Is it fair that one person with Hodgkin lymphoma will be cured and another will die, simply because of what part of the world they live in? No, says Lawrence Shulman, MD, Dana-Farber’s director of the Center for Global Cancer Medicine and senior oncology advisor to Partners In Health (PIH). Shulman, who recently published his perspective in Nature Reviews Cancer, works with Dana-Farber and its partners Brigham and Women’s Hospital and Boston Children’s Hospital to bring cancer care to PIH sites in developing countries. He shares his experience in providing cancer care in Rwanda.
Q: What is the difference between providing cancer care in the U.S. and in a setting such as Rwanda?
A: One of the most striking differences has to do with the care team. The clinical team at the Butaro Cancer Center of Excellence is mostly made up of non-specialists. These internists, pediatricians, and nurses have undergone training in cancer medicine, and they provide care with structured support from specialists at DFCI. Also, no aspect of cancer medicine is taken for granted. This country suffered through a genocide 20 years ago and only began providing cancer care in 2012. The cancer ward at Butaro is the only affordable public cancer facility in the country, and is bursting at the seams with patients seeking care. Dana-Farber’s partnership with the Ministry of Health in Rwanda has enabled us to make a difference in the lives of these patients, and we are committed to doing whatever it takes.
Q. Is cancer more prevalent in developed countries such as the U.S.?
A. Cancer gets more attention in places like Boston, but actually the majority of cancer cases and most related suffering and death occur in low and middle income countries, least-armed to deal with this global crisis.
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Q. What are the most common types of cancer seen in Rwanda?
A. One-third of our adult patients at Butaro have breast cancer. We see certain diseases more often in Rwanda than in Boston, such as a Wilms’ tumor. We generally see patients with more advanced stage of disease. Since there was little affordable cancer care in the country until recently, there was no reason for patients to seek care early on.
Q. When it comes to cancer in Rwanda and similar settings, isn’t prevention better than treatment?
A. Preventing disease is always better than having to treat it. But we cannot only focus on prevention because two-thirds of all cancers cannot be prevented. The medicines and procedures that would make a huge impact in Rwanda are often old and affordable. In fact, the very drugs developed in the basement of Children’s Hospital by Sidney Farber in the 1940s and 1950s are still not available to many of the world’s poor.
Q. What is needed to bring cancer care to the developing world?
A. To have a major impact on cancer mortality worldwide, we need the resources, organizational infrastructure, and political will to bring the diagnostics and treatments currently available in the developed world to the large portion of the world’s population who currently have no access and therefore denied the chance to survive their cancer.