An international survey has revealed barriers to accessing cancer drugs deemed essential for routine clinical care. The survey was published in The Lancet Oncology.

Researchers surveyed medical oncologists from 82 countries and found that some essential cancer drugs were accessible but came with “substantial” out-of-pocket (OOP) costs, some drugs were accessible but had a high risk of “catastrophic expenditure,” and some were unavailable to patients for other reasons.

“These problems are particularly acute in lower-middle-income countries and upper-middle-income countries, where a substantial proportion of patients will incur financial catastrophe even to pay for older cytotoxic medications,” the researchers wrote.

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With this study, the researchers sought to determine whether cancer drugs on the World Health Organization’s (WHO) Essential Medicines List (EML) are aligned with the priorities of frontline oncologists worldwide and the extent to which these drugs are available to patients in routine clinical practice.

The researchers developed a 28-question electronic survey that was disseminated to a global network of oncologists. The primary question asked oncologists to select the 10 cancer drugs that would provide the greatest public health benefit to their country. Other questions explored the availability and cost of cancer drugs.

In all, 948 oncologists responded to the survey. Most (65%) were from high-income countries, 17% were from upper-middle-income countries, and 17% were from low-income and lower-middle-income countries.

Top Cancer Drugs

In response to the question about the top 10 cancer drugs, the most commonly selected drugs were doxorubicin (53%), cisplatin (50%), paclitaxel (45%), pembrolizumab (44%), trastuzumab (42%), carboplatin (41%), and 5-fluorouracil (41%). 

Among the top 20 high-priority cancer drugs selected by respondents, 19 (95%) are currently on the WHO EML. Of these, 12 (60%) are cytotoxic agents, and 13 (65%) were approved by the US Food and Drug Administration before the year 2000.

Access to the top 20 drugs varied across economic settings. The proportion of respondents who indicated universal availability of each top 20 drug ranged from 9% to 54% in low-income and lower-middle-income countries, from 13% to 90% in upper-middle-income countries, and from 68% to 94% in high-income countries.

Catastrophic Expenditure and OOP Costs

The risk of catastrophic expenditure — defined as spending that exceeds 40% of total consumption, minus food expenditures — was found to be more common in low-income countries.

In low-income and lower-middle-income countries, 13% to 68% of respondents said accessing each of the high-priority drugs placed patients at risk of catastrophic expenditure. Those percentages were 0% to 41% for middle-income countries and 0% to 9% for high-income countries.

The researchers noted that oncologists in middle-income countries reported a substantial risk of OOP expenditures and catastrophic expenditure even for older drugs, such as imatinib (30% and 4%, respectively), trastuzumab (23% and 9%), and gemcitabine (21% and 8%). 

Although drugs were generally more accessible in high-income countries, respondents in these countries also reported substantial OOP costs for older drugs, such as imatinib (24%), paclitaxel (12%), and doxorubicin (11%).

“Although these data suggest strong convergence between the WHO EML and oncologists’ perceptions of high-priority cancer medicines, we identified major barriers to drug access, largely in lower-middle-income and upper-middle-income countries,” the researchers wrote.

“These findings challenge the feasibility of adding additional expensive cancer medicines to the EML. There is an urgent need for global and country-level policy action to ensure patients with cancer globally have access to high-priority medicines.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Fundytus A, Sengar M, Lombe D, et al. Access to cancer medicines deemed essential by oncologists in 82 countries: An international, cross-sectional survey. Lancet Oncol. Published online September 21, 2021. doi:10.1016/S1470-2045(21)00463-0

This article originally appeared on Cancer Therapy Advisor