Lung cancer remains the leading cause of cancer mortality in Taiwan, with the five-year survival rate for advanced stages lingering around 10%. Despite significant advances in medical technology and treatment protocols worldwide, Taiwan faces a critical gap in aligning its National Health Insurance reimbursement with international standards for lung cancer treatment.

“Despite some progress in lung cancer outcomes, we still have a long way to go,” says Professor Yu Chong-jen, superintendent of National Taiwan University Hospital Hsinchu Branch. “The major needed step is to ensure that we can provide the best therapy for patients from the very beginning.”

Taiwan has pioneered in implementing a nationwide program for early lung cancer detection among high-risk groups through low-dose computed tomography (LDCT). This proactive approach has showcased the potential to significantly improve survival rates by detecting cancer at earlier, more treatable stages.

“The best way to improve survival is to find lung cancer as early as possible,” says Professor Yu. “That means that the LDCT program needs to cover more of the population. To double the survival rate, you need to ensure that at least 50% of your patients are in the early stages of cancer. Right now, it’s only around 32%. And for advanced and metastatic lung cancer, the best chance of survival comes from the most advanced and innovative treatments that adhere to international treatment guidelines.”

To adopt this two-pronged approach, aligning reimbursement scope with international treatment guidelines is crucial. Such alignment would ensure that late-stage treatments not only comply with global standards but are also accessible financially to those in need. By prioritizing funding for new drugs that demonstrate clear clinical benefits, Taiwan can close the current treatment gap and enhance survival rates.

For many patients, the reality is a dire one: access to first-line, innovative treatments is limited by financial constraints within the national health insurance system. This limitation not only delays the administration of potentially life-saving treatments but also impacts the clinical experience of physicians, potentially diminishing Taiwan’s future capabilities in cancer treatment.

A notable example of this challenge involves third-generation targeted therapy, which is recognized internationally as the first-line treatment for patients with advanced EGFR mutation non-small cell lung cancer. Despite over half of Taiwan’s lung cancer patients being suitable candidates for this drug, current reimbursement scopes only allow about 10% of them to benefit due to budget limitations.

“The government’s planned Cancer Drugs Fund is a step in the right direction,” says Professor Yu. Still, he adds that the planned NT$10 billion allocated for innovative treatments won’t be enough to reach the government’s stated goal of reducing cancer mortality by one-third and doubling lung cancer survival rates by 2030. “Taiwan’s healthcare expenditure at around 6.6% of GDP is also not enough – if we can at least match Korea’s 8%, we’d have a much higher chance.”

Adopting practices from countries like Japan, South Korea, and Singapore, which have successfully integrated advanced cancer treatments into their healthcare systems, could offer valuable lessons for Taiwan. These countries adhere strictly to international guidelines and have begun to promote benefits or even reimburse for early-stage treatments. But there’s also another important difference that allows for more innovative treatments.

“South Korea allows co-payment, which allows more expensive drugs in the system,” Professor Yu adds. “That has helped Korea catch up in cancer treatment. But Taiwan’s National Health Insurance law doesn’t allow co-payment.”

The journey toward transforming lung cancer treatment in Taiwan is multifaceted. It requires a robust strategy involving enhanced early detection program, alignment of reimbursement scopes with international standards, and increased government funding for healthcare. By addressing these key areas, Taiwan can significantly improve lung cancer survival rates and set a benchmark for comprehensive cancer care globally.