Enhancing global access to cancer medicines
Enhancing global access to cancer medicines
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DOI：
10.3322/caac.21597
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发表时间：
2020-02-18
影响因子：
254.7
通讯作者：
Arribas, Joaquin
中科院分区：
文献类型：
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作者：
Cortes, Javier;Perez-Garcia, Jose Manuel;Arribas, Joaquin
在全球范围内，癌症是第二大死亡原因，其数量大大超过人体免疫缺陷病毒/后天免疫缺陷综合症、结核病和疟疾的总和。获得及时诊断、负担得起的有效治疗和高质量护理的机会有限，这只是导致国家之间和国家内部癌症生存率差异的一些因素。在这篇文章中，作者考虑了阻止获得癌症药物（特别是获得基本癌症药物）的各种因素。即使一种基本癌症药物被列入国家药品清单，但费用可能会妨碍其使用，可能会被不适当地开处方或使用，薄弱的基础设施可能会使那些可能受益的人无法获得，或者质量可能得不到保证。讨论了解决获取问题的潜在战略，包括基本癌症药物的全民健康覆盖，更公平的癌症药物定价方法，降低开发成本，优化监管，提高全球供应链的可靠性。优化癌症治疗的时间表不仅可以降低成本，还可以减少不良事件，并改善可及性。需要更多更好的生物标志物来靶向最有可能从癌症药物中获益的患者。癌症药物的最佳使用取决于与肿瘤学相关的几种服务的有效提供（包括实验室，成像，手术和放射治疗）。从这些支持性服务到技术，以及对卫生保健工作者和其他工作人员的培训，在癌症护理的各个方面都需要投资。
Globally, cancer is the second leading cause of death, with numbers greatly exceeding those for human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and malaria combined. Limited access to timely diagnosis, to affordable, effective treatment, and to high-quality care are just some of the factors that lead to disparities in cancer survival between countries and within countries. In this article, the authors consider various factors that prevent access to cancer medicines (particularly access to essential cancer medicines). Even if an essential cancer medicine is included on a national medicines list, cost might preclude its use, it might be prescribed or used inappropriately, weak infrastructure might prevent it being accessed by those who could benefit, or quality might not be guaranteed. Potential strategies to address the access problems are discussed, including universal health coverage for essential cancer medicines, fairer methods for pricing cancer medicines, reducing development costs, optimizing regulation, and improving reliability in the global supply chain. Optimizing schedules for cancer therapy could reduce not only costs, but also adverse events, and improve access. More and better biomarkers are required to target patients who are most likely to benefit from cancer medicines. The optimum use of cancer medicines depends on the effective delivery of several services allied to oncology (including laboratory, imaging, surgery, and radiotherapy). Investment is necessary in all aspects of cancer care, from these supportive services to technologies, and the training of health care workers and other staff.