Currently over half of the world’s population lives in cities, with 95% of urban expansion in the next decades anticipated to take place in developing countries. As people continue to move to urban environments the world over, this brings an additional challenge of sustainable healthcare infrastructure and planning to national and local governments. 

Cancer, for example, is the second leading cause of death worldwide, with 70% of mortalities occurring in Low-and Middle-Income Countries (LMIC). Health systems are struggling to respond to a rising cancer burden, with an urgent need for timely diagnosis, standardisation of care, improved data systems, health financing and a specialised workforce.

Roche has taken a lead role in an exciting partnership with(C/Can) to support cities across the globe in their efforts to improve equitable access to quality cancer care.

Since its launch in 2017 by the Union for International Cancer Control (UICC), C/Can has developed a new model of addressing access to cancer care that, for the first time, leverages the city as a key enabler in a health system’s response to cancer. The approach is built on the core principle that cities can drive impact at national level by crafting data-driven solutions with the support of a network of global, regional, and local partners that reflect an understanding of the unique local context. C/Can is currently active inaround the world.

Roche is working with C/Can, along with partners from the private sector including additional healthcare companies and others, to bring an end-to-end, multi-sector health system solution for cancer care at the city level. C/Can engages with cities with populations of over 1 million in LMICs and aims to address the complex array of issues that can hinder access to quality cancer diagnosis, treatment and care. Its mission is to create a global community of cities and partners working together to design, plan and implement cancer solutions to save lives.

For example:

Roche is supporting C/Can to work with Rwanda’s Biomedical Centre in Kigali in setting up a patient navigation programme to improve cancer care for women in Rwanda. Theprovides integrated multi-disciplinary care for breast and cervical cancers via an open, secure and inclusive digital platform. The project allows specialists from hospitals in the country’s three main cities to share information to ensure systematic multidisciplinary clinical decision-making. 

The participating clinics will now be able to coordinate the best treatment plan across multidisciplinary teams including oncologists, surgeons, radiation oncologists and pharmacists. Each team will have a designated nurse navigator to follow-up on all the stages cancer patients go through, including screening, data entry, treatment, discussion of available health insurance and advocacy. The project is expected to optimise the use of existing healthcare resources, support teleoncology for remote service delivery and be replicated in other C/Can cities so that many more patients can access quality care. 

Five treatment hospitals in Rwanda are involved in the programme, with patient navigation now a national priority for the country. In all, more than 1,354 cancer patients have benefited from the improved patient navigation program as of June 2023. The impact of the programme was an accelerated treatment initiation pace, with 92% of patients touched by the programme initiating treatment in less than 60 days, compared to the baseline of 66%. This solution has proven to be a cost-effective intervention and it is hoped it will improve patient outcomes, improve adherence and reduce cancer-related morbidity and mortality.

Roche has also collaborated with C/Can to support its network of local, regional and global partners and experts in Asuncion, Paraguay. Together with C/Can, theon a process to identify, design and develop sustainable cancer care solutions that respond to local needs by bringing together a multidisciplinary and multi-sectoral team including scientific societies and institutions that provide cancer care. Most recently, Paraguay’s Ministry of Public Health and Welfare approved the creation of multidisciplinary (MDT) Tumour Committees & Guidelines for Diagnosis and Treatment of Breast and Cervical Cancer. In addition, the Ministry has sanctioned the mandatory evaluation of cancer cases in a multidisciplinary manner, obliging the heads of hospitals and institutions that provide services or treatment to cancer patients to set up treat patients according to the MDT guidelines.

Cali was the first city to join C/Can, in May 2017, and Roche has supported the City Engagement Process in the city since the beginning. Some of the achievements locally were:

  • the development and endorsement of care guidelines for leukemia and breast, cervical, prostate and pediatric cancers; 

  • standardization of pathology lab procedures; 

  • palliative care training for health workers;

  • strengthening planning and capacity development for health workers, 

  • a radiotherapy development and quality assurance plan. 

All projects have now transitioned to a local independent, non-profit organization, Pro Pacifico, that is coordinating the implementation, scale-up, monitoring and evaluation of these efforts. Roche continues to support the cancer control work in Cali, focusing on breast and cervical cancer control and supporting a scale-up of HPV diagnostics for cervical cancer prevention.

Since C/Can began working with the government, the private sector and other stakeholders in the Georgian capital in 2019, the number of patients treated for cancer has doubled. This has come about due to a range of interventions, including the expansion of Universal Health Coverage. The Roche team in Tbilisi was proud to support C/Can’s initial engagement process in the city with public and private sector stakeholders, and through the development and execution of programmes and solutions to address priority needs. 

In October 2023 Roche was the first signatory to Georgia’s Universal Health Programme for Oncology, an agreement which will ensure all citizens - regardless of income or insurance status - receive the full suite of oncology interventions for their specific needs. 

In addition, following the Ministry of Health’s decision to include cancer diagnostics in the Universal Health program, C/Can is currently working with all relevant stakeholders to enable this huge step forward to ensure patients can be properly diagnosed in a timely manner.

Today, more and more cities are supported in their efforts to close the cancer care gap. In addition to Kigali, Asuncion, Cali and Tbilisi, C/Can has programmes in the cities of Kumasi (Ghana), Abuja (Nigeria), Phnom Penh (Cambodia), Rosario (Argentina), Yangon (Myanmar), Porto Alegre (Brazil), Greater Petaling (Malaysia), Leon (Mexico), Arequipa (Peru) and Nairobi (Kenya); together these have already reached 66 million people. 

In the coming years, C/Can will continue to grow as it pursues its mission of supporting cities around the world as they work to improve access to equitable, quality cancer care. Another six cities are expected to join the initiative over the next two years with an estimated reach of 100 million people.

Find out more at

References

  1. 95% of urban expansion in the next decades will take place in developing countries -

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