A Consensus Plan for Action to Improve Access to Cancer Care in the Association of Southeast Asian Nations (ASEAN) Region

Abstract

In many countries of the Association of Southeast Asian Nations (ASEAN), cancer is an increasing problemdue to ageing and a transition to Western lifestyles. Governments have been slow to react to the healthconsequences of these socioeconomic changes, leading to the risk of a cancer epidemic overwhelming the region.A major limitation to motivating change is the paucity of high-quality data on cancer, and its socioeconomicrepercussions, in ASEAN. Two initiatives have been launched to address these issues. First, a study of over 9000new cancer patients in ASEAN - the ACTION study - which records information on financial difficulties, as wellas clinical outcomes, subsequent to the diagnosis. Second, a series of roundtable meetings of key stakeholdersand experts, with the broad aim of producing advice for governments in ASEAN to take appropriate accountof issues relating to cancer, as well as to generate knowledge and interest through engagement with the media.An important product of these roundtables has been the Jakarta Call to Action on Cancer Control. The growthand ageing of populations is a global challenge for cancer services. In the less developed parts of Asia, andelsewhere, these problems are compounded by the epidemiological transition to Western lifestyles and lack ofawareness of cancer at the government level. For many years, health services in less developed countries haveconcentrated on infectious diseases and mother-and-child health; despite a recent wake-up call (United Nations,2010), these health services have so far failed to allow for the huge increase in cancer cases to come. It has beenestimated that, in Asia, the number of new cancer cases per year will grow from 6.1 million in 2008 to 10.6million in 2030 (Sankaranarayanan et al., 2014). In the countries of the Association of Southeast Asian Nations(ASEAN), corresponding figures are 770 thousand in 2012 (Figure 1), rising to 1.3 million in 2030 (Ferlay et al.,2012). ASEAN consists of Brunei Darussalam, Cambodia, Indonesia, Lao, Malaysia, Myanmar, the Philippines,Singapore, Thailand and Viet Nam. It, thus, includes low- and middle-income countries where the double whammyof infectious and chronic diseases will pose an enormous challenge in allocating limited resources to competinghealth issues. Cancer statistics, even at the sub-national level, only tell part of the story. Many individuals whocontract cancer in poor countries have no medical insurance and no, or limited, expectation of public assistance.Whilst any person who has a family member with cancer can expect to bear some consequential burden of careor expense, in a poor family in a poor environment the burden will surely be greater. This additional burdenfrom cancer is rarely considered, and even more rarely quantified, even in developed nations.