Personalized Medicine in Oncology in the Developing World: Barriers and Concepts to Improve Status Quo

Abstract

Personalized medicine (PM) has revolutionized oncology management in high human development indexed countries. By interrogating both disease and host factors through a variety of tools, oncologists have been able to better target an individual's cancer, leading to improved outcomes. But both the tools used to define these variables, such as next generation sequencing, large immunohistochemical and fluorescence in situ hybridization (FISH) panels, and the weapons employed against each target are extremely expensive. The expenses have to be measured as not only the direct cost to the patient but also the cost to the system to develop and deploy the necessary infrastructure to optimally use them. However, the concepts of predictive, timely prevention and PM have demonstrated improvement in patient's satisfaction and cost effectiveness. In this paper we will summarize the relevant barriers and challenges that limit the implementation of PM in the developing world with an emphasis on the challenges in Nigeria and Nepal.

Fighting Cancer around the World: A Framework for Action

“…Poor health in these countries is mainly due to inadequate prevention and lack of prudent access to basic health care. Moreover, since pooling of risk and insurance is not in place, it has led to health-related impoverishment [ 14 ]. Higher rates of cancer incidence significantly influence the health and finances of individuals and states.…”

“…There is a partially implemented health insurance policy that has several limitations, is not available to everyone, and also lacks funding. All of this leads to delays in presentation, diagnosis and treatment [ 14 ] ( Table 2 ).…”

“…The principal causes of poor health in poorer countries are inadequate prevention and lack of reasonable access to basic health care, together with health-related impoverishment resulting from a lack of risk pooling and insurance [ 63 , 64 , 65 , 66 ]. The health and finances of individuals and states are highly influenced by the increasing prevalence of cancer [ 14 ]. In Zimbabwe, 80% of cervical cancer patients present with advanced disease [ 67 ], and in Tanzania, more than 90% of breast cancer patients were diagnosed at stage III and above [ 68 ].…”

“…Upstream, the care itself is heavily dependent on the availability and quality of the supportive infrastructure, ranging from diagnostic and testing centers and the necessarily associated laboratories, to treatment centers with links to data and tissue banks–and even on consistent electricity supplies to power them, as essential to permit the reality of practicing advanced genetic testing. PM in oncology is not widely practiced even where it is a focus in large cancer centers and those who fund research, because of the cost associated with genomic sequencing and the use of companion diagnostic devices, along with the absence of advanced genetic testing facilities [ 14 , 15 ].…”

The Dimensions of Reports From Around the World That Address Diversity in Oncology

“…Padala et al from the United States reviewed the epidemiology of renal cell carcinoma around the world [ 7 ]. Adeniji et al from Nigeria collaborated with colleagues from Nepal and the United States and reviewed the barriers and how to improve personalized medicine in oncology in the developing world [ 8 ]. Dulal et al from Nepal reported the feasibility of fewer fraction palliative radiotherapy in a resource-limited setting [ 9 ].…”