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Review Supportive Care Can we Continue to Afford Access to Cancer Treatment? Nils Wilking, 1 Gilberto Lopes, 2 Klaus Meier, 3 Steven Simoens, 4 Wim van Harten 5,6 and Arnold Vulto 7 1. Karolinska Institutet, Solna, Sweden; 2. Sylvester Comprehensive Cancer Center, University of Miami, FL, US; 3. HKK Soltau, Lower Saxony & Heidekreis-Klinikum GmbH, Soltau, Germany; 4. KU Leuven, Leuven, Belgium; 5. University Twente, Enschede, The Netherlands; 6. Rijnstate Hospital, Arnhem, The Netherlands; 7. Erasmus University Medical Center, Rotterdam, The Netherlands O ncology is facing a crisis of affordability that is not sustainable. The economic burden of cancer is growing, as a result of the rising cancer incidence and increased survival, alongside growing investment in disease prevention, diagnosis and treatment. The prices of new cancer drugs continue to increase, placing growing pressure on many healthcare systems. The aim of this article is to explore the reasons why the cost of cancer care is increasing, and why this increase may become unsustainable unless changes are made. There are only limited options for future health spending. Finding ways to improve the allocation of existing resources to achieve the best outcomes for patients will be key to achieving sustainability, whilst safeguarding the continued development of new, effective cancer treatments. Currently, too many cancer drugs are approved without robust evidence of value, and spending more on treatments does not necessarily translate to improvements in health. For all new drugs, in addition to efficacy and safety, there should be a focus on value, with measured outcomes and pricing that ensures these drugs are affordable. Fundamental changes to healthcare systems and industry are needed to sustain cancer care and allow continued access to effective and safe treatments for all patients. Keywords Sustainability, cancer care, value, outcome, affordability, healthcare Disclosure: Nils Wilking, Gilberto Lopes, Klaus Meier, Steven Simoens and Wim van Harten have nothing to disclose in relation to this article. Arnold Vulto has nothing to disclose in relation to this article and no financial interest in any pharmaceutical company. His institution receives financial compensation for consulting/lecturing activities on behalf of AbbVie, Amgen, Biogen, Boehringer Ingelheim, EGA (Medicines for Europe), Mundipharma, Pfizer/Hospira, Roche and Novartis/Sandoz/Hexal. Acknowledgements: Editorial assistance was provided by Sarah Stutfield, PhD, of Spirit Medical Communications Ltd., funded by Sandoz International GmbH. Compliance with Ethics: This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 8 June 2017 Accepted: 7 August 2017 Innovation in healthcare is highly beneficial from a patient perspective; however, the introduction of new drugs, often at high cost, is placing increasing pressure on many healthcare systems. 1 As a result, these systems are facing a growing crisis of affordability, both globally and locally, which is unsustainable. Oncology is the area of greatest concern. In Europe alone, cancer is a major cause of morbidity and mortality. 2 In 2013, cancer represented 17% of the total burden of disease in Europe (as measured in disability adjusted life years [DALYs]), 3 and caused the equivalent of 25 million years of healthy life lost due to ill-health, disability and death. 4 According to the latest GLOBOCAN data, the estimated cancer incidence in Europe in 2012 was 3.4 million cases, 2,5 representing a 31% increase compared with 1995 2 and this trend is expected to continue. Cancer care consumes up to 30% of total hospital expenditure across Europe, 6 and spending on cancer treatment has risen faster than spending in many other areas of healthcare, with costs continuing to rise considerably. 7,8 However, despite this, the share of healthcare expenditure allocated to cancer remains significantly lower than the share of the cancer disease burden (Figure 1). 3 Citation: European Oncology & Haematology, 2017;13(2):114–9 Corresponding Author: Nils Wilking, Department of Oncology and Radiation Physics, Skåne University Hospital, Lund/Malmö, Department of Oncology- Pathology, Karolinska Institutet, Stockholm, Sweden. E: nils.wilking@skane.se Support: The publication of this article was supported by Sandoz International GmbH. The views and opinions expressed are those of the author and do not necessarily reflect those of Sandoz International GmbH. The increasing economic burden of cancer is closely linked to rising cancer incidence, and increased survival, alongside growing investment in disease prevention, diagnosis and treatment. 2 It is estimated that new, cancer drugs have accounted for 50–60% of the increase in cancer survival rates since 1975, 9 but at an increasing cost. In Europe, total cancer drug sales more than doubled between 2005 and 2014, increasing from €8.0 billion to €19.8 billion. 2 These rising costs are due to the rising prices of newly approved drugs, the growing number of patients requiring treatment, and increased survival rates leading to higher cumulative treatment costs over a patient’s lifetime. 2,10 In some countries, this increasing economic burden is placing physicians under significant pressure to balance the cost of cancer care with each testing and/or prescribing decision, which can lead to patients being 114 TOU C H ME D ICA L ME D IA