In an exclusive email interview with BioPharma APAC, Carmen Auste, the CEO of Cancer Warriors Foundation Philippines and Vice President of Cancer Coalition Philippines, sheds light on the formidable challenges faced by patients in low- and middle-income countries (LMICs) concerning access to cancer prevention, research, diagnostics, treatment, and psychosocial support. Auste delves into the repercussions of financial toxicity, the scarcity of resources, and the fragmented healthcare systems in these regions. Moreover, she offers insightful perspectives on the urgent need for collaborative efforts, both locally and internationally, to bridge the gaps in resource allocation for fighting cancer. Auste's extensive experience prompts a discussion on effective solutions and scalable strategies to enhance access to cancer care, emphasizing the vital role of financing, capacity development, and cross-country collaboration in building resilient healthcare ecosystems. Join us as we explore the challenges and opportunities in the pursuit of equitable cancer care on a global scale.

What challenges do patients in low- and middle-income countries (LMICs) face in terms of access to cancer prevention, research, diagnostics, treatment, and psychosocial support, and how do these challenges impact cancer survivorship in these regions?

A key challenge that patients face is financial toxicity due to the catastrophic costs of cancer treatment and care, including essential medicines. This serves as a deterrent to seeking early diagnosis and leads to non-adherence to treatment protocols or discontinuance of treatment.  This results in most patients in LMICs being diagnosed when they are already in advanced stages of cancer.

Limited resources and competing development priorities mean that the budget for cancer prevention, screening, treatment, and care in the public sector is oftentimes inadequate. Screening programs are also limited in scale and scope. Likewise, hospitals offering cancer services are mostly found in major cities and patients have to travel far distances to access care. This also entails additional costs. There is also a shortage of oncology specialists and nurses, even for countries like the Philippines which is a source of medical professionals. Cancer research and programs for psychosocial support (e.g. child life services, patient navigation services, palliative care) are usually still in nascent stages. While its importance is recognized, adequate budget needs to be allocated to make it part of the priority programs for cancer.

Fragmentation and lack of integrated patient care pathways and robust referral systems from primary health care settings to tertiary level of care is another barrier to timely, quality diagnosis, treatment and care.

Given the disparities highlighted in global resource allocation for fighting cancer, how can local and international organizations collaborate more efficiently to address the urgent need for improved access to care in LMICs?

There could be a global multistakeholder initiative for market-shaping interventions that will bring down the costs of cancer medicines, especially innovator drugs proven to delay the progression of cancer and or improve survivorship. 

Twinning between medical societies and hospital/health facilities in high-income countries and low-income countries can be initiated and supported by philanthropic institutions and international development organizations.

A Global Fund for Fighting Cancer and Supporting Needs of cancer patients in LMICs can be created much like the global fund for TB and for HIV AIDS.

Special regional bodies like the ASEAN and APEC can be engaged so that regional collaborative initiatives for medicines procurement as well as regional learning and experience sharing  networks can be established.

In your experience, what are some effective solutions to enhance access to cancer care in LMICs, and how can these solutions be implemented on a broader scale?

Adequate and sustainable financing for cancer care is a crucial pathway to ensure enhanced access and better cancer care in LMICs. International Financing institutions and international development partners need to design innovative financing mechanisms appropriate and tailor fitted to the challenges and economic realities of LMICs. 

Capacity development interventions are necessary for stronger and more integrated healthcare systems, more capable and competent health care professionals  and health care workers  and a more responsive cancer care ecosystem. These capacity development interventions should start from strengthening capacities of the primary health care level to promote cancer literacy, provide cancer screening services and timely referral to tertiary cancer specialty centers.

In addition, strengthening of capacities of volunteer health care workers and lay volunteers need to be scaled up to meet gaps in HR especially in patient navigation from primary health care settings. 

Workplaces and academic institutions  (both public and private) are health enabling spaces which need to be reached and engaged for health promotion and cancer literacy (e.g., correcting myths and misconceptions on cancer, causes of cancer, cancer treatment and cancer survivorship etc) as well as provision of basic cancer services. 

Sharing of successful innovative and cost-effective models of care between countries/regions is also an effective means to strengthen health systems capacities, enhance cancer care and improve survivorship.