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Enhancing global access to cancer medicines. ​

Literature Information ​

DOI10.3322/caac.21597
PMID32068901
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2020
Times Cited97
Keywordsantineoplastic agents, drug regulation, health services accessibility, immunomodulation, price
Literature TypeJournal Article, Review
ISSN0007-9235
Pages105-124
Issue70(2)
AuthorsJavier Cortes, Jose Manuel Perez-García, Antonio Llombart-Cussac, Giuseppe Curigliano, Nagi S El Saghir, Fatima Cardoso, Carlos H Barrios, Shama Wagle, Javier Roman, Nadia Harbeck, Alexandru Eniu, Peter A Kaufman, Josep Tabernero, Laura García-Estévez, Peter Schmid, Joaquín Arribas

TL;DR ​

This article addresses the significant disparities in cancer survival rates globally, emphasizing the barriers to access essential cancer medicines, such as high costs, inappropriate usage, and weak healthcare infrastructure. The authors propose strategies to improve access and optimize cancer treatment, including universal health coverage, fair pricing, better regulation, and investment in comprehensive cancer care services.

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antineoplastic agents · drug regulation · health services accessibility · immunomodulation · price

Abstract ​

Globally, cancer is the second leading cause of death, with numbers greatly exceeding those for human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and malaria combined. Limited access to timely diagnosis, to affordable, effective treatment, and to high-quality care are just some of the factors that lead to disparities in cancer survival between countries and within countries. In this article, the authors consider various factors that prevent access to cancer medicines (particularly access to essential cancer medicines). Even if an essential cancer medicine is included on a national medicines list, cost might preclude its use, it might be prescribed or used inappropriately, weak infrastructure might prevent it being accessed by those who could benefit, or quality might not be guaranteed. Potential strategies to address the access problems are discussed, including universal health coverage for essential cancer medicines, fairer methods for pricing cancer medicines, reducing development costs, optimizing regulation, and improving reliability in the global supply chain. Optimizing schedules for cancer therapy could reduce not only costs, but also adverse events, and improve access. More and better biomarkers are required to target patients who are most likely to benefit from cancer medicines. The optimum use of cancer medicines depends on the effective delivery of several services allied to oncology (including laboratory, imaging, surgery, and radiotherapy). Investment is necessary in all aspects of cancer care, from these supportive services to technologies, and the training of health care workers and other staff.

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Primary Questions Addressed ​

  1. What are the specific barriers to accessing essential cancer medicines in low-income countries?
  2. How can international collaborations improve the distribution of cancer medicines globally?
  3. What role do health care policies play in ensuring equitable access to cancer treatments?
  4. How can advancements in technology and telemedicine enhance the accessibility of cancer care?
  5. What impact does the pricing strategy of pharmaceutical companies have on the availability of cancer medicines in different regions?

Key Findings ​

1. Research Background and Purpose ​

Cancer remains a formidable global health challenge, being the second leading cause of death worldwide, with a mortality rate surpassing that of HIV/AIDS, tuberculosis, and malaria combined. The disparities in cancer survival rates are attributed to various factors, including limited access to timely diagnosis, affordable treatments, and high-quality care. This study aims to explore the barriers preventing access to essential cancer medicines and to propose strategies to enhance global access to these critical therapeutic agents.

2. Main Methods and Findings ​

The authors examine several barriers to accessing cancer medicines, particularly essential ones, which may include:

  • Economic Barriers: Even if essential medicines are listed nationally, prohibitive costs can limit their use.
  • Prescription Issues: Inappropriate prescribing can lead to ineffective treatment regimens.
  • Infrastructure Weakness: Poor healthcare infrastructure can hinder patients from accessing available treatments.
  • Quality Concerns: Lack of assurance regarding the quality of medicines can deter their use.

To address these challenges, the authors discuss several potential strategies:

  • Universal Health Coverage: Implementing universal health coverage to ensure that essential cancer medicines are accessible to all.
  • Fair Pricing Models: Developing equitable pricing methods for cancer medicines to make them more affordable.
  • Cost Reduction in Development: Strategies to lower the costs associated with the development of cancer drugs.
  • Regulatory Optimization: Streamlining regulatory processes to facilitate access.
  • Supply Chain Reliability: Improving the reliability of global supply chains for cancer medicines.
  • Therapy Optimization: Adjusting cancer therapy schedules to reduce costs and adverse effects while enhancing access.
  • Biomarker Development: Advancing the discovery of biomarkers to better target treatments to patients who will benefit most.

The findings underscore that optimal use of cancer medicines is contingent upon the effective integration of various healthcare services, including laboratory work, imaging, surgery, and radiotherapy.

3. Core Conclusions ​

The research highlights that multiple interrelated factors obstruct access to cancer medicines globally. Strategies to improve access must be multifaceted, addressing economic, infrastructural, and regulatory barriers. Investment in the entire cancer care continuum, from supportive services to healthcare worker training, is essential for improving access to essential cancer medicines and enhancing patient outcomes.

4. Research Significance and Impact ​

This study is crucial in illuminating the urgent need for global strategies to enhance access to cancer medicines, given the rising burden of cancer worldwide. By identifying key barriers and proposing actionable solutions, the research provides a framework for policymakers, healthcare providers, and stakeholders to collaborate in improving cancer care. Ultimately, enhancing access to cancer medicines can significantly reduce cancer mortality rates, thereby improving public health outcomes on a global scale. This research can serve as a catalyst for future initiatives aimed at achieving equity in cancer care, particularly in low- and middle-income countries.

Literatures Citing This Work ​

  1. Prognostic Significance of Tumor-Infiltrating Natural Killer Cells in Solid Tumors: A Systematic Review and Meta-Analysis. - Shuo Zhang;Weijian Liu;Binwu Hu;Peng Wang;Xiao Lv;Songfeng Chen;Zengwu Shao - Frontiers in immunology (2020)
  2. MicroRNA Profiling in Paired Left and Right Eyes, Lungs, and Testes of Normal Mice. - Jiangcheng Shi;Chengqing Hu;Yuan Zhou;Chunmei Cui;Jichun Yang;Qinghua Cui - Molecular therapy. Nucleic acids (2020)
  3. Lack of access to CDK4/6 inhibitors for premenopausal patients with metastatic breast cancer in Brazil: estimation of the number of premature deaths. - Tomás Reinert;Rodrigo Pellegrini;Carlos Henrique Barrios - Ecancermedicalscience (2020)
  4. The efficacy and safety of moxibustion for chemotherapy-induced gastrointestinal adverse reaction: A protocol for systematic review and meta-analysis. - Han-Xiao Zhang;Cheng-Shun Zhang;Xiao-Qin Dai;Chuan-Yi Zuo;Peng Lv;Rui-Zhen Huang;Qian-Ning Mo;Yi-Feng Bai;Yi Zhou - Medicine (2020)
  5. Advances in synthetic lethality for cancer therapy: cellular mechanism and clinical translation. - Win Topatana;Sarun Juengpanich;Shijie Li;Jiasheng Cao;Jiahao Hu;Jiyoung Lee;Kenneth Suliyanto;Diana Ma;Bin Zhang;Mingyu Chen;Xiujun Cai - Journal of hematology & oncology (2020)
  6. Carcinogenesis: Failure of resolution of inflammation? - Anna Fishbein;Bruce D Hammock;Charles N Serhan;Dipak Panigrahy - Pharmacology & therapeutics (2021)
  7. Cancer disease progression and death during the COVID-19 pandemic: a multidisciplinary analysis for the Peruvian setting. - Juan Astigueta-Pérez;Milagros Abad-Licham;Carlos Chávez-Chirinos;Luis Beraun-Milla;Alberto Lachos-Dávila;Elizabeth Diaz-Pérez;Karem Portugal-Valdivia;Paul Pilco Castañeda;Isaías Pérez Alférez;Edward Mezones-Holguín - Ecancermedicalscience (2020)
  8. Emerging role of long noncoding RNA-encoded micropeptides in cancer. - Mujie Ye;Jingjing Zhang;Meng Wei;Baihui Liu;Kuiran Dong - Cancer cell international (2020)
  9. Erythropoietin combined with traditional Chinese medicine for chemotherapy-induced anemias: A protocol of systematic review and meta-analysis. - Long-Feng Wang;Shu-Zheng Song;Jin Huang;Chuan-Hui Dou - Medicine (2020)
  10. Shortages and price variability of essential cytotoxic medicines for treating children with cancers. - Yehoda M Martei;Kotoji Iwamoto;Ronald D Barr;John T Wiernkowski;Jane Robertson - BMJ global health (2020)

... (87 more literatures)

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