Rethinking Cancer: More Focus on Supportive Care

We have had great advances in cancer treatment in recent decades. After diagnosis, people live six times longer than forty years ago and despite this, it is still one of the main causes of death worldwide: about 10 million people every year. In contrast, deaths during the entire COVID-9 pandemic, from 2020 to date, total approximately 6.3 million people.

According to the Pan American Health Organization, cancer is one of the main causes of mortality in the Americas, causing 1.4 million deaths in 2020, 47% of them in people 69 years of age or younger. The number of cancer cases in the Region of the Americas was estimated at 4 million in 2020 and is projected to increase to 6 million in 2040.

On the other hand, the estimated annual global expenditure for health systems is close to 200,000 million dollars, with an estimated growth rate for the next 5 years (CAGR) of around 12%, which represents a significant and growing financial burden on health systems.

The efforts of different governments, in different parts of the world, have focused, until now, on increasing the survival of cancer patients through coverage and access to therapies intended for this purpose, such as surgery, radiotherapy, chemotherapy, immunotherapy, etc., which are very expensive.

As a counterpart to this, the quality of life of cancer patients, whose survival is sought to be extended, has had less priority in public health policies.

Precisely, the so-called “Support Care” or “Supportive Care” seek to focus on this aspect, which is fundamental, both for patients and for their family environment. The Multinational Association for Supportive Care in Cancer (MASCC) defines Supportive Care as: “The prevention and management of the adverse effects of cancer and its treatment”. MASCC points out that this includes the prevention and treatment of physical and psychological symptoms and side effects, from diagnosis to treatment and aftercare. It also includes the improvement of rehabilitation, secondary prevention of cancer, survival and care until the end of life.

Cancer pain, nausea, hair loss or alopecia, and weight loss are just some examples of adverse effects that cancer patients face during their therapy, affecting their quality of life and the development of their disease. Patients without adequate and timely access to Support Care are people who cannot continue to carry out their daily tasks, who are significantly altered, with a high impact on their family environment.

Various studies point out that adequate and timely Support Care for cancer patients not only improves their quality of life and survival, but also optimizes the use of health system resources, since these patients tend to be hospitalized less. , use emergency rooms to a lesser extent, among others. Additionally, better Supportive Care can ensure greater adherence to cancer treatment protocols.

A good example of the above is the model used in the United Kingdom, called the “Enhanced Supportive Care Programme” of the English National Health System (NHS), where the early involvement of Supportive Care (not in the final stages), and the best practices in the use of chemotherapies are key elements.

Latin America has a long way to go in terms of adequate and timely access to Support Care for cancer patients, being able to benefit from good practices and models already used in other countries.

Progress must come from the incorporation of Supportive Care in national programs, protocols or specific clinical guidelines that include good international practices that are based on evidence. It is also necessary that medicines and health technologies related to Supportive Care -which from the perspective of their economic evaluation- contribute to health systems, be registered and reimbursed within reasonable times. And, finally, it is also required that health systems contemplate Support Care units with a multidisciplinary approach, and not reduce them only to palliative care.

For this, it is necessary that there is political will and involvement of the different actors of the health ecosystem, always listening to the voice and needs of patients and caregivers, in order to materialize the changes that are required so that Health Care Support acquire the relevance that corresponds to them.

*The author is an expert in public health policies, director of the Chilean Association of Health Law and has been an academic at various Chilean universities on issues related to health systems.

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