Access to essential anticancer medicines for children and adolescents in Europe

Research output: Contribution to journalArticlepeer-review

Authors

  • G Vassal
  • O Kozhaeva
  • S Griskjane
  • F Arnold
  • K Nysom
  • L Basset
  • L Kameric
  • A Kienesberger
  • S Kamal
  • N Cherny
  • G Bricalli
  • N Latino

External organisations

  • Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France.
  • Department of Social Policy
  • Clinical and Experimental Sciences University of Southampton and Southampton Children's Hospital; University Hospital Southampton NHS Foundation Trust; SO16 6YD
  • Childhood Cancer International - Europe (CCI-E)
  • Rigshospitalet
  • CCI-E
  • Kids Cancer Centre, Sydney Children's Hospital.
  • Shaare Zedek Medical Center
  • European Society for Medical Oncology (ESMO)
  • Institute of Cancer and Genomic Sciences
  • NIHR Birmingham Biomedical Research Centre
  • SIOP-Europe Office
  • SIOPE Brussels

Abstract

BACKGROUND: Essential anticancer medicines are an indispensable component of multidisciplinary treatment of paediatric malignancies. A European Society for Medical Oncology (ESMO) study reported inequalities in the availability of anticancer medicines for adult solid tumours and provided a model for the present survey. The aim of this survey was to assess the accessibility of essential medicines used in paediatric cancer patients aged 0 to 18 years across Europe in 2016-2018.

METHODS: A list of medicines was drawn with input from the European Society for Paediatric Oncology (SIOP Europe) Clinical Research Council referring to the World Health Organization Model List of Essential Medicines for Children (WHO EMLc) 2017. A survey was sent to nominated national clinician and pharmacist rapporteurs and parent associations in up to 37 countries; answers were obtained from 34 countries.

RESULTS: The full survey list contained 68 medicines, including 24 on the WHO EMLc 2017. Health professionals reported that 35% of all medicines were prescribed off-label in at least one country and that 44% were always available in >90% of countries. Only 63% of the EMLc 2017 medicines were reported as always available. The main determinant of unavailability was shortages, reported for 72% of medicines in at least one country. Out-of-pocket costs were reported in 8 countries. Twenty-seven percent (27%) of orally administered medicines were never available in child-friendly formulations. Parents detailed individual efforts and challenges of facilitating ingestion of oral medicines as prescribed. Inequalities in access to pain control during procedures were reported by parents across Europe.

CONCLUSIONS: Children and adolescents with cancer in Europe experience lack of access to essential medicines. Urgent actions are needed to address shortages, financial accessibility, availability of safe age-appropriate oral formulations, and pain management across Europe.

Details

Original languageEnglish
JournalAnnals of oncology : official journal of the European Society for Medical Oncology
Publication statusE-pub ahead of print - 31 Dec 2020