Without health insurance, the survival rate may be 3 times worse! Doctors single out lung squamous cell carcinoma and head and neck cancer as "treatment disadvantages"
“Lung squamous cell carcinoma” treatment stopped 30 years ago? Strict immunization benefits may lead to missed opportunities
Lung cancer has long been the leading cause of death among the top ten cancers and has been called Taiwan’s “new national disease.” Although lung cancer has made great progress in the field of “precision treatment” for detecting genetic mutations in recent years, most of the drug development and benefits are targeted at the lung adenocarcinoma population. In comparison, the first-line treatment is only chemotherapy-based “lung squamous cell carcinoma”. The payment conditions for advanced treatments such as immunotherapy are relatively strict, resulting in no significant breakthrough in patient survival rate for many years. It can be said to be a national disease. “Vulnerable Cancer”.
Dr. Lin Yuqing, director of the Department of Thoracic Oncology at Chiayi Chang Gung Memorial Hospital, said that about 37% of Taiwanese lung cancer patients do not have genetic mutations and are not suitable for targeted therapy. According to international treatment guidelines, it is recommended to use cancer immunotherapy drugs or cancer immunotherapy drugs combined with chemotherapy for lung cancer without genetic mutations. However, currently, only about 5% of the medical insurance payment for lung cancer drugs is used for immunotherapy. Compared with the various first-line treatments for lung adenocarcinoma that target different genetic mutations, lung squamous cell carcinoma only provides two main treatments, and the 5-year survival rate is nearly three times lower than that of lung adenocarcinoma.
“The treatment methods for lung squamous cell carcinoma in Taiwan are very different from those 30 years ago, which only relied on chemotherapy, and the condition of payment is that the patient must first use first-line chemotherapy. However, studies have found that the first-line treatment for lung squamous cell carcinoma fails. Immunization or immunotherapy combined with chemotherapy will cause the patient to lose the chance of treatment!”
Dr. Lin Yuqing pointed out that the US Cancer Treatment Guidelines (NCCN Guildeline) and Taiwan’s advanced lung cancer treatment consensus both recommend the use of immunotherapy combined with chemotherapy for groups with lung squamous cell carcinoma PD-L1 expression levels between 1-49%. At present, advanced countries in Europe and the United States have included immunotherapy combined with chemotherapy as first-line benefits, and Taiwan’s payment standards even lag behind those of Hong Kong and South Korea. For lung squamous cell carcinoma patients, who are mostly from the blue-collar class and cannot afford the high out-of-pocket expenses, they are like being abandoned outside the medical care system, with little hope for survival rate and quality of life.
The 5-year survival rate is nearly 3 times different! Head and neck cancer benefits become a treatment dilemma?
Coincidentally, although head and neck cancer ranks sixth among the top ten cancers and ranks third among male cancers, restrictions on drug development and payment also make head and neck cancer a “treatable cancer.”
Yang Muhua, director of the Department of Medical Oncology at Taipei Veterans General Hospital, said that in the past, head and neck cancer was mainly treated with traditional surgery, chemotherapy, and radiotherapy. Targeted drugs began to be available in 2006. After 2016, immunotherapy gradually played an important role and is currently the most important treatment for head and neck cancer. One of the treatment methods. Nearly half of head and neck cancers are in advanced stage three or four when they are discovered. Coupled with the low five-year survival rate, treatment is a race against time.
Dr. Yang Muhua pointed out that in clinical trials, it was found that when immunotherapy is used for head and neck cancer, the five-year survival rate is higher than that of combined targeted chemotherapy in the past, and the five-year survival rate is nearly three times higher. However, the treatment dilemma of head and neck cancer is similar to that of lung squamous cell carcinoma, both of which are related to payment conditions. The International Treatment of Head and Neck Cancer has listed cancer immunotherapy drugs as first-line treatment, but Taiwan’s health insurance is still in the second-line treatment, and even targeting and immunity can only be used selectively.
“What’s even more unfavorable for the treatment of head and neck cancer (patients) is that you can only choose between target and immune delivery. Patients cannot use two drugs on the front and back lines. Therefore, many patients can only use chemotherapy as the first line! In the past ten years, head and neck cancer has Drug reimbursement has only been updated 4 times, and the average drug cost is only 1/7 of the highest cancer category. Once the health insurance cannot support it, patients can only bear it silently. "
Dr. Yang Muhua said that the risk of suicide in head and neck cancer patients is higher than that of other cancers, more than five times higher than that of healthy adults. In addition, most of them are blue-collar workers and the breadwinners of the family in their 50s. Failure to receive good care will have a serious impact on the family and the overall social workforce. In addition, if head and neck cancer does not receive standard treatment, it may result in being unable to participate in international clinical trials and losing the opportunity to fight the disease and prolong survival. It shows that head and neck cancer, as a “treatable vulnerable cancer”, needs more attention and support from society and the health insurance system.
In order to advocate Taiwanese people to pay attention to the issue of “treating vulnerable cancers” and uneven distribution of cancer treatment resources, the Taiwan Society of Clinical Oncology and the Taiwan Cancer Foundation remind that including lung squamous cell carcinoma, head and neck cancer and other cancer types, first-line treatment is still 20 years old. The current prescription of chemotherapy has caused patients to be isolated and vulnerable in the health care system. We call for health care cancer treatment to be in line with international standards and catch up with the first-line treatment guidelines of advanced countries, so that the treatment rights of vulnerable cancer patients can be properly improved.
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