Gynecological cancers in developing countries: the challenge of chemotherapy in low-resources setting

Abstract

The epidemiologic pattern of cancers in developing countries differs in many aspects from that of industrialized nations. Cancer natural history, microbiologic environment, patient's immune system, and drug availability may differ as well. Four of five new cases of cervical cancer and most of cervical cancer deaths occur in developing countries. Where chemoradiation and supportive care facilities are unavailable, it would be logical to consider an inexpensive effective drug. In locally advanced cases, neoadjuvant chemotherapy followed by surgery should be considered the treatment of choice. For ovarian cancer, it may be reasonable to maintain a secure supply of platinum and/or taxanes. For endometrial cancer, platinum compounds are proved active chemotherapic single agents. Oral medroxyprogesterone acetate (MPA) may represent a good chance for treating an advanced or recurrent disease. For vulvar/vaginal cancer, the role of chemotherapy alone is currently considered limited, and it is mostly used as palliative treatment in advanced or recurrent cases. Whenever possible, standard western chemotherapic regimens should be applied in developing countries as well. When standard therapies are unavailable, drugs of choice should be easily accessible, inexpensive, and effective. The most commonly used drugs are cisplatin, cyclophosphamide, and MPA.

Difference in the Incidences of the Most Prevalent Urologic Cancers from 2003 to 2009 in Iran

“…The epidemiological pattern of cancers incidence in developing countries differ in many aspects from that of industrialized nations (Basile et al, 2006). Therefore, it is essential to understand the epidemiological feature of these cancers.…”

Weekly gemcitabine and cisplatin concurrent with pelvic irradiation for primary therapy of cervical cancer: report of the first seven cases in Thai women

“…1 The National Cancer Institute (NCI) of the United States announced this new standard in February 1999. 2 The risk of death can be decreased by 36% when compared to either irradiation alone or to irradiation concurrent with non-platinum-containing chemotherapy.…”

Ovarian cancer survival population differences: a "high resolution study" comparing Philippine residents, and Filipino-Americans and Caucasians living in the US

“…The number of residual sites also appears to be important [41]. Current chemotherapy protocols are based on the experience of developed countries and its effectiveness do not necessarily translate in developing country settings, given the differences in resources and attitudes [42]. The availability and affordability of drugs differ between the developed and developing world, and complex chemotherapy regimens might not be feasible or affordable in low income nations [42].…”

“…Current chemotherapy protocols are based on the experience of developed countries and its effectiveness do not necessarily translate in developing country settings, given the differences in resources and attitudes [42]. The availability and affordability of drugs differ between the developed and developing world, and complex chemotherapy regimens might not be feasible or affordable in low income nations [42]. Furthermore, patients might not complete prescribed regimens due to financial constraints [42], as most chemotherapy drugs are paid for privately in developing countries [43].…”

“…The availability and affordability of drugs differ between the developed and developing world, and complex chemotherapy regimens might not be feasible or affordable in low income nations [42]. Furthermore, patients might not complete prescribed regimens due to financial constraints [42], as most chemotherapy drugs are paid for privately in developing countries [43]. …”