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• W3208286783 abstract "The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean. The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean. This is the first in a Series of two papers about cancer control in Latin America and the Caribbean Cancer is a major public health problem in Latin America and the Caribbean. In 2020, more than 1·4 million new cases of cancer (excluding non-melanoma skin cancer) and more than 600 000 deaths were reported in the region, well in line with the predictions made in the two previous Lancet Oncology Commissions in 2013 and 2015.1Goss PE Lee BL Badovinac-Crnjevic T et al.Planning cancer control in Latin America and the Caribbean.Lancet Oncol. 2013; 14: 391-436Summary Full Text Full Text PDF PubMed Scopus (296) Google Scholar, 2Strasser-Weippl K Chavarri-Guerra Y Villarreal-Garza C et al.Progress and remaining challenges for cancer control in Latin America and the Caribbean.Lancet Oncol. 2015; 16: 1405-1438Summary Full Text Full Text PDF PubMed Scopus (101) Google Scholar The most common cancers in the region occur in the breast (15% of cases), prostate (14%), colorectum (9%), lung (7%), and stomach (5%). Cancer registries have documented a slight increase in incidence, with raising rates of the common cancer types (breast, prostate, and colorectal). Declines in the incidence of gastric and cervical cancers have been observed in the past 5–8 years. Lung cancer is the leading cause of death in Latin America and the Caribbean, followed by colorectal, prostate, breast, and stomach cancers. Cancer mortality rates have been stable or declining since 2015 in most of the region except for colorectal tumours, with increasing numbers in many countries.3The Cancer AtlasAmerican Cancer Society.https://canceratlas.cancer.org/the-burden/latin-america-and-the-caribbeanDate accessed: July 12, 2021Google Scholar With the COVID-19 pandemic, every aspect of cancer control has been negatively affected by a worldwide shift in focus to cope with this public health crisis. Predictions for the long-term effects on cancer control in Latin America and the Caribbean are devastating. In the two previous Commissions1Goss PE Lee BL Badovinac-Crnjevic T et al.Planning cancer control in Latin America and the Caribbean.Lancet Oncol. 2013; 14: 391-436Summary Full Text Full Text PDF PubMed Scopus (296) Google Scholar, 2Strasser-Weippl K Chavarri-Guerra Y Villarreal-Garza C et al.Progress and remaining challenges for cancer control in Latin America and the Caribbean.Lancet Oncol. 2015; 16: 1405-1438Summary Full Text Full Text PDF PubMed Scopus (101) Google Scholar we addressed important cancer control issues in the region; in this Series, we examine the progress over the past few years and discuss remaining challenges. In the first paper of the Series, we examine progress over the past few years and discuss remaining challenges in cancer control, with updates on previously identified areas of interest. Latin America and the Caribbean is a vast region with diversity in geography and natural resources, government and developmental progress, racial and ethnic representation, education, distribution of wealth, and access to quality health care. We identify heterogeneities in obstacles to cancer control and update potential actions to address cancer health disparities. Finally, we discuss the impact of the COVID-19 pandemic on cancer care. Universal health care remains an important objective for the Latin American and the Caribbean region. Many initiatives to increase population coverage, expand services, improve quality of care, and reduce inequities are underway. Leading organisations have developed important reports on the status of countries and their progress towards universal health care, including the Lancet Oncology Commissions,1Goss PE Lee BL Badovinac-Crnjevic T et al.Planning cancer control in Latin America and the Caribbean.Lancet Oncol. 2013; 14: 391-436Summary Full Text Full Text PDF PubMed Scopus (296) Google Scholar, 2Strasser-Weippl K Chavarri-Guerra Y Villarreal-Garza C et al.Progress and remaining challenges for cancer control in Latin America and the Caribbean.Lancet Oncol. 2015; 16: 1405-1438Summary Full Text Full Text PDF PubMed Scopus (101) Google Scholar the world health report on health systems financing: the path of universal coverage, and the Pan American Health Organization (PAHO) resolution to implement the Strategy for Universal Access to Health and Universal Health Coverage. The World Bank embraced the issue declaring the aim to achieve universal health coverage by 2030.4Dmytraczenko T Almeida G Toward universal health coverage and equity in Latin America and the Caribbean: evidence from selected countries. World Bank, Washington, DC2015https://openknowledge.worldbank.org/bitstream/handle/10986/22026/9781464804540.pdfDate accessed: February 27, 2021Crossref Google Scholar Regional strategies addressing health needs and capacity can be identified in two main types of reform: increasing financial coverage and concentrating on organisational restructuring.5PAHOSalud en las Américas+, edición del 2017. Resumen: panorama regional y perfiles de país. Pan American Health Organization, Washington, DC2017https://www.paho.org/salud-en-las-americas-2017/wp-content/uploads/2017/09/Print-Version-Spanish.pdfDate accessed: April 12, 2021Google Scholar Focusing on strategies that increase health coverage by various insurance models has been the tactic in Peru, Colombia, Chile, Mexico, and Uruguay. Alternatively, Guatemala, El Salvador, Honduras, and Paraguay have tried to strengthen health systems by restructuring their organisation. Although progress continues to lag in some countries, the universal health coverage index ranged from 49·0 to 83·0 in 2017 (table 1).7World BankUHC service coverage index - Latin America & Caribbean. World Bank, Washington, DC2017https://data.worldbank.org/indicator/SH.UHC.SRVS.CV.XD?locations=ZJDate accessed: March 3, 2021Google Scholar, 13Báscolo E Houghton N Del Riego A Lógicas de transformación de los sistemas de salud en América Latina y resultado en acceso y cobertura de salud.Rev Panam Salud Publica. 2018; 42: e126Crossref PubMed Scopus (14) Google Scholar Nevertheless, the ability to offer high-quality health care to the most vulnerable population remains limited throughout the region.14Frenk J Gómez-Dantés O Health systems in Latin America: the search for universal health coverage.Arch Med Res. 2018; 49: 79-83Crossref PubMed Scopus (20) Google Scholar In a 2018 report on obstacles to accessing health care, the percentage of the population who face barriers in accessing care (eg, waiting times; geographical distances; and availability, acceptability, and convenience of services)—ranging from 20% in Mexico to 66% in Peru—remains of concern, indicating that millions of people in Latin America and the Caribbean do not have access to quality health care.13Báscolo E Houghton N Del Riego A Lógicas de transformación de los sistemas de salud en América Latina y resultado en acceso y cobertura de salud.Rev Panam Salud Publica. 2018; 42: e126Crossref PubMed Scopus (14) Google ScholarTable 1Selected health systems indicators and PBCRs in Latin America and the CaribbeanPopulation size (2019)UHC service coverage index*Presented on a scale of 0 to 100. (2015)UHC service coverage index*Presented on a scale of 0 to 100. (2017)Proportion of population covered by PBCR (2020)Proportion of population covered by high-quality PBCR†High-quality PBCR defined as included in the latest volume of the Cancer Incidence in Five Continents publication.12 (2020)Cancer control plansPercentage of GDP spent on health care (2018)Out-of-pocket expenditure‡Refers to percentage of current health expenditure. (2018)Argentina44 938 71276·076·041·0%18·6%NCD, NCCP9·6%27·7%Belize390 35366·064·0NANANCD5·7%23·2%Bolivia11 513 10064·068·0NANAFor specific cancers6·3%23·2%Brazil211 049 52778·079·022·0%9·8%NCD9·5%27·5%Chile18 952 03866·070·015·0%7·9%NCD, NCCP9·1%33·2%Colombia50 339 44376·076·025·0%9·1%NCCP7·6%15·1%Costa Rica5 047 56176·077·0100·0%100·0%NCD7·6%22·4%Cuba11 333 48381·083·0100·0%NANCCP11·2%11·0%Dominican Republic10 738 95874·074·029·1%NANA5·7%44·7%Ecuador17 373 66276·077·045·9%41·4%NCD, NCCP8·1%39·8%El Salvador6 453 55375·076·028·4%NANCD, NCCP7·1%28·8%Guatemala16 604 02657·055·0NANANCD, NCCP5·7%58·0%Guyana782 76670·072·0100·0%NANCD5·9%32·3%Haiti11 263 07747·049·0NANANA7·7%43·6%Honduras9 746 11766·065·013·0%NANA7·1%51·2%Mexico127 575 52976·076·012·7%NANCD5·4%42·1%Nicaragua6 545 50271·073·0NANANA8·6%32·9%Panama4 246 43976·079·0100·0%NANCCP7·3%28·7%Paraguay7 044 63668·069·0NANANCD6·7%45·3%Peru32 510 45377·077·034·6%30·6%NCD, NCCP, for specific cancers5·2%29·2%Puerto Rico3 193 694NANA100·0%100·0%NCCPNANASuriname581 36370·071·0100·0%NANCD, NCCP8·0%19·9%Uruguay3 461 73479·080·0100·0%100·0%NCD9·2%17·0%Venezuela28 515 82973·074·0NANANA3·6%38·2%Population size,6World BankPopulation, total. World Bank, Washington, DC2018https://data.worldbank.org/indicator/SP.POP.TOTL?end=2018&locations=ZJ.&start=1960&view=mapDate accessed: July 7, 2021Google Scholar UHC service coverage index,7World BankUHC service coverage index - Latin America & Caribbean. World Bank, Washington, DC2017https://data.worldbank.org/indicator/SH.UHC.SRVS.CV.XD?locations=ZJDate accessed: March 3, 2021Google Scholar percentage of GDP spent on health-care,8World BankCurrent health expenditure (% of GDP) - Latin America & Caribbean. World Bank, Washington, DC2018https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=ZJDate accessed: February 27, 2021Google Scholar and out-of-pocket expenditure data9World BankOut-of-pocket expenditure (% of current health expenditure) - Latin America & Caribbean. World Bank, Washington, DC2018https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=ZJDate accessed: February 27, 2021Google Scholar are from the World Bank, PBCR data are from Piñeros et al,10Piñeros M Abriata MG de Vries E et al.Progress, challenges and ways forward supporting cancer surveillance in Latin America.Int J Cancer. 2021; 149: 12-20Crossref PubMed Scopus (4) Google Scholar cancer control plans are from the International Cancer Control Partnership Portal.11International Cancer Control PartnershipNational Plans.https://www.iccp-portal.org/mapDate accessed: March 3, 2021Google Scholar GDP=gross domestic product. NA=not available. NCCP=national cancer control plan. NCD=non-communicable disease control plan. PBCR=population-based cancer registry. UHC=universal health coverage.* Presented on a scale of 0 to 100.† High-quality PBCR defined as included in the latest volume of the Cancer Incidence in Five Continents publication.12Bray F Mery L Piñeros M Znaor A Zanetti R Ferlay J Cancer incidence in five continents. volume XI. International Agency for Research on Cancer, Lyon2017https://publications.iarc.fr/Book-And-Report-Series/Iarc-Scientific-Publications/Cancer-Incidence-In-Five-Continents%C2%A0Volume-XI-2021Date accessed: March 3, 2021Google Scholar‡ Refers to percentage of current health expenditure. Open table in a new tab Population size,6World BankPopulation, total. World Bank, Washington, DC2018https://data.worldbank.org/indicator/SP.POP.TOTL?end=2018&locations=ZJ.&start=1960&view=mapDate accessed: July 7, 2021Google Scholar UHC service coverage index,7World BankUHC service coverage index - Latin America & Caribbean. World Bank, Washington, DC2017https://data.worldbank.org/indicator/SH.UHC.SRVS.CV.XD?locations=ZJDate accessed: March 3, 2021Google Scholar percentage of GDP spent on health-care,8World BankCurrent health expenditure (% of GDP) - Latin America & Caribbean. World Bank, Washington, DC2018https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=ZJDate accessed: February 27, 2021Google Scholar and out-of-pocket expenditure data9World BankOut-of-pocket expenditure (% of current health expenditure) - Latin America & Caribbean. World Bank, Washington, DC2018https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=ZJDate accessed: February 27, 2021Google Scholar are from the World Bank, PBCR data are from Piñeros et al,10Piñeros M Abriata MG de Vries E et al.Progress, challenges and ways forward supporting cancer surveillance in Latin America.Int J Cancer. 2021; 149: 12-20Crossref PubMed Scopus (4) Google Scholar cancer control plans are from the International Cancer Control Partnership Portal.11International Cancer Control PartnershipNational Plans.https://www.iccp-portal.org/mapDate accessed: March 3, 2021Google Scholar GDP=gross domestic product. NA=not available. NCCP=national cancer control plan. NCD=non-communicable disease control plan. PBCR=population-based cancer registry. UHC=universal health coverage. Increases in health coverage are not necessarily associated with increased access to care. Barriers seem to have been decreasing at a slow rate. While the high rates of health coverage in Uruguay and Chile remain stable between 2010 and 2016, Colombia and Mexico show increases in barriers to access. Honduras’ Health Care Plan 2021 has initiatives to decrease the percentage of the population without access to care.15Secretaría de Estado en el Despacho SaludPlan Nacional de Salud 2021. SITEAL, 2021https://siteal.iiep.unesco.org/sites/default/files/sit_accion_files/hn_0311.pdfDate accessed: February 27, 2021Google Scholar In most countries, the poorest segments of the population more frequently report prolonged waiting times and cultural and economic barriers. As an example to facilitate access, the so-called 60-day law in Brazil, introduced in May, 2013, aims to reduce the time from diagnosis to treatment to under 60 days.16Presidência da RepúblicaLEI No 12.732 DE 22 DE NOVEMBRO DE 2012.http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12732.htmDate: Nov 22, 2012Date accessed: July 12, 2021Google Scholar A pilot programme showed that the median time from diagnosis to treatment decreased from 42 days in 2017, to 37 days in 2018.17Agência Nacional de Saúde SuplementarProjeto Oncorede Análise Dos Dados do Projeto-Piloto de abril 2017 a abril 2018. Agência Nacional de Saúde Suplementar, Rio de Janeiro2019https://www.gov.br/ans/pt-br/arquivos/assuntos/gestao-em-saude/projeto-oncorede/relatorio-conclusivo-oncorede-pdfDate accessed: July 1, 2021Google Scholar Cultural barriers such as fear of suffering, dying, and abandoning the families, stigmas for some types of cancers, and cultural stereotypes such as machismo (male chauvinism) compromise preventive measures and contribute to delays in detection and treatment. Misconceptions about the incurability of cancer and low health literacy result in low cancer awareness that hampers access to early diagnosis, treatment, palliative care, and rehabilitation programmes.18Pinto JA Pinillos L Villarreal-Garza C et al.Barriers in Latin America for the management of locally advanced breast cancer.Ecancermedicalscience. 2019; 13: 897PubMed Google Scholar Long distances to reach specialised centres, combined with long waiting times and limited availability of new medicines, further compromise care and outcomes. Political changes in many countries have led to severe financial restrictions that destabilised health systems and disrupted the quality and coverage of cancer care. For example, in Mexico, the health-care restructuring that replaced Seguro Popular (coverage for the uninsured population) with INSABI (Instituto de Salud para el Bienestar) in 2020 has resulted in a national shortage of some essential antineoplastic drugs and patients experiencing difficulties to continue cancer care.19Villarreal-Garza C Aranda-Gutierrez A Ferrigno AS et al.The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.Lancet Oncol. 2021; 22: 170-171Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar In Venezuela, health services have been in decline since 2012—decreased vaccination coverage, increased incidence of infectious diseases such as malaria, tuberculosis, and HIV, a nutrition crisis, and a shortage of medicines, supplies, and health providers have all affected cancer care.20Large-scale UN response needed to address health and food crises. Human Rights Watch, New York, NY2019https://www.hrw.org/report/2019/04/04/venezuelas-humanitarian-emergency/large-scale-un-response-needed-address-health#_ftn1Date: April 4, 2019Date accessed: June 24, 2021Google Scholar Although expansion towards universal health coverage represents a move in the right direction, inequities in health care remain a major challenge for the region." @default.
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• W3208286783 title "Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward" @default.
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