Global Health Equity: Cancer Care Outcome Disparities in High-, Middle-, and Low-Income Countries

Souza, Jonas A. de; Hunt, Bijou R.; Asirwa, Fredrick Chite; Adebamowo, Clement; Lopes, Gilberto

doi:10.1200/jco.2015.62.2860

Cited by 156 publications

(171 citation statements)

References 24 publications

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“…These cancers are concentrated among the poor in middle- and high-income countries, and prevention and early detection should be a high, targeted priority. 29 …”

Section: Discussionmentioning

confidence: 99%

Avoidable Mortality: The Core of the Global Cancer Divide

Knaul

Arreola-Ornelas

Rodríguez

et al. 2018

JGO

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PurposeThe incidence of infection-associated cancers and lethality of cancers amenable to treatment are closely correlated with the income of countries. We analyzed a core part of this global cancer divide—the distribution of premature mortality across country income groups and cancers—applying novel approaches to measure avoidable mortality and identify priorities for public policy.MethodsWe analyzed avoidable cancer mortality using set lower- and upper-bound age limits of 65 and 75 years (empirical approach), applying cancer-specific and country income group–specific ages of death (feasibility approach), and applying cancer-specific ages of death of high-income countries to all low- and middle-income countries (LMICs; social justice approach). We applied these methods to 2015 mortality data on 16 cancers for which prevention is possible and/or treatment is likely to result in cure or significant increase in life expectancy.ResultsAt least 30% and as much as 50% of cancer deaths are premature, corresponding to between 2.6 and 4.3 million deaths each year, and 70% to 80% are concentrated in LMICs. Using the feasibility approach, 36% of cancer deaths are avoidable; with the social justice approach, 45% of cancer deaths are avoidable. Five cancer types—breast, colorectal, lung, liver, and stomach—account for almost 75% of avoidable cancer deaths in LMICs and worldwide.ConclusionEach year, millions of premature cancer deaths could be avoided with interventions focused on four priority areas: infection-associated cancers, lifestyle and risk factors, women’s cancers, and children’s cancers. Our analysis of the global burden and the specific cancer types associated with avoidable cancer mortality suggests significant opportunities for health systems to redress the inequity of the global cancer divide.

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“…These cancers are concentrated among the poor in middle- and high-income countries, and prevention and early detection should be a high, targeted priority. 29 …”

Section: Discussionmentioning

confidence: 99%

Avoidable Mortality: The Core of the Global Cancer Divide

Knaul

Arreola-Ornelas

Rodríguez

et al. 2018

JGO

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“…56 It is suggested that given the high population burden of preventable cancers, these cancers should be prioritised in lowincome countries, while in middle-income settings, risk reduction and adhering to the WHO essential list of medications is warranted. 57 Reductions in the comprehensiveness of care may shift the financial burden to employers or households and will usually increase the role of out-of-pocket costs or co-payments in the health system. This has the potential for patients to delay seeking treatment and promote inefficiencies by encouraging people to use resource-intensive emergency services instead of cost-effective primary care.…”

Section: Potential Impact Of Reaching the Sustainability Ceiling Of Cmentioning

confidence: 99%

“…Given the chronicity of cancer and very high treatment costs, even moderate co-payments would mean that access to treatment could become dependent on a patient's ability to pay. 63 Evidence shows that young uninsured adults in the US are more likely to present with advanced disease, be undertreated, or die after a diagnosis of cancer compared with those who are insured, 57 with co-payments potentially further increasing these disparities.…”

Section: Potential Impact Of Reaching the Sustainability Ceiling Of Cmentioning

confidence: 99%

What Happens when the Cost of Cancer Care Becomes Unsustainable?

Simoens¹,

Harten²,

Lopes³

et al. 2017

European Oncology &Amp; Haematology

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Cancer places a heavy burden on healthcare systems. The cost of cancer drugs is increasing, driven largely by the introduction of new, ever more innovative cancer treatments. This raises questions about value for money and the future sustainability of cancer care, and presents significant challenges for decision-makers in providing all patients with access to treatments and effective new cancer medicines. The aims of this article are to provide an understanding of how sustainability in cancer care is defined, what signs indicate that the limits of sustainability are being reached, and what potential impact this may have on patients with cancer within Europe. Each country is faced with making difficult decisions about the allocation of healthcare resources to cancer care, to best meet the health needs of their patients. Determining the value of individual cancer drugs can help to inform these decisions, because premium pricing for incremental innovation is no longer sustainable. When the cost of cancer care becomes unsustainable, countries may be forced to restrict health expenditure by limiting demand, cutting spending and reducing investment. This can lead to restricted access to treatment. New, innovative cancer treatments must provide greater value than current options, and measures are needed to contain and reduce expenditure and make best use of scarce resources, without impeding access to effective and safe treatments for all patients.

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“…Even after "Obamacare" there are still 33 million Americans without health insurance (10.4%), 4.5 million of them children 33,34 . The risk of death for several cancers is significantly higher for insolvent patients 35,36 , bankruptcy and high debt in cancer survivors are twice that of the overall population 37 , and there is growing concern about new-drug affordability 38 .…”

Section: The Equity Mattermentioning

confidence: 99%