{"id":2141,"date":"2014-12-29T10:33:50","date_gmt":"2014-12-29T10:33:50","guid":{"rendered":"http:\/\/touchoncology.com\/personalised-cancer-care-a-global-perspective\/"},"modified":"2014-12-29T10:33:50","modified_gmt":"2014-12-29T10:33:50","slug":"personalised-cancer-care-a-global-perspective","status":"publish","type":"post","link":"https:\/\/touchoncology.com\/supportive-cancer-care\/journal-articles\/personalised-cancer-care-a-global-perspective\/","title":{"rendered":"Personalised Cancer Care \u2013 A Global Perspective"},"content":{"rendered":"

There has been much discussion in the cancer community around socalled \u2018personalised medicine\u2019. Controversy exists over its definition and about the likely impact personalised medicines will have on patients of different settings, genetic backgrounds and resources. There are also different names proposed: personalised medicine, precision medicine, molecular medicine and targeted therapies are some of them, and the imprecise definition adds some confusion to the subject.<\/p>\n

We need to take into account different views according to the position of each player in the cancer care continuum: from the patient\u2013doctor relationship to the criteria of medical societies and, moreover, public health perspectives. Each one has diverse considerations and deserves a separate evaluation. <\/p>\n

Likewise, it is also relevant to reflect on different levels of analysis: from a global scale to regional or national guidelines and recommendations; from scientific societies\u2019 perspectives to a clinical level. In this editorial, the topic from a global public health perspective will be considered.<\/p>\n

We are not considering this subject as a controversy between science and economy, or an argument against the urgent need for more and better knowledge on the mechanisms and processes in the development of cancer. We consider that this is a discussion about the best possible and more rational use of existing resources for cancer care and control and an analysis for better strategies. We also present some reflections on how to strategise and implement the existing available knowledge (that today only applies to around 10 % of the world\u2019s population) to be applicable to a broader portion of the globe.<\/p>\n

Today, an individual\u2019s odds of surviving cancer is strongly correlated with where that person lives. Whereas in the US the 5-year survival rate for patients with breast cancer is 84 %, in the Gambia, breast cancer survival is just 12.5 %.1<\/sup> Interestingly, gains in survival have not always been due to very expensive treatments. Frequently, increased survival has been achieved by cancer treatments that are relatively low cost. On the other hand, the curability rate obtained with the new targeted therapies is low or non-existent.<\/p>\n

The European Society of Medical Oncology (ESMO) produced an editorial on the matter, defining personalised cancer medicine and making general considerations and recommendations on professionals\u2019 and patients\u2019 education.2<\/sup> <\/p>\n

Similarly, the American Society of Clinical Oncology (ASCO) President, Dr Peter Yu, stated:<\/p>\n

\u201cAlthough we have generated more effective therapies in the treatment of cancer through the knowledge we have gained in clinical trials, we have not always focused as much attention on how to apply that knowledge to individual patients to realize the goal of personalized medicine. I believe the best clinical results are achieved for each patient when the patient\u2019s personal values and goals are met. That is really what quality of care is all about: achieving outcomes that matter to patients.\u201d3 <\/sup><\/i><\/p>\n

The European parliament recently debated the matter of life-saving medicines and the excessively high pricing in certain member states. Speaking in the context of the debate, health spokesperson Michele Rivasi, who initiated the discussions, said: <\/p>\n

\u201cThe astronomical prices of some life-saving medicines is meaning those suffering from these illnesses are unable to afford their treatment. This is a scandal in itself but it is an even greater scandal that the European Commission is refusing to address the issue, notably by tackling the issue of monopolies and abuse of market position.\u201d4 <\/sup><\/i><\/p>\n

Cancer Drugs \u2013 Some Facts <\/b><\/p>\n

The 20 leading oncology brands generated global sales just shy of US$50 billion in 2012 with an overall expansion of US$63 billion by 2018.5<\/sup> The cost of cancer drugs has more than doubled in the past decade. Of the 12 cancer drugs approved in 2012 by the US Food and Drug Administration (FDA) for cancer, 11<\/sup> were priced at more than US$100,000 per patient per year.6 <\/sup><\/p>\n

Innovative cancer drugs are developed with public and private investment in cancer research. The pharmaceutical industry spends US$6.5\u20138 billion per year on cancer research, but public investment in cancer research (i.e. governmental and charitable) is at much lower levels and, frequently, research and development of cancer drugs is mainly driven by commercial considerations rather than by public health priorities.<\/p>\n

America\u2019s biopharma research companies are testing 771 medicines and vaccines to fight the many types of cancer affecting millions of patients worldwide. Approximately half of the investigational products in late-stage development are targeted therapies.7<\/sup><\/p>\n

The price of targeted therapies has been set very high, and as more targeted therapies enter the market and are used as long-term maintenance therapy, the overall cost of cancer care will increase significantly. Under the current circumstances, targeted therapies will become unaffordable for many countries, even for the most developed. <\/p>\n

<\/p>\n

World Health Organization Position <\/b><\/p>\n

The World Health Organization (WHO) estimates that nearly one-third of the world\u2019s population does not have access to full and effective treatment with the medicines they need \u2013 this rises to over 50 % in the most underprivileged parts of the world. Even in highly developed countries, access to some drugs and the best available therapy is not guaranteed for everyone.8<\/sup><\/p>\n

Cancer therapies represent one of the great \u2018missing links\u2019 in cancer control efforts in low- and middle-income countries (LMIC). Access barriers to cancer drugs are especially striking in light of the many research advances of recent years, which have significantly elevated the role of systemic therapy in the management of many priority cancers. There is little or no international funding for cancer treatment compared to the billions of dollars that are used for other health-related purposes. <\/p>\n

WHO has previously produced recommendations on the essential drugs required for cancer therapy, and over the last 5 years several new anticancer drugs have been aggressively marketed. Most of these are costly and produce only limited benefits.9<\/sup> <\/p>\n

WHO divided currently available anti-cancer drugs into three priority groups (curable, increased curability-adjuvant and prolong survival). Curable cancers and those cancers where the cost\u2013benefit ratio clearly favours drug treatment can be managed appropriately with regimens based on only 17 drugs. All of these are available, at relatively low cost, as generic preparations and the wide availability of these drugs should be the first priority, especially for LMIC.9<\/sup> <\/p>\n

Union for International Cancer Control Position <\/b><\/p>\n

Worldwide access to the best possible cancer treatment, care and support is a top UICC priority. To deliver on its vision of a world where cancer is eliminated as a major life-threatening disease for future generations, UICC is committed to participating in building collaboration and cooperation to address barriers in access to cancer drugs worldwide.10<\/sup><\/p>\n

Barriers to Access<\/p>\n

Drug costs:<\/i> The high price of patent-protected cancer drugs makes them unaffordable for many countries. Patent enforcement by pharmaceutical companies in underprivileged countries can also inhibit access. <\/p>\n

Insufficient public funding of health:<\/i> Governments in some countries do not provide reimbursement for essential cancer drugs. This means that patients have to pay for drugs themselves. <\/p>\n

Poor infrastructure: <\/i>Many countries lack the facilities necessary to enable complex cancer drug regimens to be administered safely and effectively.<\/p>\n

Irrational use of cancer drugs:<\/i> There is a dearth of adequately trained health professionals who are competent to prescribe and administer cancer drugs.In addition, many countries lack national evidence-based treatment guidelines for the rational selection of cancer drugs. <\/p>\n

Bureaucratic policies: <\/i>In many countries national opiate policies are too restrictive, which limits the availability of morphine and other painrelieving drugs. It is estimated that 80 % of cancer patients who suffer severe pain have no access to opiates.<\/p>\n

Counterfeit medicines:<\/i>In developed countries sales of counterfeit drugs represent less than 1 % of the pharmaceutical market. This rises to 10\u201330 % in parts of Asia and Latin America and up to 70 % in some African countries.<\/p>\n

Overcoming Barriers <\/b><\/p>\n