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More investment needed in radiotherapy and surgery

Many cancer deaths worldwide are preventable

Jo Carlowe

Tuesday, 29 September 2015

Millions of premature cancer deaths could be prevented by addressing the shortfall in radiotherapy and safe surgery.

This is the message given by international experts in two reports published in The Lancet Oncology, this week, both of which call for greater investment in these services, particularly in poorer countries.

The first report* reveals that up to nine out of 10 people in low income countries have no access to radiotherapy, while in less poor countries only 40% to 60% of cancer patients having access to this vital treatment. Even in high-income countries such as Canada, Australia and the UK, numbers of radiotherapy facilities, equipment and trained staff are described as “inadequate”.

Report author Professor Rifat Atun, from Harvard University in the US, highlighted a “widespread misconception” that the costs of providing radiotherapy put the treatment “beyond the reach of all but the richest countries”.

Atun said, “nothing could be further from the truth”. The authors estimate that all patients in need of radiotherapy in low-and middle income countries could be given access by 2035 for as little as US $97 billion, with potential health benefits of 27 million life years saved, and economic benefits ranging from US $278 billion to US $365 billion over the next 20 years.

The second report,** led by a UK-based team, estimated that while over 80% of the 15 million people diagnosed with cancer worldwide this year will need surgery, less than a quarter will have access to proper, safe, affordable surgical care when they need it.

Professor Richard Sullivan, of the Institute of Cancer Policy at King’s College London, explained: “With many competing health priorities and substantial financial constraints in many low- and middle-income countries, surgical services for cancer are given low priority within national cancer plans and are allocated few resources.”

He added: “Our new estimates suggest that less than one in 20 patients in low-income countries and only roughly one in five patients in middle-income countries can access even the most basic cancer surgery.”

Commenting, Emlyn Samuel, senior policy manager at Cancer Research UK, described surgery and radiotherapy as “cornerstones” of cancer treatment, providing patients with the best chance of a cure.

“These reports rightly identify the need for all countries to invest in these services to make sure their cancer patients can have the best possible treatment. But lack of availability of these treatments is not only an issue for low- and middle- income countries – many patients in the UK still miss out on the most advanced forms of radiotherapy and there is also evidence that older patients are less likely to have surgery. 

“The recent cancer strategy for England calls for improvements in these areas, particularly to modernise our radiotherapy service to have the best equipment and workforce to provide these treatments. It’s now crucial that the NHS invests in these services so that all patients have the best chance of surviving cancer.”

The proportion of the annual global cancer research and development budget that goes towards surgery is just 1.3%. In the UK, only 2.1% of research spending on cancer is allocated to surgery. 

Both papers were presented at the 2015 European Cancer Congress in Vienna, Austria.

* Prof Rifat Atun, et al. Expanding global access to radiotherapy. The Lancet Oncology, Volume 16, No. 10, p1153–1186, September 2015. DOI: 10.1016/S1470-2045(15)00222-3

** Prof Richard Sullivan, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. The Lancet Oncology, Volume 16, No. 11, p1193–1224, September 2015. DOI: 10.1016/S1470-2045(15)00223-5

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