Around the world governments and researchers are embracing audacious goals to reduce deaths resulting from cancer, with an increased confidence humanity’s 5000 year fight against cancer may just be achievable.
In Australia the Cancer Council has argued for a focused plan that leverages the work of recent governments in screening, anti-smoking measures, skin cancer awareness, drug availability and research will prevent at least 130,000 cancer deaths above current projections and prevent many thousands more cancer cases. In fiscal terms the council says this would generate economic returns in excess of $3 billion.
A global battle
In the US, former president Obama established the Cancer Moonshot project. The Blue Ribbon panel of experts came up with 10 transformative research recommendations for achieving the moonshot’s ambitious goal of making a decade’s worth of progress in cancer prevention, diagnosis, and treatment in just five years.
One of the American recommendations includes a major focus on data analytics and the building of a national ecosystem for sharing and analysing cancer data. This echoes similar moves in Australia, where a major consultation is now considering the protocols around secondary use of data in the My Health Record system for research, policy planning, system use, quality improvement and evaluation activities.
The most optimistic prognosis has come from the UK, where a 2015 report Overcoming Cancer in the 21st Century by researchers from Kings College and University College of London concluded: “It is realistic to expect that by 2050 nearly all cancer related deaths in children and adults aged up to (say) 80 years will have become preventable through life style changes and because of the availability of protective technologies and better pharmaceutical and other therapies.”
According to UCL Emeritus Professor of Pharmaceutical and Public health policy David Taylor, “What makes this a special point in history is that cancers are in the process of becoming either preventable or effectively curable.”
The report, which was funded by the Boots UK pharmacy group, argued that while cancer is responsible for around a quarter of all deaths, the cost of cancer treatment was about 7% of all healthcare spending in the UK. The report noted drug treatments typically represent about a fifth of the total cost of cancer care, which translates to about 0.1% to 0.2% of GDP. Australian figures are broadly consistent with these UK numbers.
The Australian experience
On current trends 131 Australians a day die from cancer, with an average of 367 people a day diagnosed with a new case of cancer. Cancer is also Australia’s leading cause of loss of healthy life years.
But while death rates as a proportion of population have fallen by about a quarter over the last 30 years — and survival rates also up — our rising and aging population means 1.7 million Australians are likely to die from cancer by 2040, according to the Cancer Council’s estimates.
The strategies countries are contemplating to comprehensively beat cancer, all involve a mix of preventative, early intervention measures and research-led innovation .
Bowel cancer, for example, is Australia’s most costly cancer by health-system expenditure and has the second-highest rate of cancer death. Academic modelling strongly suggests lifting participation in the successful national screening program from the current 40% to 60% would save over 83,000 lives. This would also save around $2.1 billion in public health expenditure. Australia spends less than 2% of its health budget on preventative programs. But with “investment” thinking starting to take hold across social policy design, federal Health Minister Greg Hunt is keen to give much greater priority to preventative approaches.
Investing in health
Many of the advances against cancer are being driven by the extraordinary worldwide investment in pharmaceutical cancer research. According to the American Cancer Society scientists have learned more about cancer in the last two decades than had been learned in all the centuries preceding, and it is the growth in our knowledge of cancer biology has led to remarkable progress in cancer prevention, early detection, and treatment.
There are now over 800 cancer medicines currently in industry research pipelines, with Australia considered a leader in immuno-oncology drugs. This has created a major opportunity to develop Australia’s pharmaceutical research sector.
The surge in cancer research is challenging health policy makers, regulators and researchers, who are balancing the demand for early access, solid clinical evidence to support therapeutic claims and the high research costs often associated with pharmaceutical development.
Waiting times for drug access in Australia are long by global standards. A variety of papers and reviews have precipitated changes have been implemented to ensuring that Australians are not disadvantaged relative to other patients in comparable nations when it comes to accessing the most up-to-date breakthrough cancer medicines.
A further 1400 drugs were last week listed by the federal government on the Pharmaceutical Benefits Scheme, including chemotherapy medication drug capecitabine. On the weekend the prime minister announced an improved version of cervical cancer vaccine, Gardasil 9 would be made available free to all 12 and 13 year olds. The government is also expected to announce today the PBS listing of the leukaemia and lymphoma drug imbruvica.
But it is the particular life ending characteristics of many cancers, and the prevalence of cancer in people’s “healthy years” that has challenged traditional drug evaluation regulatory systems and the evidentiary frameworks they should apply. Valuing the long tail of benefits from cancer medicines is problematic, as is costing the research infrastructure need to support large scale innovation and breakthrough treatments .