Home > Parasitologi Lingkungan > PERCEPTIONS OF CANCER


 Cancer and cancer care are increasingly recognized as a major worldwide challenge given their global financial, social, and health implications. The prevalence of cancer, primarily a disease of aging, is increasing in step with the increasing lifespan in both high- and low-income nations. In 1970, 15% of newly reported cancers were in developing countries, compared with 56% in 2008.2 Today, almost two thirds of the 7.6 million annual cancer deaths worldwide occur in low- or middle-income countries. Furthermore, by 2030, the proportion of newly reported cancer in developing countries is expected to be 70% of the worldwide total. Cancer is a leading cause of global mortality, which is increasingly pronounced in countries with limited health care resources. Disparities in infrastructure to detect and manage chronic disease lead to an increased burden of advanced stages of cancer detected and managed in low-income countries. This burden is becoming more pronounced as improved survival rates in high-income countries are benchmarked against lower survival rates in low-income countries. Case fatality from cancer (approximated by the ratio of incidence to mortality in a specific year) is approximately 46% in high-income countries, compared with 75% in low-income countries.

Perversely, there is also great disparity across cancer types in the distribution of resources directed toward research and care, but it is not aligned with the global burden of cancer. For example, cancer prevention research in low- and middle-income countries may focus on areas such as early detection of cervical and oral cancer through clinical exams and human papillomavirus testing but discount screening for breast cancer, despite the prevalence of patients diagnosed with advanced stages of breast cancer at presentation.

Furthermore, the vast majority of resources addressing cancer care are delivered to high-income nations, although the vast majority of burden is borne by low- and middle-income nations, particularly in Asia with its large population. Addressing these challenging inequities requires the partnership of health care providers, health funders, nongovernmental organizations, scientists, and the worldwide community. In response, a global workforce for cancer care is developing, and cancer care research and innovation in health services delivery are important components of a forward-looking agenda. Given the diverse populations and diverse health care infrastructures that exist around the globe, research directed toward optimizing treatment, symptom relief, prevention, early detection, and resource distribution is needed.

As a starting point, workshops to address the growing need for well-trained cancer clinical investigators have been developed and are actively training early-career faculty and senior trainees under the sponsorship of well-recognized and distinguished cancer research and care organizations, such as the American Association for Cancer Research (AACR), ASCO, the National Cancer Institute, the European Society of Medical Oncology (ESMO), and the Medical Oncology Group of Australia. Examples of these workshops include the AACR/ASCO Program for Methods in Clinical Cancer Research in Vail, CO; the ECCO-AACR-EORTC-ESMO Workshop Methods in Clinical Cancer Research in Flims, Switzerland (ECCO, European Cancer Organization; EORTC, European Organisation for Research and Treatment of Cancer); and the Australia and Asia Pacific Clinical Oncology Research Development (ACORD) Workshop in Queensland, Australia.

Each is designed as an on-site, intensive training program, engaging hundreds of professionals at the beginning of their professional career, and each is committed to diverse education across tumor types, providing hands-on instruction and guidance by a worldrenowned faculty. Workshop attendees are generally preparing themselves for a future of leadership in cancer care and cancer clinical research, and are in a critical position to address opportunities and challenges ahead. Attendees are competitively selected on the basis of their training, letters of recommendation from supervisors and mentors, and research interests. Travel scholarships are offered, but participants tend to be geographically aligned. The ACORD workshop’s location in Australia places it in a region of the world proximal to significant developing economies. ACORD has been training clinical cancer researchers of Asia Pacific origin since 2004, with participants from (in decreasing frequency) Australia, India, Taiwan, New Zealand, China, South Korea, Singapore, Japan, Pakistan, Philippines, Nepal, Bangladesh, the Middle East and North America. Because attendees of the ACORD workshop represent clinical oncology practitioners from regions of the world that are not typically included in American or European surveys of cancer care and research, we conducted a survey of 2010 ACORD workshop attendees about the most important health questions faced in the participants’ home countries, especially concerning cancer.

We used the survey as a broad approach to understand the complexity of clinical care, professional education, and clinical research needs that respondents anticipate in the future. As an additional component, we held an open panel discussion to hear observations on research around the world from both workshop participants and faculty members.

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