Institute of Cancer Policy
Institute of Cancer Policy
News Article | April 28, 2017
In new research published today by King's College London - Institute of Cancer Policy and the Conflict & Health Research Group in the journal ecancermedicalscience, the difficulties of prioritising preventable disease and long term health issues in post conflict zones are explored. The paper particularly focuses on tobacco control. Globally, one in ten deaths is caused by smoking but in post-conflict zones tobacco usage rates are higher than global averages. This increase coupled with opportunistic industry activity and blackmarket trade poses long-term risks for public health. The paper lays out effective tactics learnt from successes and failures in tobacco control and health policy from Vietnam, Iran and Croatia that can be used to limit the health threats to citizens in Iraq. Prof Richard Sullivan, from the Institute of Cancer Policy and the Conflict & Health Research Group, London, UK and one of the authors of the review states "[Tobacco control] is essential but we recognise that this requires strong governance which is often missing. What is also clear is that what countries self declare to WHO around their tobacco control measures (and other NCD risk factor control measures) often does not hold up under practical scrutiny." Taxation is reported by many institutions, including the WHO, as the most effective means of reducing demand, but between low import duties, open corruption, and recorded collusion between smuggling rings and tobacco firms, success has been limited in post conflict settings. As for the longer-term prospects of disease development in the region, Prof Sullivan cautions "We know very little about the long-term effects; we can surmise that these are poor as more children and young adults take up smoking but to date there have been very few long-term studies. What we have seen already is an increase in tobacco smuggling, higher tobacco usage in women and dramatically lower quit rates." While overall global smoking prevalence has decreased over the last 25 years (29.4% to 15.3%), population growth has meant that the overall number of smokers has increased by almost 60 million people. Those rates are even higher in post conflict settings such as Iraq, an established importer/exporter of cigarettes, with a large smoking population (31% of men and 4% of women). "This work was part of the KCL Conflict & Health Research Group thematic research into NCD control in conflict." says Prof Sullivan, "We know countries in conflict undergo radical changes in their exposure to pro NCD risk factors, yet there is little country specific analysis; working with collaborators from Iraq we were able to conduct this country specific research which provides a more practical, focused example of the issues and threat that tobacco plays in the conflict and post-conflict environments."
News Article | May 18, 2017
Who owns your health data and why? 'Public ownership of health data is the most plausible way forward.' Who owns data about your health: you? The healthcare institution? The funding body? This new study explores the conundrum of personal health data ownership. It considers the interests of all stakeholders and recommends public ownership of health data as the most plausible way forward. The research highlights several different groups who would claim rightful ownership of the health data, amidst people's increasing concerns that it is being wrongfully appropriated. However, the development of personalized medicine relies upon the aggregation and analysis of personal health data. This article recommends and justifies the most plausible model for the ownership of health data and explores the need for recognition of personal interest as well as ownership claims. Data Sharing and the idea of ownership, Jonathan Montgomery - Professor of Health Care Law at University College London and Chair of the This link will be live from 18th May 2017 at 12:01am BST Video link can been found here: http://www. Who really benefits from new cancer treatment development? 'There is an increasing gulf between high-income and low-middle income countries regarding the affordability of these drugs.' Unlike other branches of economics, the emotive issue of cancer drugs is intricately associated with socio-political factors, emotional overlay, and public pressure which can lead to industry manipulation. This new study examines the value added by new cancer drugs being developed in a multi-billion-pound market and the socio-political agenda around them and highlights the increasing gulf between high-income and low-middle income countries regarding the affordability of these drugs. The authors propose that to achieve a more value-based pathway to drug development, serious changes within the industry need to occur. Examples of such change could be federal authorities taking initiatives in conducting clinical trials and low and middle income countries taking proactive steps in developing and drugs with active properties similar to those that have been previously licensed. Economics of Cancer Medicines: for whose benefit? Richard Sullivan - Institute of Cancer Policy, King's College London and KHP Comprehensive Cancer Centre, UK and Bishal Gyawali. This link will be live from 18th May 2017 at 12:01am BST Video link can been found here: http://www. Does personalised medicine live up to the hype? 'The current optimism for personalised medicine is distorting clinical consultations, resource allocation and research funding prioritization' Personalised medicine is widely considered to be the way of the future for medicine. This article examines how the promise and the hype around personalised medicine is changing healthcare. The study's author suggests that the current optimism for personalised medicine is distorting clinical consultations, resource allocation and research funding prioritization when in fact most common diseases are caused by a complex interplay of multiple genetic and environmental factors. research concludes that clinicians have a key role to play both as innovators and as a firewall against hype, bringing a sober realism into the ongoing debates. The promise and the hype of 'personalised medicine' Timothy Maughan -- Clinical Director of the CRUK/MRC Oxford Institute for Radiation Oncology at the University of Oxford and an Honorary Consultant Clinical Oncologist at the Oxford University Hospital Foundation Trust. This link will be live from 18th May 2017 at 12:01am BST Video link can been found here: http://www. Does personalised medicine help us to know ourselves? 'Stratified medicine offers a newly precise kind of humanising health care through societal solidarity with the riskiest.' This article examines how and why self-knowledge is important to communication about risk and behaviour change. It argues that communication about genetic risk between specialists and the public could be improved through deeper engagement with the values, beliefs and cultural commitments of the diverse public. This research claims that genetic knowledge should not properly be called 'self-knowledge' and so temptations to reduce identity into genomic terms should be resisted. Moreover, any effort to change people's behaviour must engage with cultural self-knowledge, values and beliefs, with genetic risk information acting as a catalyst. The article concludes that self-knowledge may be found in compassionate communion, made possible through processes of stratification. Stratified medicine thus offers as a newly precise kind of humanising health care through societal solidarity with the riskiest. Self-knowledge and risk in stratified medicine, Joshua Hordern - Associate Professor of Christian Ethics, Faculty of Theology of Religion, Harris Manchester College, University of Oxford and leader of the Oxford Healthcare Values Partnership This link will be live from 18th May 2017 at 12:01am BST Video link can been found here: http://www. What is the real-life value of precision medicine? 'Uncritical adoption of the concept of precision medicine could make healthcare finances even more difficult in every country with those most in need bearing the cost.' "Precision medicine", medical care tailored for specific groups of patients using techniques such as genetic profiling, carries huge potential in the treatment of many diseases. However it also raises troubling questions about the use of resources. In this research it is argued that precision medicine risks concentrating resources on those that already experience greater access to healthcare and power in society, nationally as well as globally. Healthcare payers, clinicians, and patients must all be involved in optimising the potential of precision medicine. Throughout the article the NHS RightCare Programme is referred to as an example of a national initiative aiming to improve value and equity in the context of NHS England. It is concluded that, despite great promise, at present precision medicine is potentially low value when applied to complex disease and healthcare payers. Uncritical adoption of the concept of precision medicine could make healthcare finances even more difficult in every country with those most in need bearing the cost. There is, therefore, a need for clear directions for clinicians on how it can be best utilised. Equity and value in 'precision medicine' Muir Gray - Department of Primary Care, University of Oxford, United Kingdom, Viktor Dombrádi and Tyra Lagerberg This link will be live from 18th May 2017 at 12:01am BST Video link can been found here: http://www. When referencing the article: Please include Journal title, author, published by Taylor & Francis and the following statement: Read the full article online here: [Article link] This links will be live from 18th May 2017 at 12:01am BST To arrange an interview or for a copy of the study, please contact: Taylor & Francis Group partners with researchers, scholarly societies, universities and libraries worldwide to bring knowledge to life. As one of the world's leading publishers of scholarly journals, books, ebooks and reference works our content spans all areas of Humanities, Social Sciences, Behavioural Sciences, Science, and Technology and Medicine. 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Sullivan R.,Institute of Cancer Policy |
Sullivan R.,King's College London |
Alatise O.I.,Obafemi Awolowo University |
Anderson B.O.,University of Washington |
And 52 more authors.
The Lancet Oncology | Year: 2015
Surgery is essential for global cancer care in all resource settings. Of the 15·2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US$6·2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery-eg, pathology and imaging-are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning. © 2015 Elsevier Ltd.
Frost A.,King's College London |
Boyle P.,International Prevention Research Institute |
Boyle P.,Institut Universitaire de France |
Autier P.,International Prevention Research Institute |
And 6 more authors.
The Lancet Public Health | Year: 2017
Background Explosive remnants of war (ERW)—landmines, unexploded ordnance (UXO), and abandoned explosive ordnance (AXO)—have been recognised as a threat to health since the 1990s. We aimed to study the effect of ERW on global public health. Methods In this systematic mixed-studies review, we searched the Web of Science, Scopus, PubMed, and ProQuest databases, and hand searched relevant websites, for articles published between Jan 1, 1990, and Aug 31, 2015. We used keywords and Medical Subject Headings related to ERW, landmines, UXO, and AXO to locate original peer-reviewed quantitative, qualitative, or mixed-methods studies in English of the direct physical or psychological effects of ERW on direct victims of the explosive device or reverberating social and economic effects on direct victims and indirect victims (their families and the wider at-risk community). We excluded studies if more than 20% of participants were military, if they were of deminers, if they were from high-income countries, or if they were of chemical weapons. We identified no peer-reviewed studies of AXO effects, so we extended the search to include grey literature. We critically appraised study quality using a mixed methods appraisal tool. We used a narrative synthesis approach to categorise and synthesise the literature. We extracted quantitative data and calculated means and percentages. Findings The initial search identified 10 226 studies, leaving 8378 (82%) after removal of duplicates, of which we reviewed 54 (26 [48%] were quantitative descriptive studies, 20 [37%] were quantitative non-randomised studies, four [7%] were mixed-methods studies, and four [7%] were grey literature). The direct psychological effects of landmines or UXO appear high. We identified comorbidity of anxiety and depression in landmine or UXO victims in four studies, more women presented with post-traumatic stress disorder than did men in two studies, and landmine or UXO victims reported a greater prevalence of post-traumatic stress disorder, anxiety, or depression than did control groups in two studies. Overall injury and mortality rates caused by landmines or UXO decreased over time across five studies and increased in one. More men were injured or killed by landmines or UXO than were women (0–30·6% of women), the mean ages of casualties ranged from 18·5 years to 38·1 years, and victims were likely to be doing an activity of economic necessity at the time of injury. The proportion of casualties of landmines or UXO younger than 18 years ranged from 22% to 55% across twelve studies. Landmine or UXO victims who had one or more limbs amputated ranged from 19·5% to 82·6%. Landmines and UXO had a negative effect on internally displaced populations and returning refugees, physical security, economic productivity, child health and educational attainment, food security, and agriculture in studies from seven countries. We could not establish the proportion of casualties caused by AXO from unplanned explosions at munitions sites, although the grey literature suggests that AXO is a substantial problem. Interpretation Individually, these landmine and UXO results are not new and substantiate findings from existing research. Taken together, however, these findings provide a picture of the effect of landmines and UXO that stretches far beyond injury and mortality prevalence, making landmine and UXO clearance a more favourable option for funders. AXO effects are understudied and warrant further research. Funding King's College London. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Ades F.,Free University of Colombia |
Senterre C.,Free University of Colombia |
de Azambuja E.,Free University of Colombia |
Sullivan R.,Institute of Cancer Policy |
And 3 more authors.
Annals of Oncology | Year: 2013
Background: The European Union (EU) is a confederation of 27 member states, the institutions of which work according to negotiated decisions. The EU has implemented similar legislation and a common market, and has adopted the same currency in most of its member states. Although financing health systems is a responsibility of the national governments, the EU has enacted the Charter of Fundamental Rights to standardize public health policies. However, for historical reasons, health policy and health expenditure is not uniform across the 27 EU member states (EU-27). Material and methods: We hypothesized that increased health expenditure would be associated with better cancer outcome and that this would be most apparent in breast cancer, because of the availability of effective screening methods and treatments. Using publically available data from the World Health Organization, the International Monetary Fund, and the World Bank, we assessed associations between cancer indicators and wealth and health indicators. To do so, we constructed scatter plots and used the Spearman's rank correlation coefficient. Results: A marked difference in wealth and health expenditure indicators was observed between Eastern and Western European countries, with Western European being the higher. Higher wealth and higher health expenditures were associated both with increased cancer incidence and decreased cancer mortality. In breast cancer, the association with incidence was stronger. We created mortality/incidence ratios and observed that the more spent on health, the fewer the deaths after a cancer diagnosis. Conclusion: Despite the initiatives to standardize public health policies of the EU-27, health expenditure continues to be higher in Western European countries and this is associated with better cancer outcome in these countries. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology All rights reserved.
Mallath M.K.,Tata Medical Center |
Taylor D.G.,University College London |
Badwe R.A.,Tata Memorial Center |
Rath G.K.,All India Institute of Medical Sciences |
And 20 more authors.
The Lancet Oncology | Year: 2014
Cancer can have profound social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1·2 billion. In age-adjusted terms this represents a combined male and female incidence of about a quarter of that recorded in western Europe. However, an estimated 600 000-700 000 deaths in India were caused by cancer in 2012. In age-standardised terms this figure is close to the mortality burden seen in high-income countries. Such figures are partly indicative of low rates of early-stage detection and poor treatment outcomes. Many cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Social factors, especially inequalities, are major determinants of India's cancer burden, with poorer people more likely to die from cancer before the age of 70 years than those who are more affluent. In this first of three papers, we examine the complex epidemiology of cancer, the future burden, and the dominant sociopolitical themes relating to cancer in India. © 2014 Elsevier Ltd.
Autier P.,Strathclyde Institute of Global Public Health at IPRI |
Autier P.,International Prevention Research Institute IPRI |
Boniol M.,Strathclyde Institute of Global Public Health at IPRI |
Boniol M.,International Prevention Research Institute IPRI |
And 4 more authors.
PLoS ONE | Year: 2016
Background The role of breast screening in breast cancer mortality declines is debated. Screening impacts cancer mortality through decreasing the number of advanced cancers with poor diagnosis, while cancer treatment works through decreasing the case-fatality rate. Hence, reductions in cancer death rates thanks to screening should directly reflect reductions in advanced cancer rates. We verified whether in breast screening trials, the observed reductions in the risk of breast cancer death could be predicted from reductions of advanced breast cancer rates. Patients and Methods The Greater New York Health Insurance Plan trial (HIP) is the only breast screening trial that reported stage-specific cancer fatality for the screening and for the control group separately. The Swedish Two-County trial (TCT)) reported size-specific fatalities for cancer patients in both screening and control groups.We computed predicted numbers of breast cancer deaths, from which we calculated predicted relative risks (RR) and (95% confidence intervals). The Age trial in England performed its own calculations of predicted relative risk. Results The observed and predicted RR of breast cancer death were 0.72 (0.56-0.94) and 0.98 (0.77-1.24) in the HIP trial, and 0.79 (0.78-1.01) and 0.90 (0.80-1.01) in the Age trial. In the TCT, the observed RR was 0.73 (0.62-0.87), while the predicted RR was 0.89 (0.75-1.05) if overdiagnosis was assumed to be negligible and 0.83 (0.70-0.97) if extra cancers were excluded. Conclusions In breast screening trials, factors other than screening have contributed to reductions in the risk of breast cancer death most probably by reducing the fatality of advanced cancers in screening groups. These factors were the better management of breast cancer patients and the underreporting of breast cancer as the underlying cause of death. Breast screening trials should publish stage-specific fatalities observed in each group. © 2016 Autier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PubMed | Institute of Cancer Policy, International Prevention Research Institute iPRI and Strathclyde Institute of Global Public Health at iPRI
Type: Journal Article | Journal: PloS one | Year: 2016
The role of breast screening in breast cancer mortality declines is debated. Screening impacts cancer mortality through decreasing the number of advanced cancers with poor diagnosis, while cancer treatment works through decreasing the case-fatality rate. Hence, reductions in cancer death rates thanks to screening should directly reflect reductions in advanced cancer rates. We verified whether in breast screening trials, the observed reductions in the risk of breast cancer death could be predicted from reductions of advanced breast cancer rates.The Greater New York Health Insurance Plan trial (HIP) is the only breast screening trial that reported stage-specific cancer fatality for the screening and for the control group separately. The Swedish Two-County trial (TCT)) reported size-specific fatalities for cancer patients in both screening and control groups. We computed predicted numbers of breast cancer deaths, from which we calculated predicted relative risks (RR) and (95% confidence intervals). The Age trial in England performed its own calculations of predicted relative risk.The observed and predicted RR of breast cancer death were 0.72 (0.56-0.94) and 0.98 (0.77-1.24) in the HIP trial, and 0.79 (0.78-1.01) and 0.90 (0.80-1.01) in the Age trial. In the TCT, the observed RR was 0.73 (0.62-0.87), while the predicted RR was 0.89 (0.75-1.05) if overdiagnosis was assumed to be negligible and 0.83 (0.70-0.97) if extra cancers were excluded.In breast screening trials, factors other than screening have contributed to reductions in the risk of breast cancer death most probably by reducing the fatality of advanced cancers in screening groups. These factors were the better management of breast cancer patients and the underreporting of breast cancer as the underlying cause of death. Breast screening trials should publish stage-specific fatalities observed in each group.
Autier P.,Institut Universitaire de France |
Autier P.,International Prevention Research Institute iPRI |
Boniol M.,Institut Universitaire de France |
Boniol M.,International Prevention Research Institute iPRI |
And 4 more authors.
Journal of the Royal Society of Medicine | Year: 2015
Objectives: We compared calculations of relative risks of cancer death in Swedish mammography trials and in other cancer screening trials. Participants: Men and women from 30 to 74 years of age. Setting: Randomised trials on cancer screening. Design: For each trial, we identified the intervention period, when screening was offered to screening groups and not to control groups, and the post-intervention period, when screening (or absence of screening) was the same in screening and control groups. We then examined which cancer deaths had been used for the computation of relative risk of cancer death. Main outcome measures: Relative risk of cancer death. Results: In 17 non-breast screening trials, deaths due to cancers diagnosed during the intervention and post-intervention periods were used for relative risk calculations. In the five Swedish trials, relative risk calculations used deaths due to breast cancers found during intervention periods, but deaths due to breast cancer found at first screening of control groups were added to these groups. After reallocation of the added breast cancer deaths to post-intervention periods of control groups, relative risks of 0.86 (0.76; 0.97) were obtained for cancers found during intervention periods and 0.83 (0.71; 0.97) for cancers found during post-intervention periods, indicating constant reduction in the risk of breast cancer death during follow-up, irrespective of screening. Conclusions: The use of unconventional statistical methods in Swedish trials has led to overestimation of risk reduction in breast cancer death attributable to mammography screening. The constant risk reduction observed in screening groups was probably due to the trial design that optimised awareness and medical management of women allocated to screening groups. © 2015, © The Royal Society of Medicine.
Hussain S.A.,Bangabandhu Sheikh Mujib Medical University |
Sullivan R.,Institute of Cancer Policy
Japanese Journal of Clinical Oncology | Year: 2013
Cancer is predicted to be an increasingly important cause of morbidity and mortality in Bangladesh in the next few decades. The estimated incidence of 12.7 million new cancer cases will rise to 21.4 million by 2030. More than two-thirds of the total expenditure on health is through out-of-pocket payments. According to the Bangladesh Bureau of Statistics, cancer is the sixth leading cause of death. International Agency for Research on Cancer has estimated cancer-related death rates in Bangladesh to be 7.5% in 2005 and 13% in 2030. The two leading causes are in males are lung and oral cancer and in females are breast cancer and cervical cancer. Bangladesh is now in severe shortage of radiation therapy machines, hospital bed, trained oncologists, medical radiation physicists and technologists. Bangladesh having different cancers associated with smoking and smokeless tobacco use, Human papilloma virus infection, Hepatitis B and C infection, Helicobacter Pylori infection, arsenic contaminated groundwater, availability of chemical carcinogens mainly formalin treated fruits, fish and vegetables at open market, tannery waste contaminated with chromium (which is used for poultry feed and fish feed preparation). AWorld Health Organization study revealed the annual cost of illnesses in Bangladesh attributable to tobacco usage is US$500 million and the total annual benefit from the tobacco sector is US$ 305 million as tax revenue. Bangladesh has developed a National Cancer Control Strategy and Action Plan with the aim of delivering a universal, quality-based and timely service. Cancer prevention through tobacco control, health promotion and vaccination program, cancer early detection program for oral cavity, breast and cervix has initiated. Cancer detection and diagnostic facilities will be made available at medical colleges and districthospitals and establish a referral chain. National capacity development, more cancer research will allow Bangladesh to deal effectively and efficiently with the cancer problems through evidence-based decision making. © The Author 2013. Published by Oxford University Press. All rights reserved.