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Background: Cancer is a global health burden; the outcome varies widely across all countries. Sharing of experience in setting health policy (including health expenditure) is important. However, there is yet no comprehensive comparison of cancer outcome across all countries. Furthermore, comparison of cost-effectiveness of different systems is especially complex because the incidence of different cancers varies across countries, and their chances of curability differ substantially. Aim: We aims to provide the comparisons using available data and to stimulate global attention to the association of economic parameters with different outcomes. Methods: Cancer statistics from all 184 countries and 27 major cancers listed in GLOBOCAN 2012 were analyzed. The overall outcome of cancer patients was estimated by taking the complement of age-standardized mortality/incidence ratio [1 − (ASM/ASI)] as the proxy relative survival (RS). Taking into account the variation of country-specific cancer pattern, the proxy cancer site-standardized RS (SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. The overall economic parameters of different countries listed by the World Bank were correlated with the corresponding proxy SS-RS. Results: The unadjusted proxy RS among the 184 countries ranged from 0.111 to 0.702 (median = 0.386), the corresponding proxy SS-RS ranged from 0.124 to 0.622 (median = 0.359). The median total health expenditure per capita (HE) increased from US$37 for countries with proxy SS-RS < 0.2, to $4255 for countries with proxy SS-RS ≥ 0.5. Results from logarithmic regression model showed exponential increase in total HE for better outcome. The expenditure varied widely among different strata, but the widest difference was observed among countries with SS-RS ≥ 0.5 (with total HE ranging from US$962 to $9361). Conclusion: Similar to age-standardization, estimation of outcome with adjustment for variation in pattern of cancer incidence is suggested for comparison among different countries, especially for studies related to assessment of health systems. Cancer outcome correlated significantly with economic parameters; the amount of HE escalated exponentially and varied widely among countries with high SS-RS ≥ 0.5. Sharing of experience among different countries will be valuable for developing the most cost-effective health system. [ABSTRACT FROM AUTHOR]

The protracted COVID-19 pandemic has overwhelmed health systems globally, including many aspects of cancer control. This has underscored the multidimensional nature of cancer control, which requires a more comprehensive approach involving taking a wider perspective of health systems. Here, we investigated aspects of health system resilience in maintaining cancer services globally during the COVID-19 pandemic. This will allow for health systems to be resilient to different types of system stressors/shocks in the future, to allow cancer care to be maintained optimally. Using the World Health Organization health system framework (capturing aspects of service delivery, health workforce, information, medical products, vaccines and technologies, financing and governance and leadership), we carried out a comparative analysis of the impact of COVID-19 and the synthesis of the findings in responses in cancer care in 10 countries/jurisdictions across four continents comprising a wide diversity of health systems, geographical regions and socioeconomic status (China, Colombia, Egypt, Hong Kong SAR, Indonesia, India, Singapore, Sri Lanka, UK and Zambia). A combination of literature and document reviews and interviews with experts was used. Our study revealed that: (i) underlying weaknesses of health systems before the pandemic were exacerbated by the pandemic (e.g. economic issues in low- and middle-income countries led to greater shortage of medication and resource constraints compounded by inadequacies of public financing and issues of engagement with stakeholders and leadership/governance); (ii) no universal adaptive strategies were applicable to all the systems, highlighting the need for health systems to design emergency plans based on local context; (iii) despite the many differences between health systems, common issues were identified, such as the lack of contingency plan for pandemics, inadequate financial policies for cancer patients and lack of evidence-based approaches for competing priorities of cancer care/pandemic control. We identified four key points/recommendations to enhance the resilient capacity of cancer care during the COVID-19 pandemic and other system stressors: (i) effective pandemic control approaches in general are essential to maintain the continuity of cancer care during the emergency health crises; (ii) strong health systems (with sufficient cancer care resources, e.g. health workforce, and universal health coverage) are fundamental to maintain quality care; (iii) the ability to develop response strategies and adapt to evolving evidence/circumstances is critical for health system resilience (including introducing systematic, consistent and evidence-based changes, national support and guidance in policy development and implementation); (iv) preparedness and contingency plans for future public health emergencies, engaging the whole of society, to achieve health system resilience for future crises and to transform healthcare delivery beyond the pandemic. • Effective containment of COVID-19 in general led to least disruption of cancer care. • Pre-existing weakness of health systems was exacerbated during the pandemic. • Adaptive strategies need to evolve with evidence and changing circumstances. • Preparedness plans are needed for future shocks to enable systematic response. • Building resilience requires both health system improvements and emergency preparedness. [ABSTRACT FROM AUTHOR]