Two years ago, the World Health Organisation (WHO) invited the Society to assist in the evaluation of Kazakhstan’s cancer treatment protocols and medicines, which has led today to the improvement of cancer care services in the Asian country.
Health is a human right, not a privilege (Universal Declaration of Human Rights). However, today over 800 million people spend at least 10% of their household budget to pay for healthcare and at least half of the world’s population still do not have access to essential health services (WHO fact sheet) 12 December celebrates the International Universal Health Coverage (UHC) Day, calling for equitable access to quality healthcare services for every person while protecting them from financial hardship.
As the goal of healthcare is to improve quality of life in the population, people should not be pushed into poverty due to high out-of-pocket medical care costs, with potential heavy consequences on their vulnerability. The UN Sustainable Development Goals (SGDs) adopted in 2015 set as overarching goal the achievement by 2030 of Universal Health Coverage that provides people with effective and affordable healthcare services. Achieving UHC is not all about budgets, but also requires the availability, accessibility and capacity of a specialised health workforce to deliver patient-centred integrated care.
Sustainable cancer care is a key pillar of the ESMO Vision 2020, and ESMO is proud to support WHO projects that can facilitate UHC and the inclusion of quality cancer services in national UHC health benefit packages, which are still lacking in many countries
“UHC affects our everyday work as medical oncologists and our ability to offer the best possible care to our patients", says ESMO President Prof. Josep Tabernero. "ESMO is committed to developing resources to support governments, oncologists and decision-makers to prioritise high-impact investments in cancer care as well as guide evidence-based clinical practice and education. No cancer patient should be left behind without access to affordable quality cancer and palliative care services.”
ESMO tools that support sustainable cancer care
Actions speak louder than words. Whereas UHC is primarily a responsibility of governments, which organize and deliver health services and medical care to citizens, much can be done by healthcare stakeholders for the development of pragmatic tools to support the translation of what is a global political goal into practice at national and regional levels. ESMO has raised awareness at UN and WHO meetings about ESMO tools and resources that can provide tangible solutions that can support countries in the achievement of sustainable cancer care.
“Over the past years, ESMO has developed pragmatic tools that can be used by every country to make progress toward UHC and the inclusion of cancer services in national UHC packages,” highlights Dr Rosa Giuliani, Clatterbridge Cancer Centre, UK, recently appointed as ESMO Public Policy Director (2020-2021). “One tool is the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) that supports clinicians and governments on how to prioritise cancer treatments. Also, the evidence-based ESMO Clinical Practice Guidelines and the derivative Pan-Asian Adapted ESMO Guidelines aim to understand the best pathways of care for patients and provide guidance in clinical practice.”
Chances of receiving appropriate and quality treatment also depend on access to well-trained professionals. In this regard, the ESMO-ASCO Global Curriculum in Medical Oncology outlines the training requirements for medical oncologists worldwide. Giuliani concludes, “ESMO has also run many discussions on how to promote access to cancer medicines, whether they are expensive or inexpensive.”
Responding to ever-growing cancer needs: the achievements of Kazakhstan
The issue of access to optimal cancer care is not only restricted to low-income countries where resources are limited. As the needs of cancer patients and the costs for each patient’s cancer treatment keep rising, all governments, even those where healthcare systems have traditionally been accessible and affordable need to address the critical challenge of more sustainable cancer care services.
In Kazakhstan cancer care is completely free for its citizens. Since the country has a longstanding commitment to UHC, the Kazakhstan Ministry of Health engaged in close collaboration with the WHO and IARC in December 2016, with the aim to continue to offer patients access to the best possible quality of cancer care. “The WHO ImPACT mission, which analysed the healthcare services in our country, resulted in a set of recommendations on how to improve and implement cancer screening programmes, clinical protocols and provide educational opportunities for our oncologists,” explains Dr Dilyara Kaidarova, Director of the Kazakh Research Institute of Oncology & Radiology, who is leading the project for Kazakhstan and interacting with international partner organizations.
ESMO was invited by the WHO to assist in the evaluation of the country’s cancer treatment protocols and medicines. Over 200 cancer treatment protocols and 85 medicines in 14 settings for solid tumors, as well as 100 protocols and 62 cancer medicines in 5 settings for hematological malignancies were reviewed using the 2017 WHO Model List of Essential Medicines (EML), the European Medicines Agency’s medicine availability indications, the ESMO Clinical Practice Guidelines, the ESMO-MCBS and expert review of cancer medicines not on the 2017 WHO EML.
The backbone of the new Kazakhstan’s National Cancer Control Plan 2018-2022 stemmed from the collaborative work with WHO and ESMO, and now includes three instead of six evidence-based cancer screening programmes, with more effective outcomes and reduced healthcare expenditure. “Twenty years ago, we had only about five anti-cancer medicines in our hospitals, while nowadays our patients have access to 26 new targeted medicines included in treatment protocols,” comments Kaidarova. The joint Kazakhstan-WHO-ESMO project helped to optimise resource allocation in the country, with an overall increase of the cancer budget to ensure that all essential and effective cancer treatments can be offered free of charge to cancer patients. Today, 19 new targeted medicines – including the most expensive ones - are included in the national list of essential medicines and reimbursed by the Kazakhstan government. “The improvement of cancer care services allows to increase screening coverage in breast and cervical cancer from 60% to 90% and population coverage for cancer treatment up to 88.65% in the country. Also, we start molecular-genetic testing for lung cancer and include new target options to personalise patients treatment (National Cancer Control Plan 2018-2022, Kazakhstan),” concludes Kaidarova. “I am very proud that I can now tell my patients that they can have access to many options of care and I can do much more for them than in the past.”