Global innovation in better-value cancer care is needed to face current challenges
The primary modalities of cancer treatment are surgery, systemic therapy, and radiotherapy; these may be used alone or in combination. Of those cancer patients who are cured, curability is attributed as follows: surgery (49%), radiotherapy (40%) and chemotherapy (11%). Optimal treatment and diagnosis in early stages of disease have contributed to the decline in cancer mortality rates in most developed countries. In low- and middle-income countries (LMICs), limited access to affordable and quality cancer diagnosis and treatment has contributed to mortality-to-incidence ratios approximately 20% higher than those of industrialized countries.
The cost of cancer care has skyrocketed partly as a result of the development of expensive imaging techniques, radiation therapy equipment, and anticancer agents, including molecularly targeted therapies. As a result, the availability and receipt of treatment has been limited in many parts of the world. For example, despite approximately 60% of cancer patients being able to benefit at some point during the course of their disease from radiotherapy, this technology is far from being accessible to the 82% of the world’s population living in the developing world. LMICs have 60% of new cancer cases but only 32% of the radiotherapy machines available worldwide. Africa and Southeast Asia face the largest shortages of radiotherapy units, with approximately 30 countries without radiotherapy services available.
The WHO List of Essential Medicines includes medicines associated with cancer survival increase at a relatively low cost that are also off-patent.
Examples of medicines from the WHO essential medicines list used alone or in combination for curative treatment of common cancers.Download High Res Text alternative: Examples of medicines from the WHO essential medicines list used alone or in combination for curative treatment of common cancers
In low- and middle-income countries (LMICs), limited access to affordable and quality cancer diagnosis and treatment has contributed to mortality to incidence ratios approximately 20% higher than those of industrialized countries.
Exacerbating the lack of access to modern diagnostic services, surgical oncology, radiotherapy equipment and chemotherapy is a drastic shortage of trained healthcare workers, which is a critical barrier to access to quality and equitable health services for cancer diagnosis and treatment. In Sub-Saharan Africa, trained pathologists, oncologists, and oncologic surgeons are exceedingly rare, and surgery is often performed by a general surgeon lacking specialty knowledge of cancer care. Many countries in Sub-Saharan Africa average less than one pathologist per million population, and several lack even one trained medical oncologist or radiation oncologist.
Global scientific approaches and innovation are needed to ensure greater affordability of and access to better value cancer care for all. Policymakers and several organizations are currently working to expand patient access to therapy and increase the number of trained workforce personnel, although challenges in leveraging existing infrastructure and lowering costs remain.
With the exception of South Africa and Botswana, countries in Sub-Saharan Africa average less than one pathologist per 500,000 population.
Population per pathologist, 2012Text alternative: Population per pathologist in sub-Saharan Africa, 2012
“The time has come to challenge and disprove the widespread assumption that cancer will remain untreated in poor countries."