Collaborating to Close the Cancer Care Gap

In 2023, more than half the world’s population remained without essential health service coverage.1 This has to change.

Despite significant advances in cancer screening and innovative treatments, there remains a significant global disparity in risk factors, prevalence, incidence and mortality across the world. These variations are further impacted by social and economic development and local healthcare landscapes. Cancer care should not be determined by who you are or where you live: this inequity must be addressed urgently. 

Closing the cancer care gap in a way that will secure the health of patients now and in the future, means there is an urgent need to understand and walk along with patients through their entire healthcare journey. This includes:

• advancing scientific discovery and securing access to it, 

• achieving Universal Health Coverage and ensuring it includes cancer screening, early diagnosis and standard of care treatment, 

• training and supporting healthcare workers to deliver specialised cancer care,

• ensuring there is sustainable financing and investment in healthcare, and in cancer in particular. 

While this is not a simple challenge, the vision - a world where everyone has equitable access to healthcare - is a shared responsibility to which we can all contribute. At Roche, we know that partnerships are much more than the sum of their parts: they’re about making a bigger and better difference in the world than could be done alone. 

This is why we collaborate with governments, global organisations, public authorities, healthcare professionals, patient groups and civil society, to name a few, to create tailored solutions that can truly address patient and health system needs and enable rapid and equitable access to medical innovation. 

Early detection and accurate diagnosis are pivotal in ensuring appropriate cancer care. Implementing effective cancer screening programmes, using high quality testing and digital technologies, are fundamental to ensuring appropriate treatment, to ultimately improve patient outcomes. This, in turn, also supports the effective use of limited resources of healthcare systems. Yet for many patients across the world, cancer is diagnosed at a late stage, making it more difficult to treat. There are a multitude of reasons as to why someone will receive a late diagnosis, including cultural and socio-economic barriers and limited screening availability, uptake and/or access.  

Such a gap in care has long been present in the Philippines, which has a population of over 110 million on more than 7,000 islands, making the geographic challenges of delivering care uniquely challenging. Many people do not have timely access to healthcare - from screening to diagnosis to treatment - and are frequently diagnosed at a late stage. This has a very real impact and contributes to the fact that approximately 11 women die each day in the Philippines from cervical cancer.

To start changing this,to provide simplified, scalable HPV DNA testing with self-collection sampling to increase early detection of cervical cancer. Aligned with UICC’s goal for implementing routine screening globally, the project has already impacted thousands of women and is continuing with a commitment to ensure lasting change.

As part of our commitment to fostering progress in screening, early diagnosis and early treatment, with the ultimate goal of helping improve outcomes for people with cancer, Roche, along with many other like-minded partners, played an active role in contributing to the design and implementation of Europe’s Beating Cancer Plan, including the update of the Screening Recommendations in Europe. Following the European Commission's proposal to strengthen cancer prevention through screening and early detection, the Council of the European Union adopted a new approach on cancer screening, with an ambitious aim to help ensure that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered such screening by 2025. The new approach also calls for extending screening programmes to prostate, lung and, under certain circumstances, gastric cancer, in a stepwise approach. 

Through partnering with Jhipego in the Philippines and taking on the challenges of geography by empowering patients to self-collect, as well as playing an active role in Europe’s Beating Cancer Plan, we have been able to impact more women than had we worked in isolation. However the ability to optimise care is not only dependent on the availability of medicines and diagnostics - to effectively make use of innovations, medical professionals and support staff must have specialised training and education. 

In Indonesia, a desire to understand why patients were experiencing a gap in care led to Roche collaborating on a project with Dharmais National Cancer Care, Indonesian Oncology Nurses Association and the University of Indonesia, revealing that there was only one cancer specialist nursing programme nationwide, and no standardised national accreditation, resulting in a deficit of specialised nursing staff and a direct impact on the patient care journey. This discovery sparked a new partnership to provide oncology nursing scholarships and patient-centred training. As more nurses were trained, leading to a tangible improvement in the overall patient experience, more partners got on board. What started as a group of four now has over 50 organisations building a robust and sustainable specialist oncology nursing training system. 

The first oncology public-private partnership in Indonesia was co-created to increase the number of oncology nurse specialists. The collaboration between Roche, the National Cancer Center, the Indonesian government and a top oncology nursing group, developed and provided patient-centric training that upskilled nurses to fully support patients and families, as well as guide oncologists and policymakers in shaping future care.

Increasing access to screening and upskilling and supporting healthcare workers are critical to ensure patients get the intervention they need, however these are only a few pieces of the puzzle. Social determinants of health are present in every country, and are often pronounced in countries where insurance models are limited for those with low income and where universal healthcare is lacking. This means the financial burden of treatment often lies with patients themselves, creating a further barrier to care. Patients’ concerns around affording treatment may delay a patient from diagnosis and/or may prevent them from seeking treatment. There is a clear need for systemic change, to enable oncology access solutions that offer affordable cancer care for low-income regions both now and in the future.

There were approximately 125,000 new cases of cancer in Nigeria in 2020. As fewer than 10% of Nigerians were insured, there were significant delays in seeking cancer care due to the fear of additional financial burden.

To address this barrier, Roche engaged with the National Health Insurance Authority and a number of policy makers in Nigeria, to enter a Memorandum of Understanding for a new insurance model. This cost-sharing model has already had a significant impact, with more people presenting for screening and treatment earlier, which will in turn lead to better outcomes for both the patients and the community more broadly.

Now, an increasing number of patients are receiving treatment under this plan, and, importantly, patients are presenting at an earlier stage without fear of overwhelming financial burden. This, in turn, increases their chances of an earlier diagnosis and positive response to treatment. 

In 2013, in Georgia, cancer care was partially available for low-income patients, however most people had to rely on private insurance to receive the care they needed. This resulted in many Georgian people not being able to access treatment, and those that did often faced limitations. As a result, cancer care became a priority for the government, and in 2019, Tbilisi - capital of Georgia - was selected to join City Cancer Challenge. This project focused in on the cancer care needs of the Georgian people and fostered collaboration around cancer care delivery.  

Following extensive engagement with Georgia’s Ministry of Health, Roche was the first signatory to Georgia's Universal Health Programme for Oncology, which was signed in November 2023. This landmark agreement will ensure all citizens - regardless of income or insurance status - receive the full suite of oncology interventions for their specific needs. Roche is proud to have been the first signatory on this agreement, leading the way through collaboration for cancer care policy reform and showing that partnerships can truly drive change to achieve a shared vision.

The approaches seen in Nigeria and Georgia not only transform the lives of patients, their families and communities, but have broader societal benefits. By investing in a sustainable insurance model in Nigeria and Universal Health Coverage in Georgia, an investment is also being made in the physical and economic health of these countries. 

These projects would have not been possible without a collaborative effort. A deep exploration of the unique regional and local challenges, beyond our own area of expertise, has been key and this cannot be achieved in isolation. Developing sustainable cancer care models involves understanding barriers and limitations and then working to harness each stakeholder’s differing resources and capabilities to find long-term solutions.

References

1. World Health Organization and International Bank for Reconstruction and Development / The World Bank. Tracking universal health coverage: 2023 global monitoring report. [Internet; cited January 2024]. Available from: