Why Southeast Asia needs to establish an ASEAN Cancer Center – The Diplomat

Cancer is a growing problem in Southeast Asia. The latest data from the International Agency for Research on Cancer in 2020 found that there were more than 1 million new cases of cancer in Southeast Asia and nearly 700,000 deaths. Based on that same database, that number is expected to increase steadily over the next few years to 1.6 million.

But these statistics alone don’t tell the full story. Historically, in many parts of Southeast Asia, receiving a cancer diagnosis has been disastrous for patients and their families. In 2015, a landmark longitudinal study that followed 9,513 cancer patients across the region found that over 75% of patients experienced death or financial catastrophe within a year of diagnosis. Of patients who survived the first year after diagnosis, 44% of people used all of their life savings to fund treatment.

Take, for example, the story of Cambodian cancer patient Oun Retra. She was diagnosed with colon cancer in 2017 and chose to go to Thailand for treatment due to the limited treatment options available in her own country. Her family ended up spending over $40,000 on multiple rounds of chemotherapy in Thailand. Sadly, her treatment was interrupted with the onset of the COVID-19 pandemic and Retra passed away in November 2020.

Despite these dire health and financial outcomes for people across the region, cancer is still not being prioritized in public health debates and national health agendas in most Southeast Asian countries. This is an issue on which all member states of the Association of Southeast Asian Nations (ASEAN) need to unite, to pool their resources to address this devastating problem.

Limited access to cancer drugs

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Health systems in many Southeast Asian countries face far-reaching challenges when it comes to diagnosing and treating cancer. A particularly pressing issue for ASEAN member countries is the lack of access to cancer drugs, whether due to shortages or the high costs associated with these drugs.

A 2016 global research-based study reported that access to newer drugs is often limited in Southeast Asia. The lack of affordability and availability of new drugs has had a negative impact on patient outcomes in the treatment of common cancers such as breast, colorectal and lung cancer, which together account for more than a third of deaths in Asia.

Thailand and Malaysia are considered to have relatively good medical infrastructure. However, cancer patients in these two countries still have limited access to innovative therapies and cutting-edge drugs, while other new treatment paradigms are limited, placing a burden on patients and their families. For example, researchers found that lack of access to pertuzumab, a monoclonal antibody drug used to treat patients with HER2-positive breast cancer, had a serious impact on patient outcomes in many Southeast Asian countries. The researchers found that lack of access to just this drug led to a loss of 15.7 months in median survival time.

Meanwhile, the situation in the Philippines illustrates another aspect of this problem. The drugs used to treat HER2 Positive breast cancer are technically available in the market, but the cost of these drugs makes them virtually unaffordable for most patients.

Cancer drug shortages were reported to be most severe in Myanmar and Malaysia. The main barrier to access reported was the lack of reliable supply of these drugs, especially given the lack of commercial interest for suppliers to enter and remain in these national markets. These barriers limit cancer patients’ ability to access treatment through newer drugs, and if these drugs are available, there is often a high direct cost.

In Cambodia, obtaining chemotherapy drugs at an affordable price remains a challenge, according to Dr. Katherine Tarlock, MD, volunteer with Health Volunteers Overseas (HVO), a non-profit program based in the United States. The Doctor. Ben Watkins, MD, another HVO program volunteer, explained that because of the costs associated with these cancer drugs, doctors are often forced to make difficult decisions, forgoing the most up-to-date treatment protocols because introducing these drugs into Cambodia to cancer patients would represent too great a financial burden.

Meanwhile, in Vietnam, geographic disparities resulting from the country’s mountainous terrain pose a challenge, making it difficult to distribute drugs and chemotherapy services to provincial hospitals. In addition, limited supplies of up-to-date drugs are also a concern. Targeted therapies and newer drugs that treat certain types of cancer are available only at the National Cancer Hospital in Hanoi and are unaffordable for most Vietnamese, even with government subsidies.

Minimal funding for cancer control and high costs of targeted and cytotoxic drugs (even when subsidized) are major challenges. Health insurance in Vietnam does not yet cover all fees, especially those for advanced technologies and targeted therapies.

The high demand and limited supply of cancer drugs has also given rise to unscrupulous import schemes involving counterfeit drugs, which pose a real challenge in the region. In a high-profile recent case, a former Vietnamese deputy health minister was sentenced to four years in prison earlier this year for his involvement in importing counterfeit cancer drugs into Vietnam.

While there may be a willingness to pursue new mechanisms that can improve access to innovative medicines with high clinical value, current budgets and political priorities pose substantial barriers to broader access. There are no country-specific cancer evidence-based data, such as a country’s cancer burden and a national list of cancer drugs, in Asian countries that can provide the conceptual framework for formulating “precision” policies.

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Given the limitations of the status quo, ASEAN should seriously consider creating a regional cancer center, which would allow member states to study, discuss and focus on connecting Southeast Asian cancer patients with accessible and affordable medicines.

What can an ASEAN cancer center do?

Although cancer cases are predicted to increase, there has not yet been a coordinated regional effort to meet this challenge head-on. An ASEAN Cancer Center is needed to respond to the lack of access to cancer drugs, whether due to market shortages or high costs.

One of the key roles that an ASEAN Cancer Center could play is to gather relevant cancer data from member countries. Evidence-based data will help policymakers in each county and region to design effective national cancer plans. At present, data on cancer rates, the prevalence of different types of cancer and the demand for essential medicines are limited in most ASEAN countries. If we as a region had access to reliable data on these topics, our policymakers could design more effective responses to patients’ needs.

For example, policymakers might consider including drugs that are most in demand on their national drug lists so that patients pay less for the drugs they need most. Clear data on drug needs would also help countries avoid drug shortages, which play a major role in price increases.

An ASEAN Cancer Center could also provide the collective bargaining power to negotiate drug prices across the region with pharmaceutical companies, rather than each country negotiating on its own. According to a 2019 study on Improving Access to Medicines, between 2000 and 2010, most ASEAN states reported a cost increase of more than eight times the international average; for the Philippines, the number was more than 26 times the average.

There is also clearly a large gap in purchasing power parity between ASEAN countries when it comes to cancer drugs. For example, as of 2017, a drug that treats bone marrow cancer and some types of lymphoma costs US$3622.22 in Malaysia and US$4630.12 in Thailand, while a targeted drug used to treat gastrointestinal cancer costs US$150.47 in Malaysia and US$89.20 in Thailand. This reality further highlights the importance of ASEAN’s cross-border collaboration, particularly in terms of how a regional institution can influence drug price transparency and price negotiation across the region.

Lessons can be learned from the regional intergovernmental collaboration between Belgium, the Netherlands, Luxembourg and Austria (BeNeLuxA) in 2015, which was created to jointly negotiate drug prices and share information across borders to combat information asymmetry between buyers and pharmaceutical companies . Following in the footsteps of BeNeLuxA, in 2017, Malta, Cyprus, Greece, Italy, Spain and Portugal signed the Valletta Declaration, an alliance of southern EU member states, which aims to explore strategies to jointly negotiate prices for new medicines and therapies with the pharmaceutical industry.

Cancer is too big an enemy for governments to tackle alone. Instead, ASEAN should adopt a collaborative cross-border approach. The creation of a dedicated ASEAN Cancer Center has the potential to strengthen this region’s ability to protect patients and their families and deliver better outcomes for those dealing with this disease.

Why Southeast Asia needs to establish an ASEAN Cancer Center – The Diplomat

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