The State of Oncology 2013

A proposal for a new financing model to tackle the major disparities that exist in the prevention, diagnosis, treatment and outcome of cancer in countries worldwide has been presented at the 2013 European Cancer Congress (ECCO 2013). While much progress has been made against cancer over the last century, a new report brings together evidence that not every patient benefits from it, nor even has the opportunity to benefit. The economics of cancer are daunting and the current model of financing is broken, said Professor Peter Boyle, President of the International Prevention Research Institute (Lyon, France) and Director of the Institute of Global Public Health of the University of Strathclyde (Glasgow, United Kingdom and Lyon, France) in a presentation entitled 'The State of Oncology'.

The presentation was about a report of the same name based on the contributions of the four overall leaders of the project, seven regional leaders and over 100 eminent medical scientists who described the state of oncology in over 50 countries.

Cancer is only part of the growing burden of chronic disease worldwide, and is set to continue to increase in the future, with India, China and Nigeria contributing the most. The United Nations estimates that the current global population of 7.2 billion will reach 9.6 billion by 2050 and that by 2028 India and China will each have a population of 1.45 billion people. Best estimates are that by 2050, the population of Nigeria will have overtaken that of the United States.

With this population growth there will be a dramatic rise in the cancer burden in India, China and Nigeria, and these demographic increases, coupled with increases in cancer risk through the adoption of western lifestyle habits by their populations, will drive the numbers of cases of cancer diagnosed in these countries upwards. Increases in these countries, plus the surge in cases expected in populous countries such as Indonesia, Pakistan, Bangladesh and Vietnam, where rapid change is also taking place, will be the driving force behind the expected rise in the global burden of cancer, as well as in other chronic diseases, said Prof Boyle.

Many parts of the world are already unable to cope with the current situation and are totally unprepared for the future growth of the cancer problem. In lower-resource countries, for many patients the stigma associated with cancer leads them to seek alternative care and if they do present to medical services they do so frequently when the disease is advanced and only palliation is possible, Prof Boyle continued.

The rights of cancer patients can be achieved by implementing and adhering to what we call the Four Pillars of Oncology: prevent all cancers that can be prevented; treat all cancers that can be treated; cure all cancers that can be cured; and provide palliation whenever palliation is required. While progress in oncology has been remarkable in recent decades, and the future looks very encouraging, not every cancer patient is able to benefit from the advances that have been made in treating the disease. The contrast in diagnosis, treatment and its outcome between the high-resource and low-resource countries is dramatic.

It is bad to have cancer, and worse to have cancer if you are poor. The gap between rich and poor, highly educated and least educated and the north-south divide is substantial and continuing to grow. Radical solutions are urgently needed: the status quo is not an appropriate response to the current situation. It should be recognised that no single source of philanthropy has the means to solve this problem, and that new models are needed to cope with and improve this situation.

It is impossible to avoid the conclusion that there is a need for a major public-private partnership, involving a number of sources from different areas, to make the necessary progress with the briefest delay. Such a partnership needs the commitment of the pharmaceutical industry and the wide span of industries involved in diagnostic and treatment technology. It also needs the commitment of governments and non-governmental organisations to be effective, and its effectiveness will be measured against the success in delivering the most appropriate treatment and care to every cancer patient.

Given the scale of the need to deal equitably with cancer worldwide, working to improve health must cease to be viewed as a competition. Public and private organisations have an underlying suspicion of each other that must be overcome in the interests of improving global cancer care and outcomes. The situation described in the State of Oncology Report 2013 is dramatic and urgent, and all parties should put any deep-rooted suspicion behind them and develop an effective collaboration to improve this key aspect of public health throughout the world, he concluded.