AJMC
Mary Caffrey
June 4, 2022
visualstrata
The American Society of Clinical Oncology (ASCO) and the World Health Organization (WHO) will join forces to measure and improve the quality of cancer care worldwide, with the aim of closing equity gaps between rich and poor countries and increasing survival in low-income countries, which are being left behind as wealthy nations see the fruits of innovation.
The collaboration, put in place through a Memorandum of Understanding, was presented Saturday during a keynote address by surgical oncologist and WHO Cancer Control Officer André Ilbawi, MD, during the presidential symposium at the 2022 ASCO Annual Meeting taking place in Chicago.
ASCO President Everett E. Vokes, MD, FASCO, also highlighted the agreement during his talk on his meeting theme, “Advancing Equitable Cancer Care Through Innovation.”
Since the start of the COVID-19 pandemic, the focus on health equity in the United States has noted differences in outcomes between the rich and the poor, between patients who are White and patients of color, and between those near academic centers vs rural settings.
Since the start of the COVID-19 pandemic, the focus on health equity in the United States has noted differences in outcomes between the rich and the poor, between patients who are White and patients of color, and between those near academic centers vs rural settings.
Saturday’s session pointed out cancer care disparities of a different order of magnitude-those between high-income countries and the rest of the world.
Saturday’s session pointed out cancer care disparities of a different order of magnitude-those between high-income countries and the rest of the world.
The data presented were truly stark:
- 5-year cancer survival rates in the United States are 90%,
- but 3-year rates in Africa are just 30%.
- Over a 2-year period, cancer kills twice as many people in low- and middle-income countries as it does in high-income countries.
- And this does not go unnoticed within the US health system, where more than a third of medical trainees are from other countries.
5-year cancer survival rates in the United States are 90%, but 3-year rates in Africa are just 30%.
Over a 2-year period, cancer kills twice as many people in low- and middle-income countries as it does in high-income countries.
“Despite advances in cancer care in the last 2 decades, inequalities between and within countries are staggering and progressively increasing,” Ilbawi said.
“The experience of someone affected by cancer is profoundly determined by where they live and their socioeconomic status.”
In his address, Everett spoke of the incredible innovation that has occurred over his career-from the work by Janet D. Rowley on the Philadelphia chromosome and the relationship to the — leukemia and lymphoma, to the discoveries that have revolutionized treatment for lung cancer.
And he also highlighted recent efforts by ASCO to ensure that all patients have access to care, such s programs for rural patients. Yet, there’s much left to do.
Implementing the ASCO/WHO agreement
“In seeking quality cancer care worldwide, the goals of ASCO and the WHO are fully aligned,” Vokes said in a statement released early Saturday.
“Building on years of informal collaboration with the WHO, we now look forward to working with our WHO colleagues and stakeholders to advance international quality programs for cancer care-one of ASCO’s strategic focus areas.”
Through its Department for Noncommunicable Diseases, WHO is working to strengthen cancer control programs in breast, cervical, and childhood cancers.
The organization, which works in 194 countries from 149 offices, has taken the following steps:
- It is distributing information, best practices, and innovative strategies on cancer control among developing countries
- WHO is working to ensure that an additional 3 billion people worldwide get universal health coverage, are protected from health emergencies, or have access to evidence-based policies and programs.
Ilbawi noted that a third of ASCO’s 45,000 members practice outside the United States; thus, the collaboration brings together 2 groups that are already distributed worldwide.
ASCO members can work to improve care quality “by providing direct support to governments and hospitals-by particularly those in low- and middle-income countries-and incentivizing organizational and social innovations.”
“We are bound in this together,” Ilbawi said, “but who will take responsibility?”
“We are bound in this together,” Ilbawi said, “but who will take responsibility?”
Innovation-but Only for Some
To be sure, innovation has spurred the identification of more than 50 molecular targets, setting the era of precision oncology in motion.
“But we have not taken innovation to scale,” he said.
“Twenty-five years after the FDA approved trastuzumab, only about one third of the world has access to this live-saving therapy.”
“But we have not taken innovation to scale,” he said.
“Twenty-five years after the FDA approved trastuzumab, only about one third of the world has access to this live-saving therapy.”
Gaps exist, too, in the problems of financial toxicity and social distress, with 70% of cancer patients in low- and middle-income countries and 20% in high-incomes countries selling assets to pay for treatment.
Both the loss of spending power and loss of life have economic consequences, according to a 2018 essay published by ASCO, which found that less than 30% of low- and middle-income countries had adequate cancer care facilities, and data resources needed for modern care were woefully inadequate in most areas.
Both the loss of spending power and loss of life have economic consequences …
less than 30% of low- and middle-income countries had adequate cancer care facilities, and data resources needed for modern care were woefully inadequate in most areas.
What is the path forward?
Ilbawi said global equity in cancer care requires attention in 3 areas, which will demand collaboration from government, industry, and professional societies:
- Technology innovation: from new products to new digital tools
- Operations innovation: helping low-income countries gain access to new facilities and new business models for delivering care
- Social innovation: low-income countries need more community support for things such as patient navigation.
global equity in cancer care requires attention in 3 areas :(1) Technology innovation; (2) Operations innovation; and (3) Social innovation.
“We should change how we measure success,” he said. Only 1% of early phase clinical trials measure quality of life, and Ilbawi said this must change.
“We should change how we measure success,” …. Only 1% of early phase clinical trials measure quality of life, and Ilbawi said this must change.
“As we move through these times of instability with our patients, we are urging them to face the greatest disruption in the world systems in almost 70 years,” he said.
And yet, both Ilbawi and Vokes pointed to examples of how COVID-19 fueled creativity, which will deliver new cancer vaccines or care delivery models.
Hard times breed innovation, he said. “We must use this opportunity.”
Hard times breed innovation, he said. “We must use this opportunity.”
Originally published at https://www.ajmc.com on June 4, 2022.
Names mentioned
WHO Cancer Control Officer André Ilbawi, MD,
ASCO President Everett E. Vokes, MD, FASCO
Janet D. Rowley on the Philadelphia chromosome
