How Should Governments Respond to the Cancer Burden?

Despite the fact that advances in cancer treatments have progressed at an unprecedented pace in the last two decades, a substantial proportion of the population still call for cancer services to be more affordable so that everyone can access them regardless of age, gender, income or geography, and without incurring financial hardships. This is one of the main outcomes of a global survey commissioned by the Union for International Cancer Control (UICC) and released today on the 20th anniversary of World Cancer Day, an annual initiative supported by global partners, including ESMO. The survey, which involved more than 15,000 adults across 20 countries had the aim to portray what people feel, think and believe about cancer. It also highlights that people fully rely on governments to take action by adopting policies to reduce the burden of cancer and enhance the effective control of cancer, and to ensure palliative care to all.

A key first step: implementing National Cancer Control Plans

But how can a government’s commitment be turned into action? There is growing evidence that a concrete way to translate the latest achievements of research and the commitment to cancer into practice comes through the implementation of National Cancer Control Plans. They are defined by the World Health Organization (WHO) as ‘a public health programme designed to reduce cancer incidence and mortality and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources’. A recent global analysis of NCCPs from 158 countries (Lancet Oncol. 2018;19:e546–555), which involved ESMO experts among reviewers and authors, has showed that a first step to translate commitment into action has already been taken by 82% of the WHO Member States with cancer-related plans aiming to adapt global recommendations to local realities. Although the review provides evidence that there have been improvements in cancer plans since 2000, detailed budget planning and resource allocation are still major challenges to put effective, but also economically realistic NCCPs into practice.

ESMO tools for sustainable cancer care

Building on the third pillar of the Vision 2020, ESMO has been advocating and working for sustainable cancer care by developing tools and resources that can provide tangible solutions to set priorities and estimate costs of proposed NCCP strategies. A global recognition of ESMO’s commitment comes from the WHO Report on Cancer 2020 which has been published today on World Cancer Day during the 146^th session of WHO Executive Board (3-8 February 2020). The document, led by WHO and prepared with the International Agency for Research on Cancer (IARC) in collaboration other stakeholders including civil society, aims to provide guidance to decision-makers on translating cancer knowledge and science into action. It reports the case study of cancer in Kazakhstan’s agenda for universal health coverage in which ESMO tools and experts played a prominent role. The ESMO Clinical Practice Guidelines, the ESMO-MCBS version 1.1 and ESMO expert review of cancer medicines and protocols were used together with the WHO EML (Essential Medicines List) and the European Medicines Agency’s medicine availability indications to review cancer treatment standards for more than 20 cancer in the country. The joint project helped to optimise resource allocation by prioritising the most valuable interventions to shape the country’s national cancer control plan for the period 2018-2022. It led to an increase in screening coverage in breast and cervical cancer from 60% to 90% and population coverage for cancer treatment from 85% to 89%. The WHO Report notes that these joint efforts enabled the country to ‘maintain its long-standing commitment to offer its citizens evidence-based comprehensive cancer care as part of universal health coverage.’