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Delivering affordable cancer care in high-income countries
Abstract
The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.
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“The indirect economic costs associated with premature death and lost productivity from the growing cancer burden have been estimated at US$1.16 trillion a year,3 or approaching 2% of global GDP.103”
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Mahumud, R. A., Chen, Y., Shahjalal, M., Dahal, P. K., & Alam, K. (2026) · JAMA Oncology · doi:10.1001/jamaoncol.2025.6080 · Cited by 3
Gallant, G. (2011) · Future Medicinal Chemistry · doi:10.4155/fmc.11.164 · Cited by 3
Envisioning Possibilities and Challenges of AI for Personalized Cancer Care
Kong, E. W. S., Huang, K., & Gautam, A. (2024) · ACM Conference on Computer Supported Cooperative Work (CSCW) · doi:10.1145/3678884.3681885 · Cited by 3
Li, Z., Chen, G., & Du, G. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1570792 · Cited by 3
Nadeem, R. M. (2013) · Breast Cancer · doi:10.1007/s12282-013-0484-0 · Cited by 3
“This saving could be more substantial by taking into consideration the large number of symptomatic cancers also suitable for this approach especially when cancer treatment is becoming a major economic expenditure for all developed countries [44].”
BackgroundPrevención, iatrogenia y salud pública
Segura, A. (2014) · Gaceta Sanitaria · doi:10.1016/j.gaceta.2014.02.002 · Cited by 3
Paediatric oncology: are there ways to bend the costs?
Calaminus, G. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70224-8 · Cited by 3
Aiming for Ideal Care: A Proposed Framework for Cancer Quality Improvement
McNiff, K. K., & Jacobson, J. O. (2014) · Journal of Oncology Practice · doi:10.1200/jop.2014.001305 · Cited by 3
“Yet despite these advances, and the growing proportion of health care expenditures consumed by patients with cancer, many perceive a widening gap between our growing knowledge and our ability to reliably deliver care to patients with cancer.(1) This commentary is not meant to diminish the successes achieved over the l…”
BackgroundBlázquez, A. L., Pita, C. C., Álvarez, M. C., Suárez-Gil, P., Martínez, F. M., & Calleja, M. Á. (2014) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s62572 · Cited by 3
“This is important because one of the ways to make cancer treatments more affordable is to monitor and reduce off-label use, which is used sometimes, according to Sullivan et al, 30 in scenarios where there is little benefit and more toxicity compared with drugs that cost much less.”
Price trends of reimbursed oncological drugs in Switzerland in 2005–2019: A descriptive analysis
Rachamin, Y., Ackermann, C. J., Senn, O., & Grischott, T. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259936 · Cited by 3
The Care Dependency Scale: A cross validation study in inpatients with cancer
Piredda, M., Candela, M. L., Marchetti, A., Biagioli, V., Maria, M. D., Facchinetti, G., Albanesi, B., Iacorossi, L., & Marinis, M. G. D. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.102087 · Cited by 3
dos Santos, R. L. B., Pepe, V. L. E., & Osorio-de-Castro, C. G. S. (2022) · BMC Cancer · doi:10.1186/s12885-022-09851-3 · Cited by 3
“According to the literature, the rising cost of antineoplastic drugs may be caused by a number of different factors, including: increased access and utilization [18, 19] (due to growing incidence of different types of cancer and wider access to diagnosis and, consequently, treatment); an increase in prices [20, 21] of…”
BackgroundKim, D. J., & Kim, S. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192215331 · Cited by 3
“In addition, traditional and newly developed cancer treatments have a large economic burden [4,5].”
BackgroundCost items in melanoma patients by clinical characteristics and time from diagnosis
Buja, A., Cozzolino, C., Zanovello, A., Geppini, R., Miatton, A., Zorzi, M., Manfredi, M., Bovo, E., Fiore, P. D., Tropea, S., et al. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1234931 · Cited by 3
“While patients with stage I CMM often recover after the fi rst tumour removal, more advanced melanoma patients face higher recurrence rates, which may in fl uence the course of their disease in subsequent years and thus also increase costs (8, 31 – 33).”
BackgroundHigh cost of chemotherapy for gynecologic malignancies
Takahashi, N., Seki, T., Sasaki, K., Machida, R., Ishikawa, M., Yunokawa, M., Matsuoka, A., Kagabu, M., Yamaguchi, S., Hiranuma, K., et al. (2024) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyae089 · Cited by 3
Giuliani, J., & Bonetti, A. V. (2016) · Journal of Gastrointestinal Cancer · doi:10.1007/s12029-016-9862-0 · Cited by 3
Methodologies to Increase the Level of Evidence of Real-life Proton Therapy in Head and Neck Tumors
Dionisi, F., Widesott, L., van Vulpen, M., Fuller, C. D., Frondizi, R., Meneguzzo, M., Blanchard, P., Amichetti, M., & Sanguineti, G. (2021) · International Journal of Particle Therapy · doi:10.14338/ijpt-20-00051.1 · Cited by 3
“Moreover, as underlined by the Lancet Oncology Commission in 2011 [13], because of the unique nature of medical device development, the use of the same criteria to evaluate pharmaceuticals and medical devices is inappropriate.”
Background
Metadata
- Authors
- Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N. J., Amir, E., Khayat, D., Boyle, P., Autier, P., Tannock, I. F., Fojo, T., Siderov, J., Williamson, S., Camporesi, S., McVie, J. G., Purushotham, A. D., Naredi, P., Eggermont, A., Brennan, M. F., Steinberg, M. L., De Ridder, M., McCloskey, S. A., Verellen, D., Roberts, T., Storme, G., Hicks, R. J., Ell, P. J., Hirsch, B. R., Carbone, D. P., Schulman, K. A., Catchpole, P., Taylor, D., Geissler, J., Brinker, N. G., Meltzer, D., Kerr, D., & Aapro, M.
- Affiliations
- Guy's Hospital (GB)
- Duke Medical Center (US)
- The University of Melbourne (AU)
- University Hospitals Seidman Cancer Center (US)
- University of Toronto (CA)
- Pitié-Salpêtrière Hospital (FR)
- International Prevention Research Institute (FR)
- National Cancer Institute (US)
- Austin Hospital (AU)
- Northumbria Healthcare NHS Foundation Trust (GB)
- King's College London (GB)
- European Institute of Oncology (IT)
- Umeå University (SE)
- Institut Gustave Roussy (FR)
- Memorial Sloan Kettering Cancer Center (US)
- University of California, Los Angeles (US)
- Vrije Universiteit Brussel (BE)
- Peter MacCallum Cancer Centre (AU)
- University College London (GB)
- Duke University (US)
- Vanderbilt University Medical Center (US)
- Association of the British Pharmaceutical Industry (GB)
- University of London (GB)
- Susan G. Komen Breast Cancer Foundation (US)
- University of Chicago (US)
- University of Oxford (GB)
- Clinique de Genolier (CH)
- Corresponding author
- Sullivan, Richard
- ORCID
- Sullivan, Richard
- Peppercorn, Jeffrey
- Sikora, Karol
- Zalcberg, John
- Meropol, Neal J
- Amir, Eitan
- Boyle, Peter
- Autier, Philippe
- Tannock, Ian F
- Fojo, Tito
- Siderov, Jim
- Williamson, Steve
- Camporesi, Silvia
- Purushotham, Arnie D
- Naredi, Peter
- Eggermont, Alexander
- Brennan, Murray F
- Steinberg, Michael L
- McCloskey, Susan A
- Verellen, Dirk
- Storme, Guy
- Hicks, Rodney J
- Schulman, Kevin A
- Taylor, David
- Geissler, Jan
- Meltzer, David
- Kerr, David
- Aapro, Matti
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 12
- Issue
- 10
- Pages
- 933-980
- ISSN
- 1470-2045 (ISSN-L)
- OpenAlex
- W2111285159
- Cited by
- 718
- References
- 279
- Citations by year
- 2026: 21 · 2025: 24 · 2024: 34 · 2023: 16 · 2022: 33 · 2021: 43 · 2020: 40 · 2019: 32 · 2018: 60 · 2017: 45 · 2016: 56 · 2015: 67 · 2014: 75 · 2013: 81 · 2012: 76
- FWCI
- 199.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- Conquer Cancer Foundation
- King's College Hospital NHS Foundation Trust
- National Institute for Health and Care Research
- Department of Health and Social Care
- King's College London
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advances in Oncology and Radiotherapy
- Keywords
- cancer costs, high-income countries, value-based pricing, access to cancer treatment, health equity, regulatory regimes, health policy, overuse of health care
- MeSH terms
- Australia, Cost-Benefit Analysis, Europe, Health Expenditures, Health Policy, Health Services Accessibility, Health Services Misuse, Health Services Research, Humans, Insurance, Health, Neoplasms, Socioeconomic Factors, United States, Cost Savings, Health Care Costs, Health Care Reform, Models, Economic, Delivery of Health Care, Integrated, Healthcare Disparities
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