ASCO recently collaborated with the Middle East Cancer Consortium (MECC) to provide a 3-day International Palliative Care Workshop in Kazakhstan for health-care professionals, advocates, and volunteers in the former capital of Almaty. Dilyara Kaidarova, MD, PhD, Director of the Almaty Oncology Centre, hosted the workshop, along with several ASCO members from the United States.
“Palliative care is still not adequately addressed in Kazakhstan and remains an underdeveloped aspect of health care,” Dr. Kaidarova said. “Two years ago, domestic and international nongovernmental organizations helped to develop the country’s national standards for palliative care, and the Ministry of Healthcare and Social Development approved the document. It is an important milestone, but in order to provide efficient palliative care, we need qualified physicians, nurses, social workers, and psychologists. In this respect, we rely on reputable international organizations such as ASCO and MECC to share their knowledge and expertise.”
Michael Silbermann, DMD, PhD, Executive Director of MECC, described the benefits and challenges of holding a workshop in Almaty. The city is Kazakhstan’s largest population center near the Kyrgyzstan border and is approximately 200 miles from the Chinese border. He emphasized the importance of MECC’s policy of respect for the different cultures and traditions of people attending workshops in the Middle East and Central Asia yet noted that there were both professional and intellectual challenges in developing the courses and workshop.
For example, because most Kazakhstanis only speak Russian or Kazakh, materials were translated from English into those languages. A translator was also present to help facilitate lectures and discussion. The workshop facilitators also found it necessary to learn more about the attendees—largely doctors, nurses, and social workers from the surrounding area—and their way of life. Dr. Silbermann emphasized that the point of the workshop was not “to tell them how to do things” with regard to the advanced cancer care paradigm used by the United States. Rather, the purpose was to provide attendees with different models for practicing cancer care and give them the tools to decide which would work best for them.
The Current State of Cancer Care in Kazakhstan
According to Dr. Silbermann, community-based medical education in the Middle East and Central Asia is “initiated mainly through goodwill on behalf of many people and governments.” Among others, he and Dr. Kaidarova have collaborated on the book Cancer Care in Countries and Societies in Transition, which was published this year. Dr. Kaidarova wrote the chapter on Kazakhstan, in which she cites “insufficient use of modern clinical guidelines/protocols on the prevention, diagnosis, treatment, and rehabilitation” of patients with cancer as one of the top challenges to delivering effective cancer care in the country.1
According to Dr. Kaidarova, brachytherapy, the implementation of which could save about 1,500 lives a year in Kazakhstan, is at the initial stage of development. There is only one positron-emission tomography (PET) imaging unit in the entire country, located in the capital city of Astana. Kazakhstan has implemented a national cancer screening program; however, a lack of resources and training for technologically advanced therapies and testing (eg, proton therapy, intraoperative radiation therapy, etc.) prevents oncologists from being able to intervene with radical treatments at early stages of disease detection. As a result, cervical cancer, which makes up only 0.8% of new cancer cases in the United States, has a morbidity rate of 9.1% in Kazakhstan.2
In 2013, the most recent year for which data are available, the highest rates of cancer incidence were found in lung, stomach, breast, esophagus, colon, and pancreas. Every year, 17,000 people in Kazakhstan die from cancer, which is almost 10% of the total population.1
Gulnara Kunirova, President of the Kazakhstan Palliative Care Association, Executive Director at Together Against Cancer Foundation, and organizer of the first Almaty in-house palliative care team, said that the goal of the workshop was to address “the most compelling issues” for palliative care in Kazakhstan, including “palliative care principles and values; pain and symptom management in patients with advanced cancer; the role of effective communication; teamwork; and models of delivering palliative care in different environments.”
The main objective of the workshop, she said, was to “demonstrate that palliative care can be successfully started and implemented even if resources are limited on all levels, including a personal one.” ■
1. Silbermann M: Cancer Care in Countries and Societies in Transition, 1st ed. Springer, 2016.
2. Kazakh Scientific Institute of Oncology and Radiology: Indicators of Oncology Services in Kazakhstan. Almaty, 2013.
Originally printed in the ASCO Daily News. © American Society of Clinical Oncology. “ASCO and MECC Sponsor International Palliative Care Workshop in Kazakhstan.” am.asco.org/dn. All rights reserved.