The presentation this morning which is around the theme of the conference – balancing healthcare needs in a changing context – was really trying to put into a broader global perspective for the audience this morning the issues that are pressing in a cancer environment. As healthcare professionals we tend to think about issues of balancing unmet healthcare needs for people purely from a cancer context but the purpose of the talk this morning was to raise points of discussion about where within a global perspective around unmet needs for health, whether that’s sanitation, clean water, poverty and equity, where do we place the conversation about meeting unmet needs in cancer in that domain and really structuring the talk around what will come over the next day and a half in the programme which is a series of really detailed papers that focus on many of the issues that I raised at a macro level this morning where people in their talks of the next day or two will really drill down into the detail.
What do you think the future holds?
An issue of change in terms of addressing unmet needs has been that there has been at no time in the history, certainly of cancer therapy, such rapid advances in technology, not just in some of these remarkable new genetics drugs that we’re seeing but in some of the large technology like the radiotherapy delivery machines. The issue is that although that brings fantastic opportunities and hope for many, many people who are diagnosed with cancer, there is the real challenge of recognising that what we see increasingly are the high income countries who have access to an ability to enable people to have these remarkable opportunities through new drugs, new technologies, whilst two-thirds of the population of cancer people, 85% of the people who live in the poorest parts of the world, have virtually no access or no resource to access what we take for granted. So it was about saying when we think about meeting unmet needs in today’s context the challenges have never been greater, the disparity between those who have and have not has never been greater. So it’s what is the responsibility and the voice of a global cancer nursing workforce to speak up about that inequity whilst supporting and enabling the incredible advances that we need but alongside a conversation of saying, ‘Let’s not forget about the two-thirds of the world who actually don’t have access to this stuff.’
How was your presentation received?
What was really interesting after the talk was the number of people who came forward and said, ‘These are the issues that we’re thinking about.’ We look after people with cancer but the questions we ask ourselves are, ‘I may have given this person state of the art therapy but they’re going back to an environment where they have no job, they’re struggling with health literacy to understand their disease and what they need to do to keep well, they may be smoking heavily, they may be drinking heavily as a way of coping, they may have family disruption, they may have lost their job because of the cancer diagnosis. So although it’s incredibly important that we make sure people get the right treatment, investing huge amounts of money into new drugs without taking account of the fact that unless we look at those social determinants of health we continue to curtail people’s opportunity to have the best outcomes possible for them.
Is there anything that patients or doctors should be aware of, going forward?
From a conversation this morning that was very much potentially quite overwhelming, the amount of enormity of need is enormous and when we look at data we can see that people, whether through their gender, through their race, through where they’re born, have huge disadvantage.
To think the opportunity for those of us at the top this morning was to ask the question, what is my role in this piece of the equation? How do I, in the individual interactions I have with people on a day to day basis, think about what might be important to this person? What do I need to understand about the person in front of me that may put them at disadvantage of having the best outcomes possible even before we start their cancer therap. What do we, as a profession, as a community need to help patients and family members understand about what is important for us to hear and giving them the advocacy and the legitimacy to say I’m really grateful for the treatment that you’re giving me but I’m what I’m really worried about is how do I pay the next bill or how do I support my child to go to school or how do I pay my mortgage? Because that is the stuff that we know from robust research that at the end of the day actually does have a difference on people’s prognostic outcomes. If they’re living with anxiety and depression and emotional distress they will not have the outcomes that we would hope for them.
