Multidisciplinary consideration of cancer therapy in Latin America

A multidisciplinary approach to cancer control, diagnosis, pretreatment evaluation and particularly treatment requires cooperation among surgeons, internists, chemotherapists and radiotherapists. The best sequence of radiotherapy and chemotherapy in patients who need both treatments is essential to avoid interference between treatments or potentiation of the adverse toxic effects. Several features may interfere in the detection and delivery of the best treatment combination in patients with cancer in Latin American countries, compared to patients in more developed countries: (1) There are differences among countries in the percentages for certain cancer sites and stages of disease. (2) Most of the cancer incidence figures are originated in hospital-based registries and not population-based registries. (3) On many occasions the modality of treatment of an individual patient depends on which doctor the patient sees first--the physician, the surgeon, or the radiotherapist. (4) In many radiotherapy services the treatment capacity is outweighed by the great amount of cancer patients, and radiotherapy is used primarily for curative purposes. (5) A higher percentage of patients arrive with advanced incurable disease because of lack of the awareness of the significance of early signs and symptoms on the part of patients, relatives and even doctors. (6) Another frequent problem is the lack of communication, transportation and accommodations near the treatment center. Many patients come from long distances; these factors make adequate follow-up of patients difficult. (7) There is a lack of radiotherapy services and there are numerous non-functioning units due to break-downs. A collaborative cancer treatment research program was initiated in 1977 between Latin American cancer centers and U.S. centers. This program is coordinated by the Pan American Health Organization and U.S. National Cancer Institute. Most of the protocols include multiple modality treatment (surgery, radiotherapy, chemotherapy and immunotherapy). This program has shown that, good control clinical trials can be performed in multiple cancer centers in Latin America in spite of the problems mentioned above.