Cancer is a major cause of morbidity and mortality today.1 More deaths are caused by cancer worldwide than by HIV infection, tuberculosis, and malaria combined.2 Worldwide there are more than 10 million new cases and more than 6 million deaths each year.1 By 2020, it is estimated that every year there will be 15 million new cancer cases and 24 million in 2050, with almost 70% of those cases expected to occur in low-income and middle-income countries (LMICs).1,3 Although cancer has received much attention in high-income countries (HICs), it has received less attention in LMICs because other diseases, particularly communicable diseases, have historically been far more significant.4 Other reasons contributing to the lack of attention to controlling cancer in LMICs include deficiencies of human and financial resources, poor vaccine use, inadequate or nonexistent cancer registries, misunderstanding and fear of cancer on the part of the public, and a lack of political will to commit to cancer control.5 Given that noncommunicable diseases serve as a major contributor to poor health and are becoming the most common causes of death in LMICs,4,6 more of a focus is needed on developing and sustaining programs for noncommunicable diseases including cancer in LMICs.
Cancer has now emerged as a major burden in LMICs4 that is often greater than that in higher-income and resource-rich countries.6 For example, while the childhood cancer survival rates are around 75% in resource-rich countries, approximately two-thirds of children with cancer in resource-poor countries die7 as a result of having little or no access to effective therapy.8 Furthermore, this gap in survival between HICs and LMICs will only expand considering the number of children with cancer in LMICs will increase 30% by 2020 based on the current population growth and decreased infant mortality rates.8 Overall, individuals of all ages in LMICs do not have access to well-organized and well-regulated cancer control systems.8 Low-income and middle-income countries have made limited progress in tobacco-control measures and in the development of cancer registries as well as in early detection, treatment, and palliative care.9 In short, resources available for cancer control are restricted or nonexistent in LMICs.
Clearly, reducing the burden of cancer in LMICs will take a concentrated effort in all areas of cancer control including prevention, early detection, diagnosis, treatment, psychosocial support, and palliative care.4 However, as is the case for other established health issues such as child and maternal health and tropical infectious diseases, cancer control will not advance in LMICs without support from the global health and development community. A partnership between public- and private-sector agencies is needed to work with LMICs in prioritizing and planning next steps and providing resources to carry out plans.4
The key to reducing the burden of cancer in LMICs is the fostering of nursing partnerships that will help to build capacity among nurses in LMICs and worldwide. With cancer rates expected to rise in LMICs, there is a greater need for the advanced practice oncology nurse.10 By assuming a lead role in all areas of cancer control, advanced practice nurses could do much to curtail deficiencies in human and financial resources associated with cancer control in LMICs. Advanced practice oncology nurses in resource-rich countries could help educate nurses from LMICs who have limited training in cancer prevention and treatment. Initiatives led by nursing organizations or societies such as the Oncology Nursing Society that help to develop collaborative relationships with many international organizations to educate nurses around the world, need to be encouraged.6 As well, twinning between hospitals and colleges or faculties of nursing in HICs and LMICs would provide the perfect opportunity to develop programs for oncology nurses from LMICs and educate international students, as well as help to develop future nurse leaders in oncology nursing education and research. Development of a global advanced oncology nursing curriculum would also help to bridge the gap between oncology nurses across continents.10 Nurse partnerships in international research and policy development would help to advance oncology nursing knowledge and the quality of care for individuals with a history of cancer and their families. International collaborations not only benefit nurses from LMICs but also afford nurses from HICs the opportunity to learn about cultural differences of patients and nurses from LMICs and hence will help them to be more culturally sensitive in their practice. Having an understanding of the differences and similarities of individuals in the context of cancer is essential to developing cancer control strategies that promote cultural awareness and sensitivity.6 Cancer control is a global concern as is nursing care, and therefore, collaborations and partnerships between nurses worldwide are inevitable and make perfect sense!
- Roberta L. Woodgate, PhD
Faculty of Health Sciences
College of Nursing
University of Manitoba
Winnipeg, Canada
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