Limited applicability and implementation of the international oncology treatments guidelines in low- and middle-income countries, an example from the Mediterranean area borders

The quality of cancer care in the modern era is based on a precise diagnosis and personalized therapy according to patients and their disease based on validated guidelines with a high level of evidence. During cancer patients’ management, the objective is first to make an accurate diagnosis and then offer the best treatment, validated beforehand in a multidisciplinary board meeting, with the best benefit/risk ratio. In the context of many low- and middle-income countries, the limited available means do not allow an adequate offer, resulting in non-optimal patients’ care. In addition, in many low- and middle-income countries, priority can be given to other types of disease than cancer, which may considerably reduce allocation of specific resources to cancer care. Thus, the limited availability of systemic therapy, radiotherapy machines, brachytherapy and technological development may come up against another difficulty, that of geographical distribution of the means in the countries or a lack of expertise due to insufficient training programs. For all these reasons, the implementation of the guidelines established in Western countries could be impossible for many low- and middle-income countries which, moreover, have to face a completely different epidemiology of cancers compared to developed countries. In this work, we will discuss through a few examples of common cancers on both borders of the Mediterranean area, the applicability of the guidelines and the limits of their implementation for optimal cancer care. La qualité des soins doit passer par une offre adaptée aux patients et leur maladie en se basant sur les recommandations validées avec un haut niveau de preuve. Durant les parcours de soins des patients atteints de cancers, l’objectif doit être d’abord de poser un diagnostic précis puis administrer un traitement, validé en réunion de concertation pluridisciplinaire, permettant d’assurer le meilleur ratio entre le bénéfice et le risque attendus. Dans le contexte de nombreux pays à faibles et moyens revenus, l’absence de certains moyens diagnostiques et thérapeutiques ne permet pas cette offre avec comme conséquence une perte de chance pour les malades. De plus dans beaucoup de pays à faibles et moyens revenus la priorité peut être donnée à d’autres types de maladies que le cancer ralentissant considérablement l’attribution des moyens. Ainsi, parfois l’indisponibilité de certains traitements systémiques, de machines de radiothérapie, de curiethérapie