Health Policy

Developing Cancer Care Institutions for the Developing World

For our #radonc journal club this month we go global; the development of institutions for cancer care in the low and middle-income countries (LMICs) worldwide.

The #radonc community is already global through the reach of social media, but our journal club focus is usually on the provision and improvement of cancer care in higher income countries (HICs) that are the homes for the majority of our correspondents. Whilst a recent journal club discussed the introduction of protons, there are still too many citizens in the world that cannot yet access even photons.

Over time, changes have come in many forms appropriate for the variety of what our authors refer to as “health ecosystems and historical contingencies” in these regions. These include initiatives by philanthropists, governments, cross-border agencies and twinning arrangements with HICs.

The journal article this month comes from a multinational panel of authors (India, Lebanon, Jordan, Zambia, Brazil and the USA) with the first and last from the UK. This group defines the nebulous ‘Cancer Centre’, takes stock of its current provision of cancer care, then explores barriers faced when establishing these institutions from the difficulties of linking the archipelagos of Indonesia, migrants from conflict in Jordan, surgical staff shortages in Africa and disparities in rural and urban populations in India.

There are optimistic examples, but a long list of problems, some of which may be foreign to readers accustomed to their own geographies; training, governments, travel, legislation and of course money.

We are delighted that both the first and last author on this important paper will be joining us on Sunday the 23rd of September to answer questions around their work.  Dr Bhawna Sirohi is Consultant Medical Oncologist at Barts Hospital in London and current President of the Oncology section of the Royal Society of Medicine. Professor Richard Sullivan is Professor of Cancer & Global Health at Kings College London, Director, Institute of Cancer Policy and Co-Director of King’s Conflict & Health Research Group

The team at Lancet Oncology have kindly made the article free and open access for the duration of the Journal Club here (although you will need to register with Lancet Oncology for free).

Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres  Lancet Oncol 2018; 19: e395–406

The paper is open for comments and questions from now until Sunday night. Dr Sirohi and Prof Sullivan will join us online for one hour on Sunday from 8pm BST (7pm GMT, 3pm CST). Please remember to tag your tweets with #radonc #jc. We are keen for insights from all over the globe and hope that they may contribute to more robust models for cancer centres worldwide.

We will frame our questions (as usual) around these themes:

T1: What is your definition of a Cancer Centre and are there differences as to how it should be defined in LMICs compared to HICs?

T2: What are the greatest challenges in establishing successful Cancer Centres in LMICs?

T3: Using the example of radiotherapy what are the potentials for networking and technology to improve the current situation?

T4: How can the HIC Oncology community best support and develop cancer provision in LMICs?


  • Here are guidelines on how to sign up and participate
  • Read our disclaimer for ways to keep it rewarding and professional. If you’re not ready, just lurk and tune into the conversation.

Any suggestions? Leave a comment or tweet us at @Rad_Nation.

Please join us this weekend!


Additional Readings and References:

1 Dr Bhawna Sirohi, Consultant Medical Oncologist:

2 Professor Richard Sullivan:

3 Farmer, P et. al. Expansion of cancer care and control in countries of low and middle income: a call to action. Global Task Force on Cancer Control. Lancet 2010; 376: 1186–93.

4 World Child Cancer. Example of a twinning partnership model:

5 Kerr, S et. al. How Useful Are International Treatment Guidelines in Low- and Middle-Income Countries? Journal of Global Oncology. 2017.

6 Kerr, D. Midgley, R. Can we treat cancer for a dollar a day? Guidelines for low-income countries. NEJM 2010.

7 International Federation of Pharmaceutical Manufacturers & Associations. Enhancing access to cancer care. 2016.

8 Aberg, L et. al. How health systems can improve value in cancer care. McKinsey Health International. 2012.

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