Management and Treatment
In 2024, 23 low-and middle-income countries with populations over 1 million, mostly in sub-Saharan Africa, did not have access to radiotherapy.
The delivery of high-quality, patient-centered cancer care requires capacity across multiple domains (infrastructure, staffing, resources, research, and data management systems) and multidisciplinary collaboration among health care centers, governments, nongovernmental organizations, and the international community. There remain unmet needs across the main modalities of cancer treatment in many areas of the world. For example, a study in sub-Saharan Africa showed that receipt of guideline-concordant breast cancer treatment ranges from 49% in Namibia to only 3% in Republic of Congo (Figure 37.1).
Only 1 in 4 individuals with cancer in sub-Saharan Africa received adequate cancer-directed treatments.
Receipt of adequate treatment for patients with breast cancer in sub-Saharan countries, 2009-2015
Surgical therapy
Overall, over 80% of all cancer patients require surgery, but over 90% of the population residing in lower- and middle-income countries (LMICs) lack access to safe, affordable, and timely surgical care, compared to 15% in high-income countries (HICs) (Figure 37.2).
Solutions to improve availability and access in LMICs include:
- Investing in long-term strategies to build a cancer surgical workforce
- Establishing regional centers for affordable, high-impact interventions
- Including surgical representation in cancer policy and guideline discussion
- Supporting universal health coverage (UHC) and microfinancing models
Over 90% of the population residing in lower- and middle-income countries lack access to surgical care.
Proportion of population without access to cancer surgery, 2015
“Efforts to reduce cancer disparities still need the kind of visibility, status, investment, excellence, and rigor that the rest of cancer research enjoys.”
Systemic therapy
Systemic therapies, such as chemotherapy, immunotherapy, targeted therapy, and hormonal therapy, reduce cancer morbidity and mortality. Between 2018 and 2040, the annual number of patients requiring first-course chemotherapy will increase from 9.8 million to 15.0 million. While treatment guidelines exist across various settings, implementing equitable high-quality care and maintaining resource capacity across the globe remains challenging. For example, essential cancer medicines, as defined by the World Health Organization, are often unavailable in many LMICs due to supply chain issues and high costs (Figure 37.3). Partnerships with cancer centers from HICs, non-governmental organizations, and philanthropic groups can aid LMICs in workforce training, capacity-building, and securing access to lifesaving systemic therapies.
Proportions of physician’s response to availability of 20 essential oncology medications in low- and low-middle-income countries, 2020
Radiation therapy
Access to radiotherapy, essential for curative or palliative care for many cancers, remains highly inequitable. In 23 LMICs with populations over 1 million, mostly in sub-Saharan Africa (78%), no active radiotherapy is available in 2024 (Map 37.1). Key challenges include infrastructure deficits, workforce shortages, lack of education and training for providers, and high patient cost. Solutions include decentralizing radiation services, fostering global-local partnerships for equipment maintenance, adopting hypofractionated schedules, using multidisciplinary clinics for care coordination, and utilizing e-learning platforms globally.