Opinion: 5 steps to ensure access to cancer care

On May 30, health leaders from across the world reaffirmed cancer control as a critical health and development priority as they adopted a new cancer resolution at the 70th World Health Assembly in Geneva.

In high-income settings, we all share a one-in-two lifetime risk of being diagnosed with cancer. Cancer incidence is also rising in low- and middle-income countries. In East Africa, for example, one in six people will face a cancer diagnosis in their lifetime. This means that primary health care providers across Africa are more likely to need to respond to symptoms of cancer than a positive HIV test. Not only is cancer one of the world’s most pressing health concerns, it is estimated to cost world economies $1.16 trillion annually, underscoring the need to act now.

Inclusion of cancer services in universal health coverage plans is critical. At the international level, we are challenged to respond to the global disparities in cancer-related mortality. The cancer resolution highlights the need to consider vulnerable populations. Here, children and young adults with cancer are a compelling example of the global divide in availability and access to life-saving services. In high-income countries with strong health systems, significant advances in diagnosis, treatment, and supportive care means that 80 percent of children diagnosed with cancer can expect in excess of five-year survival, the point at which we speak of cure. This is a remarkable success given that a few decades ago, five-year survival rates were around 30 percent. However, five-year survival rates can fall to as low as 10 percent in low-income settings with poor access to health services.

In addition, cancer treatment is often financed out-of-pocket, placing a tremendous burden on patients and families around the world. A study of new cancer patients in the Association of Southeast Asian Nations region found that after diagnosis, 29 percent had died and 48 percent experienced financial catastrophe. The study offers compelling evidence that a cancer diagnosis can be disastrous, with a high risk of death and impoverishment within a year of diagnosis.

Affordable UHC is achievable, but misconceptions and entrenched mindsets that view cancer control as too expensive or complicated to implement within the public health system will need to change. Here are just some of the ways countries can increase their level of cancer care and, in turn, make steps toward UHC.

1. Set up and operationalize a national cancer control plan

An NCCP is a sustainable strategic plan to control cancer based on a country’s cancer burden, cancer risk factor prevalence, and the resources available in the context of the socioeconomic environment and national health care system. It is a cornerstone of a public health approach and many of the measures identified within the plans will strengthen noncommunicable disease services, as well as the health system more broadly. Encouragingly, more than 70 percent of countries now have a NCCP in the public domain.

Operationalizing these according to a country’s epidemiological burden and health system capacity to provide financially stable and impactful cancer services is the next step for many governments. The period of the plan must be continuous, monitored, evaluated against targets, and updated at least every five years. The NCCP needs to be budgeted and macro-level funding mechanisms identified and utilized to take the plan forward. It should consider cancer control as an investment with health and economic returns, rather than seen simply as a “cost.”

2. Take actions that address entire populations

Lowering the burden of NCDs requires a population-based approach across the life course. It should work across different sectors of government to provide a policy framework and health system that empowers people to adopt positive lifestyles, become aware of signs and symptoms of cancer, and access early detection and treatment services. Like communicable diseases, the dual challenge facing those working to lower the burden of NCDs in their settings is disease prevention and ensuring the availability and access to treatment and care, including palliative care, for all who need it.

There is now global consensus on a menu of policy options and interventions within the Global Action Plan on NCDs that include “very cost effective and affordable interventions” for cancer, such as human papillomavirus and Hepatitis B vaccinations; screening for select cancers; treatment of early stage cervical, breast, and colorectal cancers; and palliative care. In LMIC countries, implementing national screening and early detection interventions can result in a “stage shift” of cancers from late to early stage, which can save lives and costs to the health system.

For cervical cancer, a killer in which nine out of every 10 global deaths is a woman living in a developing country, the investment in the prevention of cervical cancer through HPV vaccinations, early detection, and treatment is a moral imperative. This shameful disparity must be addressed through increased access to interventions we know are effective and have the potential to eliminate this type of cancer.

3. Increase access to data 

At a national level, data and capacities to improve forecasting and systematic procurement are needed and recommendations from the World Health Organization on essential medicines, priority technologies, and interventions based on cost-effectiveness must shape actions.

Robust and timely data are essential to guide national cancer plans that reflect a country’s cancer burden. For example, more than 30 percent of cancers are infection-driven in some LMICs, versus only 5 percent in higher income settings. Population-based cancer registries are an integral part of a country’s cancer control structure and are needed to measure the national cancer burden and assess the impact of specific interventions. The coverage of high-quality cancer registration varies enormously across the world from 100 percent in Nordic countries to less than 10 percent in Latin America, Asia, and Africa. Initiatives such as the Global Initiative for Cancer Registry Development are working to change this picture and provide assistance to countries seeking to expand and improve registries.

4. Improve primary and tertiary health care

Primary health care is a critical entry point for people with cancer signs and symptoms. There are a number of opportunities to integrate cancer interventions into existing health services at primary care level, such as cervical cancer screening as part of prenatal care, delivering palliative care through home care services, or referring people with early warning signs to the appropriate health facilities.

As articulated in the 2017 cancer resolution, the establishment of centers of excellence, with skilled staff and essential medicines and technologies, is a fundamental national must-have. Such centers should provide oversight via treatment guidelines, processes, and standards; establish accountability mechanisms for the monitoring of safe and quality cancer management; work in the catchment area to develop strong referral pathways hand in hand with primary and secondary care providers; and lead education and training to develop the next generation of cancer specialists for the multidisciplinary teams that we know are key to optimizing patient outcomes and reducing costs. As the world continues to urbanize, cities offer important opportunities to expand access to health services.

5. Mobilize multiple stakeholders and support policy coherence

Health authorities working in partnership with other relevant sectors of government should assess and develop opportunities to promote good health, reduce exposure to risk factors, and improve access to health services, ensuring that policies are consistent and support efforts to reduce the burden of NCDs in their population.

A key mechanism to engage stakeholders is through an NCCP committee, which includes representatives from the ministry of health and allied ministries, civil society groups, patient groups, academia, representatives from the private sector, and professional organizations. The committees can ensure relevant parties are actively engaged in the cancer control plan and have oversight over its implementation, monitoring, and evaluation.

In light of the cancer resolution this year, and a renewed focus on UHC, it is time to reinvigorate national action to improve access to cancer prevention, treatment, and care. Reducing cancer illness and death is possible and can deliver a significant return on investment, allowing governments to justify placing cancer control at the heart of their national health plans.

How do we ensure that people worldwide get the care they need without the risk of being pushed further into poverty? Devex explores the path to universal health coverage. Join us as we ask what it will take to achieve UHC for all by visiting our Healthy Horizons site and tagging #HealthyHorizons, #Health4All and @Devex.