Every country in Latin America is different and at a distinct stage of development in terms of cancer care infrastructure and services capacity. Regardless, countries share many common challenges to greater adoption of precision oncology. We have identified ten.
The overall pressing problem in Latin America is the capacity gap between private health care systems and the public sector in precision oncology. Resources, expertise, quality and access can be first-rate for the relative few with access to and coverage in the private health market, while counterpart public health or social security systems covering the majority of the population usually lag years behind. There is an urgent need to frame a path forward for precision in public sector health systems by addressing the following challenges:
- Political instability and economic uncertainty make it diffcult to build the necessary political will and leadership.
- Precision medicine favors advances in oncology and rare diseases, but other public health issues are equally a priority.
- There is an inability to export expertise from major urban areas to more rural areas due to vast geographic and demographic limitations.
- Prices are perceived as too high for innovative targeted medicines and sophisticated molecular tests.
- Companion diagnostic systems and industry support for patient testing are an easier path than initiatives to expand high-end laboratory medicine and pathology services.
- There is uneven system incorporation of targeted medicines and molecular tests. Even when approved, implementation is slow and can be ineffective.
- The lack of substantive local clinical research infrastructure means few data or evidence to support country-level real-world value determinations for targeted medicines and testing equipment.
- Multidisciplinary care teams and molecular tumor boards are difficult to setup and run due to health system fragmentation, a lack of specialists, and no funding for this work.
- There is a patchwork of clinical practice guidelines in cancer from different sources, mostly outdated, or tailored only to what’s available instead of to what is recommended.
- Patient and public advocacy for precision oncology are still at an early stage in terms of educational outreach, messaging and goal-setting.
