In an effort to remove one of the leading causes of lung cancer, the Taiwan government has through various campaigns and new regulations reduced the adult male smoking rate from around 55% in 1996 to 23% in 2020. For adult women, the smoking rate has been kept at a low 3-5%. But despite these efforts, lung cancer has been the number one cause of cancer deaths for both men and women in Taiwan for the past two decades.
“Around two-thirds of lung cancer patients in Taiwan are never-smokers,” says Yang Pan-chyr, Professor of Internal Medicine at National Taiwan University. “Looking into why never-smokers get lung cancer, we realized that genetic factors play a very important role.” Other factors include air pollution, exposure to cooking fumes, and environmental carcinogens found in food preservatives.
Around 50% of all lung cancer cases in Taiwan are discovered at Stage IV, when the cancer has spread to other parts of the body and the survival rate is low. As a result, a majority of the resources from the National Health Insurance (NHI) are spent on late-stage treatment rather than prevention and treatment in the early stages.
To address this issue, a national government-funded screening program was launched last year. The program offers free scans using low-dose computed tomography (LDCT), a type of X-ray that takes multiple pictures while the patient lies on a table that slides in and out of the machine.
The program has proven highly successful – in its first year of operation, 531 cases of positive results for lung cancer were discovered among nearly 50,000 people. About 85% of the cases were Stage 0 or I, when surgical intervention is most likely to be curative. It also put Taiwan on the map as the first country in the world to provide lung cancer screening for people with a family medical history of lung cancer in addition to heavy smokers.
“The detection rate was very high among never-smokers with risk factors including family history of lung cancer – in the first round of our previous TALENT trial of LDCT lung cancer screening for never smokers, it was 2.65%,” says Dr. Yang. “In comparison, the most famous lung cancer screening program – the Dutch-Belgian NELSON trial –had a detection rate of around 1%.” At the end of the first year of national lung cancer early detection operation, the overall lung cancer detection rate under the LDCT program was 1.1%, 0.6% for heavy smokers, and 1.5% for never-smokers with a family history of lung cancer. Dr. Yang stresses that for the government to achieve its expressed goal of doubling the lung cancer survival rate by 2030, earlier detection is fundamental. He says Stage IV detection needs to go from constituting around 50% of cases down to 20-35% in favor of detection at Stage I, when the five-year survival rate is over 90% in Taiwan. In comparison, survival rates stand at around 30% in Stage III and less than 10% in Stage IV.
“By continuing with the LDCT screening program, we can achieve our treatment goals for Stage I patients,” says Dr. Yang. “But for the advanced stage, our five-year survival rate is only around 10% – that’s not good enough.” For these patients, improving and expediting access to innovative treatments is essential.
The National Health Insurance Administration’s approval rate for new cancer drugs falls below the global standard. Patients in Taiwan need to wait an average of two to three years for innovative cancer drugs, and only 30% of cancer drug indications are eligible for National Health Insurance (NHI) coverage.
“We’re in urgent need of a cancer fund that will ensure access to new drugs for patients in Taiwan,” notes Dr. Yang. While the Ministry of Health and Welfare’s proposed a new cancer drug fund aims at reaching a total of NT$10 billion and is set to be launched next year, there is currently no consensus on how much of it will be allocated within the NHI.
Another issue in need of being addressed is that of co-payment. Dr. Yang says Taiwan could draw on examples from South Korea and Japan, which has implemented a co-payment system for new cancer drugs. Taiwan, however, does not have a co-payment or private health insurance scheme, which means that new and costly treatments can at many times not be covered by the NHI’s limited budget.
“We are seeing great and encouraging dedication from the National Health Insurance Administration to address lung cancer,” says Dr. Yang. “They are committed to increasing the budget for new cancer drug reimbursement and gradually increasing overall healthcare spending. If we increase resources and address shortcomings of current policies, we are on our way of saving many more lung cancer patients in Taiwan.”
Message from AstraZeneca.