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Department of radiotherapy. University Hospital Ibn Rochd Casablanca – Morroco Cancer Control Resources in Maghreb countries Pr. BENIDER Marrakech June 19th 2010
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Maghreb map
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MAGHREB Epidemiologic transition - Demographic transition - Transformations of the environment - Change of the way of life Non transmissible chronic diseases Health priorities Cancer = Major problem of public health INTRODUCTION
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1929: Bergonié Centre -Casablanca Ibn Rochd Oncology Center Historical 1929-1980 1947: Casablanca Mayor inaugurating the hospitalization of the Bergonié center
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Historical 1929-1980 Treated cancers in Cancer Centre bergonié
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1980: First two radiotherapy specialists (Pr.Gueddari - Pr.Kahlain) 1985: National Institute of Oncology-Rabat 1989: First private center - Casablanca Historical 1980-2005 2005: Lalla Salma Association Against Cancer 2010: Cancer Plan (2010 - 2019) After 2005
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Epidemiological Data
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Cancer Standardized Incidence In Maghreb All Sites MaleFemale MOROCCO (Casablanca*) 100,3104,2 ALGERIA (Alger**)148,6 151,3 TUNISIA (Tunis***)133,2101,4 LYBIA (Benghazi****) 116,9295,11 * Registre des Cancers de la région du Grand Casablanca Edition 2004 ** Registre des tumeurs d’Alger Edition 2003 *** Registre des Cancers de Nord Tunisie 1999-2003 **** Benghazi Cancer Registry 2004
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Cancer Standardized Incidence In Maghreb All Sites MaleFemale MOROCCO (Casablanca*) 100,3104,2 ALGERIA (Alger**)148,6 151,3 TUNISIA (Tunis***)133,2101,4 LYBIA (Benghazi****) 116,9295,11 USA (New Jersey)566,2439,2 France (Loire)422,7256 CANADA 398,5308,3
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COMMONLY CANCERS IN MALE MOROCCO (Casablanca*) ALGERIA (Alger**) TUNISIA (Tunis***) LYBIA (Benghazi****) Lung ProstateColon/RectumBladderColon/Rectum BladderColon/RectumHead Neck NHLStomachProstateBladder LarynxProstateSkinProstate * Registre des Cancers de la région du Grand Casablanca Edition 2004 ** Registre des tumeurs d’Alger Edition 2003 *** Registre des Cancers de Nord Tunisie 1999-2003 **** Benghazi Cancer Registry 2004
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COMMONLY CANCERS IN FEMALE MOROCCO (Casablanca*) ALGERIA (Alger**) TUNISIA (Tunis***) LYBIA (Benghazi****) Breast Cervix uteriColon/Rectum ThyroidCervix uteriSkinCorpus uteri Colon/RectumThyroidCervix uteriNHL Ovaries ThyroidCervix uteri * Registre des Cancers de la région du Grand Casablanca Edition 2004 ** Registre des tumeurs d’Alger Edition 2003 *** Registre des Cancers de Nord Tunisie 1999-2003 **** Benghazi Cancer Registry 2004
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Breast Cancer Comparison of standardized incidence of other countries CountryIncidence MOROCCO (Casablanca)35,04 ALGERIA (Alger)44,5 TUNISIA (Tunis)29,6 USA (New Jersey)129,4 FRANCE (Loire)109,8 CANADA95,5
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Health facilities
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Cancer facilities in Morocco Casablanca Public (1) Private (2) Rabat Public (1) Military (1) Private (2) Oujda Public (1) Total : 8 cancer centers Al houceima Before 2005
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Cancer facilities in Morocco Functional Casablanca (4) Rabat (4) Agadir (1) Oujda (1) Al Houceima (1) Marrakech (2*) Fes (1/1*) Total : 12 (3*) cancer centers Planned Tanger Meknes (2) Safi Laayoune Al houceima After 2005 *Functional soon
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Cancer facilities in Algeria ALGERIA Constantine Algiers Ain-Naadja Blida Ain Misserghin Oran 6 centers......
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Cancer facilities in Tunisia - 3 functional centers: Tunis Sousse Sfax Jendouba - 3 planned centers: Gafsa Gabes Jendouba
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Radiation Therapy Equipment in Morocco Before 2005 Linac10 Cobalt7 Simulator (CT)3 Brachy LDR16 Brachy HDR2 TPS10 After 2005 22 (2*) 6 5 (7*) 16 7 28 (14*) * Planned
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Radiation Therapy Equipment in Algeria Linac9 Cobalt6 Brachy4
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Radiation Therapy Equipment in Tunisia PublicPrivateTotal LINAC1/4*1/1*2/5* Cobalt459 Simulator32/1*5/1* TPS33 * Planned
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Comparison of Radiation Therapy Equipment in Maghreb countries MoroccoAlgeriaTunisia Linac22(2*)92(5*) Cobalt669 Simulator (CT) 5(7*)-5(1*) Brachy LDR164- Brachy HDR7-- TPS28(14*)-3 * Planned - No data available
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22 Human resources in cancer centers in Morocco Radiotherapy Specialists: 82 Residents: 61 Medical Oncology Specialists:20 Residents:51 Surgical Oncology Specialists:16 Total: Specialists: 118 Residents : 112
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23 Human resources in cancer centers in Algeria Medical Oncologists: 250 Radiation Oncologists: 50 Surgeons: 100
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24 PublicPrivateTotal Surgical Oncology Specialists11415 Residents13 - Radiotherapy Specialists15419 Residents19- Medical Oncology Specialists201232 Residents32- Total Specialists461864 Residents64 - Human resources in cancer centers in Tunisia
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25 MoroccoAlgeriaTunisia Surgical Oncology Specialists1610015 Residents- -13 Radiotherapy Specialists825019 Residents61- 19 Medical Oncology Specialists2025032 Residents51- 32 Comparison of Human resources in cancer centers in Maghreb countries - No data available
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Moroccan cancer Plan 2010-2019 Conceptual Framework National and international mobilization Prevention Early diagnosis Detection Diagnosis and treatment Palliative cares Legislation Research / Training Social support Communication
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Moroccan cancer Plan 2010-2019 Health facilities organization Level 1: Basic health centers, General practionners Level 2: Provincial hospitals Diagnosis centers Clinics Level 3: University hospitals, Regional cancer centers Private cancer centers
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Tunisian cancer Plan 2006-2010 In collaboration with the Institut National Français du Cancer (INCa) Piloting comittee and sub-commissions : - Formation/Research - Epidemiology - Primary Prevention - Screening/Early Diagnosis - Management
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Recommendations
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International Resources Standards in Radiotherapy EQUIPMENT 1 device / 250 000 - 500 000 inhabitants. OMS/AIEA recommendations for developing countries : 1 device for 1 million inhabitants.
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International Resources Standards in Radiotherapy HUMAN RESOURCES 1 Radiation Oncologist / 300 - 400 annual treatments 1 Radiation Physicist / 350 - 500 annual treatments 2 therapy radiographers / each treatment device At least 1 therapy radiographer / simulator At least 1 dosimetrist.
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Moroccan equipment Requirement in Radiotherapy (cancer Plan 2010-2019) For each cancer center 2 LINACs with MLC 1 Simulation system (standard or CT) 1 TPS with network link HDR Brachytherapy
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Moroccan Human Resources Requirement in Radiotherapy (cancer Plan 2010-2019) For each cancer center At least 2 radiation oncologists, and above depending on the center activity: 1 radiation oncologist / 400 - 500 patients treated per year At least 2 Radiation Physicists, and above depending on the center activity: 1 radiation Physicist / 600 - 700 patients treated per year At least 12 radiation therapy radiographers At least 2 Brachytherapy radiographers At least 1 dosimetrist, and above depending on the center activity
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Conclusion Cooperation Governments - NGOs would allow: * Cancer prevention * Cancer treatment * Palliative care * Better quality of life
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