Striking a balance between idealism and fatalism

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Great strides have been made over recent decades in the treatment of cancer. Outcomes are improving and the numbers of cancer survivors are rising rapidly. These advances have taken place on the back of remarkable research, which has fostered a much deeper understanding of the fundamental complexities of tumour and host biology and its translation to the clinic. New technologies, regimens, and care algorithms offer countless choices for screening, diagnosis, treatment, and prognosis, and have increased the customisation of cancer management allowing greater alignment with patients' individual needs. Advances in prevention and palliation have also taken place, albeit at a slightly less dramatic pace. These developments have placed extra demands on existing health-care systems—demands that many care infrastructures were not designed to meet. Long-term follow-up and care for cancer survivors, for example, is becoming an increasingly difficult dilemma. Moreover, these changes come at a price. The scale of this cost is fiercely debated, ranging from the idealistic, which advocates that everything is possible irrespective of cost, to the fatalistic point of view, in which health-care systems will collapse imminently. Neither of these two extremes will be correct, but what is certain is the current approach to the provision of cancer care is unsustainable, even for the wealthiest countries. Delivering affordable cancer care in high-income countriesThe burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Full-Text PDF