ASCO, WHO to Launch Global Quality Initiative in Cancer Care

The American Society of Clinical Oncology (ASCO) and the World Health Organization (WHO) will join forces to measure and improve the quality of cancer care worldwide. Their aim is to close equity gaps between high- and low-income countries and increase survival in low-income ones, which are being left behind as wealthy nations see the fruits of innovation.

News of the collaboration, established through a memorandum of understanding, was presented on June 4 by surgical oncologist and WHO Cancer Control Officer André Ilbawi, MD, in a keynote address during the presidential symposium at the 2022 ASCO Annual Meeting in Chicago. ASCO President Everett E. Vokes, MD, FASCO, also highlighted the agreement during his talk, “Advancing Equitable Cancer Care Through Innovation.”
Since the start of the COVID-19 pandemic, the focus on health equity in the United States has underscored differences in outcomes between high-income and low-income individuals, between patients who are White and patients of color, and between those living near academic centers vs those in rural settings.

ASCO’s Saturday session pointed out cancer care disparities of a different order of magnitude—those between high-income countries and the rest of the world.

The data Ilbawi presented were stark: 5-year cancer survival rates in the United States are 90%, but 3-year rates in Africa are just 30%. Over a 2-year period, cancer kills twice as many people in low- and middle-income countries as it does in high-income countries. And this does not go unnoticed within the US health system, where more than a third of medical trainees are from other countries.

“Despite advances in cancer care in the last 2 decades, inequalities between and within countries are staggering and progressively increasing,” Ilbawi said. “The experience of someone affected by cancer is profoundly determined by where they live and their socioeconomic status.”

In his address, Everett spoke of the incredible innovation that has occurred over his career—from the work by Janet D. Rowley, MD, on the Philadelphia chromosome and its relationship to leukemia and lymphoma to the discoveries that have revolutionized treatment for lung cancer. Everett also highlighted recent efforts by ASCO to ensure that all patients have access to care, such as setting up programs for rural patients. Yet much remains to be done.

Implementing the ASCO-WHO agreement
“In seeking quality cancer care worldwide, the goals of ASCO and the WHO are fully aligned,” Vokes said in a statement.¹ “Building on years of informal collaboration with the WHO, we now look forward to working with our WHO colleagues and stakeholders to advance international quality programs for cancer care—one of ASCO’s strategic focus areas.”

Through its Department for Noncommunicable Diseases, the WHO is working to strengthen cancer control programs in breast, cervical, and childhood cancers. The organization, which works in 194 countries from 149 offices, is taking the following steps:

• Distributing information, best practices, and innovative strategies on cancer control among developing countries
• Working to ensure that an additional 3 billion people worldwide get universal health coverage, are protected from health emergencies, or have access to evidence-based policies and program.

Ilbawi noted that one-third of ASCO’s 45,000 members practice outside the United States; thus, the collaboration involves 2 groups whose members are already distributed worldwide. ASCO members can work to improve care quality “by providing direct support to governments and hospitals—particularly those in low- and middle-income countries—and incentivizing organizational and social innovations,” he explained.

“We are bound in this together,” Ilbawi said, “but who will take responsibility?”

Innovation—but Only for Some
To be sure, treatment innovation has spurred the identification of more than 50 molecular targets, setting the era of precision oncology in motion. “But we have not taken innovation to scale,” Ilbawi said. “Twenty-five years after the FDA approved trastuzumab, only about one-third of the world has access to this life-saving therapy.”

Gaps also exist regarding financial toxicity and social distress, with 70% of patients with cancer in low- and middle-income countries and 20% in high-income countries selling assets to pay for treatment. Both loss of spending power and loss of life have economic consequences, according to a 2018 article published by ASCO, which indicated that less than 30% of low- and middle-income countries had adequate cancer care facilities and that data resources needed for modern care were woefully inadequate in most areas.²

What is the path forward? According to Ilbawi, global equity in cancer care requires attention in 3 areas, which will demand collaboration from government, industry, and professional societies:

• Technology innovation: from new products to new digital tools
• Operations innovation: helping low-income countries gain access to new facilities and new business models for delivering care
• Social innovation: low-income countries need more community support for things such as patient navigation.

“We should change how we measure success,” he pointed out. Only 1% of early-phase clinical trials measure quality of life, which Ilbawi said must change.

“As we move through these times of instability with our patients, we are urging them to face the greatest disruption in the world systems in almost 70 years,” he said. And yet, both Ilbawi and Vokes pointed to examples of how COVID-19 fueled creativity, which will lead to new cancer vaccines or care delivery models.

Hard times breed innovation, Ilbawi noted. “We must use this opportunity.”

References
1. ASCO & WHO to collaborate on quality indicators for cancer facilities. News release. American Society of Clinical Oncology. June 4, 2022. Accessed June 13, 2022. https://www.asco.org/about-asco/press-center/news-releases/asco-who-collaborate-quality-indicators-cancer-facilities
2. Lopes G. Tantalizingly close: global health equity and the influence of socioeconomic disparities on cancer care outcomes. ASCO Connection. November 9, 2018. Accessed June 13, 2022. https://connection.asco.org/blogs/tantalizingly-close-global-health-equity-and-influence-socioeconomic-disparities-cancer-care