The most effective and efficient treatment programmes are those that: a) are provided in a sustained and equitable way; b) are linked to early detection; and c) adhere to evidence-based standards of care and a multidisciplinary approach.
Such programmes also ensure adequate therapy for cancer types that, although not amenable to early detection, have high potential for being cured (such as metastatic seminoma and acute lymphatic leukaemia in children), or have a good chance of prolonging survival in a significant way (such as breast cancer and advanced lymphomas).
Diagnosis
The first critical step in the management of cancer is to establish the diagnosis based on pathological examination. A range of tests is necessary to determine the spread of the tumour. Staging often requires substantial resources that can be prohibitive in low-resource settings. Because of late diagnosis, however, a consequence of poor access to care, most patients have advanced disease in such settings.Once the diagnosis and degree of spread of the tumour have been established, to the extent possible, a decision must be made regarding the most effective cancer treatment in the given socioeconomic setting.
Major treatment modalities
This requires a careful selection of one or more of the major treatment modalities – surgery, radiotherapy and systemic therapy – a selection that should be based on evidence of the best existing treatment given the resources available.Surgery alone, and sometimes radiation alone, is only likely to be highly successful when the tumour is localized and small in size. Chemotherapy alone can be effective for a small number of cancers, such as haematological neoplasms (leukaemias and lymphomas), which can generally be considered to be widespread from the outset. Combined modality therapy requires close collaboration among the entire cancer care team.
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