An international cross-sectional survey reported in The Lancet Oncology by Fundytus et al found that access to cancer medicines considered essential by oncologists is lacking across the spectrum of low- and lower middle–income to high-income countries.
As stated by the investigators, “The World Health Organization (WHO) Essential Medicines List (EML) identifies priority medicines that are most important to public health. Over time, the EML has included an increasing number of cancer medicines. We aimed to investigate whether the cancer medicines in the EML are aligned with the priority medicines of front-line oncologists worldwide, and the extent to which these medicines are accessible in routine clinical practice.”
A 28-question electronic survey was disseminated to a global network of oncologists in 89 countries and regions. Oncologists who prescribe systemic anticancer therapy to adults were eligible to participate in the survey, which was open from October 15 to December 7, 2020. The primary survey question asked oncologists to select the 10 cancer medicines that would provide the greatest public health benefit to their country; other questions explored availability and cost of cancer medicines.
These data demonstrate major barriers in access to core cancer medicines worldwide. These findings challenge the feasibility of adding additional expensive cancer medicines to the EML. There is an urgent need for global- and country-level policy action to ensure patients with cancer globally have access to high-priority medicines.— Fundytus et al
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Among the 89 country and regional contacts invited to participate, 46 (52%) accepted the invitation and distributed the survey. A total of 1,697 respondents opened the survey link; of these, 423 were excluded due to failure to answer the primary study question and 326 were excluded due to ineligibility. A total of 948 eligible oncologists from 82 countries completed the survey; of these, 165 (17%) were from low-income and lower middle–income countries, 165 (17%) from upper middle–income countries, and 618 (65%) from high-income countries.
In response to the primary survey question, the most commonly identified cancer medications were doxorubicin (53% of respondents), cisplatin (50%), paclitaxel (45%), pembrolizumab (44%), trastuzumab (42%), carboplatin (41%), and fluorouracil (41%).
Of the top 20 identified medications, 19 (95%) are currently on the WHO EML. A total of 12 (60%) were cytotoxic agents and 13 (65%) were granted U.S. Food and Drug Administration approval prior to 2000.
The proportion of respondents reporting universal availability of each of the top 20 identified medications was 9% to 54% in low-income and lower middle–income countries, 13% to 90% in upper middle–income countries, and 68% to 94% in high-income countries.
Catastrophic expenditure was defined as spending > 40% of total consumption net of spending on food. Risk of catastrophic expenditure for each of the top 20 identified medications was reported by 13% to 68% of respondents from low- and lower middle–income countries, 2% to 41% of respondents from upper middle–income countries, and 0% to 9% from high-income countries.
The investigators concluded, “These data demonstrate major barriers in access to core cancer medicines worldwide. These findings challenge the feasibility of adding additional expensive cancer medicines to the EML. There is an urgent need for global- and country-level policy action to ensure patients with cancer globally have access to high-priority medicines.”
Christopher M. Booth, MD, of the Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, is the corresponding author for The Lancet Oncology article.
Disclosure: For full disclosures of the study authors, visit thelancet.com.