High-Income Nations Lead, Others Lag in Cancer Care Equity

Patients in high-income countries generally have access to innovative and effective cancer treatment. However, in almost half of low- and middle-income countries, cancer drugs considered essential by the World Health Organization (WHO) remain unavailable or unaffordable for many patients, according to new findings from the European Society of Medical Oncology (ESMO).

These findings come from a survey conducted by ESMO experts, evaluating the availability, cost, and accessibility of anticancer drugs. The results were published in the journal Annals of Oncology.

This survey builds on ESMO’s first survey conducted in 2016, which revealed significant inequities in access to cancer treatments. The ongoing work is part of the ESMO Cancer Medicines Committee’s mission “to fulfill the ESMO vision to promote equitable access to clinically important cancer medicines,” the authors wrote.

The WHO Essential Medicines List (EML), which is updated every 2 years, includes treatments considered essential for addressing global health needs. The 23rd edition was released in 2023, with further updates in 2025.

Disparities in Access

In an interview with Univadis Italy, a Medscape Network platform, Dario Trapani, MD, from the European Institute of Oncology and the University of Milan, Milan, Italy, emphasized the importance of understanding the current state of access to cancer care. He explained, “The premise for formulating global strategies for cancer control is to describe the current state of access to care and the status quo for economists and policymakers. This status quo allows us to understand ‘where we start,’ defining an access benchmark on which to build data-driven strategies guided by the information available today.”

Trapani noted that there are no other studies on this topic besides ESMO’s work, which is crucial for global health planning, regional oncology strategies, and national cancer control agendas. Public health institutions globally rely on ESMO’s findings for research, economic modelling, and strategies to improve access to cancer treatment. For instance, ESMO’s data have been a useful resource for the WHO, particularly for the report Pricing of Cancer Medicines and Its Impacts, which serves as a global reference for evaluating access to cancer treatments by public health agencies.

Global Perspective

The recent ESMO study analyzed data collected through an online survey to assess the availability, patient costs, and accessibility of essential generic oncology medicines. These include treatments listed in the 22nd WHO EML and medicines used for eight high-incidence cancers. The study involved contributions from 317 participants, including medical oncologists, pharmacists, and regulatory officials from 126 countries, and was reviewed by 231 peer reviewers.

The findings reveal significant disparities between countries, particularly between high-income and low-income nations.

For instance, most chemotherapy and hormonal therapies included in the 22nd WHO EML are widely available and generally reimbursed, either partially or fully, in high-income and upper-middle-income countries. In contrast, these treatments can be expensive for patients in low- and lower-middle-income countries, where they may be poorly accessible or entirely unavailable.

These discrepancies are even wider for newer and expensive immunomodulatory or molecularly targeted treatments, such as trastuzumab for breast cancer; erlotinib, gefitinib, and afatinib for non–small cell lung cancer; and nivolumab and pembrolizumab for melanoma.

What Has Changed?

Compared with data from ESMO’s previous survey, progress has been observed, but the path to achieve true equity remains long and complex. Progress has been observed in access to chemotherapy and hormonal therapies, particularly in some upper-middle-income countries, such as Argentina, Brazil, China, Kazakhstan, and Turkey. The nations have made substantial improvements in expanding reimbursement and coverage for high-value, innovative drugs.

“The progress has occurred thanks to an increasing global awareness of cancer as a significant public health issue,” Trapani noted. He also explained that the COVID-19 pandemic has significantly affected cancer care at all levels.

“The progress we observe must be evaluated in the context of a survey that describes the world after the COVID-19 pandemic, still affected by the preexisting oncological ‘pandemic,’” he said.

Shared Commitment

Countries that have adopted effective cancer strategies prioritize on improving the quality and outcomes of healthcare and increasing funding for cancer treatment. Kazakhstan is particularly noteworthy for its commitment to investing in universal public healthcare. “It is no coincidence that one of the normative documents with the greatest impact on public healthcare developed by the WHO is called the Astana Declaration, which represents a global commitment to healthcare for all,” Trapani emphasized, highlighting ESMO’s role in the changes observed in Kazakhstan.

To change the current scenario, we must work as a community, pursue shared values and objectives, and design health policies that prioritize therapeutic value and universal healthcare.

“Healthcare for all” does not mean providing “a bit of everything,” Trapani explained. “The strategy for access to cancer treatments must develop through progressive trajectories, based on the value of drugs but also on the sustainability of therapies, declining its formulation based on the capacity of health systems to accommodate new therapeutic strategies according to their complexity and impact,” Trapani explained.

This story was translated, with slight adaptation, fromUnivadis Italy using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.