IAEA International Atomic Energy Agency Panel Discussion I: Tackling Cancer Fifth Session of Islamic Conference of Health Ministers Istanbul, Republic of Turkey, 17 – 19 Nov 2015

IAEA Speakers

IAEA Strategic Health Programme-OIC The Ministers of Health of the Member States of the OIC at the 4 th Conference (Jakarta, October 2013) adopted a Strategic Health Programme of Action 2014 – 2023 (SHPA).

IAEA Strategic Health Programme-OIC Under Thematic Area 2: Disease Prevention and Control: Action: to enhance cooperation in the area of cancer control in the member countries Through establishing networks among the relevant institutions in cancer research, diagnosis, and treatment.

IAEA The Problem Current coverage of radiotherapy services according to country as determined by global equipment databases, an activity-based operations model, cancer incidence, and evidenced- based estimates of radiotherapy need. Lancet commission Report : 14.2 million new cancer cases 8 million cancer deaths * Projected :Ferlay J et al Sources, methods and major patterns in GLOBOCAN ; 136(5):E359-E : 24.6 million new cancer cases 13 million cancer deaths*

IAEA Local Control and Survival Benefit from Radiation 6 Top 10 cancers globally by incidence: Radiotherapy utilization rate, average RT fractions and outcome benefits (absolute proportional)** ** personal communication Lancet Commission Report

IAEA CT - Transmission Imaging Structural Information: Size Shape Location NM - Emission Imaging Uptake Information Activity Function Localization CT versus PET/SPECT scans Images Courtesy D. Paez Diagnosis Staging Restaging Therapy planning Therapy response

IAEA Renal Scintigraphy-Tc-99m-MAG3 PET/CT in Use in Neurology reduced wall motion; scar on bottom Courtesy D.Paez Use in Cardiology Uses of Nuclear Medicine Imaging Anterior wall ischemia Most Common NM tests: Bone scans Thyroid scintigraphy Lung perfusion and ventilation Nuclear cardiology Renal scans Oncology Neurology and Psychiatry

IAEA Radiation Therapy Techniques Radiotherapy has been used for curative or palliative treatment of cancer, alone or combined with chemotherapy or surgery. Robotic Body Radiosurgery External Beam 3-D/IMRT Gamma-knife Radiosurgery Brachytherapy

IAEA Comparison of Techniques Radonc.ucla.edu Courtesy Sua Yu, MD

IAEA IAEA Technical cooperation (TC) programme Developed and managed jointly by the Member States and the IAEA Secretariat. The IAEA Technical Departments are responsible for the technical integrity of the TC programme. IAEA TC Department responsible for the management of the TC programme Yearly budget of about €120 million About €32 million (~26%) are spent on Human Health

IAEA Cervix Cancer Radiotherapy improves the absolute 5-year survival rate by 17% over the contribution of surgery and chemotherapy. 12

IAEA Cancer Worldwide Burden Globally, in 2012 the most common cancers diagnosed were those of the:  Lung (1.8 million cases, 13.0% of the total)  Breast (1.7 million, 11.9%)  Large bowel (1.4 million, 9.7%). The most common causes of cancer death were:  Cancers of the lung (1.6 million, 19.4% of the total)  Liver (0.8 million, 9.1%)  Stomach (0.7 million, 8.8%). *World Cancer Report 2014 launched by the International Agency for Research on Cancer (IARC)

IAEA Cancer Burden in Developing Countries Developing countries are disproportionately affected by the increasing numbers of cancers. More than 60% of the world’s total cases occur in Africa, Asia, and Central and South America, and these regions account for about 70% of the world’s cancer deaths.

IAEA Comprehensive Cancer Control Approach Coordinated activities focused around prevention, early detection, diagnosis, treatment and palliative care.

IAEA Comprehensive Cancer Control Approach Improving access, affordability, quality and delivery of cancer services to cancer patients requires a multidisciplinary set of expertise.

IAEA Panel Objectives To address the need for comprehensive cancer control and for implementation of evidence- based interventions tailored to level of resources available with Ministers of Heath. To share regional best practices Promote regional coordination mechanisms in cancer control planning and implementation in order to strengthen health systems.

IAEA A high-level panel representing different cancer stakeholders will advocate for : Comprehensive cancer control and expand on a number of critical issues that need to be considered to strengthen the health systems to effectively address cancer. Panel Objectives

IAEA Speakers

IAEA Panelist Presentations 5 minutes each for presentations Followed by questions to the panelists 8-10 minutes each. Followed by an open discussion Human Health 20

IAEA Professor Sanchia Arancha Human Health 21

IAEA Dr Daouda Malle Human Health 22

IAEA Dr Shilpen Patel Human Health 23

IAEA Dr Murat Gultekin Human Health 24

IAEA QUESTIONS TO THE PANELISTS Human Health 25

IAEA Professor Sanchia Aranda Questions to the speaker:  What is the role of NGOs in supporting governments to implement national cancer control plans?  How could NGO best contribute to raising awareness on the cancer epidemic at national and/or global level?  How could governments support the development of active and collaborative NGOs at national level?

IAEA Dr Daouda Malle  What would be the social and economic cost of not investing in cancer control and can we afford not investing on it?  While cancer services appear to be cost-effective (prevention as well as treatment, including radiotherapy), financing these services may have high initial costs, which may be challenging for low- and middle-income countries. How would you recommend these countries should approach this important issue?  Investing in cancer control would result in an overall strengthening of health systems, which may deliver results also in other health areas, thus maximising the Return on Investment (ROI). How can we factor this aspect in making investment decisions?

IAEA Dr Shilpen Patel Questions to the speaker:  How can early detection improve treatment outcome and survival?  What key messages have been found effective in order to raise awareness among the population?  Please comment on the impact of radiation therapy within cancer control?

IAEA Assoc. Prof Dr Murat Gultekin  What kind of access disparities in cancer treatment worldwide and in low and middle income countries in particular do you observe nowadays?  What in your opinion should be done by international community to recognize this equity challenge and, consequently, to address it?

IAEA Assoc. Prof Dr Murat Gultekin Questions to the speaker:  What are the main challenges normally experienced in setting up surveillance systems?  What are the most effective linkages that need to be established so that data can actually inform policy and operational decisions?  How can National Cancer Control Plans be developed in the absence of reliable population based data?

IAEA Challenges Uncertain energy supply & Lack of control of ambient temperatures in buildings Weak health systems with limited laboratory and diagnostic services & medical support. An estimated additional 215,000 health professionals will be needed by 2035 to meet the need for radiotherapy services. Human Health 31

IAEA Innovative Coordinated Research Projects (CRP) for Resource Sparing Post-mastectomy radiotherapy Pre-operative advanced rectal cancer Palliative oesophagus cancer Glioblastoma multiforme Lung cancer Painful bone metastasis Head and neck cancer (2) Cervical cancer (2)

IAEA Innovative Technologic Solutions Cloud-based radiotherapy platforms :  automated techniques for treatment planning, quality control, and peer-review Resulting in :  improved quality, reduced expertise dependence, and lower operating costs Human Health 33

IAEA Innovation in Financing Innovative financing: offers new opportunities for mobilising, pooling, channelling and funding radiotherapy services. Others include Diaspora Bonds and Social Impact Bonds 34

IAEA CONCLUSIONS Strengthen health systems with appropriate laboratory and diagnostic services & medical support. Increase education and training opportunities to provide the estimated additional 215,000 health professionals needed by 2035 to meet the need for radiotherapy services.

IAEA CONCLUSIONS Accelerated adoption of existing technologies Creation of new technologies to address diverse needs Development of new processes / models that remove impediments to efficient and effective care delivery Financing to address resource shortfalls Communication and advocacy to mobilise support and gain confidence of decision makers. 36

IAEA CONCLUSIONS Avoid fragmented approaches –not sustainable. Innovative leadership and stewardship models are required to promote multi- national partnerships with those in need. Human Health 37

IAEA Human Health 38 THANK YOU