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LIVER CANCER WORLDWIDE (2020)
The world has achieved significant successes in its fight against cancer in a number of areas. Unfortunately, liver cancer cases continue to increase and the disease remains a high burden for patients as the third most frequent cause of cancer-related deaths globally. Yet, it shouldn't be this way as risk populations and prevention strategies are well known. Action is needed urgently.
More than 80% of liver cancer cases occur in low and middle income countries, particularly in Eastern Asia (with China accounting for 50% of the global cases alone), and sub-Saharan Africa, where medical and social care resources are often constrained. These countries have a very high prevalence of viral hepatitis and other progressing liver diseases, which are the main causes of liver cancer.
GLOBOCAN 2020, https://gco.iarc.fr International Agency for Research on Cancer 2022
INCIDENCE AND MORTALITY RATE (2020)
Estimated age-standardized incidence and mortality rates (World) in 2020, liver, both sexes, all ages / per 100.000
MEDIAN SURVIVAL TIME
(from treatment initiation, 2020)
There are significant disparities with regards to survival of patients dia- gnosed with liver cancer, with a median survival time from treatment initiation of 60 months in Japan, 33 months in North America, 23/24 months in China and Eu- rope and 3 months only in Sub-Saharan African countries. 1
These inequalities are incompatible with the principle that all people should have access to the highest standard of health, regardless of race, religion, political belief, economic or social condition, which guides the global community driving for universal health coverage as part of UN Sustainable Development Goal 3.8. 2
1 Yang JD, Hainaut P, Gores GJ, et al: A global view of hepa- tocellular carcinoma: Trends, risk, prevention and manage- ment. Nat Rev Gastroenterol Hepatol 16:589-604, 2019
2 https://sdgs.un.org/2030agenda (accessed on Aug 21, 2021)
There are three major strategies tackling the global burden of liver cancer: prevention, surveillance and access to care! All are well known, based on strong scientific public health evidence and recommended by all clinical guidelines around the world and by the World Health Organisation (WHO).
However, there is still a enormous need to keep joined efforts reinforced, implementing these recommendations into clinical care practice to improve patient outcomes globally.
Strengthen prevention measures to avoid new liver cancer cases
The major risk factors for developing liver cancer are progressing underlying liver diseases such as viral hepatitis, fatty liver (NAFLD/NASH) and alcohol-related liver damage. Therefore, case finding strategies and access to state of the art management of these liver diseases are the core elements of prevention in the fight against liver cancer across the globe.
In addition, successful hepatitis B vaccination programmes need to be continued as primary liver cancer prevention.
Implement better surveillance in at-risk populations aiming for early detection of liver cancer
Prognosis of liver cancer has been significantly improved with the availability of new treatment options when started in curative stages and even in the early palliative stage, which makes timely diagnosis the most critical point with regards to prognosis and patient outcomes (e.g. survival rate) and with a positive impact on overall cost of illness.
Liver cancer is a unique example compared to other cancer entities. High risk populations are well defined and therefore surveillance programmes have been shown to be highly cost effective.
Surveillance is recommended in people living with cirrhosis by clinical guidelines consistently across the globe as they have the highest risk for developing liver cancer. In some regions monitoring of hepatitis B patients and patients with NASH is suggested, additionally.
Ensure access to state-of-the-art treatment for liver cancer patients
There are clinical management guidelines published and available in all regions defining the same global state-of-the-art treatment of liver cancer patients.
The level of implementation into clinical practice is generally dependent on many specific factors such as health system structures and funding, availability of diagnostic tools and treatment options, its affordability and local knowledge level. All this leads to significant differences in the quality of clinical management with the consequence of significantly different survival rates.
Even in regions with highest clinical standards, there are limiting factors such as delayed patient access due to complex and time consuming Health Technology Assessment processes. In addition, patients have to overcome barriers and hurdles when seeking state-of-the-art management. In these contexts, there is a strong need for transparent, dedicated pathways including multidisciplinary care teams and proper hospital, and out-patient care structures.
It is widely accepted that health-literacy and patient empowerment have a positive impact on clinical outcomes. Therefore, patients and their families need to be informed about their treatment options and should have access to independent, valid information, which are understandable and provide a basis for shared decision-making.