Lung cancer prevention and treatment remains a challenge across the Asia-Pacific region, and each country has areas where they could improve, according to a study presented during the Day 2 mini oral session, “MA04: Health Policy and the Real World.”
Lung cancer is the leading cause of cancer mortality in the Asia-Pacific region accounting for one in five cancer deaths, according to study presenter Rohini Omkar, PhD, of The Economist Intelligence Unit, Singapore. Almost 1 million people in Asia-Pacific countries died of lung cancer in 2018.
Omkar and colleagues conducted a comparative analysis of lung cancer policies across the Asia-Pacific region to discover how countries and territories are responding to the increasing burden caused by lung cancer.
“The goal is not to rank countries but to identify opportunities and improve patient outcomes within each country,” Dr. Omkar said.
To do this, the researchers conducted a rapid review of the published and grey literature on lung cancer and policies in the countries studied: Australia, China, Hong Kong, Indonesia, Japan, Philippines, South Korea, Taiwan, Thailand. They then developed a benchmarking scorecard to evaluate lung cancer care policies. Next, they convened an expert panel to review and validate the scorecard and identified 17 indicators to evaluate each country across five domains.
The five domains were defined as, lung cancer is:
- A strategic priority, focusing on cancer control plans and clinical guidelines.
- A public health issue, covering tobacco control and screening.
- A race against time, covering symptom awareness and rapid referral to treatment.
- At a crossroads, assessing effective treatment and quality care.
- A focus for research, covering registries and research.
Overall the countries scored well in the first two domains, Dr. Omkar said, demonstrating that the majority of countries included in the research had comprehensive cancer control plans alongside policies incorporating strong public health approaches to reducing the burden of lung cancer in some countries (Figure).
For the third and fourth domains — a race against time and at a crossroads — countries scored modestly reflecting challenges faced by the region’s health systems in delivering the most up-to-date treatments, Omkar said.
In the fifth domain, the availability of high-quality data varied significantly.
Dr. Omkar said that several key findings could be taken from this research.
“We found that it is important to fill gaps in cancer policy making and formalize policy implementations,” Dr. Omkar said.
National cancer control plans exist in all nine countries included in the research, however, eight of the nine lack a specific lung cancer plan. Importantly, implementation plans that are key to the success of these plans were not commonplace, Dr. Omkar said.
“Tobacco control policies fall short in some of these countries where tobacco use remains high, especially among men,” she said.
While cancer registries exist, they rarely extend to national coverage so there is not a full picture of the lung cancer situation. It is also important to demonstrate evidence specific to Asia-Pacific on the benefits of population screening for lung cancer, Dr. Omkar said.
“Although the topic of screening programs is somewhat controversial, large scale studies in Europe and the United States have shown clear reductions in lung cancer mortality as a result of screening,” she said. “We also need to improve provision of rapid diagnosis and tackle inequalities in access to care.”
Finally, countries need to expand support for patients by involving them in decision making and supporting them through their entire care journey, especially by raising awareness of the psychological burden of lung cancer and the need for adequate support services, which is still limited in the Asia-Pacific region.
Future Directions and Questions
In her discussion of this abstract, Pamela Samson, MD, MPHS, of Washington University in St. Louis, Missouri, USA, congratulated the authors on their bold effort and consideration of each country’s, government’s and population’s unique needs.
Major findings of this research identified that the majority of countries did have public health measures in place including banning tobacco advertising, anti-tobacco mass-media campaigns and mandatory health warnings on tobacco products. However, clear needs in this region include lung cancer screening programs, referral system, improved supply of radiation therapy, immunotherapy, and targeted therapy options, supportive and palliative care, and improvements in diagnostic and treatment guidelines.
Future directions and questions include, identifying the next steps in improving these crucial domains across the lung cancer care continuum and identifying key stakeholders in each country for lung cancer specific networks.
“This was and continues to be a problem in United States as well,” Dr. Samson said. “However, our formation of the National Lung Cancer Roundtable with independent task groups covering these same domains brings together populations of professionals working to advance those objectives.”
Dr. Samson said that even though the collaborative group was only formed a few years ago, the number of stakeholders involved has grown exponentially from about 20 to more than 60.
“Once the framework is there, you see individuals with the same goal of lung cancer control and treatment interact with that framework to make incremental advances,” Dr. Samson said.
