Asia-Pacific Biotech News

Fighting Cancer With Efficient Systems and Funding: South Korea’s Example for APEC Economies

In the wake of the pandemic, APEC economies need to return their chief healthcare focus to cancer, one of the region’s biggest health threats. South Korea’s experience with cancer control can serve as a useful model for countries and regions looking to adopt or adapt a long-term cancer strategy in a targeted, cost-effective manner and re-examine current cancer investments.

by Yoon-Jung Chang, MD, PhD

In most Asia-Pacific Economic Cooperation (APEC) economies, cancer ranks as one of the top three leading causes of death, and Asia alone accounts for 50% of total global cancer incidence.1 Having said that, cancer investment in Asia-Pacific is “remarkably low” with only 5–9% of total health spending directed to cancer care, even in higher-income countries, and most of the funding dedicated to treatment despite close to 40% of cancer considered to be “preventable”.2

This begs the question of whether government financing for cancer care should be re-examined. This point was included as a recommendation in the recent report launched by APEC’s Health Working Group, which I spoke on a panel at its launch. It calls on APEC economies to “examine the nature and adequacy of public funding for NCCPs, with a view to maximize government funds, generate new revenue, and minimize future expenses”, and lays out several best practices.

As described by the WHO, national cancer control programmes should leverage systematic, equitable, and evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation using available resources. However, while many APEC governments have adopted a national cancer control programme, their approaches can easily be let down by oversights, false assumptions, inflexibility, budgetary constraints, or a lack of collaboration.

Fortunately, there is an increasing body of data to draw on showing effective methods and policies, cost-efficient frameworks, and ways to tailor responses to local needs, such as evidence-based approaches using cancer incidence or five-year relative survival rates of each cancer type and stage. In order to get better at tackling cancer–in terms of treatment, prevention, palliative care, and cost reduction–we need to establish effective patterns for collaboration involving a broad spectrum of organisations and cross-border partnerships.

One of the critical elements that should be prioritised by public-private stakeholder collaboration would be the creation of guidelines for domestic Cancer Control Dashboards that would track key metrics, such as vaccination rates, patient demographics, cancer characteristics, stage of disease, treatment, and outcomes. By establishing aligned and gold-standard guidelines for territories across the region, governments and health authorities can draw on accurate, real-time data to assess the effectiveness of their national cancer control programmes (NCCP) and make adjustments as needed to ensure the impact of their cancer investment is maximised. It would also facilitate cross-border exchange and learning to further improve cancer prevention and care.


The Asian Context

Cancer responses in the Asia-Pacific region encompass a diverse array of policies and effectiveness, from the very comprehensive to the largely inadequate. This is important because half of all cancer incidence is within Asia, and by 2030, cancer incidence in APEC is expected to increase by nearly 35% (to 11.8 million cases annually), with a 40% increase in expected mortality.3

Cancer is the foremost cause of death and a significant driver of escalating medical costs in many APEC economies, which underscores the urgent need to prioritise cancer in our ageing societies. The cost burden weighs especially heavily on lower- and middle-incomed countries (LMICs), where cancer incidence is expected to rise by as much as 81% by 2040, according to the WHO.4 Cancer mortality is also much higher in LMICs, accounting for approximately 70% of global cancer-related deaths.5,6 As of 2022, an estimated 3.19 billion people live in LMICs, roughly translating to 40.1% of the global population.7

The first hurdle societies and policymakers need to overcome is a natural inhibition in the face of a massive health challenge. Too often, cancer is still regarded as a prohibitively expensive problem. Because cancer responses often demand a wide-ranging response involving multiple sectors of government and business as well as a major technological component, they can be dismissed as a costly burden. In fact, numerous studies have shown that the financial burden of cancer–through medical costs, lost labour, lost expertise, presenteeism, and absenteeism–is a severe drain on economies, not to mention the social cost of preventable deaths. Indeed, data modelling suggests that coordinated action and sustained measures could lead to a 29% drop in cancer mortality for some APEC economies.8

In the aftermath of the pandemic, the APEC region also faces the task of shifting resources from contagious diseases back to the biggest problem at hand: cancer. Despite resistance or inertia in some quarters, rigorous cost-benefit analyses show the need to return our focus to cancer programmes now that COVID-19 is endemic. Experience shows that an effective response involves a wide range of stakeholders and attention to every aspect of prevention and care.


Marshalling All Resources

While cancer treatment tends to become a flagship element of each country’s or region’s healthcare system, prevention and palliative care can be lower profile, less centralised, and therefore less noticed. Integrating and supporting these wings of cancer treatment is essential to forging a coherent cancer strategy.

Cancer treatment infrastructure has long been the keystone of the medical framework of any country or region. Establishing comprehensive tertiary cancer centres has given people access to high-quality radio imaging equipment, advanced pathological diagnostic technology, and diverse surgical capabilities, as well as pharmaceutical support, radiologic apparatus, and inpatient and outpatient care. It also signifies a well-structured hospital system and a cohesive team of multidisciplinary medical experts, including doctors, nurses, and support personnel. Cancer treatment is the most visible element of cancer control, usually offering centralised care for many patients within a single facility.

Initiatives such as cancer screening programmes, prevention strategies, and palliative care interventions are very different in nature. Unlike the centralised provision of cancer treatment, these initiatives must be firmly rooted in primary healthcare and community-based approaches. Educating people about these programmes and reinforcing their critical importance poses significant challenges.

In this regard, medical professionals can play a key role. Those working in cancer treatment can serve as trailblazers for screening and palliative care. By sharing their knowledge with primary healthcare staff, medical professionals can act as effective champions for screening, prevention, and palliative care and assume a leadership role in this area.


Role of the Government

Of course, the pivotal role of the government in cancer control cannot be understated. It is imperative for governments to formulate comprehensive national strategies for cancer control, encompassing the entire spectrum from prevention to palliative care, while also committing resources to advance cancer treatment modalities. International collaborations can also bolster the efforts of countries and regions within the APEC network, offering many opportunities for mutual learning and policy enhancement.

Critically, governments need to use the present moment in the wake of COVID-19 to re-evaluate their National Cancer Control Plans (NCCPs) using standardised assessment tools. This process is vital to identifying both the strengths and weaknesses of governments’ current plans and paving the way for targeted improvements.

Because government policy is always contingent on national finances, analyses need to encompass both the ongoing cost burden of cancer and how to fight the disease effectively with the most economic use of resources. Costing involves a holistic approach that considers new revenue streams (such as taxes on cigarettes and other cancer-causing items, also known as “sin tax”) and the potential efficiency benefits of working with partners or employing new technologies. In this regard, South Korea’s 27-year-long strategy provides a useful template for how to control cancer through an economically sustainable approach.


The South Korean Example

South Korea embarked on its journey towards cancer control in 1996 with the inauguration of a national cancer control plan. This featured a comprehensive array of initiatives, including the establishment of the Cancer Control Act, a dedicated government department for cancer control, a robust funding strategy, a cancer research strategic blueprint, and the start of an all-encompassing policy strategy. Central to these efforts was the establishment of South Korea’s National Cancer Center, where I now work. South Korea’s approach is multi-faceted, seamlessly intertwining the governmental network with the National Cancer Center (NCC), which functions both as a research institute and a policy support hub. This synergy is further augmented by the provision of medical health insurance coverage for cancer treatments and the allocation of public funds to bolster cancer control policies. South Korea’s national cancer control plan is routinely revised and updated, with a fourth iteration soon to be enacted, reflecting the country’s ongoing dedication to combating cancer on all fronts.

The NCC plays a pivotal role in buttressing government policies and overseeing the management of information systems, including the national screening programme and a programme that offers support for cancer-related medical costs. It also houses the Korea Central Cancer Registry, a wellspring of data crucial for evaluating the prevailing national cancer landscape. Additional initiatives like the Hospice and Palliative Care Programme and the National Cancer Survivorship Programme have also been established. The NCC meticulously analyses all available data and thus plays a major role in evaluating South Korea’s cancer control efficacy.

Venturing into uncharted territory, we have recently embarked on a “Cancer Big-Data Programme”, establishing a clinical cancer data grid and a standardised common data element model, which is run in collaboration with multiple cancer hospitals. The ultimate goal is to amalgamate cancer policy data with other pertinent public datasets, creating a holistic and enriched information landscape.


South Korea’s Cancer Control Journey

Since the inception of its cancer control strategy at the end of the twentieth century, South Korea has updated its plan three times. Its four “plans” have each addressed the challenges and opportunities of the moment. Together, they are a useful example of programme success that other countries can learn from and adapt according to their needs. A clear progression is evident, where the success of initial mitigation and immediate response allows for a later increase in focus on prevention, palliative care, and most recently, big data.


First Plan (1996–2005)

South Korea’s first plan for cancer can be seen as a “diving in” phase, during which the government set out to combat cancer through treatment, screening, cost reduction, prevention, and public awareness. The first major initiative arrived in 1999 with the introduction of a national cancer screening programme, targeting stomach, breast, and cervical cancer. The following year, South Korea’s National Assembly passed the National Cancer Center Act, and in 2002, the National Health Promotion Fund was initiated by increasing the tax on tobacco products. In the same year, the National Cancer Center opened its doors for the first time.

Importantly, 2002 also saw the introduction of a cancer health cost support programme for vulnerable patients and a reduction in the national health insurance co-payment rate for cancer treatment. A series of further steps followed over the next few years, including screening programmes for liver and colon cancer, new regional cancer screening centres, and the inception of a palliative care programme. In 2007, the National Cancer Information Center was opened.


Second Plan (2006–2015)

The next plan was a “development phase”, in which the reach and scope of the first plan were expanded, including six more regional cancer centres. An anti-smoking call service was launched in 2006, a milestone prevention programme that went a long way in saving lives and money. 2008 saw the first hospice units, and three years later, the hospice programme was added to the Cancer Control Act. By 2015, people could pay hospice inpatient fees through their national health insurance.


Third Plan (2016–2020)

The most recent plan was a “take-off” phase, building on the success of the previous 20 years to bring the country’s palliative care, screening, and prevention programmes in line with other developed economies. In 2017, the Hospice & Palliative Care and Life-sustaining Treatment Act was enacted. Meanwhile, anti-smoking images were mandated on cigarette packs, and a lung cancer screening programme began in 2019. Pilot programmes also began for home hospice care and shared care arrangements.


Fourth Plan (2021–2025)

In the current phase, the country is harnessing new technology to enable precision oncology and digital transformation, while also continuing to add further facilities according to demand. In 2021, the Cancer Control Act was amended to allow for further cancer prevention, carcinogen management, cancer survivorship, and cancer big data initiatives. In the same year, a national cancer big data centre was established within the National Cancer Center. Last year, a cancer survivorship programme was launched, and this year saw the designation of the 13th regional cancer centre.


Lessons for Asia and Beyond

South Korea’s successful cancer response offers some key takeaways for the wider region. The big picture is that effective national policies need a solid base of legislation, the support of public funding, the guidance of professional public health researchers, and, critically, the holistic collection of quality data and procedures to update cancer control strategies based on the latest situation. In terms of strategy, national cancer control plans should be comprehensive and adaptable, evolving with policy shifts, scientific advancements, ongoing research, changing disease patterns, and demographics.

As the WHO puts it, countries need “best-buy” – high priority, low cost – interventions that provide coverage for all individuals. The APEC Health Working Group’s Best Practices and Recommendations for APEC Collaboration on Cancer Control report lays out the most effective and comprehensive strategies of this kind in detail, based on consultations with representatives from the APEC member economies. You can read the report in full here.

Through the COVID-19 pandemic, we have seen how governments and stakeholders can come together to overcome unprecedented global health issues. Together, we have the knowledge and tools to fight the war on cancer, but it requires a collaborative approach and a holistic view that addresses all stages of the disease, from prevention to recovery and even palliative care.

The direct impact of cancer on patients and healthcare systems is severe, but more broadly, the potential impact on economic and social well-being is astronomical, particularly when considering the rapid rate at which our societies are ageing coupled with low birth rates.

Now is the ideal time for governments across APEC to reassess their healthcare priorities and seek out the most efficient and cost-effective solutions for the key health threats. As cancer remains the biggest health issue, health authorities need to press forward with effective cancer control strategies. This will involve rigorously evaluating the relevant data, engaging with the wider community of actors involved in health care, and integrating successful models from across the region. [APBN]

This article was first published in the September & December 2023 print version of Asia-Pacific Biotech News.

About the Author

Yoon-Jung Chang, M.D., Ph.D. Dr. Yoon-Jung Chang serves as the Vice Director of the National Cancer Survivorship Center at the National Cancer Center (NCC) in South Korea and is an Adjunct Professor under the Department of Cancer AI & Digital Health at the National Cancer Center Graduate School of Cancer Science and Policy. She also sits on the Ethical and Governance Committee of the International Cancer Genomic Consortium for Accelerating Research in Genomic Oncology (ICGC ARGO).