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Cancer Control Opportunities in Low- and Middle-Income Countries
cancer focus that encourages the broad objectives of cancer control and that provides exemplary patient care, appropriate to the local circumstances. This is not to suggest that a single model applies everywhere or that, as in high-income countries, a goal should not be to expand treatment to the local level, within the health care system more generally. Here, too, the notion of “resource-level appropriateness” applies. A center of excellence in Timbuktu need not look like one in Buenos Aires, Paris, or New York.
DEFINITION OF A CANCER CENTER
The term “cancer center” has no fixed definition. The United States has a well-developed network of cancer centers with official designation from the National Cancer Institute (NCI), however, and some of the language used to describe them is useful in discussing the goals and functions of cancer centers envisioned in this report for LMCs. The specifics of LMC cancer centers might differ, but the underlying goals are similar.
The NCI-designated cancer centers are the centerpiece of the U.S. effort to reduce morbidity and mortality from cancer. This includes not only providing state-of-the-art treatment, but research for the production of new knowledge about the basic nature of cancer, and about new and more effective approaches to prevention, diagnosis, and therapy. NCI describes officially recognized cancer centers as follows:
The cancer centers are … the principal deliverers of medical advances to patients and their families and the chief educators of health care professionals and the public. An excellent cancer center is a local, regional, and national resource, having an impact that goes well beyond its own walls into the communities it serves directly and, by the generalizable knowledge it creates, into the world at large…. It is expected, for example, that centers will give greater emphasis to the particular challenges presented by special populations. The disproportionate burden of cancer in minority and other underserved groups is poorly understood and badly in need of attention from the research community…. Cancer centers … are expected to inform the public about their ongoing activities in these areas through public outreach and education (National Cancer Institute, 2006a).
Cancer centers are actual, physical places, although they may differ in how they are organized. In the United States and other countries, many cancer centers are single institutions (one building or one campus) that specialize, first and foremost, in the diagnosis and treatment of cancer. In other cases, the cancer center may be a cancer unit within a larger hospital, such as a university medical hospital that treats the full range of health conditions. In still other cases, the cancer “center” is actually a consortium of hospitals or institutions that cooperate in an integrated cancer program.