Reactivity of human lymphocytes against autochthonous and allogeneic normal and tumor cells in vitro.

Human peripheral lymphocytes from tumor-bearing and non-tumor-bearing patients were added to monolayer cultures of autochthonous and allogeneic normal or neoplastic cells in vitro with or without phytohemagglutinin (PHA). The normal cells were derived from skin, the tumor cells from postnasal carcinomas or sarcomas. The cultures were scored for clearly visible plaques in the monolayer. Without PHA, lymphocytes affected autochthonous skin target cells in 1 of 16 cultures. If PHA was added,the figure increased to nearly 50%(12/28). Whether this phenomenon is related to an autoimmune reaction or to some less specific effect of the PHA stimulus is unknown at present. In the absence of PHA, lymphocytes from African tumor-bearing hosts destroyed allogeneic skin fibroblasts in 4 of 14 cases, and lymphocytes from non-tumor-bearing Swedish donors showed this effect in 14 of 24 tests. The somewhat lower reactivity of the African lymphocytes was also apparent in other tests. It cannot be stated whether the difference was due to the tumor-bearing condition of the hosts or to some other differences involved in comparison of the two groups. Without PHA, lymphocytes of the African tumor patients destroyed their own autochthonous tumor cultures in 4 of 16 cases. Addition of PHA increased the proportion of positives to 20 of 28. A comparison with the corresponding figures for autochthonous skin cultures (1/16 and 12/28, respectively) indicates a relatively higher reactivity against the autochthonous tumor cells, both with and without PHA. This cannot be interpreted as a difference in target cell sensitivity to the same lymphocyte action, because no such difference was apparent when the sensitivity of skin and tumor to allogeneic lymphocytes was compared in the absence of PHA (4/14 and 4/14 with African lymphocyte donors; 14/24 and 14/24 with Swedish lymphocyte donors, respectively). The most probable explanation is that the antigenic barrier responsible for the lymphocyte effect is larger for tumor than for skin, or that the results reflect a presensitization of the tumor donor against its autochthonous neoplastic cells.

National training of radiotherapists in Sri Lanka and Zimbabwe: priorities and strategies for cancer control in developing countries.

The development of therapy resources should not be done in isolation of other cancer control activities. The right priorities and strategies must be determined in a systematic way, preferably through well-conceived national cancer control programs. If this is not done, it is unlikely that the therapy efforts will have any impact on cancer in the developing countries, as most cancers are incurable when seen for therapy. Therapy efforts must be linked with the search for earlier referral and diagnosis of cancer patients. However even limited resources may have an effect on controlling cancer, provided that the right priorities and strategies are followed. National and regional training facilities with a suitably adapted syllabus in radiotherapy and oncology must be a part of these priorities and strategies. The World Health Organization (WHO) has initiated, in close collaboration with the National Governments, national and regional training courses in radiotherapy and oncology in Sri Lanka and Zimbabwe.

Supporting cancer care in the developing countries: role of IAEA/WHO.

Cancer management can be expensive and constitutes a major problem in many developing countries where management standards are poor due to many factors, including non-availability of sufficient funds, equipment, and trained personnel. The incidence of cancer is rising worldwide. This is more so in the developing countries, many of whom are less equipped to deal with the problems. Radiation therapy is one of the major treatment modalities for cancer, and it is estimated that about 60% of all cancer patients require this treatment at one time or another during the course of their disease. Unfortunately, radiotherapy facilities are lacking or grossly inadequate in many developing countries. Over the past 8 years the IAEA and WHO have shown more interest in the problem and treatment of cancer in the developing countries. This paper reviews the role of these international organizations, with emphasis on research activities, education (seminars, workshops, training courses), and technical assistance programs. These include establishment or upgrading of radiotherapy facilities, provision of experts, etc. Scientific papers are published with a view to disseminating current information and research findings in the developing countries. The achievements up to date are assessed and discussed.

An overview of the situation in radiotherapy with emphasis on the developing countries.

Radiotherapy services are closely linked to the level of medical care which, in turn, is an important component of the overall health care program, with its development related to social, economic, and educational factors. As a basis for understanding the situation regarding adequate coverage of the population by radiotherapy services, general information about the world population (currently 5 billion), age distribution, frequency of cancer occurrence, and causes of death is presented. For an appreciation of the obstacles that must be overcome, the situation with regard to Gross National Product (GNP), transfer of economic resources, and per capita expenditures for health services is shown. For example, in the developing world, most countries spend less than 5% of their GNP for health, and on a macro scale at least 20 billion U.S. dollars per year are being transferred from the poor nations of the southern hemisphere to the northern hemisphere. Information about the wide range of population coverage with radiotherapy resources and the trend regarding high-energy radiotherapy machines is presented. For example, in North America (USA) there are six high-energy machines for each one million persons, and each machine is used to treat about 230 new patients per year. In other parts of the world, such as large areas of Africa and South-East Asia, there may only be one high-energy radiotherapy machine for 20 to 40 million people, and one machine may be used to treat more than 600 new patients per year. Many cancer patients have no access to radiotherapy services. When estimates of the need for radiotherapy services in the developing world as a consequence of cancer incidence are compared with the current health expenditures, it is concluded that a combined effort of national authorities, donor and financial institutions, professional and scientific societies, and international organizations is required. The knowledge, skills, and technology are available in many excellent radiotherapy centers throughout the world. The key issues are priority and the commitment of sufficient resources.

Opioid availability in Latin America: the declaration of Florianopolis.

Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.

Catalonia WHO Demonstration Project on Palliative Care Implementation 1990-1995: results in 1995.

A global, comprehensive, publicly planned and financed program to implement palliative care was designed by the Department of Health of Catalonia (6 million inhabitants. Planned in collaboration with the cancer unit of the WHO in 1989, the program was implemented in 1990-1995. It included specific services, measures general resources, education and training, organizational and educational standards, opioid availability, legislation and evaluation. The aims included coverage for cancer, AIDS, geriatric and other conditions, equity, quality, reference, and satisfaction for patients, families, and professionals. The results in 1995 include the implementation of 18 hospital support teams and 19 Units, with a total of 350 beds, 42 home-care teams. The coverage for cancer and AIDS is around 40%, and 44/55 (80%) districts have a specific team. Palliative care implementation has been completely publicly financed, with a total yearly investment of 2,200 million ptas. Eighty percent of this has been saved through radical changes in costs and the pattern of the use of resources. Palliative care implementation has demonstrated efficacy in the care of the patients and families, efficiency in the provision of care, and cost-benefit in the regional global approach. It adds qualitative and organizational values to the health-care system. Its implementation must be prioritized and planned by the health administration, not only to improve the quality of care for advanced and terminal patients, but also to improve the global efficiency and appropriate use of resources in the public health system.

Compliance following referral in the early detection of oral cancer and precancer in Sri Lanka.

An innovative approach for the early detection of oral cancer and precancer within the context of the primary health care system has been field tested in Sri Lanka. The overall compliance in accepting this particular PHC approach for cancer screening, as estimated by arrival at a referral centre manned by consultant staff, was 54.1%. Nearly 80% of those who turned up without needing an additional reminder, did so within the first 2 weeks of case finding. There was a variation in the degree of compliance depending on the primary health care worker who did the screening and referral. Compliance was greater when the screening area was nearer to the referral centre and in subjects who were diagnosed as having a more advanced stage of the disease. Certain practical considerations that contributed to noncompliance were identified. Postal reminders were seen to increase overall compliance by 10.9%.