Cancer inequalities persist globally, with inequitable access and delivery of care playing a key role. Quality indicators (QIs) are widely used to assess cancer care performance and evaluate policy impacts, yet the extent to which national QI frameworks capture health equity is unclear. We conducted a narrative review and thematic analysis of QI frameworks used in G7 countries that apply the Donabedian model to breast and colorectal cancer. Searches of Medline and grey literature identified 15 eligible frameworks from five countries: the United States (n=5), United Kingdom (n=5), Canada (n=2), France (n=1), and Germany (n=1), alongside one international framework. Across frameworks, 512 QIs were extracted, the majority being process measures derived from clinical guidelines. Thirty-eight thematic domains were identified, with many frameworks incorporating measures related to equity or patient-centred care. Equity related metrics comprised those addressing systemic inequity - such as stratified performance reporting, mandating removal of barriers to treatment, and clinical trial enrolment targets - and those supporting individual care, such as assessment of social support needs and communication.Measures for removing barriers and stratified performance reporting were limited to a small number of frameworks, and measures of individual-level social support interventions were rare. Although QI frameworks could strengthen equity monitoring by incorporating stratified reporting and indicators of equity-focused interventions, such reporting requires the support of legal and information governance frameworks for sensitive data collection,contextual interpretation and case-mix adjustment, as well as safeguards against punitive use of performance data. POLICY SUMMARY: These findings provide an overview of how national and regional quality frameworks collect and report information relevant to treatment equity. We identify opportunities to strengthen national cancer quality frameworks through expanded stratified reporting and indicators of equity-focused interventions. Such developments, if underpinned by appropriate data governance, interpretation and safeguarding, could inform equity-focused policies and support monitoring their effects over time.
BACKGROUND:Cancer-related premature mortality imposes substantial economic losses through reduced productivity. Lung and pancreatic cancers remain among the leading causes of years of life lost (YLL) in Central and Eastern Europe (CEE), yet their indirect economic impact has been insufficiently quantified. This study quantifies years of life lost (YLL) and the associated productivity losses in nine CEE countries between 2010 and 2021. METHODS:YLL data were drawn from the WHO Global Burden of Disease database for Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia. Productivity losses for individuals dying before age 65 were estimated using the human capital approach (HCA), multiplying years of productive life lost by country specific average full time adjusted salary adjusted for labor force participation and discounted at 3% annually. RESULTS:YLL attributable to lung cancer declined substantially across the CEE region, falling from 1,694,868 to 1,472,743 between 2010 and 2021. In contrast, YLL from pancreatic cancer increased across most CEE countries over the same period, rising from 375,802 to 395,652. Total productivity loss attributable to working-age lung cancer mortality declined from €6.37 billion to €4.33 billion, while pancreatic cancer productivity losses remained relatively stable at approximately €1.29 - 1.21 billion. Poland, Hungary, and Romania accounted for the largest absolute burden. CONCLUSIONS:Despite meaningful reductions in lung cancer YLL between 2010 and 2021, both cancers impose a formidable and ongoing economic toll across CEE. The near-stable pancreatic cancer burden contrasts with improvements in lung cancer and highlights an emerging policy priority. Targeted interventions in early detection and equitable access to therapy remain essential.
BACKGROUND:Cancer is a leading global cause of death, with the burden rising fastest in low- and middle-income countries (LMICs). The WHO Model List of Essential Medicines for Cancer (EML-C) provides an evidence-based benchmark for prioritizing safe and cost-effective therapies for reaching Universal Health Coverage (UHC). However, only 25% of countries have a national cancer EML-C, and fewer than 10% adequately fund it. OBJECTIVE:This study aims to identify factors determining successful implementation beyond income levels. METHODS:We used a comparative case-study design of Chile, Kenya, and Thailand. Cases were selected through a two-stage purposive process using five criteria: at least 80% EML-C alignment, early-2010s upward income transition, cross-regional representation, UHC service-coverage improvement (2010-2023), and documentary support. Using the 2023 WHO EML-C (64 medicines), we analyzed national alignment, policy timelines, context, and stakeholder roles. Data came from predefined bilingual searches and were validated by country co-authors. RESULTS:All three countries showed high alignment with the 2023 WHO EML-C-60/64 medicines in Chile and 58/64 in both Kenya and Thailand-while expanding substantially beyond WHO-listed items (119, 84, and 127 total medicines, respectively). These findings reflect three implementation pathways: Chile's political-fiscal model, anchored in statutory guarantees with ministries of Health-Finance co-decisions; Thailand's technical-negotiation model, using HTA-informed selection and negotiation; and Kenya's protocol-partnership model, driven by specialist consensus and international technical collaboration. CONCLUSIONS:WHO EML-C adoption is most effective when embedded within broader UHC reforms. Policymakers should leverage "policy windows" to build institutional bridges that connect priority-setting, evidence appraisal, fiscal negotiation, and procurement. By aligning clinical evidence with fiscal authority -whether through inter-ministerial joint-decisions, health technology assessments, or expert consensus- oncology drugs can be successfully embedded into sustainable national benefit packages. High list alignment indicates implementation readiness, but does not by itself guarantee realized patient access or financial protection.
BACKGROUND:Access to essential anticancer medicines in low- and middle-income countries is shaped not only by physical availability but also by affordability. Evidence from subnational settings in Iran remains limited. This study assessed the point-in-time availability and wage-based affordability of selected essential anticancer medicines in Lorestan Province, western Iran. METHODS:In a cross-sectional survey 20 essential anticancer medicines were assessed in 13 public hospital pharmacies and 70 private community pharmacies using an adapted WHO/HAI approach. Availability was measured as stock on the survey day, and affordability as the number of daily minimum wages needed for a standard 30-day course. RESULTS:Public-sector generic availability was high overall (mean 81% ± 24%), while public-sector originator availability was lower (33% ± 28%). Private pharmacies showed almost no stock for either generics (0.3% ± 1.1%) or originators (0.5% ± 2.2%). Eighteen of 20 medicines were unavailable in private pharmacies. Only three generics-letrozole, bortezomib, and exemestane-were affordable (≤1 wage-day), along with two originators-letrozole and bortezomib. Most treatments required several to hundreds of wage-days, with the highest burdens seen for capecitabine, nilotinib, rituximab, and trastuzumab. CONCLUSIONS:Availability in public hospitals did not translate into affordability, and private-sector access was extremely poor. Policy responses should combine stronger supply monitoring, procurement reform, and targeted financial protection to improve equitable access to oncology medicines.
BACKGROUND:Process evaluations of government-led cancer programmes help to understand whether, how and why these programmes work, ensuring accountability and informing the design of future initiatives. We report on a process evaluation of the Detect Cancer Early (DCE) Programme, launched by the Scottish Government in 2012, and provide recommendations for similar initiatives elsewhere. METHODS:A mixed-methods process evaluation informed by psychological and complexity theories was carried out to understand how the DCE Programme operated, and the extent to which its aims were met. Stakeholders involved in developing or managing the programme or providing care for patients were interviewed or completed an online questionnaire investigating implementation assumptions, mechanisms of impact, contextual barriers and facilitators, and unanticipated outcomes. Interviews were analysed using framework analysis; questionnaire data were summarised using descriptive statistics, bivariate and content analysis. Results were integrated to address the evaluation questions. RESULTS:25 stakeholders were interviewed; 53 completed the questionnaire. Participants supported DCE's focus on early cancer detection, but engagement and sense of ownership were affected by limited communication about the Programme, its activities and outcomes. While increased demand for diagnostic services drove activities, there was frustration when strategies attracted the worried well. Some performance targets were perceived to be unachievable and not clinically relevant. DCE's timescales were often seen as not conducive to long-term changes. CONCLUSIONS:We identified several factors that may have influenced acceptability and implementation of DCE activities, and the ability to show Programme impact. Process evaluations of cancer programmes are still scarce, and we urge researchers and policymakers to publish results where available.
Equitable access to clinical trials is a recognised determinant of cancer outcomes, yet participation rates across oncology settings remain highly stratified by institutional research capacity. In Italy and across European health systems, a primary structural barrier to broader trial participation is the shortage of qualified clinical research personnel - a shortage sustained, in part, by an organisational model that conflates advanced data management competencies with routine data entry tasks, inflating the qualification threshold for trial activation at under-resourced sites. This article argues that a formal organisational distinction between a Data Entry Operator (DEO) and a Data Manager/CRC represents a cancer policy intervention: one that can expand trial access to under-resourced oncology sites, reduce the administrative burden on oncologists, improve data quality governance, and create a sustainable entry-level workforce pipeline in cancer clinical research. A tiered workforce model is proposed in which DEOs perform structured, protocol-driven data entry under DM supervision, while DMs/CRCs concentrate on regulatory compliance, adverse event management, protocol coordination, and quality assurance. DEOs would progress to full CRC qualification through concurrent work-based academic pathways. This model is compatible with ICH-GCP E6(R3) and EU CTR 536/2014 without legislative change. By lowering the staffing threshold for trial activation, the model may increase the number of oncology sites capable of conducting clinical trials, improve geographic and institutional equity in research participation, and strengthen the sustainability of the cancer research workforce. Implementation requires coordinated engagement from professional associations, academic institutions, and national cancer policy bodies. Prospective evaluation is required to confirm anticipated effects on site activation rates and trial access.
OBJECTIVE:To evaluate the trial characteristics, transparency, and geographic accessibility of ovarian cancer clinical trials registered on ClinicalTrials.gov from 2000 to 2025; identify major reasons for trial termination; and estimate state-level enrollment-to-incidence ratios across the United States (U.S.). METHODS:We conducted a longitudinal analysis of interventional ovarian cancer clinical trials initiated between January 1, 2000, and December 31, 2025. Trial characteristics, funding sources, transparency indicators, and reasons for termination were extracted from ClinicalTrials.gov. Comparisons were performed between U.S. and non-U.S. TRIALS:State-level ovarian cancer trial enrollment-to-incidence ratios in the U.S. were calculated. RESULTS:A total of 3720 ovarian cancer clinical trials were included in the analysis (1891 U.S.-based and 1829 non-U.S.-based). Most trials were treatment-focused (78.5%), drug-based (70.1%), employed single-arm or parallel-group designs (86.2%), and were early phase (60.8%). The majority were open-label (82.3%), and 8.8% explicitly indicated an intention to share individual participant data. Among eligible completed trials, 31.4% had posted results on ClinicalTrials.gov. Compared with non-U.S. trials, U.S. trials were more frequently early phase (75.2% vs. 45.9%), single-arm (46.4% vs. 39.5%), and drug-based (74.6% vs. 65.4%) (all P-value< 0.001). Large numbers of trials were terminated, most commonly attributed to recruitment difficulties (27.3%), sponsor decisions (25.2%), and efficacy-related concerns (13.0%). The overall estimated trial enrollment-to-incidence ratio is 12.6%. Geographic information system (GIS) analyses demonstrated substantial geographic heterogeneity in trial enrollment to incidence ratio estimates, with state-level estimates ranging from 4.7% in Arkansas to 67.5% in the District of Columbia. CONCLUSION:This analysis identifies substantial heterogeneity in ovarian cancer clinical trial design, transparency, and geographic distribution of enrollment. Strengthening trial design rigor, improving compliance with results reporting and data-sharing requirements, and adopting more geographically inclusive recruitment strategies are important steps to enhance the transparency, efficiency, and representativeness of the clinical research infrastructure.
Japan introduced national health insurance coverage for radiofrequency ablation (RFA) in selected patients with early breast cancer on 1 December 2023. We used public aggregate claims data to determine which features of early implementation were observable and which were obscured by disclosure controls. We analyzed the 10th and 11th releases of open data from Japan's National Database of Health Insurance Claims and Specific Health Checkups (NDB Open Data). Breast RFA was identified by procedure code 150444250 (K476-5 in fiscal year 2024). A matching row was found only in inpatient sheets. Fiscal year 2024 contained 376 claim-recorded procedure occurrences. All sex-by-age occurrences were tabulated in female strata. Disclosed age cells for ages 40-84 years accounted for 362 occurrences (96.3%); suppressed female cells for ages 25-39 and 85-89 years accounted for the residual 14 (3.7%). Disclosed prefectural counts summed to 320 (85.1%), whereas 56 occurrences (14.9%) remained unallocated because 20 prefectural cells were suppressed. Monthly counts ranged from 17 to 52. Including public-expense-only claims increased the annual total from 376 to 379. Public aggregate claims provided a national inpatient billing benchmark and limited age profile but could not fully characterize geographic implementation, identify unique patients, or assess appropriateness or outcomes. Post-reimbursement surveillance should use claims and clinical registries as complementary data sources, with aligned observation periods, procedure definitions, and counting units.
Principal Illness Navigation (PIN) represents an important Medicare policy advance, but coverage has not translated reliably into access. PIN addresses a real need: patients with cancer and other serious chronic illnesses often struggle with fragmented communication, scheduling complexity, insurance confusion, caregiver burden, and uncertainty about next steps. Medicare recognizes PIN under Healthcare Common Procedure Coding System (HCPCS) Level II codes G0023 and G0024, with payment established through the Medicare Physician Fee Schedule. Yet the main barriers to PIN implementation are administrative and operational rather than clinical. The billing practitioner must perform an initiating visit and remains responsible for supervision, documentation, and billing, even when auxiliary personnel furnishing navigation are external to the practice. Many private practices and oncology groups lack the infrastructure or patient volume to employ dedicated navigators. Specialized outside navigation organizations may offer a scalable alternative, but contracting, enrollment, and billing remain difficult; reassignment adds further friction when an eligible organization seeks to submit claims and receive Medicare Part B payment. This commentary argues that PIN’s implementation challenges reflect not only physician education gaps but also a broader trust problem in the administrative pathway. Historical warnings from the U.S. Department of Health and Human Services Office of Inspector General help explain physician caution. Experience from other Centers for Medicare & Medicaid Services programs, including the Medicare Diabetes Prevention Program and the Guiding an Improved Dementia Experience (GUIDE) Model, shows that CMS can modify delivery rules and formally evaluate implementation when operational barriers emerge. To make PIN function as a real benefit rather than a paper benefit, CMS should provide plain-language guidance, clarify risk boundaries, simplify enrollment and payment pathways, and measure activation, onboarding time, and successful service delivery.
PURPOSE:The rising cost of cancer care has made financial considerations increasingly prominent in oncology practice. Although patient financial toxicity is well studied, how cost-related factors influence physician treatment decision-making is less clearly understood. This systematic review evaluates how various financial factors shape prescribing and treatment decisions in oncology. METHODS:A comprehensive literature search was conducted in MEDLINE, Embase, and Web of Science databases. Eligible studies evaluated associations between financial exposures (e.g., drug pricing, reimbursement, promotional payments, formulary status, patient out-of-pocket costs) and physician treatment decisions in oncology. Quantitative, qualitative, and mixed-methods studies were included. Screening, data extraction, and risk-of-bias assessment (ROBINS-I) were performed by independent reviewers. Findings were synthesized descriptively due to study heterogeneity. RESULTS:Of the 7206 unique articles identified, 60 studies met inclusion criteria. Financial influences operated across three domains: Physician-industry, physician-patient, and physician-physician. Industry payments and financial incentives were consistently associated with increased prescribing of promoted or profitable drugs, particularly when incentives were large or salient. Patient out-of-pocket costs frequently influenced recommendations, though cost discussions were less common than cost-informed decisions. Physicians endorsed cost-conscious care in principle but reported tension between stewardship and norms of offering all potentially beneficial therapies, alongside limited access to cost information. CONCLUSION:Financial factors influence oncology treatment decisions at multiple levels, with system- and industry-level incentives exerting strong downstream effects. Physicians are tasked with delivering cost-conscious care without sufficient tools or structural support, highlighting the need for broader system-level interventions. POLICY SUMMARY:Supporting cost-conscious cancer care requires system-level redesign, not sole reliance on individual clinician behavior. Policies should embed financial considerations upstream through formularies, reimbursement policies, and clinical guidelines, while improving transparency for both clinicians and patients. Efforts should also strengthen regulation of industry-physician relationships and integrate financial navigation and decision-support tools into oncology care.
PURPOSE:In France, the Système d'Interrogation, de Gestion et d'Analyse des Publications Scientifiques (SIGAPS) identifies and validates MEDLINE-indexed publications produced by healthcare institutions. SIGAPS indicators contribute to funding allocated through the Missions d'Enseignement, de Recherche, de Référence et d'Innovation (MERRI), while conventional cumulative SIGAPS totals may also be considered in individual hospital-university dossiers. This policy perspective clarifies these distinct uses, describes the position of radiation oncology within the journal-classification framework and proposes operational safeguards for responsible assessment. METHODS:A narrative policy analysis was conducted using PubMed/MEDLINE and primary institutional documentation available up to 10 January 2026. Sources addressed SIGAPS development, publication validation, the 2021 fractional reform implemented for MERRI allocation, the published 2021 criteria of the French National Council of Universities (CNU) Section 47-02 and responsible research assessment. A descriptive dataset of 341 oncology and radiation-related journals classified from 2019 to 2023 was also examined. RESULTS:Only MEDLINE-indexed and SIGAPS-validated publications in were eligible for scoring. The conventional score is calculated as the product of the author-position coefficient (C1) and journal coefficient (C2). For the MERRI-related institutional allocation, the fractional score is calculated as (C1i/ΣC1j) × C2, with validated author contributions subsequently aggregated at the institutional level. National funds are allocated to healthcare institutions with internal redistribution determined locally. In contrast, the cumulative thresholds used by CNU 47-02 section rely on conventional, non-fractional SIGAPS scores as one element of a broader academic evaluation. Radiation oncology has no dedicated Web of Science subject category and is primarily represented within Oncology and Radiology, Nuclear Medicine and Medical Imaging. Among 341 journals, 23 (6.74%) belonged to these categories, including two ranked A and six ranked B. CONCLUSION:SIGAPS remains a valuable tool for publication identification, institutional monitoring and funding allocation, provided its different policy functions are not conflated. Fractional scores are appropriate for institutional funding, whereas individual academic evaluation should integrate conventional scores with peer review and broader academic contributions.
Introduction Digital health technologies are increasingly used across oncology services, but the available evidence remains concentrated on patient-facing and clinical applications. Organisational perspectives and the involvement of non-clinical professionals remain poorly represented. This scoping review mapped digital health technologies used in adult oncology care, examined their functions for healthcare professionals (HCPs), and assessed the extent and nature of evidence involving non-clinical professionals (NCPs). Methods A scoping review was conducted to identify studies reporting the use of digital health technologies in adult cancer care. PubMed, Embase, CINAHL, and Web of Science were searched for studies published between 2015 and June 2025, and reference lists were hand-searched. Qualitative, quantitative, mixed-methods, pilot, feasibility, and implementation studies were eligible. Findings were synthesised narratively according to the primary function of each technology and the professional groups involved. Results Forty-one studies were included. The most frequently reported technologies were electronic patient-reported outcome systems, telehealth and telemonitoring platforms, mobile applications, and decision-support or AI-enabled systems. These technologies were used mainly for symptom monitoring, communication, follow-up, survivorship support, clinical decision support, and care coordination. Reported benefits included earlier symptom detection, improved communication, greater patient reassurance, and more structured clinical workflows. Common barriers included limited digital literacy, declining engagement over time, alert burden, workflow misalignment, poor interoperability, and inadequate technical infrastructure. Only three studies explicitly included non-clinical professionals, indicating that organisational and managerial applications remain substantially under-researched. Policy summary Interoperability and workflow integration emerged as the most consistently supported implementation priorities. Equity, scalability, sustainability, and economic impact require further evaluation. Because evidence involving non-clinical professionals and AI-enabled implementation remains limited, recommendations concerning organisational adoption, AI governance, and workforce preparation should be treated as priorities for implementation research rather than established policy requirements.
Background Artificial intelligence (AI) has the potential to improve cancer care. Its implementation must align with patients’ needs, values, and lived experiences. This study aimed to explore perspectives from patient advocates representing patient organizations, including individuals with experience of melanoma, bladder and lung cancer, and to co-develop recommendations to support the ethical, patient-centered, and practical integration of AI in oncology. Methods Semi‑structured interviews were conducted with 18 patient advocates from patient organizations within the MULTIR network to explore current challenges in cancer care, perceptions of the benefits and risks of AI, and conditions for its trustworthy, sustainable and equitable adoption. Findings were reviewed and refined through a series of webinars, enabling participants to validate and strengthen the resulting recommendations. Results Participants identified key benefits and risks associated with AI and formulated six main recommendations targeting developers, policymakers, regulators, and researchers. These include: ensuring clear, accessible, and transparent communication about AI; strengthening training and capacity-building for healthcare professionals and patient organizations; demonstrating tangible clinical and patient-level benefits; developing secure, robust, and interoperable data infrastructures; reinforcing ethical and regulatory frameworks; and ensuring the sustained and meaningful involvement of patient organizations throughout AI development, implementation, and evaluation processes. Conclusion These recommendations provide actionable, patient-informed directions for advancing the integration of AI in cancer care. Although grounded in insights from specific cancer communities, they are broadly applicable across oncology. Progress will require the structured integration of patient organizations and experiential knowledge into governance, research, and implementation processes, in order to support more equitable, trustworthy, and patient-centered AI-enabled health systems. Policy Summary The recommendations have implications for European policies on healthcare regulation, digital health infrastructure, and data governance. They highlight the importance of capacity building, stakeholder engagement, and embedding principles of equitable access, responsible implementation, and patient‑centered governance of AI‑enabled health services.
BACKGROUND:Delays in diagnosis and treatment, driven in part by limited geographic access to specialized care, continue to hinder childhood cancer outcomes. In this study, we aimed to evaluate motorized travel times for children seeking care at three referral childhood cancer centers in India. METHODS:This multi-center retrospective study analyzed individual-patient level data for children (aged ≤19 years) diagnosed with cancer between 2005 and 2019 at three tertiary hospitals in India: All India Institute of Medical Sciences (AIIMS) and Rajiv Gandhi Cancer Institute (RGCI) in New Delhi, and Women's Indian Association (WIA) Cancer Institute in Chennai. Patient residential addresses were geocoded, and travel times were estimated using Malaria Atlas Project friction surface rasters and Dijkstra's algorithm. An exploratory logistic regression analysis was performed to identify factors associated with prolonged motorized travel time (>60 min). RESULTS:A total of 22,328 patients with a median age of 10 years (IQR 4-15), 32·5% (n = 7261) female, and 54·2% (n = 12,093) with solid malignancies were included. The median motorized travel time was 161 min (IQR 27-430), with 73·5% of patients traveling > 60 min. Male sex (aOR 1·23, 95% CI: 1·15-1·31; p < 0·001) and solid malignancies (aOR 1·09, 95% CI: 1·03-1·16; p = 0·004) were associated with prolonged travel time. Compared with AIIMS, WIA had higher odds (aOR 2·79, 95% CI: 2·58-3·03) and RGCI had lower odds (aOR 0·69, 95% CI: 0·65-0·74) of prolonged travel time (p < 0·001). CONCLUSION:Children with cancer in India face a substantial travel time burden to access cancer care, highlighting the need for expansion of pediatric oncology services. POLICY SUMMARY:There is a need for policies that expand pediatric oncology capacity beyond major urban referral centers, strengthen regional treatment networks, and improve referral systems to reduce delays and disparities in diagnosis and treatment and improve childhood cancer outcomes.
BACKGROUND:Breast cancer remains a major global health concern and the leading cause of cancer-related mortality among women. The National Cancer Institute projects 30 million new cases and 15.3 million deaths worldwide by 2040. Early detection through screening significantly reduces mortality. Young women often perceive themselves as being at low risk, resulting in limited knowledge about breast cancer and low uptake of BSE. OBJECTIVE:This systematic literature review synthesises the existing literature to examine the research trends, levels of knowledge, attitudes, and practices related to breast cancer and BSE among young women. The study also examined the existing barriers and facilitators to derive evidence-based recommendations for increasing the uptake and practice of BSE. METHODS:Following PRISMA guidelines, literature searches were conducted in Scopus, PubMed, and Web of Science. Empirical studies examining BSE-related KAP among women aged 15-30 were included. Fifty-seven studies met the inclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and thematic synthesis was used to appraise themes. RESULTS:Young women demonstrated fair general awareness of breast cancer, their knowledge of risk factors, symptoms, and screening methods was often limited. Mass and digital media were the primary information sources. Despite high awareness, BSE practice remained low due to informational, psychological, cultural, and behavioural barriers. CONCLUSION AND POLICY IMPLICATIONS:A significant gap exists between awareness and screening practice among young women. Targeted and culturally tailored educational interventions along with awareness campaigns are strongly recommended to increase the screening practices among young women.
PURPOSE:Molecular Tumor Boards (MTBs) are widely implemented in precision oncology, yet no health system has established a mandatory outcome accountability framework. This article uses Italy's nationally mandated MTB programme, established by Ministerial Decree in 2023 and progressively adopted through formal regional acts (15 of 21 regions and autonomous provinces by 2024), as a case study of a governance gap affecting MTB programmes across health systems. METHODS:Synthesis of published evidence across 34 studies and 12,176 patients, Italian institutional series (IEO Milan, IRE Rome), the NCI-MATCH trial, and ESMO 2024 NGS recommendations. RESULTS:Cumulative attrition in the MTB pathway reduces real-world clinical benefit to approximately 8 of every 100 patients discussed. Four structural mechanisms drive this: absence of mandatory ESCAT-based pre-triage; conflation of genomic alterations with actionable targets (the driver/passenger fallacy); absent outcome registries; and failure to evaluate whether MTB network architecture is volumetrically justified. Cost per patient with documented benefit is estimated at €26,000-66,000. CONCLUSIONS:Four mutually reinforcing reforms are proposed: mandatory ESCAT I/II pre-discussion triage; a national outcome registry linked to six-month therapeutic outcome; a pay-at-result basket trial in which industry provides matched therapy free of charge with reimbursement contingent on verified clinical benefit; and a structured pilot to evaluate MTB model adequacy as molecular profiling evolves. Each reform is grounded in operational precedents: the UK Cancer Drugs Fund, the French Accès Précoce mechanism, and the German MASTER trial network.
Background Childhood cancer survival in sub-Saharan Africa remains below 30%, largely due to delayed diagnosis, weak referral systems, and limited specialised services. To improve access and continuity of care, Cameroon launched a national Shared Care Network (SCN) for paediatric oncology in 2023 under the WHO Global Initiative for Childhood Cancer and within the CureAll framework. This study aimed to describe the development process, baseline findings, network design, and early lessons from establishing Cameroon’s national paediatric oncology Shared Care Network. Methods A baseline assessment using the International Society of Paediatric Oncology (SIOP) Global Mapping Survey was conducted in ten hospitals across six regions. Data were collected on oncology infrastructure, staffing, diagnostic and treatment capacity, and access to supportive services. Centres were classified according to service level, and findings were validated through stakeholder workshops involving the Ministry of Public Health, the National Committee for the Fight Against Cancer (NaCFAC), and partner organisations. These findings informed centre classification, referral pathway design, service package definition, workforce training priorities, and development of a national SCN implementation manual. Results Two hospitals: Mbingo Baptist Hospital and the Mother and Child Centre, Chantal Biya Foundation were designated as hub centres with full oncology services. Eight others function as shared-care centres, providing basic chemotherapy and diagnostics with referral links to the hubs. All facilities had access to X-ray and ultrasound, while CT scans and paediatric surgery were available only at the hubs. None had immunohistochemistry or radiotherapy. Forty-nine healthcare workers were identified, including five paediatric oncologists and thirty-five trained nurses. Psychosocial and rehabilitative services were available in only three centres. Civil society groups provided key support in transport, accommodation, and drug procurement. The development process produced a nationally validated SCN framework with defined hub and shared-care roles, referral pathways, service packages, and training priorities. Conclusion The establishment of Cameroon’s SCN demonstrates the feasibility of developing a coordinated and decentralised paediatric oncology network within an existing health system in a resource-limited setting. Integrating the SCN into national policy, investing in diagnostics, and institutionalising training will be essential for sustainability and scaling toward universal coverage and improved childhood cancer survival in Cameroon.
