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Research.  There are many fundamental questions that remain unanswered specific to cancer in developing coun- tries. For instance, it cannot be assumed that approaches to treating cancer from developed settings will produce the same results when applied in other countries. Considerations include potential differences in disease bulk, malnutrition, rates of chronic infections such as HIV/tuberculosis/hepatitis B, and genetic polymorphisms affecting disease biology and treatment response. 108–112 Resources for supportive care and quality assur- ance are also considerations. There are many unknowns in can- cer epidemiology and basic science, and, as mentioned, more health services research is emphatically needed into areas such as access, quality, and economics. 87 Supporting research on cancer by investigators in the devel- oping world is important as it can build local research capacity and provide a means of adapting scientific knowledge to local circumstances to meet national health priorities. 113 The U.S. National Cancer Institute has also been involved with numer- ous international collaborations. Protocol-driven clinical research can also strengthen local treatment capacity. The INCTR has been involved in designing clinical trials relevant to developing world situations, as has the IAEA. International research partnerships are essential in the interconnected and interdependent world we live in. 113 Many developing countries have quite advanced resources to sustain research activities; for instance, a number of clinical trials for cervical cancer radiotherapy have occurred in India (e.g., HDR vs. LDR brachytherapy, radiation vs. chemoradiation). 114,115 India is also home of the Advanced Center for Treatment, Research and Education in Cancer (ACTREC), part of the Tata Memorial Center. Regional research collaborations are devel- oping, for example, the FNCA. In addition, of note, a number of research/teaching twinning partnerships between developed and developing countries have been formed. 97,98 ,116 Undoubtedly, industry and development will play an impor- tant role in improving access to quality radiation therapy equip- ment. Equipment that is affordable, safe, and technically suit- able for developing country conditions is needed. 77 The IAEA has taken leadership in advocacy for such equipment, and there is hope that new solutions will proliferate. Creative public–private partnerships will be important, as will be innovative equipment design. This last point has been exemplified by a group in Canada that has pioneered cobalt-60 tomotherapy. 117 Conclusion Cancer in the developing world is an urgent problem, reaching critical proportions. Almost 60% of all cancer cases occur in the developing world. Vast numbers of people in developing coun- tries have either limited access or no access to radiation therapy. At a time when new gains in oncology outcomes in the developed world are incremental, oncologists have the chance to help make some of the largest survival gains in history in the developing world. In addition, the potential for health care gains through cancer prevention and early detection, and the relief of suffer- ing through palliative care are enormous. The poor deserve fair access to quality cancer care. The challenge will now be to deliver this in a thoughtful and contextually appropriate way. Selected References A full list of references for this chapter is available online. 1. World Bank. World Bank country classifications. 2010. Available at: http://data. worldbank.org/about/country-classifications. Accessed August 13, 2011. 2. World Health Organization. Projections of mortality and burden of disease, 2004-2030. 2008. Available at: http://www.who.int/healthinfo/global_burden_ disease/projections/en/index.html. Accessed August 13, 2011. 3. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008 v.1.2, Cancer incidence and mortality worldwide. IARC CancerBase No. 10 [Internet]. 2010. Available at: http://www-dep.iarc.fr. Accessed August 14, 2011. 6. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011;61(2):69–90.

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