November 2007, Volume 34, Number 6



Noblesse Oblige

Rose Mary Carroll-Johnson, MN, RN, Editor



This issue marks a first for Oncology Nursing Forum. It represents a collection of articles that we are presenting as part of our participation in a global theme issue effort spearheaded by the Council of Science Editors. We are 1 of more than 230 biomedical and scientific journals simultaneously publishing articles and research reports related to the topic of poverty and human development around the world. When we decided to participate, I had hoped to attract a handful of papers on the topic. To our gratification, virtually all of the articles in this issue are related to the challenges, both domestic and global, in improving the care of patients living with and dying from cancer.


According to a recent and comprehensive exploration of the global problem of cancer (Institute of Medicine [IOM], 2007), low- and middle-income countries around the world devote precious little of their already meager healthcare systems to the prevention and treatment of cancer. In well-developed countries, such as the United States, cancer is viewed with some hope as we reap the benefits of better prevention and early detection and allocate increasingly larger amounts of money and effort to the development of new and improved treatments. In poorer countries, cancer rates are climbing, fueled by widespread use of tobacco and environmental factors (e.g., poor diet and sanitation, desperate poverty, lack of education, nonresponsive governments) that foster the spread of cancer-causing bacteria, beat down personal immunity, and prevent access to detection and treatment.


Many of those factors make it impossible to get an accurate number of cancer cases worldwide. IOM (2007) estimated that 11 million cases of cancer occur worldwide every year. Not surprisingly, the big offenders are lung and breast cancer, followed by liver, stomach, and cervical malignancies. Death rates from cancer in low- and middle-income countries exceed the death rates from AIDS. The United Nationsí International Agency for Research on Cancer projected that when the aging population is added to the equation, deaths around the world will more than double by the year 2030, with poorer countries bearing the greatest share of this burden (Kahn, 2007).


A global effort to address this serious problem will fall on the shoulders of more developed countries. Americans will need to participate in and support efforts by international agencies and organizations to reduce the incidence of and deaths from cancer using a multitude of strategies and short- and long-term initiatives. Globally, as here in the United States, the control of tobacco and tobacco products is a priority even if we will not see the benefits of reduced use for years to come. Greater availability of treatment, including drugs and equipment to deliver radiotherapy, and programs to produce and develop personnel skilled care to patients with cancer are initiatives that we can support and participate in through our international efforts.


At the same time, we cannot forget those in our own country who are struggling to survive a cancer diagnosis without the benefit of healthcare insurance, specialized cancer care, or sometimes even a roof over their heads. Many of the articles in this issue speak directly about those groups. We can boast to the world about the strengths of our healthcare system and all of our advances in the area of cancer care, but we must do everything possible to make those benefits accessible to allónot just to those able to afford them.


Prevention efforts need to start early, so that our hard-won gains continue to improve. Outreach efforts to the poor and those without homes or insurance must be nurtured. Legislation to support healthcare reform, control tobacco use, and provide more assistance programs for the poor, children, and older adults will depend on all of us staying current with what goes on in Washington and speaking up to voice our opinions to our legislators and at the ballot box.


I hope that the articles in this issue and in the issues of the other participating journals will raise our awareness of the scope of the problem and sensitize each of us to the need for our active support and participation if we are to conquer cancer. Do not be deterred by the size and scope of the problems. Consider, instead, that working together we can begin to make a real difference.




Institute of Medicine. (2007). Cancer control opportunities in low- and middle-income countries. Washington, DC: National Academies Press.


Kahn, M. (2007, September 24). Cancer deaths to hit 17 million in 2030: Researcher. Scientific Retrieved September 25, 2007, from


Digital Object Identifier: 10.1188/07.ONF.1091