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Uyl-de Groot C.A.,Erasmus University Rotterdam | de Vries E.G.E.,University of Groningen | Verweij J.,Netherlands Cancer Institute | Sullivan R.,Institute of Cancer Policy
Journal of Cancer Policy | Year: 2014

The costs of cancer care grow exponentially. It has been argued that there is a linear relation between costs and outcome: the more a country spends on cancer care, the better the outcome. We try to dispel this myth, by showing that the relation is not linear at all and by describing other factors in the cancer care delivery process that have an impact on outcome.We show that there is a correlation between health care expenditure and life expectancy at birth, but that there is no correlation between number of deaths per 100,000 and cost per person spent on cancer in general, neither in lung, breast, colorectal and prostate cancer. Furthermore, a decrease in survival can be related to accessibility, affordability or equity issues, but also to factors such as life style. In the real world the process of cancer delivery is complex and dynamic, with many (potential) innovations. When efficacy is proven and an innovation is considered clinically relevant, the innovation has to be incorporated in evidence based clinical guidelines. However, implementation in such a guideline is still no guarantee for optimal adoption and diffusion of an innovation.Cancer care delivery also goes beyond matters related to health-systems and cancer costs, new technologies, reimbursement agencies, hospitals, and health-care professionals by increasingly involving shared decision making. An optimal process of cancer care delivery consists of the use of new and existing diagnostic tests and treatment strategies of high quality and is effective, safe, patient centred, efficient and timely. Such health system is highly recommended and all stakeholders in society will benefit. © 2014 The Authors.


Ades F.,Free University of Colombia | Senterre C.,Free University of Colombia | de Azambuja E.,Free University of Colombia | Sullivan R.,Institute of Cancer Policy | And 3 more authors.
Annals of Oncology | Year: 2013

Background: The European Union (EU) is a confederation of 27 member states, the institutions of which work according to negotiated decisions. The EU has implemented similar legislation and a common market, and has adopted the same currency in most of its member states. Although financing health systems is a responsibility of the national governments, the EU has enacted the Charter of Fundamental Rights to standardize public health policies. However, for historical reasons, health policy and health expenditure is not uniform across the 27 EU member states (EU-27). Material and methods: We hypothesized that increased health expenditure would be associated with better cancer outcome and that this would be most apparent in breast cancer, because of the availability of effective screening methods and treatments. Using publically available data from the World Health Organization, the International Monetary Fund, and the World Bank, we assessed associations between cancer indicators and wealth and health indicators. To do so, we constructed scatter plots and used the Spearman's rank correlation coefficient. Results: A marked difference in wealth and health expenditure indicators was observed between Eastern and Western European countries, with Western European being the higher. Higher wealth and higher health expenditures were associated both with increased cancer incidence and decreased cancer mortality. In breast cancer, the association with incidence was stronger. We created mortality/incidence ratios and observed that the more spent on health, the fewer the deaths after a cancer diagnosis. Conclusion: Despite the initiatives to standardize public health policies of the EU-27, health expenditure continues to be higher in Western European countries and this is associated with better cancer outcome in these countries. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology All rights reserved.


Autier P.,Strathclyde Institute of Global Public Health at IPRI | Autier P.,International Prevention Research Institute IPRI | Boniol M.,Strathclyde Institute of Global Public Health at IPRI | Boniol M.,International Prevention Research Institute IPRI | And 4 more authors.
PLoS ONE | Year: 2016

Background The role of breast screening in breast cancer mortality declines is debated. Screening impacts cancer mortality through decreasing the number of advanced cancers with poor diagnosis, while cancer treatment works through decreasing the case-fatality rate. Hence, reductions in cancer death rates thanks to screening should directly reflect reductions in advanced cancer rates. We verified whether in breast screening trials, the observed reductions in the risk of breast cancer death could be predicted from reductions of advanced breast cancer rates. Patients and Methods The Greater New York Health Insurance Plan trial (HIP) is the only breast screening trial that reported stage-specific cancer fatality for the screening and for the control group separately. The Swedish Two-County trial (TCT)) reported size-specific fatalities for cancer patients in both screening and control groups.We computed predicted numbers of breast cancer deaths, from which we calculated predicted relative risks (RR) and (95% confidence intervals). The Age trial in England performed its own calculations of predicted relative risk. Results The observed and predicted RR of breast cancer death were 0.72 (0.56-0.94) and 0.98 (0.77-1.24) in the HIP trial, and 0.79 (0.78-1.01) and 0.90 (0.80-1.01) in the Age trial. In the TCT, the observed RR was 0.73 (0.62-0.87), while the predicted RR was 0.89 (0.75-1.05) if overdiagnosis was assumed to be negligible and 0.83 (0.70-0.97) if extra cancers were excluded. Conclusions In breast screening trials, factors other than screening have contributed to reductions in the risk of breast cancer death most probably by reducing the fatality of advanced cancers in screening groups. These factors were the better management of breast cancer patients and the underreporting of breast cancer as the underlying cause of death. Breast screening trials should publish stage-specific fatalities observed in each group. © 2016 Autier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Sullivan R.,Institute of Cancer Policy | Sullivan R.,Kings College London | Alatise O.I.,Obafemi Awolowo University | Anderson B.O.,University of Washington | And 48 more authors.
The Lancet Oncology | Year: 2015

Surgery is essential for global cancer care in all resource settings. Of the 15·2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US$6·2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery-eg, pathology and imaging-are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning. © 2015 Elsevier Ltd.


Mallath M.K.,Tata Medical Center | Taylor D.G.,University College London | Badwe R.A.,Tata Memorial Center | Rath G.K.,All India Institute of Medical Sciences | And 20 more authors.
The Lancet Oncology | Year: 2014

Cancer can have profound social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1·2 billion. In age-adjusted terms this represents a combined male and female incidence of about a quarter of that recorded in western Europe. However, an estimated 600 000-700 000 deaths in India were caused by cancer in 2012. In age-standardised terms this figure is close to the mortality burden seen in high-income countries. Such figures are partly indicative of low rates of early-stage detection and poor treatment outcomes. Many cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Social factors, especially inequalities, are major determinants of India's cancer burden, with poorer people more likely to die from cancer before the age of 70 years than those who are more affluent. In this first of three papers, we examine the complex epidemiology of cancer, the future burden, and the dominant sociopolitical themes relating to cancer in India. © 2014 Elsevier Ltd.

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