Taking the long view on cancer care

Access to healthcare, much like pasta or cheese, comes in different shapes and sizes – often including surprisingly large holes. That was brought home to me when I looked through some recent data on global cancer care, ahead of World Cancer Day today.

10 million people die every year from some form of cancer, more than HIV/AIDS, malaria and tuberculosis combined. But that global figure is far from telling the whole story, which is why this year’s Awareness Day is built around the slogan #CloseTheCareGap.

Broadly speaking, we increasingly see three different levels of inequity in cancer care: between regions, within regions and – increasingly, as a direct result of Covid-19 – between individual patients. They are different, though related issues, which need clearly differentiated policy responses. (Which is not to pass the buck: everyone involved in this critical field, including companies like Sandoz, has a role to play in proactively formulating and implementing those responses).

Shocking regional differences

The differences between regions will surprise nobody – though they still have the power to shock. Some ?65% of all cancer deaths occur in low and middle income countries (LMICs), despite having younger populations. Even more strikingly, childhood cancer survival rates are above 80% in higher-income countries, but as low as 20% elsewhere. And more than 90% of cervical cancer mortality occurs in LMICs.

Even for those “lucky” enough to get treatment, the risk of incurring so-called catastrophic expenditure (defined as over 40% of total personal spending excluding food) is far higher in LMICs: between 13 and 68% compared to 2 to 41% in high-income countries.

East versus West

Equally worrying are the access inequities within regions. A good example is biologics, where we see a striking difference between the percentage of eligible patients actually treated with biologics in Western Europe (about 80% thanks to biosimilar competition) and Central and Eastern Europe (just 10%).

Another cause for concern is the stark regional disparity in liver cancer care (and treatment outcomes) between different countries within Europe. For example, Finland and the UK have seen large increases in related mortality over the past 40 years, while the opposite is true for France and Italy.

Different folks, different strokes

Finally, Covid-19 has heightened many inequities, not just between regions and countries, but between individual patients within the same country. For cancer patients, there has been a significant disruption in the continuum of care due to delayed diagnoses, postponed appointments and missed treatments.

Patients face complex decisions, which will often be influenced by personal as much as health considerations: for instance, continuing treatment in a hospital may be the best option for their disease but also expose them to the risk of infection. And remember that most cancer cases are detected, not by a screening, but when a patient goes to a doctor with a syndrome – a highly individual decision.

Here’s to the future...

These three types of access gap will require different solutions. There are already some great ideas on the table, ranging from global initiatives such as the OECD campaign to address oncology access challenges, via regional programs such as the European Union’s Beating Cancer plan to specific projects including the US National Cancer Institute’s (NCI) ongoing study on the impact of Covid-19.

One thing is for sure: to quote NCI director Ned Sharpless, looking at cancer often means taking the long view. And that’s the good news: as Ned says, if you look back at what has been achieved in cancer care in the 50 years since the US launched its “War on Cancer” initiative, “you could drive a truck through the differences”. Here’s to the next 50 years of progress!

#CloseTheCareGap