A roadmap for improving cancer care in South Asia

A series of five papers, published today in The Lancet Oncology by a University of Pittsburgh-led international team, highlights critical public health challenges related to cancer control in the eight countries that form the South Asian Association for Regional Cooperation (SAARC) and the Rohingya refugee population in Bangladesh. The series underscores barriers contributing to significant disparities in cancer outcomes and identifies actionable solutions to address these challenges in one of the most comprehensive efforts to understand this region’s cancer burden. 

The papers call for a comprehensive, coordinated approach to address the cancer burden in SAARC countries -; Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka -; which are home to more than 1.92 billion people. The authors urge policymakers and other stakeholders to implement culturally sensitive approaches to improve cancer prevention, screening, early detection and treatment in this region. 

Although cancer incidence rates in SAARC countries are lower compared to the rest of the world, mortality rates are higher. Cancer incidence is on the rise, with lung, breast, oral and cervical cancers the most common. This is largely due to late-stage diagnoses because of a severe shortage of early detection programs, limited access to treatments and inadequate healthcare infrastructure. 

These issues are compounded in refugee settings, particularly among the nearly one million Rohingya population living in refugee camps in Cox’s Bazar, Bangladesh, where overcrowded camps, limited resources, inadequate infrastructure and political barriers worsen the situation. 

“In the SAARC countries, we face a critical shortage of trained oncology professionals, limited healthcare infrastructure and significant healthcare disparities between urban and rural regions, all of which impact access to high quality cancer care,” said corresponding author Saiful Huq, Ph.D., professor in the Department of Radiation Oncology at the University of Pittsburgh School of Medicine and director of the Medical Physics Division at UPMC Hillman Cancer Center.

There is a tremendous need for effective interventions to improve care across the entire cancer continuum – from prevention and diagnosis to treatment and palliative care for people living in these countries, which is almost one quarter of the world’s population.”

Saiful Huq, Department of Radiation Oncology, University of Pittsburgh

In the series of papers, Huq and his coauthors describe barriers specific to each SAARC country and those that are common across the region. These include a lack of awareness about cancer symptoms, risk factors such as smoking and chewing betel nut, cultural stigmas, myths that cancer is untreatable or contagious, lack of access to health care facilities in rural and remote areas, financial difficulties faced by many patients and their families and insufficient government investment in cancer care. 

A major barrier to cancer care is the shortage of trained cancer care professionals in SAARC nations -; including oncologists, medical physicists, radiation technologists and oncology nurses -;driven by insufficient educational and training programs. Additionally, the SAARC countries face disparities in cancer research funding and a lack of infrastructure to support large-scale comprehensive cancer treatment efforts. 

“SAARC nations face a myriad of challenges in providing accessible and equitable cancer care to their diverse populations,” said Huq. “As a first step to addressing these challenges, there is an urgent need to strengthen each country’s national cancer control program in order to develop strategies to upgrade health care infrastructure, particularly in rural and underserved areas, and investing in the training, education and retention of skilled healthcare professionals.” 

Other key recommendations include expanding cancer registries to improve data collection that will inform policy decisions for cancer control efforts and strengthen research capacity; launching public health campaigns to promote prevention; promoting early detection and awareness of cancer risk factors; and fostering regional collaboration and partnerships to ensure better access to cancer treatment. The papers emphasize that regional networks could play a significant role in advocacy and resource mobilization, particularly for countries with limited health care budgets. 

Among the Rohingya refugee population, cancer -; particularly hepatocellular carcinoma, oral cancer and cervical cancer -; is a rising concern. The papers call for culturally sensitive and multi-pronged interventions to address these issues, including partnerships with local leaders and communities to raise cancer awareness, reduce stigmas, improve health literacy and strengthen capacity for cancer screening, treatment and palliative care. 

To raise awareness and drive policy changes, Huq will launch this series of papers on December 12 at the Global Health Catalyst Summit in Bangladesh to an audience that will include Nobel laureate Muhammad Yunus, chief advisor of the Interim Government of Bangladesh; ambassadors from SAARC countries; and other stakeholders. 

“The dedication of Dr. Huq and the entire Global Health Catalyst to improving cancer care around the globe is truly amazing and I was honored to have the opportunity to collaborate with him in highlighting this critical issue,” said coauthor Heath Skinner, M.D., Ph.D., professor and chair of the Department of Radiation Oncology at the Pitt School of Medicine and chief medical officer of the Radiation Oncology Network of UPMC Hillman. 

Other authors of the series are listed in The Lancet Oncology papers online. 

This research was supported by funding from the National Institutes of Health awards R25CA288263 and R13CA257481 supporting the Global Health Catalyst and the Department of Radiation Oncology at the Pitt School of Medicine.