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Accessibility and Availability of Medicines and Technologies

ESMO is working to improve the availability of anti-cancer medicines and technologies in Europe and worldwide

The availability of cancer medicines is crucial for medical oncologists to be able to treat patients according to the evidence-based ESMO Clinical Practice Guidelines.

ESMO has conducted several studies to understand the availability and accessibility of antineoplastic medicines, biomolecular technologies and opioids.

ESMO Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines

Open Peer Review

The preliminary survey data is open for peer review, after which feedback will be incorporated into the final manuscript for publication.  

If you are medical oncologists, clinical oncologists or pharmacists - in general someone who can provide reliable and meaningful information about access to medicines and are willing to participate in this open peer review process please click here. The deadline to submit your review is 3 September 2023


The survey aimed to collect data regarding the availability and accessibility of cancer medicines, including patient ‘out-of-pocket’ cost for the medication and factors adversely impacting availability – as well as gathering data so that policy makers can decide how to best address and resolve the challenges identified.

The ESMO studies showed that internationally there is a growing disparity between licensed anti-cancer medicines and those that are actually available, leading to medicines shortages.

Data from the ESMO studies has been valuable to the World Health Organization (WHO), who cited the studies as the most comprehensive assessment on the availability of cancer medicines globally in the 2018 WHO Technical Report on the pricing of cancer medicines and its impacts.

Read the publications below for more information on the results of the two ESMO studies and an analysis of the data collected:

ESMO acknowledges and thanks all coordinating, collaborating and supporting project partners for their valuable contribution to this project which made it such a great success.

ESMO is committed to ensuring the timely and optimal treatment of cancer patients, which includes the usage of biomolecular technologies.

These technologies, which include biomarkers, are extremely important in the treatment of patients with cancer, but there is very little data regarding their availability, use or costs and reimbursement, so ESMO conducted a study on this important topic in Europe.

This study is important because challenges to access to biomedical technologies limit patient access to targeted medicines. To advocate for increased access and availability to these technologies, we need sufficient data from this survey to facilitate a dialogue with health authorities. The study seeks to provide a comprehensive overview of availability of biomolecular technologies to patients, the status of their use and prescription, barriers to access, and potential economic issues related to cost and reimbursement.

The study was published in July 2023 in Annals of Oncology. The questions draw upon, among others, the Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers presented in a report from the ESMO Translational Research and Precision Medicine Working Group. This ESMO study was conducted under the auspices of the ESMO Global Policy Committee in collaboration with the Cancer Medicines Committee and the National Societies Committee.

ESMO acknowledges and thanks all coordinating, collaborating and supporting project partners for their valuable contribution to this project which made it such a great success.

The ESMO-led Global Opioid Policy Initiative (GOPI) project evaluated the barriers to the availability and accessibility of opioids recommending that policy reform is necessary worldwide to manage severe cancer pain and avoid unnecessary suffering by patients.

Within this project, ESMO and the European Association for Palliative Care (EAPC) conducted Consortium Studies in Europe and internationally on the availability of opioid analgesics for pain management using standards derived from the WHO and the International Narcotics Control Board (INCB).

The studies measured barriers and proposed recommendations to improve to access to opioids for legitimate medical use, including cancer pain.

They identified formulary deficiencies and excessive regulatory barriers which interfere with appropriate patient care in many countries. They revealed that urgent and intensive efforts to increase access to opioids for legitimate medical use are needed.

The survey results were used in ESMO policy initiatives to support the 2014 WHO Resolution on Palliative Care, where a joint statement by ESMO and other societies supported its successful adoption at the World Health Assembly.  

ESMO supported a successful international initiative to ensure that the 2016 Outcome Document of the United Nations General Assembly Special Session on the World Drug Problem contained recommendation to ensure access to controlled substances, such as opioids, for legitimate medical and scientific purposes, while preventing their diversion.

These WHO and UN resolutions need to be fully implemented because adequate pain relief is a major goal of supportive and palliative care, especially for cancer patients. The WHO factsheet on palliative care state that only around 14% of the almost 57 million people in need of palliative care each year actually receive it due to unnecessarily restrictive regulatory barriers.

Read the publications below for more information on the results of the two ESMO studies and the analysis of the data collected:

The international study is accompanied by summary infographics and infographics by geographical region.  A  10-point plan to reduce opioid access barriers proposes a solution for each barrier. It stresses the need for licensed physicians to have the required medical education, knowledge and skills to use opioid medications in the relief of cancer pain appropriately and safely as an integral part of high-quality healthcare. The plan recommends countries provide their citizens with at a minimum the palliative care medicines on the WHO Model List of Essential Medicines (See Section 2: Medicines for Pain and Palliative Care) for opioid formulary, which should include oral codeine, immediate-release morphine, controlled-release morphine tablets and injectable morphine.

To address the barriers and improve access and availability of opioids, united efforts between all stakeholders, including international organisations, authorities and regulators, is extremely important, and require particular focus on countries with the most severe restrictions.

ESMO acknowledges and thanks all coordinating, collaborating and supporting project partners for their valuable contribution to this project which made it such a great success.

Take action with the resources below

  • Read the patient stories of lack of availability of pain medicines leading to untold and unnecessary suffering worldwide.
  • Learn about the status of the availability of opioids in your country and region. Listen to the videos from across the globe
  • Download the infographics representing the study results.
  • Drive implementation of the 10-point plan to reduce opioid access barriers in your country, using the resources from the study which include summary information and infographics of the study results by geographical region, as well as links to editorials, advocacy materials, videos and much more.

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