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21 September 2021

Access to essential cancer medicines unequal across countries

Patients in most countries of the world do not have access to basic cancer medicines, according to new research from King’s College London Global Oncology Group Professor Richard Sullivan and collaborators at Kingston University and the World Health Organization.


The World Health Organization (WHO) has updated and released an Essential Medicines List) (EML) every two years since 1977. This list helps policy-makers worldwide prioritize which medicines to provide for patients.

Professor Sullivan and the international team surveyed 948 frontline cancer doctors from 82 countries to learn which cancer medicines they considered the most important for patient care. 

The research team found that the most important medicines identified by oncologists are primarily older inexpensive chemotherapy and hormone medicines. With one exception, all of the top 20 high-priority cancer medicines are already included on the EML. Oncologists consider these medicines to be the most important because they have large benefits for patients across many common cancers.

15 of 20 medications are common to all three top 20 lists, however although the list for low-income and lower-middle-income countries does not include any immunotherapy agents and the only hormone therapy listed is tamoxifen, the lists for upper-middle-income countries and high-income countries include and newer hormonal treatments.

The paper also reports that in most health systems, patients are unable to afford even these basic cancer medicines. In lower and middle-income countries, most patients face major financial barriers to accessing anticancer medications—even older, generic, and inexpensive chemotherapy drugs. Financial barriers also exist in many high-income countries.

“Our study demonstrates that the most important cancer medicines are not sufficiently prioritized by many government health systems. This leads to limited access to even the most fundamental regimens for cancer care.

Professor Richard Sullivan, a co-author of the study from the School of Cancer & Pharmaceutical Sciences,

He added: "The primary reason why medicines are not available to patients is because they are not affordable. This is tragic as most of these medicines are older generic drugs and provide major benefits to patients. These problems are most pressing in low-middle and upper-middle income countries where the rates of cancer are most rapidly escalating.

“There is an urgent need for global and country-level policy action to ensure patients with cancer globally have access to affordable high priority effective medicines.”

In this story

Richard  Sullivan

Director, Institute of Cancer Policy and Co-Director of the Centre for Conflict & Health Research