Department of radiotherapy. University Hospital Ibn Rochd Casablanca – Morroco Cancer Control Resources in Maghreb countries Pr. BENIDER Marrakech June 19th 2010

Maghreb map

MAGHREB Epidemiologic transition - Demographic transition - Transformations of the environment - Change of the way of life Non transmissible chronic diseases Health priorities Cancer = Major problem of public health INTRODUCTION

1929: Bergonié Centre -Casablanca Ibn Rochd Oncology Center Historical : Casablanca Mayor inaugurating the hospitalization of the Bergonié center

Historical Treated cancers in Cancer Centre bergonié

1980: First two radiotherapy specialists (Pr.Gueddari - Pr.Kahlain) 1985: National Institute of Oncology-Rabat 1989: First private center - Casablanca Historical : Lalla Salma Association Against Cancer 2010: Cancer Plan ( ) After 2005

Epidemiological Data

Cancer Standardized Incidence In Maghreb All Sites MaleFemale MOROCCO (Casablanca*) 100,3104,2 ALGERIA (Alger**)148,6 151,3 TUNISIA (Tunis***)133,2101,4 LYBIA (Benghazi****) 116,9295,11 * Registre des Cancers de la région du Grand Casablanca Edition 2004 ** Registre des tumeurs d’Alger Edition 2003 *** Registre des Cancers de Nord Tunisie **** Benghazi Cancer Registry 2004

Cancer Standardized Incidence In Maghreb All Sites MaleFemale MOROCCO (Casablanca*) 100,3104,2 ALGERIA (Alger**)148,6 151,3 TUNISIA (Tunis***)133,2101,4 LYBIA (Benghazi****) 116,9295,11 USA (New Jersey)566,2439,2 France (Loire)422,7256 CANADA 398,5308,3

COMMONLY CANCERS IN MALE MOROCCO (Casablanca*) ALGERIA (Alger**) TUNISIA (Tunis***) LYBIA (Benghazi****) Lung ProstateColon/RectumBladderColon/Rectum BladderColon/RectumHead  Neck NHLStomachProstateBladder LarynxProstateSkinProstate * Registre des Cancers de la région du Grand Casablanca Edition 2004 ** Registre des tumeurs d’Alger Edition 2003 *** Registre des Cancers de Nord Tunisie **** Benghazi Cancer Registry 2004

COMMONLY CANCERS IN FEMALE MOROCCO (Casablanca*) ALGERIA (Alger**) TUNISIA (Tunis***) LYBIA (Benghazi****) Breast Cervix uteriColon/Rectum ThyroidCervix uteriSkinCorpus uteri Colon/RectumThyroidCervix uteriNHL Ovaries ThyroidCervix uteri * Registre des Cancers de la région du Grand Casablanca Edition 2004 ** Registre des tumeurs d’Alger Edition 2003 *** Registre des Cancers de Nord Tunisie **** Benghazi Cancer Registry 2004

Breast Cancer Comparison of standardized incidence of other countries CountryIncidence MOROCCO (Casablanca)35,04 ALGERIA (Alger)44,5 TUNISIA (Tunis)29,6 USA (New Jersey)129,4 FRANCE (Loire)109,8 CANADA95,5

Health facilities

Cancer facilities in Morocco Casablanca Public (1) Private (2) Rabat Public (1) Military (1) Private (2) Oujda Public (1) Total : 8 cancer centers Al houceima Before 2005

Cancer facilities in Morocco Functional Casablanca (4) Rabat (4) Agadir (1) Oujda (1) Al Houceima (1) Marrakech (2*) Fes (1/1*) Total : 12 (3*) cancer centers Planned Tanger Meknes (2) Safi Laayoune Al houceima After 2005 *Functional soon

Cancer facilities in Algeria ALGERIA Constantine Algiers Ain-Naadja Blida Ain Misserghin Oran 6 centers......

Cancer facilities in Tunisia - 3 functional centers: Tunis Sousse Sfax Jendouba - 3 planned centers: Gafsa Gabes Jendouba

Radiation Therapy Equipment in Morocco Before 2005 Linac10 Cobalt7 Simulator (CT)3 Brachy LDR16 Brachy HDR2 TPS10 After (2*) 6 5 (7*) (14*) * Planned

Radiation Therapy Equipment in Algeria Linac9 Cobalt6 Brachy4

Radiation Therapy Equipment in Tunisia PublicPrivateTotal LINAC1/4*1/1*2/5* Cobalt459 Simulator32/1*5/1* TPS33 * Planned

Comparison of Radiation Therapy Equipment in Maghreb countries MoroccoAlgeriaTunisia Linac22(2*)92(5*) Cobalt669 Simulator (CT) 5(7*)-5(1*) Brachy LDR164- Brachy HDR7-- TPS28(14*)-3 * Planned - No data available

22 Human resources in cancer centers in Morocco Radiotherapy Specialists: 82 Residents: 61 Medical Oncology Specialists:20 Residents:51 Surgical Oncology Specialists:16 Total: Specialists: 118 Residents : 112

23 Human resources in cancer centers in Algeria Medical Oncologists: 250 Radiation Oncologists: 50 Surgeons: 100

24 PublicPrivateTotal Surgical Oncology Specialists11415 Residents13 - Radiotherapy Specialists15419 Residents19- Medical Oncology Specialists Residents32- Total Specialists Residents64 - Human resources in cancer centers in Tunisia

25 MoroccoAlgeriaTunisia Surgical Oncology Specialists Residents- -13 Radiotherapy Specialists Residents Medical Oncology Specialists Residents Comparison of Human resources in cancer centers in Maghreb countries - No data available

Moroccan cancer Plan Conceptual Framework National and international mobilization Prevention Early diagnosis Detection Diagnosis and treatment Palliative cares Legislation Research / Training Social support Communication

Moroccan cancer Plan Health facilities organization Level 1: Basic health centers, General practionners Level 2: Provincial hospitals Diagnosis centers Clinics Level 3: University hospitals, Regional cancer centers Private cancer centers

Tunisian cancer Plan In collaboration with the Institut National Français du Cancer (INCa) Piloting comittee and sub-commissions : - Formation/Research - Epidemiology - Primary Prevention - Screening/Early Diagnosis - Management

Recommendations

International Resources Standards in Radiotherapy EQUIPMENT 1 device / inhabitants. OMS/AIEA recommendations for developing countries : 1 device for 1 million inhabitants.

International Resources Standards in Radiotherapy HUMAN RESOURCES 1 Radiation Oncologist / annual treatments 1 Radiation Physicist / annual treatments 2 therapy radiographers / each treatment device At least 1 therapy radiographer / simulator At least 1 dosimetrist.

Moroccan equipment Requirement in Radiotherapy (cancer Plan ) For each cancer center 2 LINACs with MLC 1 Simulation system (standard or CT) 1 TPS with network link HDR Brachytherapy

Moroccan Human Resources Requirement in Radiotherapy (cancer Plan ) For each cancer center At least 2 radiation oncologists, and above depending on the center activity: 1 radiation oncologist / patients treated per year At least 2 Radiation Physicists, and above depending on the center activity: 1 radiation Physicist / patients treated per year At least 12 radiation therapy radiographers At least 2 Brachytherapy radiographers At least 1 dosimetrist, and above depending on the center activity

Conclusion Cooperation Governments - NGOs would allow: * Cancer prevention * Cancer treatment * Palliative care * Better quality of life