Taking actions to improve awareness and access to better cancer care for all.
Cancer is a leading cause of death worldwide accounting for nearly 10 million deaths in 2020. Over two million new cases of cancer are expected to be diagnosed in the US alone in 2022, with 609,000 projected deaths from cancer, and health experts have suggested that people missing cancer screenings and doctor appointments due to the COVID-19 pandemic may cause cancer rates to rise even more in the coming years.
The pandemic was a reminder of the egalitarian nature of disease. Social upheaval has focused attention on addressing inequalities and discrimination in our societies and, in healthcare. But even before COVID, documented disparities already existed in healthcare related to overall access to care and to specific disease outcomes and illustrated gaps and adverse differences between certain population groups in cancer care across areas such as incidence, morbidity, mortality, prevalence, survivorship and quality of life after cancer treatment.
The burden of cancer shouldn’t be variable because of factors such as access, geography or socioeconomic status. Access to effective care and treatment is important as the world continues to combat cancerous disease. The Union for International Cancer Control (UICC) established World Cancer Day to encourage collaboration across the industry to raise awareness about the disparities in cancer care and are committed working collectively to eliminate these disparities and improve the outcomes of cancer patients around the globe.
Ben Newton, MD, General Manager, GE Healthcare Oncology Solutions
Clinicians believe that patient outcomes can be improved by removing the barriers that exist in cancer care, from improving access to care and removing social determinants, to standardizing protocols on diagnostic exams, rapid selection of precision therapies and sharing scientific information across facilities or the globe.
Closing the gaps in cancer care
With the world’s aging population on the rise, experts indicate that incidence trends for all cancers have increased in most countries and across all age groups, which, they believe, may also lead to changing patterns of patient needs internationally. In order to provide care for these populations, an important step is helping to reduce health disparities, so everyone has access to quality care.
“Cancer is a disease characterised by inequality,” said Sonali Johnson, PhD, Head of Knowledge, Advocacy and Policy at UICC. “There are huge disparities around the world in the ability of people not only to access cancer information and prevention services, but also early diagnosis and care.”
Awareness of breast cancer care disparities
Breast cancer has the highest rate of new cancer cases globally, 2.26 million in 2020, however is a well-documented example where improving awareness, access to screening, early diagnosis, management and treatment has made a difference in health outcomes. Even though progress has been made in improving breast cancer outcomes, patient populations in lower income countries and in some ethnic groups lag behind the survival rates and improved outcomes seen in other groups, as seen through tools such as population-based cancer registries, incidence and survival data.
Understanding where the gaps are can help clinicians target patient outreach to better serve these populations. Breast cancer survival of five years after diagnosis now exceeds 80% in most high-income countries, compared with 66 percent in India and just 40 percent in South Africa, for example. But several recent studies in the US found that women of color were 40 percent more likely to die of breast cancer, despite the US being a high-income country and despite women of color having lower incidence rates of breast cancer than white women.
Awareness of lung cancer care inequities
Breast cancer isn’t the only clinical area that suffers from care inequity. Lung cancer, second to breast cancer in new cases globally at 2.21 million in 2020, could also be highly impacted by efforts to eliminate disparities in care. With 1.8 million deaths estimated worldwide in 2020, lung cancer is the leading cause of cancer death among men in 93 countries, and women in 25 countries. The global aggregate of a five-year survival is only 10 to 20 percent in most countries.
In a recent US report, evidence has indicated that patient lives have been extended longer than ever before because health care providers now have many options of treatments available, for some patients. And while a decrease in smoking has impacted the current incidence of lung cancer in countries like the US, there are also other factors that influence the incidence and prevalence of the disease such as tobacco control, environmental pollution along with access to screening and diagnostic tools.
“Unfortunately, this progress has been limited to only a few countries worldwide,” said Vivek Tomar, Patient Research Advocate at a plenary session for the International Association for the Study of Lung Cancer (IASLC). “There are so many countries and millions of patients who do not have access to targeted therapies (despite the existence of effective agents) and, if patients do have access to the latest treatment, these potentially life-saving therapies are often unaffordable. In addition, there is significant lack of awareness among healthcare providers and the general population in some countries regarding lung cancer diagnosis (molecular profiling), latest treatments, and clinical trials. For patients from those parts of the world, living with lung cancer with an acceptable quality of life even for one-year post-diagnosis still is a dream.”
Improving access to technology for cancer care
Cancer screening tools, such as mammography continue to be the primary method of breast cancer detection. However, magnetic resonance imaging and ultrasound are becoming elevated to a similar standard of care, particularly for women at high risk such as for those with dense breasts. Other diagnostic screening tools such as automated breast ultrasound and contrast enhanced spectral mammography are also being used as additional diagnostic test options after inconclusive mammography. Evidence exists for the benefit of implementing additional screening tools, and more information is being collected to support the adoption of a multimodality approach to screening and diagnosis.
Tracking and sharing the real-world impacts of these technologies and the treatments they enable for patient populations is one way to help health systems prioritise their investments in care areas. Oftentimes, high cost or access to new technology can be a barrier for some providers or geographic areas. Industry partners are trying to address this issue and are working to set benchmarks on the availability of equipment across different countries.
“While 50-60 percent of all cancer patients will need radiotherapy, the availability of radiotherapy is mainly concentrated in high income countries, with a huge unmet need in lower to middle income countries,” Dr. Johnson explained. “For example, 90 percent of people in low-income countries have no access to radiotherapy.”
Similarly, the results of an IASLC global survey on molecular testing in lung cancer across more than 100 countries were published in September 2020. Molecular testing can identify patients with advanced non-small cell lung cancer (NSCLC) who may benefit from targeted therapy or immunotherapy. The frequency of molecular testing was found to be significantly different among regions and molecular testing is almost nonexistent in poorer countries. The study concluded that molecular testing for lung cancer is relatively low across the world (less than 50 percent of patients are tested). The barriers identified included cost, access, quality, and lack of awareness.
Bringing innovation and awareness together to address health equity
We’re continuing to innovate to overcome limited access to care and health equity by providing solutions such as intelligent diagnostic and therapy selection tools built with artificial intelligence-based applications. Another area that can help enable clinicians to deliver more precise and consistent care is by standardizing imaging protocols across geographic locations. Low-dose options for computed tomography (CT) lung cancer screening are also available as more populations begin to recognize the importance of screening for this deadly disease. Solutions, such as providing mobile imaging is bring screening and diagnostic imaging to areas without access and we’ve created the one-stop clinic in breast care to help reduce the time from screening to diagnosis in breast cancer.
Together, leaders in the imaging industry, patient advocacy groups and clinicians are working to increase awareness of the importance of screening and early diagnosis, as well as to provide the tools necessary to manage and treat cancers around the globe.
Help to #CloseTheCareGap and learn more at WorldCancerDay.org.
Learn about GE Healthcare’s oncology solutions to help provide the technology and access needed for cancer care.
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