On the occasion of World Cancer Day, The Economist Intelligence Unit (EIU) has published a new multi-pronged research program looking at global cancer survivorship. Providing integrated care to cancer survivors is becoming a global challenge for policymakers, employers and health care professionals as more and more people live with and beyond cancer. The research highlights that there are still significant gaps in the level of support to cancer survivors.
The number of people living with cancer is growing. This positive trend presents challenges for patients, health care systems, employers and policymakers, which are addressed in a new research program published by The EIU, Global cancer survivorship: the need for integrated care, commissioned by Bristol-Myers Squibb.
The EIU research highlights that cancer survival rates are improving across the globe. Forty years ago few people diagnosed with cancer could expect to live five years or longer after their diagnosis. Today, five-year survival rates exceed 50% in many high-income countries. For example, according to data from the US National Cancer Institute, a person diagnosed with cancer in the US had a less than 50% chance of surviving for five years in 1975; that probability had increased to nearly 70% by 2012. Coupled with an increase in incidence, this means that the number of people living with or beyond cancer is growing. This increase has given rise to concerns about the quality of survival.
The patients' perspective
Cancer survivors face significant challenges that extend far beyond the immediate physical impact of the disease and treatment. One in four people who complete primary treatment for cancer continue to experience long-term ill health and disability. Mental and emotional challenges include post-traumatic stress disorder, anxiety, fear of recurrence, survivor guilt and depression. Survivors also face concerns about workplace discrimination, highlighted by a global survey by The EIU of 500 employers in 20 countries in the Americas, Asia-Pacific, Europe, the Middle East and Africa on the subject of cancer in the workplace. The survey found that 44% of respondents were concerned about reintegrating cancer survivors into the workplace. Financial challenges can amplify these problems given the risk of financial hardship if treatment is not covered by insurance. There are also significant economic impacts beyond the immediate cost of treatment, such as difficulties to return to work full-time.
What can be done? The EIU research highlights the need for care pathways that map treatment, rehabilitation and aftercare (including survivorship plans) from start to finish. By recognizing patients as individuals, aftercare pathways can be adapted to suit each survivor’s level of autonomy. In the UK, for example, there are patient pathways for each type of cancer, used to identify patients at risk of specific consequences, as well as ongoing monitoring. Survivors also need assistance in their return to work, including for example workplace adjustments, option of work-at-home days and the advice of an occupational health provider. However, the EIU research highlights room for improvement in training of managers to support direct reports who are dealing with cancer.
The primary-care perspective
Primary-health care professionals face growing demands on their time and often lack the information and resources needed for integrated cancer care. There is often a lack of information on specific follow-up, centralized electronic medical records and co-ordination with tertiary institutions. Comprehensive assessment and management and care coordination is needed, but there are resource constraints. For example, the predominant fee-for-service payment model in the US means that primary-care practices often do not have financial incentives to provide integrated cancer care as it may cause additional costs for individual practices, even if these efforts generate savings for the overall health system.
To respond to these primary-care challenges, information flows from specialist facilities must improve (e.g. by sharing electronic medical records). Primary-health care professionals also need support and training (e.g. via task shifting and continuing professional education). Moreover, health-system financing will need to be restructured (e.g. through concerted efforts by policymakers, medical professionals, health insurers and patients).
The policymakers' perspective
Policymakers in many countries are only just beginning to address survivors' needs. Many policymakers are still unaware of just how many people are living with or beyond cancer as well as survivors’ physical, psychosocial and financial needs. As an example, the core self-assessment tool of the World Health Organization's National Cancer Control Programmes (NCCP) contains only the barest reference to aftercare. In Europe, the European Partnership for Action Against Cancer (EPAAC) has published a “European Guide for Quality National Cancer Control Programmes” in 2015. More and more countries are developing national cancer plans and cancer registries, but there are significant gaps, for example the need for integrated care pathways that cater for the entire cancer journey. Few countries provide holistic psycho-oncological and psychosocial care.
What can be done? Our research has identified three crucial determinants of policy on cancer care:
· How health care is financed;
· Culture and civil society involvement (patient advocacy); and
· Evidence-based research, data collection and dissemination.
Even sophisticated health care systems such as Switzerland's, for example, face major challenges with providing integrated cancer care. Switzerland's federal system complicates the development of national plans, while its current financing models do not yet create the right incentive for integrated, multidisciplinary cancer care. There is also a lack of strong patient advocacy.
By contrast, in the UK, for example, a National Cancer Survivorship Initiative (NCSI) and the Cancer Strategy of the National Health Service (NHS) were developed by the government in cooperation with patient advocacy groups, notably Macmillan Cancer Support. Moreover, the reimbursement system (a single payer) has facilitated the integration of care, while extensive research and pilot projects have been conducted. There is also strong civil society support.
Rising urgency
World Cancer Day 2017 has provided a great opportunity to reflect on what can be done to fight cancer and support those living with and beyond cancer. But the fight continues. The EIU research on global cancer survivorship has highlighted the rising urgency to focus on the quality of survival as more and more people live with cancer longer. Cancer survivors face significant challenges that extend far beyond the immediate physical impact of the disease and treatment. Primary-health care professionals face growing demands on their time and training needs and often lack the information for specialist aftercare. And policymakers are for the most part only just beginning to address these needs.
For additional reading the EIU content hub on Global cancer survivorship: the need for integrated care consists of a series of compelling, interconnected research elements on the need for integrated cancer care, including an overview of cancer survivorship, articles on providing integrated care to cancer survivors (from the point of view of cancer survivors, health care professionals and policymakers), a global survey of employers on cancer in the workplace and an associated briefing paper (with ten in-depth interviews with cancer experts) and infographic, and several What If scenarios on the future of cancer care. Additional content, including six country profiles on cancer care across the world, will be added to the EIU content hub at http://cancersurvivorship.eiu.com/ in 2017.