Networks in global cancer—potential synergies and opportunities
Authors: Rifat Atun, Felicia M Knaul, Mary Gospodarowicz
Journal: The Lancet Global Health (2018)

The burden of cancer has increased rapidly worldwide in the past decade, especially in low-income and middle-income countries (LMICs). In 2016, 15 million new cancer cases and about 9 million deaths from cancer were reported worldwide—an 18% increase relative to 10 years previously.1GBD 2016 Causes of Death CollaboratorsGlobal, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017; 390: 1151-1210Summary Full Text Full Text PDF PubMed Scopus (2930) Google Scholar However, worldwide, and especially in LMICs, health systems have failed to effectively respond to the rapid epidemiological transition that has brought high burden of cancer,2Farmer P Frenk J Knaul F et al.Expansion of cancer care and control in countries of low and middle income.Lancet. 2010; 376: 1186-1193Summary Full Text Full Text PDF PubMed Scopus (482) Google Scholar with a huge shortfall in coverage of cancer services, cost-effective prevention, and medical, surgical,3Sullivan R Alatise OI Anderson BO et al.Global cancer surgery: delivering safe, affordable, and timely cancer surgery.Lancet Oncol. 2015; 16: 1193-1224Summary Full Text Full Text PDF PubMed Scopus (339) Google Scholar and radiotherapy services4Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar. The consequences of the poor health-system response are dire. Projections suggest that, by 2030, the number of cancer cases will increase to 24·6 million and the number of deaths from cancer to 13·0 million.5Bray F Jemal A Grey N Ferlay J Forman D Global cancer transitions according to the Human Development Index (2008–2030): a population-based study.Lancet Oncol. 2012; 13: 790-801Summary Full Text Full Text PDF PubMed Scopus (1445) Google Scholar In 2015, more than 61 million people experienced serious health-related suffering worldwide, and this included 25·5 million people who died (accounting for 45% of the 56·2 million deaths worldwide). HIV and cancer were responsible for most of the serious health-related suffering worldwide.6Knaul FM Farmer PE Krakauer El et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2017; (published online Oct 11.)http://dx.doi.org/10.1016/S0140-6736(17)32513-8Summary Full Text Full Text PDF PubMed Scopus (512) Google Scholar Cost-effective interventions to address the burgeoning cancer burden in LMICs exist,7Gelband H Sankaranarayanan R Gauvreau CL et al.Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries. Key messages from Disease Control Priorities.Lancet. 2016; 387 (3rd edition): 2133-2144Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar but these interventions are not reaching the people in need, leading to wide inequities. Scaling up effective medical, surgical, and radiotherapy-based services could bring substantial health, economic, and societal benefits.4Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar, 7Gelband H Sankaranarayanan R Gauvreau CL et al.Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries. Key messages from Disease Control Priorities.Lancet. 2016; 387 (3rd edition): 2133-2144Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar There is therefore an important opportunity to harness cost-effective interventions and strengthen health systems to close the equity divide.8Knaul FM Atun R Farmer P Frenk J Seizing the opportunity to close the cancer divide.Lancet. 2013; 381: 2238-2239Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar Effective management of the cancer response will necessitate global action that is underpinned by strong global and country-level partnerships and networks. These partnerships and networks are crucial in developing coordinated, cohesive, and inclusive action on: (1) establishing global public goods9Blanchet N Thomas M Atun R Knaul F Jamison D Hecht R Global collective action in health: the WDR+20 landscape of core and supportive functions. WIDER Working Paper No. 2014/011. UNU-WIDER, Helsinki2014Google Scholar (eg, surveillance systems, capacity to establish and implement population-based cancer plans, and tackling legally and operationally the use of tobacco and other harmful carcinogenic substances); (2) supporting research and development to make cost-effective and affordable interventions and service delivery models available in LMICs;10Howitt P Darzi A Guang-Zhong Y et al.Technologies for global health.Lancet. 2012; 380: 507-535Summary Full Text Full Text PDF PubMed Scopus (232) Google Scholar (3) developing innovative financing instruments11Atun R Silva S Knaul FM International innovative financing for global health 2002–2015: analysis of innovative financing instruments.Lancet Glob Health. 2017; 5: e720-e726Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar to mobilise new and additional funds and mechanisms12Atun R Knaul FM Akachi Y Frenk J Innovative financing for health: what is truly innovative?.Lancet. 2012; 380: 2044-2049Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar to effectively channel funds to countries for the cancer response; (4) building human resource, technological, and infrastructural capacity to expand provision of cancer services across the care continuum; and (5) creating meaningful public–private collaborations that can deliver value to all the stakeholders concerned. An inclusive approach to the development of partnerships and networks that harnesses the capabilities of the stakeholders involved in the global cancer response is crucial to create synergies, reduce duplication of effort, reach scale, and develop a sustainable response. These stakeholders include a rich array of actors, such as governments, multilateral, UN and international development agencies (eg, the World Bank, WHO, the International Agency for Research on Cancer, the International Atomic Energy Agency, the US Agency for International Development, the UK Department for International Development, and the European Commission), regional development agencies and financing institutions (eg, the African Development Bank and the Asian Infrastructure Investment Bank), patients with cancer and their families, civil society, professional associations and societies (eg, the American Society of Clinical Society, the European Society of Medical Oncology, the European Society for Radiotherapy and Oncology, the American Society for Radiation Oncology, and the Paediatric Radiation Oncology Society), the Union for International Cancer Control, the World Oncology Forum, the Global Task Force for Cancer Care and Control, philanthropic institutions (eg, the Bill and Melinda Gates Foundation and the Clinton Health Access Initiative), research funders (eg, the US National Institutes of Health, the Wellcome Trust, the UK Medical Research Council), the private sector, and others such as associations of parliamentarians. An inclusive and coordinated response has the benefit of creating synergies and reaching meaningful scale, and the failure to do so will mean continuation of the prevailing fragmented and anaemic response that has failed to achieve an effect. The Sustainable Development Goals, with universal health coverage as a global target,13UNSustainable Development Goals—17 goals to transform our world. Goal 3: ensure healthy lives and promote well-being for all at all ages.http://www.un.org/sustainabledevelopment/health/Date: 2015Google Scholar the UN General Assembly Resolution on the prevention and control of non-communicable chronic diseases (NCDs),14UNResolution adopted by the General Assembly on 13 May 2010. 64/265. Prevention and control of non-communicable diseases.http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/64/265&Lang=EGoogle Scholar the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020,15WHOGlobal action plan for the prevention and control of NCDs 2013–2020.http://www.who.int/nmh/events/ncd_action_plan/en/Google Scholar and initiatives such as the C/Can 2025: City Cancer Challenge16Adams C Henshall S Torode J D'Cruz AK Kumar HS Aranda A C/Can 2025: City Cancer Challenge, a new initiative to improve cancer care in cities.Lancet Oncol. 2017; 18: 286-287Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar have provided a new impetus to the global and country-level response to tackle cancer in LMICs. An accelerated, large-scale and sustainable response can only be achieved through partnerships and networks to address the unacceptable global inequities in cancer. We declare no competing interests.