World Oncology Forum makes a strong case for investing in cancer services, in light of the 2019 high-level meeting on Universal Health Coverage

By Anayo Ezugwu

THE World Oncology Forum, WOF, has called on the United Nations to make investment in cancer services an integral part of its frameworks to improve global health.  The WOF said UN need to develop a simple and compelling case that can challenge the assumptions of those who assert that providing treatment for people with cancer should not be a priority for developing countries.

In its latest report on affordable cancer services, Rifat Atun, professor of Global Health Systems at Harvard University, and co-chairman, WOF Taskforce, said the key to success is to build an easy-to-understand, credible narrative that starts by depicting the economic and human impact of cancer, including on the world’s poorest communities. “It then needs to highlight the asymmetry between that impact and the tiny proportion of global health spending currently devoted to tackling cancer.

“Most importantly, it needs to spell out the returns that can be expected from investing more in essential cancer services. Finding a core set of meaningful and measurable indicators, he argued, would give confidence to policy makers and funders about the value of such investment, and also makes it possible to compare progress between regions and countries and track progress. We just need one signature publication a year that is going to summarise all the achievements and the excellent work that is going on, and will highlight the challenges that remain,” he said.

Atun, who worked at the Global Fund for AIDS TB and malaria as a member of the executive management team as the director of Strategy and Performance, described how introducing the principles of transparency, benchmarking and pooled purchasing helped minimise prices while protecting quality and access to a variety of drugs, diagnostics and other technologies. “Evidence, we published in the BMJ 2017, showed that improving price, quality, consistency and probity the rough effective procurement can lead to efficiency gains of between seven percent and 74 percent.

Other opportunities identified for doing more with less included developing standardised training protocols to equip non-medical personnel to take on many tasks that do not require full medical training, and promoting capacity building initiatives at a regional level or between regions with similar levels of resources and health service development. An Omani initiative to train cancer nurses from across the Middle East, and even some Arabic speaking African countries was cited as a good example.”

On her part, Sania Nishtar, co-chair, World Health Organisation, WHO, High-Level Commission on Non-Communicable Diseases, said failure to address the issue of access to treatment meant that, even with greater investment in early diagnosis and diagnostic technologies, poorer people across the world will continue to die of treatable cancers. She said if this happens people could face financial ruin if they try pay for treatment from their own meagre funds. “The whole discourse around the need to overcome financial access barriers to treat diseases like cancer and other expensive NCDs is missing,” she said.

Nishtar emphasised the urgent need to make a strong case for investing in cancer services, in light of the 2019 high-level meeting on Universal Health Coverage. “The taskforce agreed that credible measures of the burden of cancer are required that use transparent and consistent and internationally accepted accounting methodology that can be applied at a global, regional and national level. Such a measure should take into account the economic impact of long-term impoverishment of families that can result from incurring catastrophic expenditure to pay for treatment.

“The human cost of serious cancer-related suffering should also be measured. The taskforce heard that efforts to develop a new metric, under the working title of ‘suffering-adjusted life years’ (SALYs) could help with this. The point was made that the cancer community could learn a lot from the palliative care community about developing standardised approaches to measuring and monitoring burden and the quality of and access to services.”

According to report, measuring the amount currently invested in preventing and treating cancer was another area identified as requiring a lot more work. It noted, for instance, that while estimates for global health development aid indicated less than two percent goes to all non-communicable diseases, there is no information about what proportion of that funding goes towards cancer. Part of the problem is that cancer comprises so many different diseases, tackled in different ways, so calculating total expenditure will require bringing together money spent under a myriad of disparate headings.

On the question of how to approach making the investment case, the taskforce saw the methods used by the Lancet Oncology Commission on Global Access to Radiotherapy as a possible template. The authors made detailed analyses of the burden of cancers amenable to treatment by radiotherapy, of the cost of investing to meet the treatment needs, and of the clinical benefits of carrying out such treatments and the resultant economic returns.

The analysis was done separately for upper-middle income countries and lower-middle income countries, assuming current efficiency levels and greatest efficiency. They showed a six-fold return on investment was achievable within a matter of years for upper-middle income countries, with a two-fold return in lower-middle income countries.

The Taskforce agreed that it would be worth exploring the possibility of adapting that methodology for application to specific national cancer burdens and capacities, to make the economic case for investing more widely in the diagnostic and treatment services required.

– Feb. 15, 2019 @ 15:52 GMT |