Lung cancer is the leading cause of cancer deaths in the Asia-Pacific region, where the sheer number of lung cancer deaths each year is greater than the number of deaths from lung cancer in the rest of the world combined. Sadly, this number is projected to increase nearly two-fold by 20401. While these numbers can somewhat be attributed to Asia’s large population, lung cancer cases are disproportionately high in this part of the world, representing 14% of all cancer cases compared with 11% and 10% in Europe and the United States, respectively.
Of all cancers, lung cancer creates the most significant economic burden on healthcare systems globally, with an estimated annual global cost of nearly $4 trillion2. The high cost of lung cancer comes in part from the economic costs associated with late-stage diagnosis, with 77% of patients globally receiving a diagnosis at an advanced stage. A recent study in Canada showed that treating stage four lung cancer patients cost the healthcare system more than twice as much as treating patients with stage one lung cancer3. In Australia, it costs $1,500 - $3,300 AUD less per patient to treat stage one lung cancer compared with later stages4.
There are many factors that contribute to the high rates of lung cancer and late-stage diagnosis in the region, including smoking and exposure to second-hand smoke, air pollution, occupational hazards, genetic differences, and weaknesses in health systems and policy. Access to screening, rapid diagnosis, and treatment for lung cancer is varied across the region, with governments struggling to tackle this growing challenge. Tobacco control policies fall short in much of the region. National cancer control plans tend to lack detail with respect to the control and management of lung cancer, including related to funding sources. Guidelines for detecting and managing lung cancer vary considerably across the region, particularly around screening and shared decision-making programs5.
With respect to screening, Korea, Taiwan, and – most recently – Australia – have all embarked on national lung cancer screening programs that recommend low dose CT. Japan is unique in the region in its population-based screening approach that uses plain chest radiography and sputum cytology. In China, Southeast Asia, and India, screening programs are ad-hoc and lack a central organizing body.
Countries across the region would be well-served to consider organized screening programs. A 2019 study that simulated the effect of implementing U.S. screening guidelines utilizing low dose CT in four Asian countries showed a potential reduction in lung cancer mortality of 4.3% in Japan, 4.7% in South Korea, 4.2% in China, and 3.8% in Singapore6. The U.S., which launched its lung cancer screening program in 2013 is now seeing a 4 – 5% reduction in annual mortality from lung cancer7.
Stakeholders often voice three main concerns when discussing national lung cancer screening programs using CT. First is the dosage of radiation used in the scan and its impact on healthy tissue and organs. Second is the accuracy of the results, where there can be several false positives or false negatives. Finally, the cost and workload for medical personnel to implement a national program. Any approach or guidance must address these concerns, such as by providing ultra-low dose CT scans, AI tools to improve accuracy and reduce workload, and cost-efficient technology to screen large patient populations without compromising quality.
In addition to screening, improvements in shared-decision making programs could have a significant impact on both clinical outcomes and quality of life. Even in countries with clear guidelines on optimal care pathways, patients that could benefit from lung cancer treatments such as targeted therapy, immunotherapy, and radiotherapy are missing out. In Australia, for example, 48% of lung cancer patients that would benefit from radiotherapy as part of their treatment do not receive it8. This is due to a number of factors, including lack of awareness and involvement of patients in decisions about their care.
Improving lung cancer outcomes in the Asia-Pacific region requires a multi-stakeholder approach. In February, Siemens Healthineers, along with a number of our partners across the healthcare community, launched ASPIRE, the Asia-Pacific Policy Review & Engagement for Lung Cancer coalition. In response to the significant public health issue of lung cancer in the Asia-Pacific region, ASPIRE takes on the mission of advocating for the prioritization of lung cancer in government action plans. The coalition aims to spur decision-makers into taking action, engaging in efforts to enhance lung cancer screening, diagnosis, treatment, and care. ASPIRE provides a critical platform for robust policy discussions and campaigns on lung cancer, addressing a pressing unmet need in the region.
ASPIRE will be working closely with regional and global cancer care organizations and platforms, such as the Asia-Pacific Coalition against Lung Cancer, to drive change across the region and globally. For more information on ASPIRE, please visit the website at the link below.
Written by
Jamie Kebely is Vice President for Asia-Pacific & Japan Government Affairs at Siemens Healthineers and is based out of Singapore. Jamie is responsible for driving collaboration with government partners and key stakeholders in the region to support the Healthineers’ vision of pioneering breakthroughs in healthcare. For everyone. Everywhere. Prior to joining Varian Medical Systems and then Siemens Healthineers, Jamie led international government affairs for Boston Scientific.
She is from the U.S. and started her career working in the U.S. Government. Jamie has extensive experience in Asia and has previously lived in Japan and Hong Kong.
Siemens Healthineers