Transforming cancer care by 2040: Factsheet

Factsheet

The societal burden of cancer

• The global cancer incidence is expected to escalate to 28 million new cases per year by 2040.¹ This represents an increase in cancer cases of nearly 55% from 2020 to 2040.²
• Up to 80% of cancer deaths occur in low- and middle-income countries (LMICs), highlighting significant inequalities in cancer outcomes.³
• Even among high-income settings, where care is expected to be more evolved, cancer survival, mortality and incidence rates differ significantly between countries.⁴
• In 2022, an estimated 9.7 million people died from cancer, a figure projected to rise to 15.³ million annually by 2040.⁵
• Across the Organisation for Economic Co-operation and Development (OECD), an additional 160,000 cases of depression are recorded every year due to cancer and productivity losses equivalent to 3.1 million workers.⁶
• In Norway, a questionnaire-based study of 706 patients found that 83% of patients suffered from long-term effects of cancer treatment – including fatigue (59.2%), sleep disorder (41.5%) and pain (36.6%).⁷
• Up to 54% of cancer survivors in the United Kingdom (UK) experience at least one psychological issue a decade after treatment.⁸
• In Europe in 2021, cancer accounted for 17% of disability-adjusted life years (DALYs), resulting in a joint leading cause of DALYs in Europe, together with cardiovascular diseases.⁹
• For men, lung cancer is the most common cause of cancer deaths in Europe, and for women this is breast cancer.⁹

The economic burden of cancer

Financial toxicity

• Across high income countries (HICs) cancer patients spend on average 16% of their income on out-of-pocket costs related to their cancer care, whilst in LMICs this increases to 42%.¹⁰
• United States (US) cancer survivors report spending more than 20% of their annual income on medical care.¹¹
• Financial toxicity and its impact on households may have intergenerational impacts as costs for cancer treatment divert financial resources from childcare or healthcare for children.¹²

The impact on employment, society and the economy

• The sum of direct and indirect costs for cancer care in Europe has increased by 43% from €159 billion to €228 billion in 1995-2023.⁹
• Studies have shown that even after treatment, many cancer survivors struggle to return to full-time work or find themselves unable to re-enter the workforce, leading to significant losses in household income.¹³
• Today, only around 63.5% of cancer survivors will try to return to work after treatment. Many of those who do, face challenges like managing their workload or juggling medical appointments.¹⁴
• Cancer survivors are approximately 1.4 times more likely to be unemployed than people without a history of cancer, and roughly 25% of cancer survivors will not have returned to work 2 years after diagnosis.¹⁵
• Caregivers, who are often family members, may also reduce their work hours or leave their jobs to provide support.¹⁶
• The OECD estimates that cancer reduces workforce outputs across member countries by €163 billion annually due to lower employment and higher presenteeism and absenteeism.⁶
• In Europe, the estimated societal cost of cancer in 2018 was €199 billion.¹⁷
• By comparison in the US, in 2017, the productivity loss from cancer morbidity and premature mortality was $30.3 billion and $150 billion respectively.¹⁸

The health system burden of cancer

• In 2017, the US saw 2.8 million hospitalizations due to cancer.¹⁹
• In the UK, 1 in 6 cancer patients were admitted to hospital in an emergency at least three times.²⁰
• Global spending on oncology drugs is growing at 14 – 17% annually, driven by newer drug classes of immunotherapies and targeted therapies.⁶
• Even large institutional payers face challenges in managing the upfront costs of curative treatments like cell and gene therapies, which require full payment at initiation despite long timelines for measurable outcomes.²¹
• Evidence suggests there is inefficiencies in cancer care, as some countries such as Sweden and Switzerland have similar survival rates, but per-capita spending on cancer in Switzerland was twice as high as in Sweden.⁹

Return on investment in cancer care

Prevention and early detection

• Detecting cancer early is associated with improved survival, lower treatment morbidity, and better quality of life.^22,23
• Around 30 – 50% of new cancer cases are theoretically preventable, with smoking being the most critical modifiable risk factor.⁹
• Research has shown that the incremental cost-effectiveness of prevention efforts for breast cancer was USD $25,000, USD $24,000 for colorectal cancer and USD $34,000 for prostate cancer.²⁴
• In Vietnam, the cost of cervical cancer treatment ranges from USD $368 to USD $11,400, while the price of the preventative HPV vaccination is USD $4.55.²⁵

Diagnosis

• In the UK, at a test cost of £100, there is approximately a 75% probability of a liquid biopsy test for brain cancer being cost-effective in primary care.²⁶
• Studies estimate that digital pathology could lead to cost savings of up to USD $12.4 million over 5 years, due to improvements in pathology productivity and histology lab consolidation.²⁷
• A study shows that computational pathology can reduce the time taken to review a sample by as much as 30%, while improving accuracy.²⁸

Early treatment

• Using liquid biopsies for treatment selection can also lead to cost savings, in lung cancer.²⁹
• An Irish study suggested that ~€50,000 could be saved per each patient with colorectal cancer, by using genetic testing to inform treatment selection.³⁰
• An analysis performed in Australia demonstrates that with every AU$1 invested in treatment to improve the prognosis of a non-curative cancer diagnosis, AU$3.06 of social and economic value is gained.³¹
• In a German study, a model estimated that average expected treatment costs for breast cancer increased by 17.8% in stage II, 36.5% in stage III, and 95.9% in stage IV compared to stage I.³²

Psychological support

• In the UK, treating psychological disorders in cancer patients with 10 sessions of therapy can save up to £4,700 per patient.⁸
• A Canadian study found that breast cancer survivors who participated in therapy group sessions had less depression, better overall quality of life and fewer psychiatric symptoms, two-years post treatment.³³
• Most clinicians interviewed during a survey agreed that telehealth increases access to (91.7%) and simplifies the process for patients to receive (79.2%) early integrated palliative care.³⁴
• A US study showed that telehealth can save up to USD $186 per visit.³⁵

Cancer care pathway: Screening and early detection

Low uptake of screening

• Screening uptake across different countries is variable, even where screening programs are available. For example, in Japan only 44% of the eligible population are screened for breast cancer, compared to over 70% in Italy and the Netherlands, and over 80% in the US.³⁶
• Breast cancer screening rates of women aged 50 – 69 in Europe in 2022 vary from 83% in Denmark, to 48% in France and 28.5% in Slovakia.³⁷
• Colorectal cancer screening programs have also seen low uptake, with approximately only 25% of women having been screened for colorectal cancer in Italy.³⁸
• Lower uptake of breast cancer and cervical cancer screening is particularly evident within lower socio-economic backgrounds.³⁹
• In the UK, uptake is also affected by ethnicity, with women from South Asian, African and Caribbean backgrounds having lower uptake of cervical cancer screening.⁴⁰
• The stigma surrounding cancer diagnosis has been associated with lower participation in screening programs, in England and Asia.^41,42

Low awareness of screening

• Low public awareness of the availability of screening programs for colorectal cancer can lead to low screening participation, with 4 in 5 women in Italy being unaware of the cancer screening programs offered to them, while 29% of women surveyed had not received a screening invitation.³⁷
• In the US and Australia, similar reports of low awareness of screening programs have been identified in underserved communities.⁴³

Cultural gaps in screening

• In South Korea, lower attendance for cervical cancer screening was found for employed women, potentially as workplaces do not always provide leave for screening appointments.⁴¹
• Among low-income populations, difficult living conditions have been cited as reasons for lower screening participation, while language and cultural barriers to screening involvement have also been observed in a population of low income, immigrant women in France.⁴⁴

Limited availability and access to screening programs

• Around 70% of cancer mortality in the US is linked to unscreened cancers.⁴⁵ Up to 45% of cancer deaths could be avoided if the right care was used.³
• In the US, only 14% of all cancers are detected through available screening programs,⁴⁶ with ~50% of cancers currently being detected at an advanced stage globally.²²
• Screening programs for lung cancer are currently in their infancy, with countries like England and Italy only recently starting to adopt these.^47,48

Cancer care pathway: Diagnosis

Late-stage diagnosis

• In the UK, 1 in 4 cancer patients experience delays in diagnosis.⁴⁹
• In Ukraine, 1 in 4 breast cancer patients present in late stages.⁵⁰
• In China, an observational study found that 53% of cancer patients (across lung, esophagus, colorectum and female breast) were diagnosed at a late stage.⁵¹
• In LMICs, it is estimated that between 49% and 54% of childhood cancers go undiagnosed.⁵²
• In Oman, the Cancer Awareness Measure questionnaire revealed that ~60% of the population was unable to identify the common signs and symptoms of cancers and that women were significantly more likely to be embarrassed raising symptoms with a healthcare professional.⁵³

Diagnosis in secondary care

• In the UK, the survivability rate at 3 years post-diagnosis falls from 77% to 40% of blood cancer cases diagnosed in a GP setting compared to an emergency diagnosis.⁵⁴ Collectively blood cancers represent a sizeable proportion of the overall cancer patient population.⁵⁵
• On average, 43% of all cancers in New Zealand were diagnosed through emergency presentation, compared to 31% in Denmark and England.⁵⁶
• Lung cancer cases diagnosed through emergency presentation vary from 35% in England to 51% in New Zealand.⁵⁵

Cancer care pathway: Treatment

• One study suggests that for each 4-week delay in surgery as cancer treatment, risk of mortality from cancer increases by 6-8%.⁵⁷
• Survival rates vary for different tumor types. For example, in the United States breast cancer has an overall 5-year survival rate of 91%,⁵⁸ while for pancreatic cancer the 5-year survival rate is only 13%.⁵⁹ While 5-year survival rates in Austria and Sweden have improved for some cancers since the 1990s – such as multiple myeloma, breast, kidney and lung cancer – others have seen no or little improvement – such as brain cancer, laryngeal cancer and gynecological cancers.⁹
• When diagnosed at an early stage, pancreatic cancer has a survival rate of 44%, although this then decreases to 3% when diagnosed at a late stage.⁵⁸
• In several countries, delays occur in referral to treatment following a cancer diagnosis, such as England⁶⁰ France, Italy and Spain.⁶¹
• In Europe, between 2019 and 2022, the median time to patient access to medicines varied from 1.5 months to over 2 years post market authorization.⁶²
• In Spain, patients between 2017 and 2021 had to wait for an average of 611 days to access new treatments, in contrast to Germany and Denmark, for which the waiting time was 102 days and 145 days respectively.⁶³
• Wealthier Western European countries generally reimburse more cancer medicines than less wealthy countries in Central and Eastern Europe and smaller countries.⁹
• Almost half of the new cancer medicines approved by the EMA for solid tumors in 2015 – 2020 were associated with a predictive biomarker to tailor treatments.⁹
• Biomarker testing and whole genome sequencing have become vital to realizing the potential of precision medicine to guide therapeutic decisions. Costs for whole-genome sequencing have dropped from USD $3 billion during the Human Genome Project to approximately USD $600 today, and is predicted to drop further to USD $100 in the near future, which would enable widespread use of precision medicine.⁹

Cancer care pathway: Clinical trials

• Only 43% of clinical trials for diseases that disproportionately impact people living in LMICS are carried out in LMICs.⁶⁴
• Clinical trials can play a significant role in cancer treatment, however currently between 2-8% of patients take part in oncology clinical trials, despite evidence suggesting that people taking part in clinical trials have a higher standard of care than those who undergo standard treatment pathways.^65,66
• AstraZeneca conducted a review of close to 100 clinical trial protocols and found that 70% of data could be collected remotely in the comfort of a patient’s home.⁶⁷
• In the past, clinical trials in oncology have not adequately represented minority ethic communities.⁶⁸
• In the US, individuals of Black and Latinx ethnicity made up 22% and 44%, respectively, of their expected enrolment in relation to US cancer incidence.⁶⁹

System governance

Data and infrastructure

• Only 1 in 5 LMIC countries is able to report cancer data of sufficient quality to determine incidence estimates.⁷⁰
• More than 25% of cancer patients receive a treatment based on biomarker testing.⁷¹
• Access to whole genome sequencing⁷² and liquid biopsies is limited due to cost and/or infrastructure constraints.⁷³
• Approximately 60% of patients undergo some type of surgery to treat their cancer.⁷⁴

Workforce capacity

• In the US only a limited number of genetic counsellors exist; patients face long waiting times for these appointments and issues with reimbursement.⁷⁵
• In 2021 there was a 29% shortfall in consultant radiologists in England, with this predicted to rise to 39% by 2026⁷⁶ – a trend that is reflected globally.⁷⁷
• In Australia, the healthcare system is facing challenges in deploying radiologists into rural areas.⁷⁸

The role of National Cancer Control Plans (NCCPs)

• An analysis of seven countries over a 20-year period found that greater consistency in cancer policy formulation is positively correlated to improved cancer survival.⁷⁹
• In 2017, the World Health Assembly (WHA) passed a resolution recommending that all countries establish an NCCP to reduce their cancer burden.⁸⁰ Since then, the number of countries with an NCCP has grown from 86 in 2017 to 121 in 2022.⁸¹

Implementation of NCCPs

• NCCPs are recognized as critical frameworks for reducing the global cancer burden, yet their development and implementation can be uneven across regions.⁸²
• There are challenges to the development and implementation of NCCPs, with no global guidance to define the core elements.⁸³
• Of 158 World Health Organization (WHO) member states who had NCCPs, just 10% of these had adequate budgets or implementation plans to adopt them.⁸²
• Only 27% of NCCPs globally include financing strategies and 50% lack reference to radiotherapy strategies, demonstrating disparities in treatment access.⁸⁴
• Around a quarter of countries have set financial strategies within their NCCPs.⁸³