Recognising inequities in care is key to beating cancer

On Sunday, people in more than 135 countries observed World Cancer Day 2024, an initiative of the not-for-profit Union for International Cancer Control and supported by the World Health Organisation (WHO), primarily to further increase the awareness of a disease which respects no borders, ethnicity, gender, age, creed or socio-economic status.

Despite the huge progress in cancer research in the past five decades towards beating a scourge of humanity and one of the last bastions of frontier medicine awaiting a breakthrough cure, cancer remains the second largest cause of death after heart disease, claiming 9.7 million lives in 2022, according to the latest estimates published by the International Agency for Research on Cancer (IARC), the WHO cancer agency.

Not that a one-size-fits-all cure is remotely possible, given the fragmented and complex nature of a disease that presents multiple manifestations and therefore challenges. Some one in five people develop cancer in their lifetime, about one in nine men and one in 12 women die from the disease.

The theme of World Cancer Day 2024, “Close the Care Gap”, continues a campaign first launched in 2022, which is all about understanding and recognising the inequities in cancer care and the global burden of cancer.

This remains a recurring theme in other health, medical and science metrics, which pits the high-income-countries (HICs) against the low-and-medium-income-countries (LMICs). The Covid-19 pandemic exposed such inequalities especially in access to vaccines and financial resources, which led to profiteering in several instances across the country income matrix. The IARC data also reveal striking inequities in the cancer burden, in line with the Human Development Index notably for breast cancer.

Perhaps it is one of the perversities of humanity that cancer research outcomes have delivered more in improving the survival rate and remission timeline of cancer patients through mini breakthroughs in drugs, no matter how cytotoxic; advanced intervention techniques through chemo-therapy, radio and immunotherapies; the use of generative AI and even multidimensional holograms that create pinpoint accurate diagnostic images of muscular-skeletal and other physiological systems and so on.

The IARC estimates that in 2022, 53.5 million people were alive within five years following a cancer diagnosis.

This is in contrast to the inadequate progress in mass screening, early detection and resource allocation which prioritises the disease instead of the functionality of merely meeting misplaced targets at any cost set by politicians, sometimes with the co-operation of clinical professionals.

Above all, there is a failure in effecting behavioural changes of people, and prevention of some cancers through a proven causal carcinogenic association with tobacco and alcohol abuse through minimum pricing and health warnings.

A report a few days ago by Cancer Research UK, one of the cohort organisations that has made the UK a world leader in cancer research, titled “Cancer in the UK: Overview 2024?”, warns that the progress made in beating cancer has slowed down in the past decade compared to previous ones, calling on the government to shift its policy away from treating ill health to prevention, and closing a £1 billion funding gap which has resulted in cancer services struggling to meet increasing demand for screening, diagnosis and treatment and patients subject to some of the worst waiting times on record.

The narrative is almost universal, given the criminal underinvestment in health systems over the past two decades, creeping privatisation driven by a near obsessive ideological proclivity towards private medicine, resource and operational inefficiencies and wastage, sporadic procurement profiteering and being held captive to the vagaries of the drug and the medical appliance pricing model of Big Pharma.

Most countries do not adequately finance priority cancer and palliative care services, as part of universal health coverage (UHC); the disproportionate impact on underserved populations, and the urgent need to address cancer inequities worldwide. The need for a new collaborative model centering on patients and not profit maximisation, on equitable access and win-win collaboration is imperative.

Not that the UHC, as the UK experience is showing with the National Health Servise, is a panacea to curing cancer. Affordability, economic and health policy governance, societal behaviour, prevention, drug pricing, collaborative messaging and research, clinical and allied staff education, training, wages and working conditions to pre-empt burnout are all equally pertinent.

If South Africa’s pending adoption of National Health Insurance is mismanaged it could undermine the ethos of a UHC paid for by the taxpayer and free at the point of delivery irrespective of wealth.

While in 2022, there were globally an estimated 20 million new cancer cases and 9.7 million deaths, the IARC predicted more than 35 million new cancer cases in 2050, a 77% increase from the 2022 estimate.

“The rapidly growing global cancer burden reflects both population ageing and growth, as well as changes to people’s exposure to risk factors, several of which are associated with socio-economic development. Tobacco, alcohol and obesity are key factors behind the increasing incidence of cancer, with air pollution still a key driver of environmental risk factors,” says the IARC. But the LMIC/HIC divide could not be starker.

The global WHO survey on UHC and cancer shows that only 39% of participating countries covered the basics of cancer management as part of their financed core health services for all citizens, “health benefit packages”.

Only 28% of participating countries additionally covered care for people who require palliative care, including pain relief in general, and not just linked to cancer. IARC’s Global Cancer Observatory, the mother of all cancer research data depositories, show that 10 types of cancer collectively comprise around two-thirds of new cases and deaths globally in 2022, covering 185 countries and 36 types of cancers.

Lung cancer was the most commonly occurring cancer worldwide, with 2.5 million new cases accounting for 12.4% of the total new cases; followed by female breast cancer with 2.3 million cases (11.6%); colorectal cancer with 1.9 million cases (9.6%), prostate cancer with 1.5 million cases (7.3%), and stomach cancer with 970 000 cases (4.9%).

Lung cancer accounted for 1.8 million deaths, 18.7% of the total cancer deaths; followed by colorectal, liver, female breast cancer and stomach cancer with much lower figures – probably related to persistent tobacco use, especially in Asia.

For men, lung, prostate and colorectal cancers were the most common for new cases and deaths, and for women breast, lung and colorectal cancers.

Cervical cancer, the most common cancer in 25 countries, especially in sub-Saharan Africa, was the eighth most commonly occurring cancer globally and the ninth leading cause of cancer death, accounting for 661 044 new cases and 348 186 deaths.

“Even while recognising varying incidence levels,” says the IARC, “cervical cancer can be eliminated as a public health problem, through the scale-up of the WHO Cervical Cancer Elimination Initiative”.

South Africa has an age standardised rate incidence of all cancers (male and female) of 203.4 per 100000 in 2022 compared to 307.8 for the UK and 367 for the US. The South African incidence is dominated by lung, breast, prostate and colorectal cancers. The ASR mortality is 122.5 per 100000 compared to 98.3 for the UK and 82.3 for the US. In absolute numbers, 8672 South Africans died of cancer in 2022 compared to 35394 in the UK and 127653 in the US.

* Parker is a writer in London

Cape Times