Cancer care in China: A general review
1 Department of Radiation Therapy, Qingdao Tumor Hospital, Qingdao, China
2 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha Nebraska, United States
This article is to provide a general overview of cancer in
China including the statistics, most common cancers, their epidemiological
characteristics and the treatments. � 2008 Biomedical Imaging and
Intervention Journal. All rights reserved.
Keywords: Cancer care, China
Cancer Statistics in China
The most recent epidemiological data has shown that over
2.2 million new cancer cases (1.4 million in men, 0.8 million in women) are
diagnosed in China each year and approximately 1.6 million of the cancers
result in mortality. Over the last 20 years, the cancer-related mortality rate
has risen by 30%, which constitutes 25-35% of all deaths. From 2000 to 2005
alone, the total number of new cases increased by 14.6% with the most common
sites being lung, liver and stomach in men, and breast, lung and stomach in
women primarily as a result of population growth and aging . In addition,
the rising rates of lung cancer incidence (in both sexes) and breast cancer
mean that there will be much greater increases in the number of cases at these
two sites (27% for lung cancer in men, 38% for lung and breast cancer in
women). Cancer has become the number one cause of death in China .
As of the end of 2006, there are 104.2 million people who
are 65 years or older, constituting 7.9% of the entire population in China. At present, China also has 20% of the world�s population older than 60 years old,
which has surpassed 150 million. China has become one of the aging countries,
with the fastest growth and the largest aging population in the world. This is
one of the major reasons for rising cancer incidence in China.
In urban populations, the leading causes of death are as
follows; cancer, cerebral vascular accidents, cardiovascular, pulmonary, injury
and poisoning, gastrointestinal, endocrinological and metabolical, urological,
and psychiatric disorders. Although over the last five decades the overall cancer
incidence has continued to climb, this trend is not observed in all types of
cancers. What used to be the most common cancers such as gastric, cervical,
penile, oesophageal and nasopharyngeal cancers have declined in various
degrees, whereas lung, breast, colon, and prostate cancer rates have increased
significantly (Table 1). This kind of shift in cancer rates is more evident in
more developed coastal cities, which likely is due to the changes in lifestyle
and diet (Table 2).
The top five most common malignancies in China are lung, liver, gastric, oesophageal and colorectal cancers. The mortality of lung
cancer has increased every year. For example, in Beijing, lung cancer death
constitutes one-quarter of all cancer-related mortalities. According to the Initiative
of Promoting Healthy Living in China (Cancer 2006), the mortality rate of lung
cancer in China may exceed one million by 2025.
The main reasons for such a high lung cancer mortality
rate in China are the following:
- Lack of awareness of lung cancer
- Lack of effective screening tools for early detection. Approximately 80%
of lung cancers in China are advanced stage disease at the diagnosis
- Lack of access to health care
- Lack of health insurance and resources
- Lack of scientifically sound comprehensive care. It is estimated that
about one-third of lung cancer patients may have died from inadequate or
inappropriate therapies in China.
The cause and aetiology for common cancers in China
- Tobacco use and inhalation of second hand smoke have clearly become the
main causes of lung cancer.
- Rapid growth of aging population
- Rapid industrialisation and westernisation of cities
- Rapid urbanisation of rural communities
- Worsening pollution, especially air and water pollution
- Unhealthy lifestyles
The risk factors of lung cancer in China:
Smoking: China is the largest producer of tobacco
products in the world; 2.5 times more than that of the United States, which is the second largest producer. China is also the largest consumer of
tobacco in the world. The smoker population in China is estimated to be over
350 million. As many as 540 million Chinese are exposed to second-hand smoke,
of which 180 million are under the age of 15 years, according to a national
tobacco control report released on May 29, 2007 by the Ministry of Health of China. Women and children are most vulnerable to second-hand smoke with the smoking rate
among men reaching 57%. Ninety percent of the women are exposed to second-hand
smoke at home. There has been no collective effort to curtail the use of
tobacco products. In 2005, cigarette sales generated US$32.5 billion in taxes
and profits in China, approximately 7.6% of the government's total revenue .
It is suggested that close to 90% of lung cancer mortality is due to cigarette
smoking or inhalation of second-hand smoke. The link is even stronger in
elderly smokers. The chance of dying from lung cancer in male smokers is eight-
to 20-fold that of non-smokers. The risk of lung cancer is directly
proportionate to the amount of cigarettes consumed. The incidence of lung
cancer is 75 in 10,000 people who smoke less than 14 cigarettes daily, but this
number increases dramatically to 227 in smokers who smoke more than 25
cigarettes a day. Similarly, the duration of cigarette use also proportionately
correlates with the risk of developing lung cancer. It is an extremely
difficult task to control the use of cigarettes and to prevent lung cancer in China. China has been hit the hardest by tobacco industries with more than one million
people dying annually of tobacco-related health problems. If this trend
continues, it is estimated that over two million people by 2030 and possibly
three million people by mid-century may die of tobacco-related illnesses. By
eliminating smoking, it is estimated that the total mortality could be reduced
by 10.0% among men and by 3.5% among women in China .
Air pollution: China is facing a serious
environmental crisis due to widespread pollution. Air pollution contributes to
the high incidence of respiratory ailments and lung cancers. The main sources
for air pollution in China are industrial exhaust and dust, automobile exhaust,
coal burning for energy, etc., which are present mostly in major cities [4, 5].
Environmental and occupational exposures: Occupational
exposure to asbestos, silicon, chromium, nickel and their by-products are known
to cause lung cancer. Workers who work at charcoal mills and in the mining
industries also have a higher risk of lung cancer due to chronic exposure to
the dust which contains silicon, arsenic and radon gas.
Liver Cancer-Hepatocellular Carcinoma (HCC)
The risk factors for liver cancer in China:
Hepatitis B viral (HBV) infection: Hepatitis B is
an endemic in China. A national survey in 2002 showed a 9% rate of hepatitis B
surface antigen (HbsAg) in the general population . Around 130 million
people in China are carriers of hepatitis B virus (HBV) (almost a third of the
people infected with HBV worldwide); 30 million people in China are chronically infected . Every year, 300,000 people die from HBV-related
diseases in China, including 180,000 patients with HCC . The incidence of
hepatitis B is still increasing from 21.9 in 100,000 people in 1990 to 53.3 in
100,000 in 2003 . That increase has occurred despite a vaccination program
for newborn babies since the 1990s. By 2006, China has successfully immunised
11.1 million children living in the country's poorest provinces against
hepatitis B according to the Chinese health ministry, and the Global Alliance for
Vaccines and Immunization (GAVI).
Cirrhosis: During a five-year period, 10�20% of
patients with chronic hepatitis developed cirrhosis, and 20�23% of the cases
with compensated cirrhosis progressed to decompensated cirrhosis. Six to 15% of
the people with cirrhosis and chronic hepatitis progressed to HCC. The
five-year survival for compensated cirrhosis is 55%, for decompensated
cirrhosis is 14%, and for HCC is less than 5%. Approximately 85% of liver
cancer patients also suffer from cirrhosis, typically nodular type. In recent
years, hepatitis C related cirrhosis has become as prevalent as that of
hepatitis B associated cirrhosis.
Afflatoxins: Afflatoxins B1 (AFB1) is a well-known
carcinogen for liver cancer. These toxins are made by fungus that contaminates
peanuts and corn. Once ingested, these toxins can cause liver cancer directly
or enhance the risk from hepatitis B infection.
Contamination of drinking water: A strong
association exists between the incidence of liver cancer and the consumption of
polluted water in rural areas of China.
Alcohol consumption: Excessive drinking of alcohol
remains a risk factor for HCC. Some studies have also shown an increased risk
of HCC in those that use alcohol and tobacco due to an additive effect.
Parasite infection: A parasitic worm, commonly
known as a fluke, infests rivers in rural parts of China. Flukes can stimulate
proliferation in the epithelium of the biliary duct during feeding and
migration, which in turn can induce cholangiobiliary carcinoma.
Genetic susceptibility and hereditary
Gastric cancer and its risk factors
Dietary: Unhealthy diets and food preparations can
introduce carcinogens for gastric cancer. The most well-known substances are
nitrates and nitric acid, nitrous acid, complex aromatic hydrocarbon and its
byproducts. These may contaminate the food or can be produced during processing
of the food, and has been shown to increase the risk for stomach cancer as
demonstrated in some regions in China where smoked fish and meat are frequently
consumed. There is some evidence to suggest a correlation of stomach cancer
with diets high in sodium. The deficiency in certain nutrients such as animal
proteins, vitamins and antioxidants may also play a role in the development of
Infections: Helicobacter pylori is a
well-known cause for certain stomach cancers.
Genetics: A positive family history also increases
the risk for gastric cancer.
Oesophageal cancer and its risk factors:
Chemicals and environmental factors, including N‑nitrites,
mould-infected foods, toxins produced by fungi, a deficiency in minerals,
infectious processes such as fungal and human papilloma virus (HPV), genetic
susceptibility and an unhealthy lifestyle including the use of tobacco and
alcohol all increase the risk for oesophageal cancer. The use of pesticides,
chemical fertilisers, and the consumption of contaminated water has been linked
to the development of oesophageal cancer.
Colorectal cancer and its common risk factors:
Dietary: There is a strong association between
colon cancer and nutritional, hereditary and environmental factors. The effect
of carcinogens and familial hyper-susceptibility can induce gene mutation
leading to cancer development. With the marked improvement of living standards
in China, the Chinese are no longer faced with starvation; instead they have an
abundance of choices for nutrition. There is a significant change in the diet
in China; high calories, high fat, high protein and less fibre now comprise the
typical Chinese diet. The unhealthy diet and more westernised lifestyle may
have contributed to the increase of colorectal cancer in China.
Genetics: Hereditary factor plays a very important
role in colorectal cancer. It is estimated that 5 to 20% of colon cancers may
be due to hereditary conditions such as hereditary non-polyposis colon cancer
(HNPCC), and familial adenomatous polyposis (FAP).
Certain gastrointestinal ailments can also increase the
risk for colon cancer such as ulcerative colitis, Crohn�s disease, and
adenomatous polyposis, all of which have increased in China.
The management of lung and breast cancers in China
The strategies in the prevention and treatment of lung cancer
- Prevention: The single most effective measure to reduce lung cancer in China is smoking cessation and the elimination of all tobacco products in China. This has proven to
be extremely difficult to accomplish due to various historical, cultural,
social and economic influences. A concerted effort has not been established by
the government to ban smoking.
- Early diagnosis and intervention: Early diagnosis and intervention can
improve the treatment outcome for lung cancer. Unfortunately, effective and
practical measures to screen for lung cancer in China are not available. (Or
invasive treatments such as video-assisted thoracoscopy and thoracotomy surgery
(VATS) and radiofrequency ablation (RFA) can be used in early stages or
multi-modality therapy with a combination of local and systemic therapy can
maximise the treatment outcome for more advanced stage lung cancers. Systemic
therapy includes chemotherapy, targeted therapy and rehabilitation.
health care policy: It is necessary to increase governmental funding for the
prevention, diagnosis and treatment of lung cancer. The main focus should be
curtailing the use of tobacco in China.
The practice guidelines of lung cancer
The main treatment modalities for lung cancer are surgery,
radiation therapy and chemotherapy. More recently bio-molecular targeted
therapy has been incorporated into the comprehensive strategies of lung cancer
management. In China, there are 58 Positron Emission Tomography-Computed
Tomography (PET-CT) scanners which have played an important role in improving lung
cancer staging and radiation treatment planning.
Surgery remains the main treatment modality for early
stage (I-IIb) non-small cell lung cancer (NSCLC). Over the last decade there
have been significant advancements in minimum invasive surgery in China. This reduces the risk of surgery in elderly patients and those with significant
co-morbidities such as chronic obstructive pulmonary disease (COPD). Adjuvant
radiation therapy and/or chemotherapy are used in selected patients. For
advanced stage NSCLC, chemotherapy or supportive care are the treatments of
choice (table 3).
Radiation therapy for NSCLC
Conventional radiation therapy
The treatment volumes cover the primary with a margin of
1.5 � 2cm and ipsilateral hilar and mediastinal lymph nodes. The standard
treatment has generally been 1.8 -2 Gy per fraction, one fraction per day, five
days per week, for a total dose of 40 Gy to 66 Gy. The initial volume is
treated to a dose of 40 Gy, and then the area of residual disease detected on a
repeat CT scan will be boosted to a total dose of 66 Gy.
Intensity modulated radiation therapy (IMRT)
The treatment volume is defined according to ICRU 50.
Gross target volume (GTV) is defined as the known volume of the primary tumour
and its regional nodal metastases clinically and radiologically. GTV will be
contoured on the lung window of the CT scan. Clinical target volume (CTV) is
defined as GTV plus 1cm margin to include surrounding subclinical disease and
the area at risk for microscopic involvement. The radiologists, radiation
oncologists and physicists work together to define the CTV. Planning target
volume (PTV) is CTV plus 1.5 cm. PTV is covered by 90% isodose line. Lung V20
≤ 20%. Dose to oesophagus ≤ 40 Gy and to heart ≤ 30 Gy.
Median dose is 64.8 Gy (60 Gy to 72 Gy), 1.8 � 2 Gy per fraction, one fraction
per day and 5 fractions per week.
Several new bio-molecular targeted therapy agents, such as
gefitinib, erlotinib and bevacizumab, have become available in China.
Small cell lung cancer (SCLC)
The treatment of small cell lung cancer mainly involves
chemotherapy. Table 4 shows the most common regimens that are used in China.
Management of Breast Cancer
Table 5 shows the chemotherapy regimens for breast cancer.
Post-mastectomy radiation therapy
The radiation target volume post-radical or modified
radical mastectomy includes chest wall and regional lymph nodes. The indication
of radiation and the identification of target volume are dictated by the stage
of the primary tumour and regional lymph nodes.
Chest wall: The upper border is the thoracic
entrance or to match the lower border of the supraclavicular field (half-beam
block). The lower border is 1-2 cm inferior to the breast tissue. The medial
border is placed just medial to the inner breast tissue or the midline of
sternum. The lateral border is the midline of axilla. The chest wall
post-modified radical mastectomy is irradiated using 4 -6 MV x-ray via standard
tangent fields with wedges and bolus. The chest wall post-radical mastectomy is
irradiated en-face using electrons. The energy of the electrons is selected
according to the thickness of the chest wall. Bolus is used to increase the
skin dose to ≥ 85%. The total dose will be 45 Gy to 50 Gy.
Supraclavicular lymphatic drainage: The upper
border extends laterally across the neck and the trapezius to the acromial
process. The lower border is at the first or second intercostal space. The
medial border is the midline of the sternum or 1 cm beyond. The lateral border
is the anterior line of axilla. The dose covers a depth of 3-4 cm. The mixed
beams of photons (60Co or 4‑6 MV x-ray) and electrons (12 MeV)
are used to deliver 45 � 50 Gy in conventional fractionation.
Internal mammary chain: The upper border is at the
medial head of clavicle or to match the lower border of the supraclavicular
field. The lower border is in the fourth intercostal space. For a primary
tumour located at the inner lower quadrant, the lower border is at the sixth
intercostal space. The medial border is the midline of sternum or 1 cm beyond.
The lateral border is 5 cm from the midline of sternum to the ipsilateral chest
wall. The dose covers a depth of 3-5 cm. Electrons with appropriate energy are
used to deliver 45 � 50 Gy in conventional fractionation.
Axillary lymphatic drainage: The upper border is at
the clavicle. The lower border is at the second intercostal space. The medial
border is 1-1.5 cm lateral to the chest wall. The lateral border is at the
posterior line of the axilla. The 4-6 MV x-ray is used to deliver 45 � 50 Gy in
Post-lumpectomy radiation therapy
Tangential fields and boost fields: The borders of the
tangential fields are usually defined as follows: medial border is midline of
the sternum (or 3 cm beyond midline to include the internal mammary chain); lateral
border is mid-axillary; inferior border is 1-2 cm below the breast; superior
border is the thoracic entrance or to match the inferior border of the
supraclavicular field. The total dose is 45-50 Gy at 1.8 -2 Gy per fraction, 5 fractions
Accelerated partial breast irradiation: There are many
ways to deliver partial breast irradiation either with brachytherapy including;
interstitial brachytherapy, intracavitary brachytherapy or an external beam
radiation therapy system such as a 3D Conformal radiotherapy or IMRT and
intraoperative radiotherapy (IORT).
Hormone therapy for breast cancer
Hormone therapy is commonly used for patients with breast
cancer that stain positive for oestrogen receptor (ER) and progestron receptors
(PR). Targeted therapy such as trastuzumab is used for Her2 receptor positive
Current Status of Radiation Oncology in China
Radiotherapy Equipment in China
There is a significant shortage in radiotherapy equipment
to meet the increasing needs in China. As of September 2006, there were 952
radiation therapy centers that were equipped with 918 linear accelerators, 472 60Co
machines, 146 ortho-voltage x-ray machines, 827 fluoroscoopy simulators, and
400 brachytherapy units including 21 252Cf neutron remote afterloading
brachytherapy units. There were 851 treatment planning systems and 467
ion-chambers . In comparison to the 1997 survey, there has been a 321%
increase in linear accelerators and 481% increase in treatment planning
systems. As of 2006, there were 214 CT simulators, 149 Gamma Knives (74 for
head only, 75 for both head and body), and 467 X-Knife machines. Despite the
significant growth in radiation oncology equipment, there is less than 1 (0.7)
accelerator per million people. Even considering both 60Co machines
and linear accelerators combined, there are only 1.06 machines per one million
population, which is short of meeting the minimum requirements of the World
Health Organization of two linear accelerators per million population. The
radiotherapy equipment is also unevenly distributed throughout the country. In
the major cities or provinces such as Beijing, Shanghai, and Shandong, there
are at least two machines per million people, whereas in more remote regions of
China such as deep inland and the western part of the country, there is
limited accessibility to radiotherapy equipment.
The majority of radiation centers in China are equipped and capable of performing basic three dimensional conformal radiotherapy
(3D-CRT) as reported by the 2006 survey . Among 952 registered radiation
centers in China, 579 centres (60%) were practising three-dimensional conformal
radiotherapy, but only 115 (12%) were delivering intensity-modulated
radiotherapy (IMRT). Approximately 8% of centres were capable of doing
stereotactic radiosurgery .
Radiation Oncologists and Radiation Physicists in China
There are 18,992 healthcare workers that are involved in
providing radiation therapy in China. Among them, 5,247 are radiation
oncologists (including 2,110 residents), 4,559 radiation therapists, 6,864
nurses, 1,181 medical physicists, and 1,141 are maintenance engineers. Clearly
there is a severe shortage in medical physicists.
Radiation Therapy Funding in China
In China, there is a significant lack of funding and
reimbursement to maintain costly radiotherapy equipment and meet the demands. A
national health insurance system in China has not been developed. The
reimbursement rates for cancer treatment are set by the local governments and
vary widely due to the differences in the financial situations of each
district. For example, in City of Qingdao the municipal healthcare agency
reimburses 80% for IMRT treatment. However, at the same time they also set a
fixed reimbursement rate of 250 Chinese yuan (equivalent to approximately $40)
for each IMRT beam, 80% of which will be reimbursed. The government will only
pay 70% of the radiation treatment planning cost. The rest of the expense has
to be paid by the patients. For 3D-CRT the local government has set the maximum
reimbursement rate of 1,100 yuan (equivalent to approximately $150). Therefore,
a significant portion of the expense will have to be paid by the patients or
they have to accept substandard or no treatment at all. The same situation also
applies to chemotherapy treatments. The government will pay the full amount of
money, but only for the basic drug regimen. However, the newer or more
expensive chemotherapy drugs (which may be more effective) will get little or
no reimbursement. Furthermore, 60% of the Chinese population have no medical
insurance or coverage at all. Unfortunately for those patients, they either
have to pay completely out-of-pocket (which very few can afford), or settle for
less service, which oftentimes results in inadequate healthcare. As most people
either have no healthcare insurance or have an insurance coverage with low
reimbursement rates, it is very difficult, if not impossible, for them to
receive comprehensive or long-term care. There is also a profound disparity of
healthcare within China. In eastern regions of China, especially large coastal
cities, medical care is more advanced and relatively accessible than that in
remote areas such as many western provinces.
Unique Cancer Therapy in China
China has a long history of using its traditional Chinese
medicine for various ailments, including malignancies. Clinical and
experimental research have shown that Chinese medicine may have positive
effects on cancer and cancer therapy. The potential benefits of traditional Chinese
medicine are believed to be as follows:
- Reducing the toxic side-effects of chemotherapy and radiation therapy.
- Improving human immune systems and its functions.
- Improving haematopoiesis in bone marrow.
- Improving endocrine function and body metabolism
- Re-establishing homeostasis to promote the human body�s recovery.
- Enhancing the treatment effects which may lead to a prolonged survival.
�Qigong (an ancient Chinese exercise system of deep
breathing) is also believed to improve a patient�s overall well-being by
adjusting each organ�s function. It further improves the patient�s immune
system and boosts one�s confidence. Qigong may also perk up a patient�s
emotional and psychological state of health leading to a better tolerance of
cancer therapy and a faster recovery.
Incorporating Chinese medicine into a comprehensive cancer
treatment program may enhance the overall treatment outcomes. In recent years,
the Chinese government has approved the use of some Chinese herbal remedies
that may improve the immune function of cancer patients and also may have
additive effects to conventional cancer therapy.
Chinese Herbal Medicine
Chinese herbal medicine has existed and been practised in
cancer therapy in China for ages. It is administered based on the underlying
physio-pathologic processes of the malignancies, including the type and stage
of the malignancy, the patients� overall state of health and nutritional
status. Chinese medicine remedies also take other treatment modalities into
consideration such as the side-effects from the treatment (e.g. chemotherapy or
radiation) and clinical symptoms. It is believed that Chinese herbal medicine
may lessen the patient�s clinical symptoms, decrease toxic side-effects from
conventional western approaches and result in favourable therapeutic ratios.
The use of Chinese herbal medicine is a very complicated process that contains
the art and science of medicine as well as human experiences, wisdom, and
knowledge that have been accumulated and passed on for generations in China.
The combination of conventional western medicine and traditional Chinese
medicine may be complementary to each other and may ultimately improve the
cancer care in China.
252Cf neutron remote afterloading brachytherapy
China has a relatively large number of remote afterloading
neutron brachytherapy units using Californium-252 (252Cf) nuclide
which is a source of gamma neutron radiation. 252Cf generated by
nuclear reactions produces fast neutrons which offer high-LET radiation and
potentially a more effective cell kill effect than photons. The indication and
technique of 252Cf are similar to those that are used with 192Ir
for treating intra-cavitary/intra-luminal or body surface tumours such as
oesophageal and cervical cancer. 252Cf is, at least theoretically,
equal to or more effective than photons generated by 192Ir. Because
of its high-LET radiation 252C may offer more favourable treatment
outcomes for tumours that have large hypoxic cell population or tumours that
did not respond to conventional photon radiation. For difficult or recurrent
tumours with hypoxic cells, 252Cf neutron therapy may also produce a
faster tumour response compared to that of photon beam.
Dendritic Cell Immunotherapy
China has a very active program in basic and clinical
research on dendritic cell immunotherapy. A new and more efficient way to
culture LAK cells was developed in China. This allowed a more efficient way to
produce LAK cells for possible clinical use. This new approach was used in a
clinical trial using cultured CD3AK cells in 1999. This therapy has the
following advantages: 1) it can be used for a wide range of malignancies, 2) it
has significant effects on both primary tumours and metastases, 3) it may be
more effective than conventional chemotherapy in adjuvant setting, and 4) the
side effects are mild (only low-grade fevers). Based on early clinical
evidence, this new modality appeared to be more efficacious when combined with
chemotherapy to treat advanced stage cancers. The tumour response rate has been
reported to be as high as 60%. It was the first time that the DC + CIK was
combined with chemotherapy to treat late stage lung cancer and combined with
neutron knife to treat colon cancer in clinical trials conducted in China.
Further research and larger clinical trials are being done in this area.
The Healthcare Policies
China is experiencing a rapid growth in the aging
population and cancer incidence. In the past, the government health agencies
were focused more on cancer treatment than its prevention. Recently the Chinese
government has started to attribute more attention towards cancer prevention
and cancer therapy rehabilitation. Fortunately, the basic needs for surgical
oncology equipment have been met and many radiation therapy facilities have
been developed in the last 20 years. More and more linear accelerators and
60Co machines have been installed nationwide. But it is far from
meeting the basic needs in China. Chemotherapy is also advancing and has
adopted the international standards in many parts of China. The concept and
practice of terminal care have also been introduced into more families,
healthcare institutions and social welfare organisations in today�s practice.
The government has also allowed more use of narcotics for pain control for
terminal cancer patients. As an example, the city of Qingdao was one of the
first cities in the nation to start an education centre for cancer patients
which is supported by the local government. The centre is open to the public.
It provides guidance and assistance on a wide range of issues in cancer care
and cancer therapy rehabilitation. The centre also provides telephone hotlines
for psychological counseling for cancer patients. Patient support groups meet
regularly to discuss the variety of issues that they are facing, including
cancer therapy, the coping process and rehabilitation. Oncologists are invited
to give lectures and advice to the participating groups.
The central government has realised that the cost of
cancer treatment is overwhelming and will continue to grow exponentially in the
foreseeable future. The best way to curtail the cost in cancer care is cancer
prevention. The current health insurance system provided by the local
government does not provide funding for preventive measures, which has been a
major obstacle to the implementation of preventive medicine. Since 2004, the
Chinese government has made efforts to increase funding for cancer prevention
and early detection which are important to reducing cancer-related deaths in
China. Multidisciplinary management has become the principle of cancer
treatment, and efforts to practise the standard of care have been implemented. However,
there remains a large number of Chinese people who do not have health insurance
or have coverage that is inadequate as the cost extends beyond their financial
ability to even afford the co-pay. Therefore, cancer patients are facing heavy
financial burdens which may prevent them from obtaining little, if any, cancer
therapy. These problems are much more profound in the rural areas of China.
The Future Challenges
Cancer care is a complicated process that requires an
enormous effort and resources from the government, healthcare workers and
cancer researchers. It is estimated that 80% of cancers are preventable;
therefore, it is essential to control environmental pollution and to advocate a
healthy lifestyle and diet. An increase in the awareness of cancer prevention
and early detection through educating the public has become paramount. It is
absolutely necessary for both the central and local governments to greatly
increase the funding for cancer care and to improve the distribution of the
resources throughout China.
Table 1 The Leading Sites of New Cancer Cases in China over the last 30 years.
Table 2 The percentage of change in annual mortality rates among urban and rural areas.
Table 3 Chemotherapy regimens for non-small cell lung cancer NSCLC.
Table 4 Most common treatments for small cell lung cancer (SCLC) used in China.
Table 5 Chemotherapy regimens for breast cancer.
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|Received 20 August 2008; accepted 21 August 2008
Correspondence: 987521 Nebraska Medical Center, Omaha, NE 68918-7521, United States. E-mail: email@example.com (W. Zhen).
Please cite as: Ma XJ, Lin C, Zhen W,
Cancer care in China: A general review, Biomed Imaging Interv J 2008; 4(3):e39