Fighting Lung Cancer in Taiwan Requires Reform

Lung cancer is the deadliest form of cancer in Taiwan. More than 9,700 Taiwanese die from the disease in 2018, yet Taiwan still struggles to reduce the mortality rate from this devastating illness. In fact, the Executive Yuan’s Golden Ten-Year Plan, launched in 2010, aimed to decrease Taiwan’s standardized cancer mortality rates by 20%, but by 2019 that rate had dropped by only 7.8%, well short of the goal.

To more effectively decrease the lung cancer mortality rate, specialists have urged the government to adopt a comprehensive new strategy. According to Prof. Tsai Chun-ming, a consultant physician in Taipei Veterans General Hospital’s Department of Oncology, such a strategy should incorporate prevention, screening and early diagnosis, and accurate treatment.

Prof. Tsai Chun-ming

The first step in carrying out such a strategy should be to form a cross-ministerial lung cancer control task force, which would serve as a national discussion platform for lung cancer prevention and care, says Dr. Wang Cheng-hsu of the Hematology-Oncology Department at Chang Gung Memorial Hospital. Wang serves concurrently as chairman of the Hope Foundation for Cancer Care, a non-profit patient advocacy group in Taiwan.

Dr. Wang Cheng-hsu

In terms of lung cancer screening, the low-dose CT scan (LDCT) is a widely discussed tool. However, there is an ongoing debate over the cost-effectiveness of LDCT, and it is now mostly used for heavy smokers. Wang adds that it carries the risk of false positives and overdiagnosis.

The Taiwan government is currently conducting a large-scale survey on whether LDCT can be used to screen non-smokers, and the results of this survey are expected to be released next year. Tsai and Wang say they hope that this effort will result in localized clinical consensus guidelines for Taiwan.

In addition, the two doctors agree that the government needs to allocate sufficient resources for innovative treatments, such as targeted therapy and oncology immunotherapy. These treatments, they argue, are highly cost-effective, have demonstrated good clinical efficacy, and shown promise in prolonging the life of patients.

Tsai emphasizes that reimbursement criteria for lung cancer treatment in Taiwan should align with international standards and be based on scientific evidence. He says that indicators such as “progression-free survival” (e.g. target therapy) and “overall survival” (e.g. oncology immunotherapy) could serve as the priority criteria for clinical medication and reimbursement.

However, warns Tsai, the National Health Insurance program’s finances are presently in deficit, and the increasing cost of treatment puts the government in a tough position when it comes to securing sufficient budget for new drugs. Due to insufficient budgetary allocation, reimbursement criteria in Taiwan is relatively strict. Additionally, although a copayment system exists, it does not cover patients with major illnesses like lung cancer, which precludes such patients from early access to innovative treatments.

 “The current NHI system cannot meet the rising cost of treatment, and it lacks a fast-track review mechanism for innovative, life-saving medicines.” says Wang of the Hope Foundation. Wang’s suggestion is to calculate NHI premiums based on gross household income, rather than on individual – the current formula. “Such a system would be fairer and more just,” says Wang. “It would allow the NHI to continue operating in perpetuity and provide access to new medicines for those that need them.”

Similarly, patients’ voices should be included as much as possible in decision making, especially where it concerns the type of treatment being provided. In the past, doctors called the shots on pretty much everything related to a patient’s care, but now shared decision-making is increasingly becoming the norm in hospitals worldwide.

The NHI Administration has caught on to the trend, creating a platform for collecting patient feedback and allowing patients to join the meetings of its Pharmaceutical Benefits and Reimbursement Scheme Joint Committee. But Wang says the feedback collected on the platform is still not well-reflected in policy decisions, and patient participation in the meetings is limited to observer status.

Lung cancer patients should be empowered with the knowledge of all available treatment options to enable them to take a more active role in their battle against cancer. In the meantime, Wang emphasizes that psychological health services should also be included in any future strategy and diagnostic guidelines. Doing so would provide cancer patients and their families with significant emotional support and help them with ultimately achieving better outcomes.

[ The information source is MSD ]