By Venessa Anthony
There is a significant disparity in global cancer care and outcomes between countries, and since Sri Lanka is still a developing country with a diverse healthcare structure with no dedicated haemato-oncology/clinical haematology centres and transplant facilities or access to novel anticancer agents, treating certain diseases proves to be a challenge.
Considering progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries like ours, a large group of Sri Lankan doctors came together to conduct a clinical research study on the response and survival estimates of patients with plasma cell myeloma in a resource-constrained setting using protocols from high-income countries.
The research report was headed by Haemato-oncologist Dr. Saman Hewamana and Prof. J. Balawardena, and was a retrospective cohort study of all patients diagnosed with PCM between 1 May 2013 and 30 September 2021 at the first haemato-oncology centre in Sri Lanka.
Last week, Blood Cancer Care Sri Lanka held an event to discuss the clinical research. Speaking at the event was Dr. Hewamana, who explained that the aim of this report is to provide data on clinicopathologic characteristics, response, and survival estimates. Giving the audience some insight into what plasma cell myeloma (PCM) is, he informed us that it is a common type of blood cancer, noting that they decided to choose PCM at the focal point of the study as the incidence of PCM has increased over time, but the death rate has fallen because of the development of new treatment modalities and protocols. However, he noted that the availability of agents and applicability of protocols in low- and middle-income countries like Sri Lanka are debatable.
Dr. Hewamana highlighted that as per his knowledge, this report is the only well-characterised study on long-term survival of patients with myeloma in Sri Lanka, and the only of its kind that actually shows data on the response and long-term survival of patients with myeloma who are treated with common treatment protocols that are used in most high-income countries.
He also noted that curing most blood cancers is challenging in low-income countries, especially in a country without free and easy access to the specialty of blood cancer care, transplant facilities, or newer treatment options.
“Studies from low-income countries comparing clinicopathologic features and survival parameters with data from high-income countries have shown early-onset and late-stage presentation with reduced survival,” he explained, adding that there is a paucity of trained clinical haematologists, haematopathologists, proper patient referral system, facilities for immunohistochemistry, and centralised review processes in low- and middle-income countries.
So in order for Sri Lanka to afford effective medication for every patient and to understand the underlying etiological factors for the heterogeneity of PCM incidence, the research and stats shown by the report has helped acquire accurate and up-to-date cancer incidence data, he further noted.
This report was also published in the prestigious Journal of Clinical Oncology by the American Society of Clinical Oncology after its acceptance on 30 March.
According to Dr. Manama, the research on the report shows the successful application of treatment and supportive care protocols from high-income countries in the setting of limited resources.
“The published data will aid in benchmarking, and therefore, eventually beginning to improve the treatment which will make room for the much needed development of blood cancer care in the local setting,” he stated. With this study, Dr. Manama concluded that the doctors involved have successfully shown that it is indeed possible to apply Western treatment and supportive care protocols to the local population without a hitch.
