Addressing disparities in cancer care accessibility globally

In an article in Communications Medicine, a professor of epidemiology points out that cancer used to be a disease of the affluent, reserved predominantly for people in high-income countries. In the past few decades, however, low- and middle-income countries (LMICs) have become home to a high burden of cancer-related morbidity and mortality.

In the coming years, the number of new cancer cases, or at least newly diagnosed cancer cases, in LMICs is predicted to increase substantially. This increase will be driven by not only population growth and increases in life expectancy but also by growing exposure to risk factors for cancer – increasingly, behaviours like unhealthy diets, alcohol consumption and tobacco smoking, historically associated with wealthy countries, are becoming common in LMICs.

This is a catastrophe; there’s no other way to put it. Many LMICs already have poorly equipped and overburdened health systems. LMICs also receive the short end of the stick when it comes to infectious disease incidence, with non-communicable diseases (NCDs) other than just cancer now presenting a dual burden. In such a scenario, the growing cancer burden in LMICs will only pile more on the overfull plates of fragile health systems.

Another professor of medical oncology highlights that despite lower crude and age-adjusted cancer incidence in LMICs compared to high-income countries, LMICs often have larger populations. This is why in absolute numbers, LMICs have a higher cancer burden – unfortunately, a majority of worldwide cancer cases and deaths occur here.

Cancer drugs are available… but not everywhere

Over the past few decades, there have been exciting advances and breakthroughs in cancer drug development. However, not everyone around the world can access these treatments. Disappointingly, even in wealthy countries, providing patients with high-quality diagnostics and treatments can be a challenge, given the complexity and heterogeneity of the disease. Unsurprisingly, the situation is far worse in countries with relatively weak healthcare systems.

In an article in Nature Reviews Clinical Oncology, oncologists from 6 different countries articulated their experience of the cancer burden in the region where they practice.

In India, the lack of universal health coverage (UHC), inconsistent drug pricing, differences in cost in private and public healthcare facilities, limited monitoring of generic drug quality, frequent medicine shortages, and delayed approvals of novel oncology drugs were cited as reasons for poor access to cancer treatment. Additionally, with a significant part of the population living below the poverty line, the high out-of-pocket expenses required to access appropriate care put it out of reach for many. A survey of oncologists revealed that in India, the risk of substantial out-of-pocket spending for each essential cancer medicine was anywhere between 19 and 58%.

Price control of drugs is an option to alleviate this problem, but price control itself poses its own set of challenges. Many a time, manufacturers cannot sustain production within the price cap as prices of raw materials and distribution systems remain high; this results in frequent drug shortages. Moreover, the restrictions on sky-high profits for manufacturers mean that many novel drugs exit or don’t enter the market in question at all. The perception of low profits also impedes investments in drug discovery and development targeted towards regional cancer burdens.

In Malaysia, a large part of the problem is delayed diagnosis. Diagnosing cancer in its early stages permits efficient treatment, improved outcomes for the patient, and lower healthcare costs. Additionally, the country has inadequate oncology specialists and poorly distributed oncology facilities and professionals. Malaysia’s Ministry of Health subsidises treatment for about 65% of the population. But only 22% of the population has personal health insurance and age-old policies either provide low pay-outs or none at all in some circumstances.

An oncologist from Rwanda does not hesitate to highlight that in Rwanda and beyond, the main problem to ensuring equitable global access to cancer care is financial. The high cost of cancer drugs is a global phenomenon, but affordability is a bigger problem in LMICs compared to high-income countries. Even important, established cytotoxic drugs like cisplatin which offer a massive clinical benefit are beyond the reach of many patients in LMICs.

Addressing global inequities in cancer care access

From these examples, it is clear that there are some commonalities in the cancer care story across LMICs. Inadequate health insurance coverage, the high cost of drugs, high poverty levels, the perception of low profits for manufacturers, and weak healthcare system penetration.

PodTech™ was conceived with the vision of addressing global disparities in access to healthcare, diagnostics, and pharmaceuticals. Addressing the global disparity in access to cancer care is very much a part of this vision.

A professor of medicine in haematology-oncology at the Hospital of the University of Pennsylvania has noted the complexity and heterogeneity of cancer, making it a difficult disease to treat anywhere in the world. But he stresses the fact that even in resource-constrained settings, cancer care can be delivered safely and effectively. The most effective cancer care delivery programmes, he claims, address the five Ss: staff, stuff, space, systems, and social support. PodTech™ can help set in place at least a few of these.

PodTech™’s podules™ have applications across the production of small molecules, APIs, biopharmaceuticals, cell and gene therapies, and more. These solutions are particularly suited to manufacture novel oncology products. PodTech™’s standard podules™ for gene therapy, small-scale cell therapy, R&D, diagnosis, and patient recovery can each play a vital role when it comes to cancer care.

When it comes to staff, PodTech™ can facilitate tech transfers, ensuring that local biopharma manufacturers have the know-how needed to train their personnel and effectively operate these factory systems for their intended purpose. These podules™ can be used to produce essential oncology drugs where they are needed, bringing them within the reach of people who otherwise couldn’t have accessed them. The economical nature of these portable prefabricated factories compared to traditional construction also means that drugs could potentially be produced at lower costs. As for space and systems to provide cancer care, portable systems can be set up for the purpose, including diagnosis, treatment, pathology and radiology services.

Cancer care is currently beyond the reach of many people around the world, but it doesn’t have to be. PodTech™ is on a mission to ensure that disease screening and treatment becomes accessible and affordable to all; cancer care is just one piece of the puzzle. Today cancer, tomorrow other non-communicable and infectious diseases. Eventually, a healthier world in which no one has to miss out on existing treatments because they cannot access or afford them.