Franco Cavalli, 2013 ESMO Lifetime Achievement Awardee, commented the recently released 2014 World Cancer Report on advances in cancer research and control and shared his views on the bottom-line message of the report in an interview with the European Society for Medical Oncology (ESMO). “The 2014 World Cancer Report corresponds to the forecasts which were made years ago. What we can say is that those forecasts were correct and we are witnessing on a global scale an increase in the number of cancer cases and cancer deaths,” Cavalli said. “What is most important, however, is that although cancer incidence in developed nations is just increasing in proportion to the increase in life expectancy, it is dramatically rising in emerging countries, due to lack of early detection possibilities and a tremendous lack of therapeutic resources so that the outcome of most tumours is much worse,” Cavalli warned.
The outcome of patients with breast cancer in the developed and developing world is a good example: “While we are curing here at least 70% of the cases, in the developing world the cure rate for breast cancer is somewhere between 10 and 20%.”
“So it is important to repeat again and again the message that cancer rates are on the rise globally and something must be done soon!”
Public Opinion Can Make Cancer Control in the Developing World a Priority
Cavalli cited several reasons why cancer care in the developing regions has not been given priority, stressing that public opinion, which was the driving force behind confronting the AIDS epidemic, has not been focused on the plight of cancer patients in developing countries. “Many people, including healthcare professionals and the media, remain unaware of the stark rise in cancer incidence in these regions, making it crucial to repeat this message until the situation is adequately confronted.” He also cited the reluctance of governments to look to long-term solutions for the complex problem of cancer control, including having functional healthcare systems in place. “Without a healthcare system you cannot tackle the cancer problem and governments are scared to get involved in improving the healthcare structure on a worldwide scale,” he commented. “I think it is important that we demonstrate that a lot can be done in prevention, in early detection and in treatment of cancer,” he highlighted. “Let’s think in terms of paediatric oncology, for example, where it has been demonstrated that with very few resources you can dramatically improve the situation in the developing countries; this can help to fight against the nihilistic attitude towards the cancer problem in those regions.”
Effective and Affordable Cancer Therapy Must Be Provided
Cavalli, also former President of the International Union Against Cancer (UICC), called for the inception of a global fund similar to that already existing for AIDS, which could provide a basic package of cancer treatment to patients in developing countries. He underscored that much can be done even before such a fund is realised in the areas of cancer prevention, particularly if governments would act to enforce existing anti-tobacco legislation. “We know that about 40% of cancer can be prevented if we can avoid all of the risk factors that are known today,” he stated.
The need for efficacious but also affordable drugs was also emphasised by Cavalli who suggested putting in place a new paradigm to lower the cost of drug development: “I think it is important that oncologists realise, and many are realising, that we have the dramatic problem of the exploding costs of the new anti-cancer medicines.” The current business model for evaluating and launching new drugs is no longer sustainable: “We need new models in order to have efficacious treatment but not treatment that cost a fortune a year per patient, which is becoming impossible to finance, even for the richest countries.”
Cavalli underscored that cancer treatment encompasses far more than tending to the patients in the clinic and encouraged fellow oncologists to think globally: “We should not think only about the patients we will see today in our clinic, but we have to think of the millions of patients worldwide who desperately need better treatment, who need an affordable treatment. It is our duty to not just limit our engagement to offer treatment to our patients, we must think globally.”