Revolutionary new cancer treatments are being tested. But to help people everywhere we will need to also revolutionize health care access.
A scientist introduces liquid into a test tube at a laboratory in Bilbao, Spain on 23 May 2022. The biopharmaceutical company Oncomatryx tested a new drug that would target the microenvironment of a metastic tumor. (Europa Press via AP)
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For some years now, astonishing breakthroughs have been taking place in the realm of cancer treatment. Innovative gene therapies, targeted therapy and immunotherapies have revolutionized whole branches of oncology.
On the website where I serve as blood cancer editor, which is read mostly by physicians, even subscribers have trouble keeping up with the breakneck pace of developments.
Ever since I started covering hematology/oncology I’ve been struck by how many acquaintances, friends, loved ones and bold-face names have been diagnosed with cancer. In late 2022, U.S. Congressman Jamie Raskin announced he had been diagnosed with lymphoma. In June of 2023, former Italian Prime Minister Silvio Berlusconi succumbed to a severe form of leukemia.
Around the time I took this job in 2021, a close friend of mine died from lymphoma caused by exposure to toxins while he served as a U.S. naval “chemicals specialist” on Johnston Atoll during the Vietnam War. My son was diagnosed at age 35 with multiple myeloma, a cancer linked to toxic exposure related to the 9/11 terrorist attacks. This was just a few months after his first child was born.
These last cases hit close to home. But fast-paced developments in cancer research and treatment promise to help not only people close to us, but those diagnosed with cancer across the globe.
Curing cancer across the globe
Many of these new approaches look at the way cancers attack the body instead of focusing on the different organs attacked, such as the colon, breasts, pancreas, lungs, etc. They reflect a new way of addressing cancer treatment.
“In a way, we are moving away from anatomical sites defining cancer to a biology of disease,” said Dr. Kashyap Patel, a prominent oncologist and the immediate past president of the Community Oncology Alliance, a Washington, D.C.-based nonprofit, and CEO of Carolina Blood and Cancer Care Associates.
But researchers and doctors who specialize in cancer are also thinking differently about how treatments are administered across the world and across social and economic demographics. Under current health care systems, not everyone benefits equally from the rapid pace of developments.
According to the American Cancer Society, U.S. cancer mortality rate fell about 33% from 1991 to 2019 and is now declining by roughly 2% a year. But that success isn’t found across demographics in the United States or in other regions of the world.
“The immense progress against cancer has not been shared equally by all segments of the population,” Patel said. “Despite ranking among the top six wealthiest economies in the world per capita, the United States has sizable health disparities among its citizens that are rooted in racial, social, economic and environmental factors.”
Closing the health care equity gap
Citing findings from the American Association for Cancer Research, Patel pointed out that disparities in cancer health in the United States account for nearly 34% of preventable deaths and are estimated to result in an additional $230 billion in healthcare spending.
“There is a 15-year difference in life expectancy between the most advantaged and disadvantaged citizens in the U.S.,” Patel said, adding that this difference correlates with social determinants of health, the non-medical factors that influence health outcomes.
If equitable access to effective new treatments remains out of reach for so many in the United States, how will these new therapies become available to cancer patients in what the World Health Organization (WHO) calls “low- to middle-income nations”?
Glossary of terms
Gene therapy: A medical technique that modifies a person’s genes to treat or cure disease.
Lymphoma: A cancer that starts in cells that are part of the body’s immune system.
Social determinants of health: The non-medical factors that influence health outcomes.
Globally, cancer causes one in every six deaths, placing the “emperor of all maladies” at No. 2 on the list of most common killers, according to the WHO. While the U.S. cancer death rate is falling, researchers at New York’s prestigious Memorial Sloan Kettering Cancer Center expect that by 2030, about 75% of cancer deaths worldwide will occur in low- to middle-income nations — due to such factors as growing urbanization, longer life expectancy and population growth.
Finding cures for health care inequity
Like many of the world’s leading cancer hospital systems, Sloan Kettering operates its own program to address inequities in the global healthcare system. Established in 2011, it aims to reduce cancer deaths in these low- and middle-income countries, and specifically in sub-Saharan Africa.
The University of Texas’s renowned MD Anderson Cancer Center recently announced the expansion of its oncology initiatives in Brazil and Mozambique, begun in 2014.
In April, a hugely ambitious new global movement called Common Sense Oncology was launched by Charles Booth and Bishal Gyawali, mid-career oncologists at Queen’s University in Ontario, Canada.
They brought together 30 specialists and patient advocates in Ontario to consider ways to bring more clarity, parity and common sense to cancer care worldwide.
Participants hailed from 15 nations across six continents: Canada, the United States, Mexico, Brazil, Italy, the Netherlands, the U.K., Israel, Ghana, Rwanda, India, Japan, Nepal, Australia and New Zealand.
A world of health care for all
Common Sense Oncology aims to refocus the attention of the cancer community on patient-centric treatments that extend lives while also improving quality of life. It envisions a world in which patients have access to cancer treatments that can improve both their chance of survival and quality of life regardless of where they live.
“We’re not proposing we have all the answers or that we know what every patient would want,” Booth said. “We’re saying we’ve not done a good job of communicating to patients and relatives benefits and risks of different treatments. We want to celebrate and promote what helps and speak out about what’s not in the best interest of patients.”
Patel, meanwhile, helped establish No One Left Alone, a nonprofit organization that works to eliminate health care disparities and increase access to health care.
“Solutions for disparities and healthcare inequities would stem from local actions,” Patel said. The risk of communicable diseases and cancer can be reduced by addressing the social determinants of health such as food, environment, housing, water and sanitation, and by increasing access to disease prevention and other services alone, especially if done at the local level, he said.
Communities need to build healthcare “eco-systems” in which all stakeholders come together to create accessible and effective healthcare delivery, he said.
“The fundamental challenge in addressing these disparities is a compartmentalized healthcare delivery system,” Patel said.