![]() 9, 10 In most PICTs, cancer surveillance systems are insufficient and patients tend to present late with advanced cancers. 8 With an increasing cancer burden, PICTs are facing the triple burden of infection-related cancers, a rapid transition to cancers relating to reproductive, dietary, and hormonal factors, and growing ageing populations. Migration (permanent and temporary) to high-income countries for education or increased earning opportunities is common among PICT populations. Pitcairn Islands and Wallis and Futuna have been exduded from this analysis because no key informants were located to provide data. Self-governing state in free association with New Zealand Number of physicians per 10 000 populationġ986 (in compact of free association with USA)ġ994 (in compact of free association with USA) Mortality rate (crude, per 1000 population) ![]() ![]() Out-of-pocket expenditure (% of current health expenditure) Year of independence or political affiliationsĬurrent health expenditure as % GDP (2015) Income classification (according to World Bank classifications) 7 The following year, cyclone Winston resulted in the deaths of 44 people and caused more than US$1.4 billon in damage, with Fiji primarily affected and in 2018, cyclone Gita hit Tonga, which damaged more than a thousand homes and killed two people. Cyclones are also a regular occurrence in the region in 2015, cyclone Pam hit the island of Vanuatu, which caused 15 deaths and massive damage to infrastructure in the region. For example, in 2014 there were flash floods in Honiara, Solomon Islands, which left tens of thousands of people homeless and 22 dead. 4– 6 In addition to frequent minor climatic events (such as local flooding and minor cyclones), natural disasters occur regularly in the region. 1 Despite these differences, PICTs share common features these include, fragile economies, with a narrow export base geographical isolation and insufficiently resourced health systems, which remain vulnerable to the effects of climate change and extreme weather threats such as tropical cyclones and floods. 1– 3 For example, Papua New Guinea has a larger population than Sweden, estimated to be more than 8 million people in 2012, but, at the other end of the spectrum, Niue has a resident population of around 1500 people. PICTs are highly diverse in geography, social and economic development, population size, culture, language, and history ( table 1). The region of the Pacific island countries and territories (PICTs) consists of 22 countries and territories surrounded by 165 million km 2 of ocean ( figure 1). To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. ![]() This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs).
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