Taking Stock of Global Cancer Care

by JHI Staff on January 2, 2014

Cancer is the disease many of us most worry about. And understandably so. For one thing, the odds of getting cancer at some point are rather high—each year more 1.6 million new cases turn up in the U.S. alone. The World Health Organization points to cancer as a leading cause of death worldwide, projecting 13.1 million cancer-related deaths globally in 2030. Plus, cancer is an extraordinarily complex disease category, comprising a huge number of different diseases that have uncontrolled cell replication in common, but can vary tremendously in their cause, nature and aggressiveness—and how they present from person to person.

That complexity challenges health care systems to make the best possible cancer care available to the populations they serve. Providing standard-of-care cancer treatments can in some cases require significant resources, in terms of expertise, equipment and costly medications. That’s why the establishment of a leading-edge cancer clinic is often a major milestone for a hospital that’s seeking to build a regional reputation in specialty care. In fact, one of the reasons health care costs are so high in the U.S. is that we have so many hospitals capable of providing advanced cancer care.

But though the U.S. is indisputably an international leader in terms of the availability of high-quality cancer care, we have by no means gotten everything right. That message was hit home by a report that came out in September from the U.S. Institute of Medicine, which is the branch of the U.S. National Academies focused on medicine. Consider this statement from the report’s summary:

In the United States....the barriers to achieving excellent care for all cancer patients remain daunting....The cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs. Changes across the board are urgently needed to improve the quality of cancer care.

If the challenges facing the U.S. in cancer care are that significant, and we’re a leader, then the state of cancer in most of the rest in the world is, on average, all the more problematic.

But that’s not to say there aren’t many countries with hospitals offering excellent cancer care. We at Johns Hopkins Medicine International know well how comprehensive and leading-edge the cancer care is at many of our collaborating institutions internationally, including, to mention just a few, Johns Hopkins Singapore International Medical Centre, Beirut’s Clemenceau Medical Center, Istanbul’s Anadolu Medical Center, and Clinica Las Condes in Santiago, Chile.

Some, in fact, have made strides that we in the U.S. can learn from. Clinica Las Condes, for example, provides families in the clinic’s waiting rooms with interactive online information about the patient family member’s care. Tawam Hospital in Abu Dhabi has a world-class molecular imaging center, and has been running one of the world’s largest mobile breast-cancer screening programs.

Unfortunately, cancer care in much of the developing world badly lags the U.S. As one indication, the U.S. spends almost one thousand times as much as India does per cancer patient. Higher costs don’t always directly translate to better care or better outcomes, but that sort of extreme disparity leaves no doubt that cancer patients in India are undertreated, on average. These global inequities in access to good cancer care is a challenge not just to developing countries, but to the health care community throughout the world. (Johns Hopkins oncologist Gilberto Lopes, who, until recently practiced at our Singapore facility and teaches at our affiliated post-graduate medical school in Malaysia, is one of the world’s leading researchers on the economics of cancer care in developing countries, and a passionate advocate for addressing the care gap.)

Unfortunately, the gulf between the have and have-not nations may only grow in the coming years. That’s because cancer care is a fast-moving field, with a stream of potential research breakthroughs emerging from labs and heading into clinical trials daily. Among the currently hot research areas that could some day render most cancers manageable rather than terminal: drugs targeted at mutated genes specific to each patient’s tumors; therapies that boost patients’ immune systems into fighting cancers; gene therapies that directly alter the DNA in patients’ cells; therapies that halt cancer growth by targeting stem cells, and new types of radiation therapies that more thoroughly eliminate tumors throughout the body. But most of this research progress happens in the U.S. and few other highly industrialized countries, and even after the approach is proven effective it might take years or even decades to make its way around the world—if it can be afforded at all.

One bright spot: As medicine struggles to develop effective treatments against the more dangerous cancers, advancements in patient-centered care are improving the quality of life of patients and their families during the cancer journey. It’s a type of progress that’s affordable in most countries, though it still requires a large, ongoing commitment from health care providers and the institutions, government agencies and insurance companies that support them and pay the bills.

To quote again from the Institute of Medicine report on the state of U.S. cancer care:

All stakeholders – including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as [the U.S. Department of Health and Human Services], other federal agencies, and industries – must reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system. Working toward the recommendations outlined in this report, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

To which I would only add: Let’s make this a revolution in cancer care that doesn’t end at U.S. shores.

Feel free to listen to my podcast for further insight.

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