As the global burden of disease shifts from infectious to chronic, non-communicable diseases, health systems and industry are tackling these challenges by focusing on how to provide personalized, patient-centered care to all people who need it, while considering issues around cost and value of innovation.
Having just returned from the World Cancer Congress in Kuala Lumpur and The European Society for Medical Oncology (ESMO) Congress in Berlin, we were excited to see both conferences address the need for increasing patient access to innovative treatment and furthering initiatives to build multi-stakeholder collaborations towards cancer control. Of particular interest were the dialogues around innovative approaches in integrating patient perspectives in value frameworks and the promise of immunotherapies to get the right treatment to the right patient at the right time.
Emerging themes in the field of oncology that we observed following conversations from both conferences:
The role of personalized therapies
In recent years we’ve seen an enormous increase in the use of data in healthcare, particularly, in the fields of genomics and disease stratification. Data provides information on the genetic alterations of cancer and can potentially be used as biomarkers for the early detection and monitoring of specific cancers, offering the hope of providing an increased understanding of tumors and the development of individualized treatments.
The future holds a promising landscape of immunotherapy and patient choice. A number of studies presented at ESMO demonstrated a clear success of immunotherapy in metastatic non-small-cell lung cancer (NSCLC). Discussions focused on the benefits and risks of immunotherapy in various settings and its potential use as adjuvant and neoadjuvant treatments, such as surgery. Underlying these discussions was the need to ensure patient choice through increased patient awareness of available treatment options.
In addition to offering a full patient advocacy track, ESMO also launched patient guides, providing information on the nature of different types of cancer and available treatment options in a language understandable to patients, their relatives and caregivers. The information provided in the guides is based on ESMO Clinical Practice Guidelines and is able to facilitate patient-physician treatment-related discussions. Recently launched guides focus on breast, cervical and ovarian cancer.
Increased advocacy around access to cancer services
UICC’s ‘Treatment for All’ advocacy campaign, highlighted during the World Cancer Conference, calls on the international cancer community to address the global equity gap in access to cancer services. Closing this gap requires stronger health systems and government commitment in improving the provision of information, availability and access to treatment and care as part of universal health coverage efforts. Vaccination and screening efforts at the national level must be built up. While we have already seen many successes, such as in developing crucially important National Cancer Control Plans (NCCP) and in increasing access to cost effective cancer drugs and technologies, there is more progress to be made and we must keep the momentum going.
Another initiative aiming to increase patient access to cancer care is UICC’s City Cancer Challenge. The City Cancer Challenge is a multi-sectoral initiative supporting cities to take the lead in the design, planning and implementation of cancer treatment solutions with the goal of increasing access to quality cancer treatment for all. City Cancer Challenge was launched to address the urgent need to turn political commitments into functional, comprehensive cancer solutions that reach the majority of the world’s population. Since its launch in 2017, the first four ‘Key Learning Cities have mobilized the initiative’s network of global and local partners to develop and implement localized action plans. At the World Cancer Congress, UICC extended official invitations to Asian cities with a population of over one million to be part of the next phase of this initiative.
Increasing access to care through public-private partnerships
“Patient access challenges cannot be resolved in a vacuum, it requires a multi-stakeholder approach.” — Jose Downey, Executive Director, MSD.
A World Cancer Congress session hosted by Merck & Co., Inc. highlighted the importance of public-private partnerships in building innovative access solutions for immunotherapy. As we enter a new wave of innovation in oncology, we will need a paradigm shift in how cancer is treated, including better policies to support and increase access for patients. We have seen strong examples of multi-stakeholder action and patient involvement, such as with the establishment of a dedicated fund in Taiwan to support expedited access to innovative treatment options.
Strengthening public policy to support comprehensive cancer control
Under the theme of mobilizing public action, much of the dialogue at ESMO reviewed the different approaches to ensure sustainable, accessible and affordable cancer care. National Cancer Control Plans (NCCPs), for example, serve as an important mechanism for long-term planning at the country level. In 2017 the World Health Assembly passed a resolution recommending that countries develop NCCPs to guide all cancer prevention and management activities undertaken in a country to address the national cancer burden. However, countries must place greater emphasis on developing NCCPs that are evidence-based, financed and implemented. Only 11% of NCCPs globally have a detailed budget plan and only 7% have a detailed implementation plan, according to a global analysis conducted by the International Cancer Control Partnership. Considering that the estimated global cancer burden reached 18.1 million new cases and 9.6 million deaths in 2018, it is critical that countries build up their National Cancer Control Plans to address the cancer burden as they move towards universal health coverage.
The European Observatory on Health Systems and Policies — a partnership hosted by WHO/Europe between international organizations, European governments and academia that supports and promotes evidence-based health policy-making, recently shared a set of key pillars to provide a framework around effective, quality cancer control plans. They include:
- Prioritize prevention to reduce or postpone chronic diseases and reduce health inequalities
- Strengthen primary care and patient-centered care to better manage chronic diseases and avoid unnecessary hospital admissions
- Improve timely access to good quality care, particularly for disadvantaged groups, to reduce amenable mortality and promote greater health-related quality of life
- Improve resilience through stable health system funding and workforce planning
As countries move toward universal health coverage, we will continue to see a shift in how we address the burden of cancer worldwide to focus on patient-centered care, increased access and innovative therapies.
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