Global investment in cancer radiotherapy and surgery 'urgently needed'

In collaboration with the Press Association

Millions of premature deaths from potentially treatable cancers could be prevented by addressing a global shortfall in radiotherapy and safe surgery, according to two teams of international experts. 

"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" - Emlyn Samuel, Cancer Research UK

Two reports, both published today in The Lancet Oncology, call for greater investment in these services, particularly in poorer countries. 

According to the first report, up to nine out of 10 people in poorer countries have no access to radiotherapy. 

But the researchers say the availability issue isn’t limited to poorer countries, with only 40 to 60 per cent 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, however, that “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.

Meanwhile, the second report, led by a UK-based team, estimated that while over 80 per cent 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, based at the Institute of Cancer Policy at King’s College London, said that financial constraints can often result in surgery being made a “low priority”.

“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 said.

“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,” he added.

Commenting on the reports, Emlyn Samuel, senior policy manager at Cancer Research UK, said that surgery and radiotherapy were “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 reports suggest that up to 60 per cent of all cancer patients will require radiotherapy at some point, while more than 80 per cent of all cancers require some type of surgery, in many cases multiple times, according to data in the reports.

The problem of access to radiotherapy is most acute in Africa, where 40 countries have no radiotherapy facilities at all.

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

Yet the demand for cancer surgery is growing as many of the worst-affected countries face rising cancer rates. It is estimated that 17 million of the 22 million new cancer patients will need operations by 2030, with 10 million in low- and middle- income countries .

In sub-Saharan Africa and Asia, for instance, the need for cancer surgery is projected to increase by around 60 per cent.

Authors of the first report estimate access to radiotherapy could be increased to an acceptable level across all low- and middle- income countries by 2035 with an investment of US $184 billion, or with efficiency improvements at a cost of US $97 billion. 

Those of the second cite a serious shortfall of cancer surgeons in more than eight in 10 countries. They want to see radical action to train surgeons to deliver basic cancer surgery, and to produce more gynaecological and surgical oncologists. 

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

References

  • Atun, R., et al. (2015). Expanding global access to radiotherapy The Lancet Oncology, 16 (10), 1153-1186 DOI: 10.1016/S1470-2045(15)00222-3
  • Sullivan, R., et al. (2015). Global cancer surgery: delivering safe, affordable, and timely cancer surgery The Lancet Oncology: 10.1016/S1470-2045(15)00223-5