ESMO Asia 2015 Highlights: For Clinicians It’s Time to Come ‘Out of the Cave’

Cancer is a serious disease that is even more terrible when you are poor or socially underprivileged, says Christoph Zielinski

Oncologists worldwide have stared at rising costs of drugs used for the treatment of cancer for more than a decade. Many concepts have been put forth on how these costs could be approached and controlled. All of these considerations fell short, however, by failing to include other aspects linked to cancer, since problems of not only high drug costs, but also of cancer posing a social challenge have to be considered.

In fact, cancer is not only ‘just’ a disease which generates high costs of treatment. It is also linked to morbidity resulting from treatment side-effects, evolvement of the underlying disease resulting in the inability to follow basic tasks of daily life requiring support by the immediate surroundings, and even terminally severe restrictions in work abilities. Some or many of these aspects can be neutralised by appropriate social programmes, albeit lots of problems remain or become only slightly alleviated by even the best social systems. Thus, we as clinicians are confronted in cancer with something similar to Plato’s Allegory of the Cave --one of the best-known, most insightful attempts to explain the nature of reality, interpreting shadows as the real world.

In the ancient Greek philosopher’s book, the semi-darkness of the cave represents the state of most human beings, whose perception of reality is anchored to seeing shadows on the cave’s walls. The tale of a dramatic exit from the cave is the source of true understanding: those who escape the twisted truth of the cave can understand what reality is and it is their duty to help others embrace the same challenge.

These considerations are under a magnifying glass when reading the study presented by Dr Bhoo-Pathy from Kuala Lumpur who undertook the huge and remarkable task of analysing the medical, financial and social fate of 9513 patients from 47 hospitals located in 8 countries of the Association of Southeast Asian Nations (ASEAN). Results point to a massive problem on the personal and social level in patients with cancer: one year after diagnosis, 29% of patients had died, 48% had experienced a financial catastrophe and 5% were pushed into poverty, with only 23% of patients being alive without such heavy financial consequences. Interestingly, and supporting the assumptions and considerations put forth above, cancer stage rather than therapy was responsible for the so-called ‘financial catastrophe’.

ASEAN is population-wise (8% of world population) and area-wise (1% of world area) comparable to the European Union (EU). However, the similarities end here, as ASEAN countries have a completely different social insurance and security structure, compared to the EU. Although economic growth is impressive, individual income structures are quite restricted, as Bhoo-Pathy points out. This reminds us of structural problems in countries of Europe and the EU, which suffer from financial restrictions. Thus, we arrive to an important insight: cancer is a terrible disease, but it is even more terrible when patients are poor or socially underprivileged, with cancer treatment costs constituting only a portion of the problem.

Thus, the Allegory of the Cave applies also to cancer with many aspects of our judgements depending on where the cave is. It is high time to recognise that shadows do not reflect reality in our fight against this disease in a worldwide patient population. ESMO has very much accepted this challenge when addressing worldwide issues related to oncology.


Presidential Symposium, 20 December, 16:30 to 18:00, Hall 406

Abstract 52O Prioritizing strategies to address the economic impact of cancer in Southeast Asia