Innovation can address ‘profound inequality’ in cancer care, ASCO keynote speaker says
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CHICAGO — The keynote speaker at ASCO Annual Meeting urged attendees to focus on social and organizational innovations that can advance equity in cancer care.
André Ilbawi, MD, surgical oncologist and WHO cancer control officer, said the arc of cancer control has diverged in the past 2 decades.
One path offers patients improved survival outcomes and reliable access to high-quality care and new technologies.
“This is the path of the few,” he said. “The other path has subjected most people globally to inaccessible and poor-quality care, emotional hardship [and] financial insecurity simply because of who they are and where they live.”
For example, survival rates for breast and childhood cancers remain below 30% in many low- and middle-income countries compared with 90% in the United States, he said.
“This profound inequality results in millions of avoidable deaths each year,” Ilbawi said.
During his address, Ilbawi outlined three guiding principles for innovation in global cancer control.
Technological innovation
Technological innovation has had a major impact on global cancer care, according to Ilbawi. This includes the discovery of new genetic and molecular targets that have yielded precision therapies, as well as safer and more effective radiotherapy and surgical techniques. However, not all patients have realized the benefits of such innovations.
“Five years after the FDA approved trastuzumab, only about one-third of the world had access to this life-saving therapy,” Ilbawi said.
Innovation also has not addressed the emotional, social and financial issues many patients experience.
“More than 70% of patients globally and 20% living in the United States are selling assets to access cancer care,” he said. “Forty percent of women with metastatic cervical cancer are being abandoned by their intimate partners and experiencing profound social isolation. We cannot be bystanders as our health care systems evolve in a way that does not serve our global community.”
Although technological innovations have saved countless lives, many costly new therapies offer only marginal survival benefit, Ilbawi said.
Further, use of PFS as a primary endpoint in clinical trials has increased dramatically since 2000, although it is not strongly correlated with improvements in OS. In contrast, few early-phase trials focus on health-related quality of life, which meta-analyses have shown is prognostic for survival.
“We should change how we measure success to reflect the preferences of our patients,” he said.
Organizational innovation
Public and private investors are realizing the strategic importance of investing in health and cancer as a development priority, Ilbawi said.
Nearly 90% of NCI-designated cancer centers in the U.S. have funded global oncology projects in 110 countries, he said. WHO and partners have launched global initiatives that include a strategy to eliminate cervical cancer. St. Jude Children’s Research Hospital, a key strategic partner of WHO, has committed $200 million to provide free cancer medicines to children throughout the world.
“These are the organizational innovations that will make a difference,” Ilbawi said. “What we have to do is take what is known and make it available to every patient with cancer everywhere.”
Social innovation
In order to achieve social innovation, diverse populations must be involved in decision-making starting at the ground level, Ilbawi said.
“Commit time to learn about emerging social innovations that can be adapted in context, and together, let’s build platforms to share social innovation,” he said.
Investment in people as drivers of social innovation also is key, according to Ilbawi.
“In your clinic and classrooms, there is a generation of young oncology providers yearning to understand how our profession can advance justice and equity,” he said. “By supporting young people that pursue a career in equity, you are also becoming a duty-bearer for change.”
ASCO-WHO collaboration
Ilbawi announced a partnership between ASCO and WHO to improve the quality of cancer care through direct support to governments and hospitals and incentivizing social and organizational innovations.
The first of two initial projects in the collaboration involves developing evidence-based quality indicators for in-patient and outpatient cancer care facilities, with a focus on breast cancer and palliative care. Organizers aim to implement the indicators in select countries next year, according to an ASCO press release.
In the second project, ASCO and WHO would gather insights from care providers, patients, researchers and government authorities and share best practices in an effort to advance innovation and improve quality of care. Publication of an overall report based on the information collected is expected next year, the press release stated.
References:
ASCO & WHO to collaborate on quality indicators for cancer facilities (press release). Available at: www.asco.org/about-asco/press-center/news-releases/asco-who-collaborate-quality-indicators-cancer-facilities. Published June 4, 2022. Accessed June 4, 2022.
Ferlay J, et al. Global Cancer Observatory: Cancer today. Available at: gco.iarc.fr/today/home. Accessed June 4, 2022.
Ilbawi A. Guest speaker’s address: Innovation in global cancer control. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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Ilbawi A. Guest speaker’s address: Innovation in global cancer control. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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