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iwCLL 2025 | The key challenges in accessing and delivering CLL treatment in resource-limited settings
Anna Schuh, MD, PhD, University of Oxford, Oxford, UK, highlights the significant challenges in accessing and delivering treatment for chronic lymphocytic leukemia (CLL) in resource-limited settings. In low- and middle-income countries (LMICs), treatment options are often unavailable, diagnostics are limited, and trained hematologists are scarce. Additionally, the perception of cancer can deter patients from seeking medical care. This interview took place at the biennial International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2025 in Krakow, Poland.
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Transcript
There are many challenges when it comes to accessing treatment in low- to middle-income countries compared to high-resource settings. Obviously, to start off with, for many patients, the treatment is simply not available. Therapies are not registered, they are not licensed in those countries, they are not being distributed. So many times over these days, patients have to resort to buying copycats or going abroad for treatment...
There are many challenges when it comes to accessing treatment in low- to middle-income countries compared to high-resource settings. Obviously, to start off with, for many patients, the treatment is simply not available. Therapies are not registered, they are not licensed in those countries, they are not being distributed. So many times over these days, patients have to resort to buying copycats or going abroad for treatment.
However, equally important is the diagnostics, and in many low- to middle-income countries, flow cytometry, for example, is not available or it might be too expensive for patients to afford flow cytometry. So the interpretation of blood films relies on fully trained hematologists, and again, many times hematologists are very scarce in low- to middle-income countries. For example, in Tanzania, there are 46 hematologists for a population of 66 million. So you can imagine that the diagnosis of CLL is a lottery. So those are just two of the main challenges.
There are also challenges relating to the perception of cancer. Patients, when they hear the word cancer or leukemia, will no longer attend clinics because they think it’s a hopeless situation, and they will go and see traditional healers. That’s becoming less and less frequent, though, especially in urban settings. Patients are desperate to access treatment.
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