Access to anticancer drugs deemed essential by oncologists in 82 countries: an international and cross-sectional survey


The WHO Essential Medicines List (EML) identifies priority medicines of most importance to public health. Over time, SCL has included an increasing number of anti-cancer drugs. We investigated whether SCL anticancer drugs are aligned with priority drugs from first-line oncologists around the world, and how accessible these drugs are in routine clinical practice.


This international cross-sectional survey was developed by researchers from various clinical practice settings in low- and high-income countries, including members of the WHO Working Group on Essential Cancer Medicines. A 28-question electronic survey was developed and disseminated to a global network of oncologists in 89 countries and regions using a hierarchical snowball method; each primary contact distributed the survey through their national and regional oncology associations or personal networks. The survey was open from October 15 to December 7, 2020. Fully qualified physicians who prescribe systemic cancer treatment to adults were eligible to participate in the survey. The main question asked respondents to select the ten anticancer drugs that would bring the greatest public health benefit to their country; the following questions explored the availability and cost of anticancer drugs. Descriptive statistics were used to compare access to medicines between low- and lower-middle-income countries, upper-middle-income countries, and high-income countries.


87 country level contacts and two regional networks were invited to participate in the survey; 46 (52%) accepted the invitation and distributed the survey. 1697 people questioned opened the link to the survey; 423 were excluded because they did not answer the main question of the study and 326 were excluded because of their ineligibility. 948 eligible oncologists from 82 countries responded to the survey (165 [17%] in low- and lower-middle-income countries, 165 [17%] in upper-middle-income countries, and 618 [65%] in high-income countries). The most commonly selected drugs were doxorubicin (by 499 [53%] out of 948 respondents), cisplatin (by 470 [50%]), paclitaxel (by 423 [45%]), pembrolizumab (by 414 [44%]), trastuzumab (by 402 [42%]), carboplatin (by 390 [41%]), and 5-fluorouracil (by 386 [41%]). Of the 20 most frequently selected high-priority cancer drugs, 19 (95%) are currently on the WHO EML; 12 (60%) were cytotoxic agents and 13 (65%) obtained regulatory approval from the United States Food and Drug Administration before 2000. The proportion of respondents indicating the universal availability of each of the top 20 drugs was 9 to 54% in the low income and low income groups. middle-income countries, 13-90% in upper-middle-income countries and 68-94% in high-income countries. The risk of catastrophic spending (spending> 40% of total consumption net of food spending) was more common in low- and lower-middle-income countries, with 13-68% of respondents indicating a substantial risk of catastrophic spending for each. of the top 20 drugs in lower-middle-income countries versus 2-41% of respondents in upper-middle-income countries and 0-9% in high-income countries.


These data demonstrate major barriers to access to major cancer drugs around the world. These results call into question the feasibility of adding additional expensive anti-cancer drugs to SCI. There is an urgent need for global and national political action to ensure that cancer patients around the world have access to high priority medicines.



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