Access to Quality Healthcare for Cancer: A Fundamental Human Right and Social Justice Issue

In low- and middle-income countries (LMICs), the treatment of cancer is far behind that of  high-income countries (HICs). Inadequate investments in primary healthcare (PHC), the skills gap between cancer care providers in LMICs and their counterparts in HICs are some of the major obstacles to providing quality care for cancer patients in LMICs, along with stigma, which prevents early diagnosis and treatment. In this blog post, we will explore what needs to be done to address these identified issues towards making access to quality cancer care a reality for all, regardless of their socioeconomic status or location.

The current state of cancer treatment in LMICs 

Cancer impacts millions of people around the world, accounting for nearly 10 million deaths in 2020. Despite advancements in technology and medicine, access to quality healthcare remains a challenge for many individuals, especially in LMICs where 70% of cancer deaths occur. The lack of access to proper care has resulted in significant disparities in treatment outcomes. For instance, continentally, an estimated 90% of children diagnosed with cancer in LMICs succumb to the illness compared to only 20% in wealthier parts of the world. This inequity pushes underserved communities further into poverty, and where there are no social security provisions deny patients the space to focus on treatment, particularly where illness fall on the household earners.

Investing in primary healthcare as a priority for equity in cancer treatment

Unfortunately, the reality today is that one’s identity and location can determine the difference between life and death when it comes to accessing quality healthcare for cancer. This goes against the fundamental principle that all individuals should have access to quality healthcare as a basic human right. It is critical and urgent to invest in primary and specialist healthcare systems to ensure that patients can receive the best holistic care to prevent late diagnoses and increase their chances of beating the disease. Efforts must also factor the healthcare needs of refugees and internally displaced people and must also recognize and address the unique challenges faced by individuals with intersectional vulnerabilities, such as those who are disabled. This requires significant, stable, and sustainable investments.

Investing in the healthcare infrastructure can enhance early detection and treatment, forming a strong foundation for providing comprehensive cancer care and other related conditions that can impact health outcomes. This requires various measures, such as expanding cancer screening initiatives in remote areas, improving diagnostic tools and treatments, providing practical assistance to ensure adherence to treatment, and setting up effective referral systems for specialised care. Such efforts necessitate long-term investments in resources for health system strengthening, research and development, targeted programs, and appropriate incentive mechanisms. Despite the numerous challenges involved in providing equitable access to high-quality cancer care services in LMICs, bridging the gap between available resources and treatments remains imperative.

By investing in primary healthcare systems, we can work towards improving cancer outcomes for all. This can greatly improve the chances of survival and recovery from treatment thereby reducing the morbidity and mortality of cancers that are too often detected at a late stage. In addition to this, there must be an investment in culturally appropriate, accessible end-of-life care so that those in the late stages of cancer are cared for with dignity and humanity. This is how we reduce disparities in cancer outcomes and improve the overall health and well-being of communities.

Addressing stigma associated with cancer for better health outcomes

At the same time, access to quality healthcare can also reduce the stigma associated with cancer; this is particularly so where healthcare in primary care is integrated, for example for HIV care. When patients and survivors are cared for with dignity and respect, they are more likely to seek help early if they experience symptoms.

We must also seek to understand why patients and their relatives may struggle with stigma associated with a diagnosis of cancer, something which could lead to reluctance to seeking care. In some settings, women with cancer may not only face the challenge of a potentially devastating diagnosis but also the potential of not having spousal or family support; this can lead to additional strains including social and financial ones in the aftermath of the diagnosis. In societies where there is an emphasis on the reproductive capabilities of women, cancers may be considered to affect their perceived attractiveness and ability to bear children thereby leading to more social stigma. In addition, the association between HIV and some cancers, particularly those which are visible e.g. Kaposi’s sarcoma, can lead to increased reluctance and stigma to seeking care; this is something which is detrimental given that early diagnosis, both for HIV and associated cancers can lead to better outcomes. The complex interplay with this and socioeconomic standing and agency (and lack thereof) can also lead to worse outcomes, particularly in lower resources settings where access to healthcare is adversely affected by distance to health facilities, cost, or social responsibilities.

The need for systemic changes to reduce the skill gap in cancer treatment between LMIC and HIC

With the prevalence of cancer on the rise in many LMICs, healthcare providers are under increased pressure to deliver oncology treatment and care. But some countries do not have clinical oncologists to provide the necessary care. Even where they may exist, the expense or availability of treatments may be such that they are not accessible or patients must travel great distances, on top of associated costs to access care. Addressing the cancer treatment skill gap is arguably one of the greatest challenges facing healthcare systems globally that require systemic changes.

A multitude of entities must work together to make change happen. Government, non-governmental organisations (NGOs) and private sector actors each have their own strengths and roles to play in driving progress. Government can enact policies, while NGOs are well-positioned to establish industry standards and promote best practices. Private organisations often have the financial resources and capacity to bring larger-scale projects to fruition. A holistic approach that draws on the respective strengths of all three actors will be key for successful change. Without significant efforts towards transformation, inequalities in cancer treatment will persist.

Overcoming existing skill gaps for cancer prevention, diagnosis, treatment, and care also requires a combination of targeted funding schemes, capacity-building programmes and strategic public-private partnerships. These initiatives should focus on improving existing healthcare resources and training more personnel with advanced skill sets. Doing so will not only help fill knowledge gaps but also allow for more accurate diagnoses and better-quality treatments that can have long-term positive outcomes for patients and families.

Quality of life for those affected by cancer and mortality rates, particularly in LMICs, are at risk of remaining high without proper intervention. With targeted training and specific interventions, knowledgeable healthcare professionals can be more effective in providing the necessary services to their communities. This will help bridge the knowledge gap, equip medical practitioners with evidence-based information about treatments, as well as improve patient survivorship for years to come.

At PCI, we believe that quality healthcare is a basic human right that all individuals, regardless of identity or location, should have access to when they need it and where they need them. We work closely with governments, partners and healthcare workers to strengthen primary care systems through which we also emphasise the importance of the integration of early detection and screening for non-communicable (NCDs) into PHC systems. To truly make a difference, health and policy actors must recognise the importance of addressing these issues. Only then can we find meaningful solutions for achieving healthier outcomes for people affected by cancer in LMICs and make access to quality healthcare a reality.