did turn out to be interesting – but not in a good way. While the agenda was wide-ranging and the chair asked sensible questions to dig deeper into the issues, the audience was largely inanimate – except when the topic touched on new medical therapies.

When it came to the intricacies of the adaptive pathways approach to approving new drugs, the challenge of speeding progress through health technology assessment, the obstacles to trialling combinations of drugs in patients who stood to benefit most, the questions came thick and fast.

When the subject was how to provide care for escalating numbers of survivors, fix unacceptable variations in care quality, provide better access to different types of radiotherapy, or address missed prevention opportunities – silence.

Thinking about it, I should have expected this.

Yes, it was a well-balanced agenda, but the so-called war on cancer in reality lacks any such balance, and it is not surprising that this was reflected in the composition and interests of the audience.

Researching and developing new medical treatments remains the biggest hope for increasing cancer survival, and this effort deserves all the support it can get. But the extent to which this agenda dominates the ‘war’ strategy is out of all proportion to the contribution it is making to reducing death and suffering from cancer.

This point was made in different ways by many of the speakers.  Chris Wild, head of IARC, and Cary Adams, head of the UICC, talked about the central role of prevention, saying “We cannot treat our way out of cancer,” and “Only 3% of the cancer research budget goes towards prevention, and it’s wrong.”

Cai Grau, leader of ESTRO’s HERO project, talked about the role of radiotherapy, which accounts for around 40% of cancer cures, and has been shown to be a cost-effective treatment. He pointed out the benefit to patient outcomes that could be achieved by putting more effort into addressing the severe undercapacity in many European countries.

Francesco de Lorenzo, President of the European Cancer Patient Coalition, talked about the priority patients give to ending the treatment lottery. They want more attention paid to ensuring that wherever they are treated, they can trust their medical team to deliver high quality care.

Jane Maher, Macmillan’s Chief Medical Officer, spoke convincingly about what can and must to be done to ensure that growing numbers of cancer survivors get the support and care they need not just to survive, but to get their lives back on track and lead a fulfilling life.

What they were all saying was that we do in fact know how to make faster progress against cancer, we’re just not doing it. Sadly, this audience didn’t seem to see it as their problem. And this got me wondering about the war against cancer. Is the problem really one of “intelligence versus ignorance” as The Economist frames it, or is it that the people in the driving seat are so focused on their own agenda that the wider interests of the public, patients and survivors are being sidelined?

The problem may be that we are trying to fight a war when what we really need is a revolution.