Carolyn Y. Johnson
Wealthy countries experienced a small uptick in cancer deaths during the global economic crisis, according to a new study — an estimated 260,000 excess deaths between 2008 and 2010.
The analysis, published in the medical journal the Lancet, found intriguing evidence that access to medical care might explain the rise: Increases in the unemployment rate were associated with additional cancer deaths except in countries with universal health care, where access to health care coverage would not have depended on employment. And the associations between unemployment increases and mortality were statistically significant for treatable cancers, such as breast and prostate cancer, but not for types such as pancreatic cancer deemed untreatable because survival rates are low.
"The study demonstrates that universal health care should be implemented and prioritized, as it can protect populations from potentially unnecessary cancer deaths," said Mahiben Maruthappu of Imperial College London, one of the study's authors. "During times of economic hardship, we need to invest in health care systems, without which the consequences can be fatal."
Still, the research doesn't prove that unemployment or cutbacks in health spending were the trigger for the increase in cancer deaths. And, to put the increase in fatalities in perspective, there were roughly 9 million cancer deaths in developed countries over that time frame — an uptick of about 3 percent.
The study examined cancer mortality data from more than 70 countries. The researchers found that a 1 percent rise in unemployment was associated with 0.37 additional cancer deaths per 100,000 people. They also found a five-year lag, suggesting that, years after unemployment increases, additional people continued to die of treatable cancers. When they controlled for the presence of universal health coverage, however, those differences vanished.
Scott Ramsey, a health economist from the Fred Hutchinson Cancer Research Center in Seattle, said in an email that the increase in cancer deaths is "modest in terms of the total population of cancer patients, and the incremental impact is modest."
Nevertheless, he said he thought the findings do support the idea that universal health care coverage could improve the prognosis for patients with cancer at an early stage.
To Karen Emmons, vice president of research for Kaiser Permanente, the analysis suggests that, at a time when national cancer priorities are being determined in Vice President Biden's "Cancer Moonshot," gains in cancer survival can be made not only by coming up with new treatments but by expanding access to health care.
"If we shine the light mostly on the basic science and genetic aspects of the continuum, we’re missing something really important," Emmons said.
Several researchers said there were limitations to the study. The accuracy of cancer and mortality data — the foundation for the results — varies widely by country. The pattern, while striking, is only an association and can't prove that the economic downturn caused more cancer deaths.
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