ADVOCACY: Reimagining cancer care: The potential of timely and early intervention
Technological advances are already making a material difference in the lives of those with cancer, but much more can be done, requiring multi-sectoral collaboration and a shift in health planning
When tackling cancer, time is of the essence. The COVID-19 pandemic has overburdened health systems and caused significant disruptions in health interventions for patients around the world. For cancer patients, delayed interventions result in a drastic decline
in survival and health outcomes.
Despite recent technological advances to strengthen cancer prevention and promote earlier diagnosis and treatment,1 a large proportion of patients enter the health system at late stages. The difference in health outcomes varies greatly between patients with localised cancer (early stage, meaning it has not spread), versus metastatic cancer (later stage, meaning it has spread to other parts of the patient’s body). As cancer progresses, treatment becomes more challenging and costly for both the patient and their loved ones, and the health system.
Realising the full potential of these technological advances to tackle cancer early on will require building on the health system delivery innovations that have been put in place as part of the COVID-19 response. Coordinated action will be necessary to sustain political commitment, increase public financing and improve care pathways.
A new paradigm of care
Over the past decades we have seen the global health community, driven by leadership from countries, setting ambitious targets and taking bold action. This followed scientific innovation that transformed the way in which conditions are prevented and treated. Similarly, scientific innovation demonstrated that we are a step closer to a reality in which certain types of cancer may become liveable health conditions. Today, we have evidence that shows timely and precise diagnosis coupled with early interventions can play a critical role in lowering the chance of cancer progressing or coming back after treatment. This involves improving screening and early detection and the use of radiation, chemotherapy and other medicines before or after surgery to help to reduce the size of the tumor or boost the effects of surgery.
Achieving the promise of early interventions
The biggest challenge faced today continues to be identifying patients early enough to provide them with the best, less invasive and lowest cost treatment options. This challenge is exacerbated in low- and middle-income countries where disease awareness is lacking, health systems are less able to provide the necessary services to identify cancers at an early stage, treatment options are scarce and financial protection is minimal or absent. The COVID-19 pandemic has complicated the situation, further compromising early diagnosis and treatment.
However, these challenges are not new to the global health community. We can point to demonstrated successes across geographies and disease areas from which we can learn.2 To achieve the promise of early interventions in cancer care we suggest three areas of opportunity:
Strengthening patient literacy and awareness: Patients are often unaware of the importance of screening, the potential of treatment or the hope of significantly improved health outcomes. Partnerships between patient advocacy groups, other civil society actors and the media will play a critical role in communicating and building awareness and encouraging patients to seek care.
Improving efficiency of patient pathways: Decentralisation of cancer services between service providers and clinics, as well as disparities among urban and rural areas, often cause delays and barriers along the care pathway. Aligning provider and health system incentives, as well as promoting synergies among systems, will be critical to improving early detection and linkage to care.
Ensuring availability of early-stage detection and treatment, through health reforms to provide publicly financed universal coverage of cancer interventions: Patients continue to face vast disparities in accessing treatment and one of the main barriers is the lack of financial protection to cover the costs of care. This results in catastrophic health spending, impoverishment and poor health outcomes across and within countries.
The next frontier in cancer is a joint responsibility
It is estimated that the number of cancer cases will increase from 19.3 million in 2020 to 28.4 million by 2040.8 By contrast, the percentage of healthcare budgets spent on cancer has been unacceptably low for years. In 2018 less than 1% of health financing was allocated to cancer.9
Prioritising cancer in national health plans and investments in cancer detection, treatment and care need to mirror the reality of an ageing society and the associated disease burden. Today, spending is heavily skewed towards the high costs of late-stage care, and financial toxicity often results in patients foregoing treatment, having lower adherence to treatment and higher mortality. Timely and early intervention may deliver improved health outcomes and economic gains including pharmaceutical and health-system cost savings. We may be able to bring new hope to patients and improve survival rates –by investing in timely diagnosis and early-stage cancer treatment. For example, in melanoma, survival rates have increased by more than 17%.10
Reaching the next frontier in cancer will require a shift in health planning with a focus on long-term solutions versus short-term actions. Multi-sectoral action to respond to the COVID-19 pandemic has demonstrated the opportunity for a collaborative approach to strengthen health systems. We support the World Health Organization’s call on governments to build back better for a fairer, healthier world by implementing existing resolutions and making new and bold commitments.11 This will require political will and proactive, concerted collaboration among all stakeholders in the cancer community to increase patient literacy and awareness, improve the efficiency of patient pathways, and improve the availability of early-stage detection and treatment.
References
1. https://www.cdc.gov/cancer/ncccp/priorities/early-detection-treatment.htm
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110680/
3. https://www.bmj.com/company/newsroom/every-month-delayed-in-cancer-treatment-can-raise-risk-of-death-by-around-10/;
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21660
4.https://www.cdc.gov/cancer/ncccp/priorities/early-detection-treatment.htm
5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345192/
6.De Koning et al (2020), Reduced Lung-Cancer Mortality wit Volume CT Screening in a randomized Trial
7.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464890/
8. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21660
9. https://www.sciencedirect.com/science/article/pii/S2059702920323358
10. https://training.seer.cancer.gov/melanoma/intro/survival.html.
11. https://www.who.int/news/item/06-04-2021-who-urges-countries-to-build-a-fairer-healthier-world-post-covid-19
