The healthcare burden of cancer is growing in low and middle-income countries. How do we ensure that doctors are equipped with the right tools to serve patients from diagnosis to treatment?
As low and middle-income countries battle neonatal and infectious diseases, the burden of cancer is also growing in these regions. In 2016, out of 9 million cancer deaths worldwide, 70% of them occurred in low and middle-income countries. This is largely driven by the lack of access to timely diagnosis and treatment.
The World Health Organisation’s Essential Diagnostics List (EDL), Essential Medications List (EML) and List of Priority Medical Devices for Cancer Management help to somewhat improve the situation.
These published lists contain both cancer and non-cancer related medical products that should be widely available and affordable to meet the most important needs of a healthcare system. Many LMICs such as India use the WHO EML and EDL as pragmatic guides for procurement, although each country tailors its strategy to individual medical needs and available budget.
However, cancer is often a complex disease that requires a cohesive set of tools for diagnosis and treatment. To effectively tackle the scourge, experts matched the 3 WHO lists and checked that together, they would contain the appropriate tools to serve patients from diagnosis to treatment.
The full results of their work can be found in 2020 Journal of Clinical Oncology commentary titled “Harmonization of the Essentials: Matching Diagnostics to Treatments for Global Oncology”
The publication provides a strategic roadmap to procure medicines based on available pathology services, and inversely acts as a roadmap for procuring reagents and equipment on the basis of available therapeutics. Policymakers can use it to consider the entire care pathway and make cohesive procurement decisions.
In particular, experts found that the EML contained medicines that could treat a number of tumours that were not listed such as gastric, esophageal, anal, pancreatic tumours. Given these unlisted tumours, the authors also suggested additional diagnostic tools be made available, including immunohistochemical (IHC) stains for parsing a differential diagnosis (depending upon the population epidemiology) and therapeutic IHC stains for immuno-oncology agents.
It is not yet clear if the WHO would take these suggestions for harmonization into consideration in its next update. However, what is clear, as the publication suggests, is the need to expand these lists in a harmonized fashion, which should, in turn, make the best use of limited resources and provide patients with the best chance of survival.