We need a revolution in cancer care in Asia-Pacific

Published on Friday, 18 March 2016

Published by Susann Roth on Friday, 18 March 2016

Consultation at a public health clinic in Rajasthan, India.
Consultation at a public health clinic in Rajasthan, India.

When I used to work in a public university hospital in Germany, cancer patients were part of my daily work. Although I often worried about their prognosis, I always knew that every patient, no matter their economic background, would always receive the internationally recommended treatment.

Unfortunately, this is only the case for less than 50% of cancer patients worldwide, which leads to huge differences in cancer survival rates. If you have breast cancer in a developed country, your have in average 80% survival rate in the next 5 years, but in India and other developing countries this figure drops to 40%.

Asia accounts for 60% of the world population, and half the global burden of cancer. The incidence of cancer cases is estimated to increase to 70% by 2030, in part due to a growing aging population, lifestyle and socioeconomic changes. However, the estimates for Asia are based on weak health management information systems. The fact is that only 7.1% of the population in developing countries is covered by cancer registry, compared to 99% in developing countries.

Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions in Asia and the Pacific. What you see in many Asian countries is a still high burden of infection-related cancers like those affecting the esophagus, stomach, liver or cervix. Pacific DMCs for example, have some of the highest cancer incidence and mortality rates in the world due to cervical cancer linked to the human papiloma virus (HPV). To give you shocking statistics, in some Pacific island countries the incidence is as high as 79.7 per 100,000 women, compared with a U.S. average of 9.9 per 100,000. In other countries the burden is moving to lifestyle-related cancer types. The Philippines is one of the countries with the fastest increasing breast cancer incidence, and not very good survival rates. The same is true for Malaysia. The reasons are late diagnosis and limited access to the full range of treatment options.

According to the a recent study on ASEAN costs in oncology, of 10,000 patients in Southeast Asia who followed up 12 months after their cancer diagnosis, over 75% faced worse outcomes. Of these, 29% died of cancer while 48 percent experienced financial catastrophe. Additionally, about half of the 44% who survived experienced economic hardship as a consequence of the cancer, and the majority ended up using their life savings.

The reason for these bad health and economic outcomes is that more than 70% of cancers in low- and middle-income Asian countries are diagnosed in locally advanced clinical stages, with overall 5-year survival being generally less than 50%. This means that if a patient is diagnosed, the cancer is often at an advanced stage, so it is expensive to treat, treatment is often not accessible, and many of those who can access treatment lose their life savings and most likely not survive the disease.

This is in my view not acceptable in the 21st century. We made HIV/AIDS treatment affordable and accessible, so why does it take so long to bring affordable quality cancer care to people?

Well, one reason is that health care systems in the region’s developing member countries are severely underfunded, and very little of that funding is spent on cancer programs – it’s not yet a policy priority. Only 5% of the world’s resources against cancer are spent in developing countries, according to the Global Task Force on improving access to treatment and monitoring of cancer. In addition, very little official development assistance for Health goes to cancer.

To address this issue, this week The Economist brought together government representatives, experts and the private sector in the a health care forum entitled The War on Cancer to discuss how policy, financing, capacity building and partnerships in cancer control can be quickly mobilized to confront the massive challenge cancer is presenting to Asia and the Pacific. A few takeaways from the panel on what we need to do are:

  1. Invest in quality cancer care pathways. Developing countries should look for partners to develop infrastructure with services (infrastructure plus HR plus ICT). Cancer centers need to be in cities, operate as hubs, and collaborate with cancer centers in other countries.
  2. Better data. Developing countries need to invest in health management information systems for better data on cancer incidence and cancer care outcomes, as cancer registries are not well developed in the region. Accountability mechanism for ensuring quality cancer care according to international standards must be established
  3. Value for money. Developing countries should create a phased approach to develop cancer programs, prioritizing cancer with high burden, prevention and early detection.
  4. Strengthen financial risk protection. The increasing incidence of cancer poses a risk of impoverishing families in Asia and the Pacific, so let’s invest in expanding catastrophic health expenditure risk protection.
  5. Facilitate public-private sector collaboration. There are good opportunities for ADB to support its developing member countries to harness and align the private sector for cancer care under the universal health coverage goal.
  6. Invest in communities. Communities must be mobilized and educated to decrease lifestyle related cancer risks, demand for early detection, and access to cancer care.
  7. Best investment is in prevention. Investing in prevention of infections like HPV or hepatitis C that can lead to cancer, as well as lifestyle changes, are both quick public health wins.

We need a revolution in cancer care instead of channeling huge amounts of public and private money into overpriced, inefficient and low-quality cancer treatment in expensive tertiary hospitals. As a surgeon, my goal was to get the best possible treatment for my patient. Now as a public health expert, my goal is to support investments with the best value for money.