Benjamin O. Anderson, MD
Health investment is failing to match the challenge presented by a growing cancer burden in countries at all economic levels, enhancing the need for new approaches that help optimize the delivery of care, according to Benjamin O. Anderson, MD, during a keynote lecture at the 2017 Lynn Sage Breast Cancer Symposium.
Breast cancer is the most common cancer among women around the world, and those in low- and middle-income countries experience the most deaths from the disease, said Anderson, a surgical oncologist at the Seattle Cancer Care Alliance. This reality calls for the creation of resource-stratified guidelines to provide a framework for prioritizing healthcare strategies, which will require further implementation research.
"The new area of research that is relevant to low- and middle-income countries is called implementation research," said Anderson. "The idea is that it is beneficial to study implementation within an existing environment. Rather than having the purified data results that we receive from standard randomized trials, we are conducting an implementation and then discovering what happens with the difficulties of a real-world environment. This implementation research is about what is working with the constraints that the environment imposes."
Anderson gave the Connie Moskow Memorial Lecture at the Lynn Sage symposium. In an interview with OncLive
, he discussed the challenges and unmet needs facing global breast cancer care, specifically in low- and middle-income countries.OncLive: Can you highlight some of the implementation research happening globally? Anderson
: Implementation research is an evolving area but it started in the United States to investigate our own healthcare systems in high-income countries. The initial implementation research had very little to do with cancer, however, now we’re carrying this into the global health community and recognizing that it is a fundamental way to go.
It's also relevant to the modern issues that we're having with healthcare delivery in the United States, because we have 18% of our Gross National Product that is being spent on healthcare. The next country is at 11% and we do not have the same delivery that is taking place in Western Europe.
We do need to study what works and not just from a drug perspective but from a systems perspective.What do you believe is the biggest global unmet need that should to be addressed for those with breast cancer?
The biggest need is to address the system’s obstacles. Clearly in countries with fewer resources, financial constraints are a big issue that needs to be managed. However, an even more significant problem is the systematic disorganization that is common in limited resource environments. For example, in sub-Saharan Africa there are multiple ongoing problems, but the healthcare system has not been set up well for managing cancer.
This is a problem because prior to 2011, infectious diseases were thought to be the primary health issue in low- and middle-income countries. What is happening globally is that this is being overtaken by non-communicable diseases (NCDs), meaning heart disease, lung disease, diabetes, and cancer. The World Health Organization (WHO) has been tasked by the United Nations to address the NCDs.
The reason that this is different in certain countries is that the hospitals were set up for managing infections or trauma. Those are single event healthcare issues. For example, if the patient has a car accident, they go to the hospital, receive treatment, and eventually leave. There is no continuity. With the NCDs, there is continuity, meaning that it is not just one operation or one drug treatment. It is establishing a protocol.
This is not unique to cancer. It's the same problem with managing cardiovascular disease and diabetes. The issue is how to make systems that will manage patients in a longitudinal way and will use the resources that are available in ways that are optimal.What are the most important aspects of global breast cancer care?
I would like there to be an improvement in our overall care and not limiting ourselves. The reason we got started with this work in the late 90's and early 2000's was because the majority of people that we interfaced with in high-income countries believed that the problem wasn’t solvable. It is possible to make progress but we need to begin by getting over this idea that it's not a problem or that we can't solve it. We make incremental improvements in everything else we do in medicine, there is no reason to stop here.
We also shouldn't forget that while we talk about the wonders of medicine in the United States, we fail to recognize that we often don't deliver it. In many underserved communities, they are not getting the care that is possible in other areas of the United States.