The World Oncology Forum (WOF) is promoting for investment in accessible cancer services to be a crucial component of frameworks to improve global health. Following the third UN high-level summit on non-communicable diseases last September and as plans for the 2019 high-level summit on universal health coverage advance.
The WOF taskforce, which was composed of influential leaders in the worldwide cancer community and in health policy, met in Inveruno, Italy, in November of last year. The meeting was hosted by the European School of Oncology. They were tasked with creating a clear and convincing argument that might disprove the claims made by individuals who believe that developing nations shouldn't prioritise the treatment of cancer patients.
The WOF Taskforce's co-chair, Professor of Global Health Systems at Harvard University Rifat Atun, stated that the secret to success is to create an accessible, convincing narrative that begins by outlining the financial and human impact of cancer, including on the world's poorest communities. The difference between that impact and the small proportion of existing global health spending committed to anticancer therapy must then be highlighted. Most significantly, it must outline the benefits of investing additional money in crucial cancer services.
He stated that identifying a core group of significant and measurable indicators would help policymakers and funders understand the worth of such an investment and enable comparisons of regional and national success as well as progress tracking.
“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.
Sania Nishtar, a co-chair of the WHO high-level commission on non-communicable diseases, provided a video link context statement for international health policy. She stated that the third high-level summit on NCDs, which had taken place the month before, along with a renewed focus on bolstering healthcare systems and ensuring everyone has access to care, indicated some positive advancements in the fight against cancer.
However, 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 and their families 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,” said Nishtar. She 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 stated that valid estimates of the burden of cancer must be based on transparent, standardised accounting practises that are acknowledged internationally and that can be used at the global, regional, and national levels.
Such a strategy should consider the financial effects of long-term family impoverishment that can arise from incurring catastrophic costs to pay for therapy.
Serious cancer-related suffering has a human cost that needs to be calculated. According to information provided to the taskforce, initiatives to create a new metric known as "suffering-adjusted life years" (SALYs) may be able to assist with this. The argument was made that the palliative care community could teach the cancer community a lot about creating standardised methods for monitoring burden, service quality, and accessibility.
Another area that needed a lot more effort was measuring the amount now spent on cancer prevention and treatment. For instance, it was highlighted that although estimates for global health development aid suggested less than 2% went to all non-communicable diseases, it is unknown what percentage of that cash goes toward cancer. The fact that cancer is made up of so many distinct diseases and is treated in so many different methods makes it difficult to calculate total costs because they must be combined under a variety of different headings.
The Taskforce considered the strategies employed by the Lancet Oncology Commission on Global Access to Radiotherapy as a potential blueprint for determining how to establish the investment case. The authors conducted in-depth evaluations of the prevalence of tumours treatable with radiotherapy, the expense of making the necessary investments for treatment, the therapeutic advantages of undergoing such procedures, and the subsequent financial gains.
Under the assumptions of present efficiency levels and maximum efficiency, the analysis was carried out separately for nations with upper middle income and those with lower middle income. They demonstrated that upper middle-income countries should expect a sixfold return on investment in a few years, whereas lower middle-income countries could expect a twofold return.
The Taskforce agreed that it would be worthwhile to investigate whether it is possible to adapt that methodology for use in applications to specific national cancer burdens and capacities, in order to make the financial case for investing more widely in the necessary diagnostic and treatment services.
The European Society for Medical Oncology's Magnitude of Clinical Benefit Scale was regarded as a useful tool for standardising clinical benefit measures, which would be a crucial component of building the investment case, and it could be expanded to apply to surgical and radiotherapy treatments and diagnostics as well.
The Taskforce then focused on bolstering the investment case by figuring out methods to reduce costs by coming up with more effective and creative ways to pay for and provide cancer services.
Rifat 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 last year [2017], showed that improving price, quality, consistency and probity the rough effective procurement can lead to efficiency gains of between 7% and 74%,” he said.
Other opportunities for doing more with less were identified, such as promoting capacity building initiatives at the regional level or between regions with comparable levels of resources and health service development, and developing standardised training protocols to equip non-medical personnel to handle many tasks that do not require full medical training. One excellent example was an Omani initiative to train cancer nurses from all around the Middle East and even several Arabic-speaking African nations.
Aranda Sanchia noted that one major reason why so little money is being invested in cancer is that no one is making the argument, drawing on recent experience leading the City Cancer Challenge, a project created by the Union for International Cancer Control. There is obviously a huge need for funding, but when we speak with the individuals in charge of health financing, they claim that no one has ever contacted them. No concrete request is made in response to the need. Nobody is effectively making the case for cancer investment.
Franco Cavalli, who has co-chaired the WOF taskforce and led the World Oncology Forum series, brought the discussion to a close by highlighting the importance of piloting models for developing cancer diagnosis and treatment services that can show the benefits of investing in cancer care and can be used by other regional and national authorities. He mentioned the ambitious Chinese "Belt and Road" international development project, which just approved the breast cancer project in Kyrgyzstan, which is funded by the Chinese Academy of Medical Sciences, the European School of Oncology, the Swiss Cancer League, and other organisations. “We have shown that, starting practically from the scratch, it was possible to reach a high standard of diagnosis and treatment in this Euro-Asiatic republic in less than three years,” he said.
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