An economic template for cancer treatment guidelines

Uses affirms feasibility of the Breast Health Global Initiative's approach in the resource-diverse nations of Asia

November 9, 2009 • By Dean Forbes

Dr. Ben Anderson with Leslie Sullivan — Dr. Ben Anderson, founder, chair and director of the Breast Health Global Initiative, is pictured with Leslie Sullivan, BHGI program manager. Photo by Dean Forbes

When the prestigious British medical journal The Lancet Oncology published six cancer treatment guideline papers aimed at the resource-diverse nations of Asia this month, it used as its model the economic template developed by the Public Health Sciences Division’s Breast Health Global Initiative. The use endorsed the BHGI’s unique resource-stratification approach to cancer treatment guidelines for low- and moderate-income countries as a viable model.

“Asia represents a tremendous clinical challenge: Cancer incidence is increasing rapidly; lifestyles are becoming more westernized causing changes in disease etiology; and resources for infrastructure and disease management vary widely from country to country,” wrote The Lancet Oncology editors in their introduction to the papers. “For any clinical guidance to be universally applicable these differences need to be taken into account. The Breast Health Global Initiative provides an excellent economic template on how to achieve this goal.”

Founded in 2002, the BHGI strives to develop evidence-based, economically feasible and culturally appropriate guidelines for underdeveloped nations to improve breast-health outcomes. BHGI is co-sponsored by the Hutchinson Center and the Susan G. Komen for the Cure, and Dr. Ben Anderson of PHS serves as its founder, chair and director.

“The BHGI guidelines are intended to assist ministers of health, policymakers, administrators and institutions in prioritizing resource allocation as breast cancer treatment programs are implemented and developed in their resource-constrained countries,” said Anderson, who is also director of the Seattle Cancer Care Alliance’s Breast Health Clinic and professor of surgery and global health medicine at the University of Washington. He said the guidelines are defined by levels of resources and offer evidence-based pathways for coordinated, step-by-step quality improvements with a tiered system of resource allotment based on each resource’s potential to improve clinical outcomes.

The Lancet Oncology papers published this month cover management of a variety of malignancies, based on consensus statements from the 2009 Asian Oncology Summit held last April for cancers including: