Back to the ‘essence’ of medical treatment in oncology: the 2015 WHO Model List of Essential Medicines

Abstract

Correspondence to Dr Alexandru Eniu; aleniu@iocn.ro INTRODUCTION Forty years ago, a group of physicians gathered in Nice, France, with a shared optimism for the promise of systemic therapies to treat cancer. This conference became the inaugural meeting of what is now the European Society for Medical Oncology (ESMO), which today convenes nearly 20,000 individuals from around the world. At that time, in 1975, it was becoming clear that contemporary scientific discoveries related to the properties of chemotherapeutic agents were spring-loading the oncologist’s ability to address malignancies. Clinicians were able to employ adjuvant chemotherapy for the treatment of early-stage breast cancer, and combination chemotherapy for patients with testicular cancer, both of which would soon lead to marked improvements in overall survival. Medicines such as cyclophosphamide, cisplatin, bleomycin and others—which we often take for granted in our practices today —were then new instruments in the clinician’s anticancer toolkit. The number of systemic therapies and treatment approaches we currently have to address the needs of our patients with cancer is vast. With advanced techniques in radiology, pathology, radiation oncology, surgical oncology and other subspecialties, the benefit of medicines can be further augmented for certain types of cancer. A woman diagnosed with early-stage breast cancer in Europe today has an 80% chance of longterm survival. Similarly, a child diagnosed in Europe with acute lymphoblastic leukaemia has a nearly 90% chance to live a long and relatively healthy life after treatment. Overall, the notion that cancer is a universal death sentence has shifted from reality to fallacy in wealthy parts of the world. Yet, as these tremendous gains in advanced economies have resulted in improvements in life expectancy, and undoubtedly economic gains from productivity life-years (not to mention the social and moral imperatives implicit in cancer care), the conception of cancer as a death sentence is not a fallacy in many impoverished regions of the world: it is a reality. The authors of this editorial have been sobered time and again by the sight of patients with cancer in wards of hospitals where treatment options readily available in developed countries have not extended their reach. Even after a century of discovery in therapeutics, our society’s ability to deliver medicines to places where they are needed has been an imperfect—if not an exiguous— performance. Current advances rely on availability of certain interventions, including medicines considered essential for the success of therapy in certain cancers. The WHO recognised the importance of these medications to improve the outcome of patients worldwide, and, since 1977, proposed and subsequently maintained, the WHO Model List of Essential Medicines. Containing only a few anticancer medicines at the beginning, the list has reached its 19th version, and has been recently updated, prompting us to reflect on the worldwide implications of this project. ESMO has endeavoured to reduce these inequities as part of its societal mission, and has been among the global leaders of several crucial policy changes that are designed to dramatically improve access to cancer treatment worldwide. Our partnership with the Union for International Cancer Control (UICC), in particular, alongside many other collaborators around the world, is highlighted in the present editorial.

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Cite this paper

@inproceedings{Eniu2016BackTT, title={Back to the ‘essence’ of medical treatment in oncology: the 2015 WHO Model List of Essential Medicines}, author={Alexandru E Eniu and J. Q. Torode and Nicola Magrini and Gracemarie Bricalli}, booktitle={ESMO open}, year={2016} }