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Transforming Cancer Care in Low-Resource Settings

Aimed at addressing inequities in access to prevention, diagnosis and treatment of cancers, this project will develop a multi-disciplinary networking approach to identify the barriers to access, propose an action plan, and utilize networks to improve the quality of care for our patients. Initial efforts will focus on breast and cervical cancer in Mali and Malawi.


    What is the problem you are trying to solve?

    With 18 million new cases and 9.5 million deaths in 2018 alone, cancer is one of the leading causes of morbidity and mortality in the world. Cancer is often considered a disease of the wealthy with higher rates found in the most developed countries. However, the number of cancer cases in resource-limited settings remains greatly underestimated.

    Major inequities exist between the northern and southern hemisphere when it comes to access to cancer prevention, diagnosis, and treatment. The starkest inequalities are found in sub-Saharan Africa where the region’s epidemiological forecast for cancer is alarming. The International Agency for Research on Cancer estimates there will be 2.2 million new cases of cancer and 1.4 million cancer-related deaths in sub-Saharan Africa by 2040. Cervical and breast cancers are the most common in the region.

    Health systems in low-income countries are not only ill-equipped to respond to this public health challenge but beyond MSF, very few non-governmental organizations are involved in providing cancer care at the ground level.

    What is your solution? What motivates you to work on addressing this problem?

    MSF field teams are increasingly confronted with non-communicable diseases (NCDs) like cancer and are unable to provide a proper response. For this reason, MSF Operational Centre-Paris (OCP) has listed cancer as a priority focus in its 2020-2023 strategic plan, citing it as a major public health issue that requires new strategies. Following the completion of a cancer landscape analysis to assess the relevance and feasibility of MSF’s involvement in this area, OCP decided to engage in the fight against cancer. MSF’s strategy encompasses a three-pronged approach: cancer management projects, access to quality care, and research.

    Given the scope and ambitions of the overall project, the need to find different and adapted ways to work was important. With this TIC project, MSF OCP proposed creating a multidisciplinary and agile team that will steer the overall project strategy and network across operations (project/coordination/cell/headquarters), medical and other relevant departments, as well as external actors.

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What have you done so far and what results have you achieved?

Two MSF operational projects aimed at comprehensively managing women’s cancers were previously developed in Mali (cervical cancer and breast cancer) and Malawi (cervical cancer).

In Mali, the project is a close collaboration with local oncologists that began at the end of 2018 with the development of palliative care in the Point G University Hospital’s Department of Onco-Hematology in Bamako. In just one year, more than 2,000 medical consultations were carried out and more than 2,500 tumours were treated for hospitalized patients, patients at home, and those under ambulatory care. We have assisted with cervical cancer screenings and plan to implement breast cancer screenings. Visiting MSF medical physicists have provided support to the radiotherapy center. We are now planning to renovate the pathology laboratory and to treat cervical and breast cancer patients with surgery, chemotherapy, and radiotherapy.

Started in 2018, MSF’s cervical cancer project in Malawi focuses on providing effective, feasible, and high impact care to under-served populations in the Chiradzulu and Blantyre districts. The project began with prevention and screening efforts in cervical cancer. To date, more than 40,000 women have been screened and 9,000 girls have received HPV vaccinations. MSF has built an operating theatre, an in-patient, and an out-patient department in Queen Elizabeth Hospital in Blantyre. We have also supported the pathology lab and developed the capacity for palliative care. More than 300 cases of cervical cancer are in line for specific treatment and/or palliative care. Cancer surgery began at the end of 2019 and 10 patients will be referred to Zambia for radiotherapy.

    What challenges have you faced? What lessons have you learned?

    The pathology of cancer is complex and requires multidisciplinary and long-term care to monitor treatment side-effects and detect recurrences as early as possible. This area is new to MSF and many challenges exist.

    The most important priority right now is strengthening medical and operational capacities and skills. With the support of our expert network, we are developing a pool of specialized human resources.

    Our next challenge is to modify the way we design operational projects by planning for the long- term at the outset – we are working in close partnership with local colleagues and Ministry of Health and adopting a patient-centered approach.

    Beyond our projects, we want to address the inequity in access to prevention, diagnosis and treatment of these cancers at the national, regional and global levels. This includes working on issues related to the supply of medicines, access to radiotherapy centers and simplified screening diagnostics, research, and the use of innovative tools.

      What have staff said about the project?

      MSF’s commitment to the care of cancer patients is much appreciated by local staff. Almost all of them have a family member affected by the disease.

      “Cancer is worse than AIDS, we prefer to have AIDS than cancer” – MSF Driver, Mali

      “MSF presence in the hospital and working together with the Ministry of Health opens opportunities for collaboration with the greater scientific community. It will definitely add credibility and play a role in building a solid pathway for patient care.” – Malawi Ministry of Health Specialist

        Are you collaborating with any interesting partners?

        A network of experts (including specialists in imaging, histopathology, onco-gynecology, oncology nursing, chemo and radiotherapy, palliative care, etc.) provide technical support and training. Partnerships with a reference cancer center (Institut Curie, Paris), academics (European Society of Gynaeco-Oncology) and NGOs (Douleurs Sans Frontières, Physicien Médical Sans Frontières, Uganda Hospice Africa) are ongoing.

          What is the expected long-term impact of the project? How will this project improve MSF’s lifesaving work and the lives of MSF’s patients?

          If we succeed in meeting our ambitions, the impact of this project can significantly contribute to reducing cancer mortality in low-income countries. If not treated, cancer is always fatal. MSF could become one of the first international medical organizations to develop a global approach to patient-centered cancer care and contribute to better access to prevention, diagnosis and treatment for cancer patients beyond our projects. It is important to remember that our mission is not just to save lives but also to alleviate suffering.