In the past decade, oncologists worldwide have seen unprecedented advances in drug development and approvals but have also become increasingly cognizant of the rising costs of and increasing

inequities in access to these therapies. These trends have resulted in the current problematic situation in which dramatic disparities in outcomes exist among patients with cancer worldwide

owing, in part, to the lack of access to drugs that provide clinically meaningful benefits. In this Viewpoint, we have asked six oncologists working in different countries to describe how

they perceive this issue in their region and propose potential solutions. Access through your institution Buy or subscribe This is a preview of subscription content, access via your

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access to essential medicines. _Bull. World Health Organ._ 97, 575–577 (2019). Article  Google Scholar  Download references ACKNOWLEDGEMENTS P.R. thanks H. Kosela-Paterczyk (Maria

Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland) for her critical review of his contribution to this manuscript. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Grupo

Oncoclínicas de Pesquisa em Oncologia, Hospital São Lucas, PUCRS, Porto Alegre, Brazil Carlos Barrios * Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil Carlos Barrios

* Division of Medical Oncology, Sylvester Comprehensive Cancer Center at the University of Miami and the Miller School of Medicine, Miami, FL, USA Gilberto de Lima Lopes * Pantai Cancer

Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia Mastura Md Yusof * Cancer and Radiosurgery Centre, Subang Jaya Medical Centre, Selangor, Malaysia Mastura Md Yusof *

Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda Fidel Rubagumya * Division of Cancer Care and Epidemiology, Queens University, Kingston, Ontario, Canada Fidel Rubagumya *

Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland Piotr Rutkowski * Department of Medical Oncology, Tata

Memorial Centre affiliated to Homi Bhabha National Institute, Mumbai, India Manju Sengar Authors * Carlos Barrios View author publications You can also search for this author inPubMed Google

Scholar * Gilberto de Lima Lopes View author publications You can also search for this author inPubMed Google Scholar * Mastura Md Yusof View author publications You can also search for

this author inPubMed Google Scholar * Fidel Rubagumya View author publications You can also search for this author inPubMed Google Scholar * Piotr Rutkowski View author publications You can

also search for this author inPubMed Google Scholar * Manju Sengar View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS CARLOS BARRIOS is the

Director of the Oncology Research Center at Hospital São Lucas, PUCRS, where he has participated in over 300 research trials, and Clinical Research Director of the Oncoclínicas Group, both

in Porto Alegre, Brazil. He is currently a member of the Executive Board of the Breast International Group. GILBERTO DE LIMA LOPES is a Professor of Clinical Medicine and Division Chief for

Medical Oncology for the Sylvester Comprehensive Cancer Center at the University of Miami, USA. He is a board member for the Union for International Cancer Control (UICC)and Editor-in-Chief

of _JCO Global Oncology_. MASTURA MD YUSOF is a consultant clinical oncologist at Pantai Hospital, Kuala Lumpur, and Subang Jaya Medical Centre, Selangor, Malaysia. She is Secretary of the

Malaysian Oncological Society and Vice President of the Malaysian College of Radiology of the Academy of Medicine. She actively participates in research and is an expert adviser for clinical

practice guidelines and advisory boards related to the advancement and provision of quality cancer care in Malaysia, Southeast Asia and the Asia Pacific region. FIDEL RUBAGUMYA is a

clinical and radiation oncologist at Rwanda Military Hospital, Kigali, Rwanda. His clinical and research interests focus on the management of head and neck, breast, gynaecological and

gastrointestinal cancers. He is the recipient of many prestigious awards from different cancer organizations, including the American Cancer Society, ASCO, UICC and the African Organization

for Research and Training In Cancer. PIOTR RUTKOWSKI is a Professor of Surgical Oncology at the Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Poland, where he is

the current Head of the Department of Soft Tissue/Bone Sarcoma and Melanoma and the Plenipotentiary of Head Director of Institute for National Oncological Strategy and Clinical Trials. He

has participated in several investigator-driven trials in melanoma and sarcoma. He is also Coordinator of the Polish Clinical Gastrointestinal Stromal Tumours (GIST) Registry and a member of

several Polish and international scientific societies. He is the co-author of national and international recommendations for sarcoma and melanoma and is working very closely with national

patient advocacy groups for GIST/sarcoma and melanoma. MANJU SENGAR is Professor of Medical Oncology at the Tata Memorial Hospital, Mumbai, India, where she leads the adult haematolymphoid

disease management group. She is a recipient of the American Society of Hematology visitor training fellowship programme at Duke University, Durham, USA. Her main areas of clinical research

are HIV/AIDS-associated non-Hodgkin lymphomas and adult acute lymphoblastic leukaemia. She is the principal investigator for several investigator-initiated studies and has participated in

industry-sponsored multicentre clinical trials. CORRESPONDING AUTHORS Correspondence to Carlos Barrios, Gilberto de Lima Lopes, Mastura Md Yusof, Fidel Rubagumya, Piotr Rutkowski or Manju

Sengar. ETHICS DECLARATIONS COMPETING INTERESTS C.B. works in an institution that receives financial support from Abbvie, Amgen, AstraZeneca, Aveo Oncology, Bristol Myers Squibb, Celgene,

Checkpoint Therapeutics, Daiichi, Docs, Exelixis, GSK, Henlius, ICON, IQVIA, Janssen, Labcorp, Lilly, Medpace, Merck Serono, Merck Sharp & Dohme, Myovant, Nektar, Novartis, Novocure,

Nuvisan, OBI Pharma, Parexel, Pfizer, Pharmamar, Polyphor, Pharmaceutical Product Development, PSI, Regeneron, Roche, Sankyo, Sanofi, Seagen, Shanghai, Syneos Health, Takeda and TRIO; has

received honoraria for advisory and/or consulting roles from AstraZeneca, Boehringer–Ingelheim, Bayer, Eisai, GSK, Lilly, Novartis, Pfizer, Roche–Genentech, Sanofi and Zodiac; and owns stock

in MEDSir and Tummi. G.dL.L. works in an institution that receives or has received research funding from Abbvie, Adaptimmune, AstraZeneca, Bavarian Nordic, Blueprint Medicines, Bristol

Myers Squibb, EMD Serono, G1 Therapeutics, GSK, Janssen, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche–Genentech and Tesaro; receives research funding from AstraZeneca, E.R. Squibb

& Sons, Lucense and Xilis; has received honoraria for advisory and other roles from AstraZeneca, Blueprint Medicines, Boehringer–Ingelheim, Blueprint Medicines, Janssen, Merck and

Pfizer; and owns stock in Lucence Diagnostics and Xilis. M.M.Y. has received honoraria for lectures, advisory roles and/or travel from Amgen, Astella, AstraZeneca, Bayer,

Boehringer–Ingelheim, Celgene, DKSH, Eisai, Eli Lilly, Janssen, Merck Sharp & Dohme, Pfizer, Roche, Sanofi and Zuellig Pharma. P.R. has received honoraria for lectures and/or advisory

roles from AstraZeneca, Blueprint Medicines, Bristol Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Philogen, Pierre Fabre and Sanofi, all outside the scope of this manuscript. F.R.

and M.S. declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional

affiliations. RELATED LINKS ASCO VALUE FRAMEWORK: https://www.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/value-cancer-care ESMO MAGNITUDE OF CLINICAL BENEFIT

SCALE: https://www.esmo.org/guidelines/esmo-mcbs NATIONAL CANCER GRID OF INDIA: https://tmc.gov.in/ncg/ US NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES:

https://www.nccn.org/guidelines/category_1 SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION GLOSSARY * Community-based health insurance Voluntary pooling of funds to offset the cost of

health care. * External reference pricing (ERP). Practice of informing price negotiations in a given country by calculating a benchmark or reference price based on publicly available pricing

data from one or more other countries. * Internal reference pricing Consumers’ price expectation developed from past purchases of the same product. * Managed-entry agreements Arrangements

between for-profit firms and health-care payers that enable coverage of new medicines while managing uncertainty around their financial performance. * National Cancer Control Programmes Set

of guidelines and policies stating the approach to cancer management in a specific country. * Out-of-pocket (OOP) expenditure Medical care expenses that are not reimbursed by health

insurance, which can include deductibles, co-insurance and co-payments for covered services, and all costs for services that are not covered. * Payback Financing model that involves the

payback of a reimbursed amount if the actual reimbursement expenses exceed a fixed annual budget. * Pooled drug-procurement system Collective negotiation of drug prices as a unit, hence

asserting collective bargaining power to buy drugs at the lowest prices. * Risk-sharing Financing model in which payment is for health benefits, and thus the payer is reimbursed for new

medical technologies when the expected effects are not sufficient. * WHO Essential Medicines The WHO Essential Medicines List (EML) committee identifies drugs after a thorough review of

their benefits, toxicities and affordability47. The WHO EML is intended as a guide for WHO member states to create their national EML (NEML), which is usually considered the first step

towards making these drugs available, accessible and affordable36. A total of 137 countries have NEMLs; however, the factors that influence the creation of NEMLs remain poorly documented and

evidence of their implementation is limited. Antiviral drugs against HIV and hepatitis viruses are examples supporting the belief that, once medicines are listed as essential, they become

more accessible and affordable48. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Barrios, C., de Lima Lopes, G., Yusof, M.M. _et al._ Barriers in access

to oncology drugs — a global crisis. _Nat Rev Clin Oncol_ 20, 7–15 (2023). https://doi.org/10.1038/s41571-022-00700-7 Download citation * Accepted: 05 October 2022 * Published: 15 November

2022 * Issue Date: January 2023 * DOI: https://doi.org/10.1038/s41571-022-00700-7 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable

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