Improving Cancer Outcomes In Low- and Middle-Income Countries

The common high-income country framework for improving cancer care that is applied globally leads to calls for workforce development (or capacity building), national cancer control plans, medical professional education, well-defined quality care, clinical practice guidelines, multidisciplinary care, certification programs for outpatient care, research (generally, and not specifically implementation research), and registries. The challenges are responded to by technology transfer interventions—most commonly educational activities— with very limited and hardly rigorous evaluations of their impacts. It is hard not to compare these approaches with those of advocates for economic development generally for the past half century that were found by many to have been so wanting. As we have written, “We believe that, in fact, the major issues are broader than these and that, in any event, these current dominant framework foci can hardly be successfully addressed without attention to bigger ecological issues and themes, such as weak, dysfunctional, and underfinanced health systems, overall, dominated by operational business/money making models; governance, corruption and transparency; human rights shortcomings; incomplete knowledge about diseases, patient/host factors; and cost-effective interventions” applicable in lowand middle-income country settings.