Abstract
BackgroundLimited access to drugs is a crucial barrier to reducing the growing impact of cancer in low- and middle-income countries. Approaches based on drug donations or adaptive pricing strategies yield promising but varying results across countries or programs, The Glivec International Patient Assistance Program (GIPAP) is a program designed to provide imatinib free of charge to patients with chronic myeloid leukemia (CML) or gastrointestinal stromal tumors (GIST). The objective of this work was to identify institutional factors associated with enrollment and patient survival in GIPAP.MethodsWe analyzed follow-up data from 4,946 patients participating in 47 institutions within 44 countries between 2003 and 2010. Active status in the program was considered as a proxy for survival.ResultsPresence of ≥1 hematologist or oncologist at the institution was associated with increased patient enrollment. After adjusting for individual factors such as age (>55 years: Hazard Ratio [HR] = 1.42 [1.16; 1.73]; p = 0.001) and initial stage of disease (accelerated or blast crisis at diagnosis: HR = 4.16 [1.87; 9.25]; p < 10-4), increased survival was found in institutions with research capabilities (HR = 0.55 [0.35; 0.86]; p = 0.01) and those with enrollment of >5 patients/year into GIPAP (HR = 0.48 [0.35; 0.67]; p < 10-4), while a non-significant trend for decreased survival was found for treatment at a public institution (HR = 1.32 [0.95; 1.84]; p = 0.10). The negative impact of an accelerated form of CML was attenuated by the presence of ≥1 hematologist or oncologist at the institution (interaction term HR = 0.43 [0.18; 0.99]; p = 0.05).ConclusionsApplication of these findings to the support and selection of institutions participating in GIPAP may help to optimize care and outcomes for CML and GIST patients in the developing world. These results may also be applicable to the treatment of patients with other forms of cancer, due to the overlap of infrastructure and staff resources used to treat a variety of cancer indications. A multi-sector approach is required to address these barriers.
Highlights
Limited access to drugs is a crucial barrier to reducing the growing impact of cancer in low- and middle-income countries
While limited data are available for access programs that target non-communicable diseases, the success of various efforts to increase access to HIV therapies provides several models that may be applied to cancer and other chronic diseases [1,5,7,8]
The authors of this study identified several differences between countries with respect to the magnitude of the improvements in the health state achieved by patients enrolled in Glivec International Patient Assistance Program (GIPAP), these trends did not reach statistical significance
Summary
Limited access to drugs is a crucial barrier to reducing the growing impact of cancer in low- and middle-income countries. Several innovative strategies for reducing the impact of cancer in low- and middle-income countries have already been implemented and are showing promise in improving access to care and patient outcomes [6,11,12,13,14,15] These efforts include: decreasing cancer risk factors (such as tobacco exposure), development of guidelines for establishing national cancer programs, leveraging existing cancer research capabilities to establish additional cancer-related programs, establishment of national or regional referral centers, use of telemedicine to improve access in remote areas, increasing access to cancer screening, drug donations and adaptive pricing strategies in which patients pay what they can afford and have the rest of their medication costs covered by other organizations [6,11,12,13,16]
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