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How to achieve universal cancer care

Beyond the human suffering, the disease has profound – and growing – economic consequences: by 2030, spending on cancer care worldwide is projected to reach $458 billion.

At the upcoming second United Nations High-Level Meeting on Universal Health Coverage, the world’s governments are expected to adopt a new set of commitments focused on accelerating implementation of UHC. No resolution will be complete without the explicit inclusion of comprehensive cancer services.

Cancer causes an estimated ten million deaths each year. Beyond the human suffering, the disease has profound – and growing – economic consequences: by 2030, spending on cancer care worldwide is projected to reach $458 billion. In many countries, patients have to pay for much of their cancer care out of pocket – a burden that often leads to financial catastrophe.

Given this, investing in cost-effective prevention and early-detection strategies is not only a moral imperative, but also an economic one. Prevention is far cheaper than treatment, and where cancer cannot be prevented, early detection makes successful treatment more likely, at a far lower cost.

When cancer does progress, the full range of quality therapies – including surgery, radiation, and chemotherapy – should be accessible and affordable to all. For noncommunicable diseases overall, every dollar invested in cost-effective interventions can generate a return of up to $7 through reduced health-care costs and improved productivity.

While prevention and treatment are vital, so is palliative care, which alleviates unnecessary suffering for patients, their families, and caregivers, and provides survivorship plans for remaining healthy. In the wake of a pandemic that significantly disrupted palliative-care services, and with a rising number of cancer survivors worldwide, investments in both areas are urgently needed.

Comprehensive cancer care is essential to achieving social-development goals related to equality, social justice, and health. And, with sufficient political will, universal care can be achieved. In Pakistan, the Shaukat Khanum Cancer Hospital network offers world-class cancer care. The King Hussein Cancer Centre has significantly expanded cancer care and scientific research in Jordan, and collaborates with international partners such as St. Jude Children’s Research Hospital to deliver care to patients from Syria and Lebanon.

But countries face many challenges in incorporating cancer care into UHC schemes. In Kenya, for example, collaborative efforts by a range of cancer-control organizations have expanded access to services and removed financial barriers, but reaching rural populations remains difficult.

In Indonesia, a decentralized health system has improved health equity, but gaps remain in cancer prevention and early diagnosis. Even in Thailand, which has integrated six areas of cancer control – cancer informatics, primary prevention, early detection, treatment, palliative care, and cancer-control research – into its UHC scheme, improved public-awareness initiatives are needed to ensure that the relevant services are being used.

Nonetheless, the Thai model highlights the potential public-health benefits of UHC schemes that include comprehensive cancer care. Recognizing that potential, the Union for International Cancer Control, which has more than 1,150 members in more than 170 countries and territories, works continuously with governments and other stakeholders around the world to develop and implement national cancer-control strategies and integrate them into national health-insurance plans.

Just as a goal without a plan is merely a wish, a plan without dedicated resources gathers dust. Unless essential cancer services are covered by basic health-insurance schemes, they will remain inaccessible or unaffordable to many who need them. And where insurance exists, limits on out-of-pocket spending are crucial. Cancer patients often reach their deductible soon after diagnosis, owing to the large number of tests and procedures that are required. But treatment often lasts months or years and involves numerous visits to doctors, tests, surgeries, radiation treatments, drugs, and other services.

An effective national cancer-control strategy must reflect a nuanced understanding of cost-effectiveness that encompasses not just upfront costs, but also long-term savings, including through improved quality of life and increased productivity. It must also include a commitment to addressing not only the illness itself, but each individual’s holistic experience, and a firm resolve to break down financial and cultural barriers that prevent early diagnosis and treatment.

The UN High-Level Meeting provides a rare opportunity to elevate cancer care on the global UHC agenda. That is why it is welcome news that cancer has been referenced in the meeting’s draft resolution. But governments must not stop at lofty pledges and verbal commitments. Only concrete action to implement UHC that includes quality cancer services and accounts for the diverse needs of populations across economic strata and regions, can ensure that cancer care does not become a missing piece in the global health puzzle. — Project Syndicate

Sonali Johnson is Head of Knowledge and Advocacy at the Union for International Cancer Control.