New York City, New York — The three main blood cancers: leukemia, lymphoma and myeloma, used to be considered “deadly” cancers. That is no longer the case in industrialized countries. These diseases — although not always curable — have progressed to be treatable diseases with mostly outpatient treatments. New treatments have developed so much that blood cancer survival rates have increased more than any other type of cancer during the past two decades. Developing countries are continually working toward increasing blood cancer resources and awareness. Although there are healthcare challenges to overcome, there is also much cause for hope and optimism.
Healthcare Challenges in Developing Countries
While cancer screenings are common in developed countries, early detection is one of the largest hurdles low-to-middle income countries face. The common signs of blood cancer can be vague, leading many to delay seeking a professional opinion. Early symptoms could include weakness, anemia, loss of appetite, body aches or swollen lymph nodes. Families with limited funds tend to seek medical attention for more immediate aid, such as mending broken bones.
Access to healthcare is not affordable for everyone, and hospitals can be inconveniently located. For instance, there are only two government hospitals in South Africa that offer bone marrow and stem cell transplants to patients without medical aid. The cancer mortality rate is higher in developing countries because so many never reach a treatment facility, or by the time they do, the disease has already reached an advanced stage. Some communities have myths, especially rural communities, that cancer patients are bewitched and contagious to healthy people. Additionally, a common misconception is that cancer only affects Caucasians. Fear of contracting COVID-19, which has overwhelmed government hospitals during the last year, can also delay diagnosis.
Recent Blood Cancer Treatment Progress
Thanks to medical innovation, survival for blood cancer patients has nearly tripled in the past 20-25 years. The addition of new classes of drugs, immunotherapy and cellular therapies have made tremendous positive impacts on patients’ lives. Fortunately, many of the drugs used to treat blood cancers have gone off-patent. This allows other manufacturers to introduce more affordable generic versions.
The Borgen Project spoke with Medical Oncologist Dr. Vineet Govinda Gupta, based in Delhi, India. Dr. Gupta specializes in administering treatments that offer “maximum benefit with minimum side-effects.” With newly diagnosed patients, he is “sure to emphasize the chronic nature of their disease and long-term survival as the norm.” Dr. Gupta believes blood cancers “will be curable diseases soon in the majority of patients.” The obstacle of drug cost is no longer as big of an issue. Brand new drugs are expensive, but thankfully there are options for every budget.
Improvements with blood cancer drugs have reduced the urgency and importance of bone marrow and stem cell transplants for blood cancer patients. Transplants are expensive, and government hospitals that offer them for those without medical aid or health insurance are few and far in between. Dr. Gupta commented that “the government has made efforts to improve this situation by subsidizing transplants or developing transplant facilities in publicly-funded hospitals. I expect better accessibility of transplants in our country soon.” However, despite all of the encouraging progress with new medicines, some patients reach the point where a bone marrow or stem cell transplant is the only chance for survival.
Bone Marrow and Stem Cell Transplants
The chance of being a match for a blood cancer patient is one in 100,000. People make bone marrow and stem cell donations entirely on a voluntary basis, just like donating blood. As such, there is a 30% chance that a match will be found from a first-degree relative. However, a vast majority of patients look to a bone marrow registry in hopes of finding a compatible match. The World Marrow Donor Association (WMDA) works internationally with donor organizations. Together, the organizations help match each blood cancer patient to a compatible donor. Collectively, the worldwide registry has almost 39 million registered donors. The South African Bone Marrow Registry (SABMR) is an accredited member of the World Marrow Donor Association and is one of the many organizations fighting to give blood cancer patients a second chance at survival.
In an interview with The Borgen Project, Jane Ward, the deputy director and head of donor services at SABMR, said, “Of the potentially 200 searches we get a year, I would say half of them get activated.” She described the biggest challenge SABMR faces as diversifying the donor registry. Patients are more likely to match with a donor from the same ethnic group. “On our database and around the world, you find more Caucasians on registries than you do people of color… we need more donors. Not just on the South African database, but worldwide.”
Eligible donors need to be 16-45 years old and otherwise healthy. This is an added challenge in South Africa as there are many young people who are infected with the human immunodeficiency virus (HIV) and tuberculosis (TB). Currently, there are 73,000 donors on the SABMR database, but the registry is losing donors faster than it is gaining them. South Africa’s Department of Health, pharmaceutical companies and NGOs need to collaborate to spread awareness and dispel all misinformation, so people grow to realize blood cancer is treatable. The key to progressing future success is developing initiatives to increase awareness, gain more donors and ultimately save more lives.
Education, Outreach and Mobilization
NGOs have limited budgets, and spreading awareness and educating low-income communities is a challenge. The concepts of early detection and warning signs of cancer are new and obscure. This is especially true in rural areas, where many do not finish school. The goal is to educate these communities, which will then mobilize and inform others. Educators must be culturally relatable and able to speak the language of the people they are trying to inform. The South African Bone Marrow Registry began an ambassador’s program that is constantly developing new ideas to recruit donors and diversify its donor registry. In more Black areas, the ambassadors will stop by schools where they speak the language and ask the principal if they can speak to the students. It requires a lot of legwork but minimal expense.
SABMR’s head of donor recruitment, Nadia Chalkley, explained to The Borgen Project the importance of awareness initiatives. “When we step into a rural area […] we first have to explain what bone marrow is and […] why they would have to give away some of their bones to somebody they don’t know,” said Chalkley. SABMR has a presence on most social media platforms to help spread awareness and is currently looking into using the video-sharing TikTok app. The app is very popular among younger people, regardless of race. Additionally, SABMR has recently released a children’s book, called “Rachel’s Second Chance,” to increase education on bone marrow transplants at a primary school level. The book is light-hearted and filled with hope. “We find that the race barriers are often better crossed when there’s a little bit of humor in it, something that everybody can relate to […] these are things we try and tap into,” said Chalkley.
A Hopeful Future
Every blood cancer patient that gets diagnosed early and has access to treatment is a victory. Affordable access to treatment and a stem cell or bone marrow transplant could give patients a second chance. If governments in developing countries continue to invest in health care options for blood cancer patients without medical aid, survival rates will only continue to improve. As treatment cost decreases and awareness increases, the hope continues that blood cancers will be curable for all one day.
– Sarah Ottosen