When cancer care moves forward but people are left behind
When I was a medical student, The Lancet was the kind of journal we spoke about with awe. It felt like a grand medical “newspaper” for the world, where landmark clinical trials, major disease outbreaks and bold ideas that could change how we think about health were published.
Decades later, my work in cancer research and policy has brought me to the table with colleagues from around the world as part of a Lancet Oncology Commission. It did not focus on a new drug or high-tech genomic test but on something more fundamental, the human experience of cancer. This month, that work appears as a report on what we call “the human crisis in cancer”.
Before I write about what it means for Malaysia next month, I thought it might be helpful to take readers behind the scenes. What exactly is a Lancet Commission? How does it work? And why should it matter to people living with cancer, caregivers and those working in our cancer services?
Lancet Commissions
The Lancet is one of the world’s most influential medical journals. Over 200 years, it has grown into a family of journals including The Lancet Oncology, which focuses entirely on cancer. What appears in these journals as such often shapes how governments set priorities and how professional societies write guidelines.
A Lancet Commission is different from an ordinary research article. It is a time-limited “taskforce” assembled around a complex issue, bringing together clinicians, public health professionals, economists, psychologists, behavioural scientists, ethicists, patients and advocates. Over two to three years, the group reviews evidence, debates ideas and tests them against real-world experience. All of these are distilled into a report of about 25,000 words aimed not just at academics but also ministers, hospital managers, industry leaders, professional bodies and funders i.e. very busy people with limited time but enormous power. A Lancet Commission is therefore not merely “a glamorous publication” for someone’s CV, but a global call to action with clear messages and directions for change.
The Lancet Oncology Commission on the human crisis in cancer
In this Lancet Oncology Commission, we focus on what we call “the human crisis in cancer.” In simple terms, it argues that while science and technology in cancer care have advanced rapidly, the human experience of cancer has not kept pace. Across very different health systems, whether rich or poor, public or private, patients and families describe surprisingly similar experiences:
- Clinics that feel rushed with little time to talk about fears, values or practical concerns.
- Patchy or absent psychological and social support.
- The “cost of time”: the hours spent travelling, waiting and recovering from treatment that quietly drain energy and income, and keeps one away from family.
- Financial strain that can push families to the brink even when treatment itself is subsidised.
We tend to celebrate high-tech diagnostics, new drugs and sophisticated equipment, and with good reason. But we give far less attention and funding to the services that help people live well with and after cancer. The medical fraternity still tends to judge success mainly by survival statistics and whether the cancer ‘shrinks’ on scans, rather than whether someone can keep working, care for their children, pay their bills, or die with dignity.
Our Commission report does three main things. Firstly, it names where and how dehumanisation creeps into cancer care, for example through rushed encounters, fragmented services, rigid systems and the financial and time burdens placed on families. Secondly, it explores why this has happened including how we value and invest in cancer services and research, often privileging drugs and technology over mental health, palliative care, navigation and social support. Thirdly, it highlights solutions such as early palliative care, patient and financial navigation, community-based psychosocial services, workplace protections for people with cancer and reforms that reduce catastrophic out-of-pocket costs.
Sneak peak: What it means for Malaysia
You might wonder why should someone in Malaysia who is juggling work, family and rising living costs should care about a super long scientific report in The Lancet Oncology?
My answer is that the ideas in this Commission are about very practical things. They are about whether your mother or father is spoken to kindly in the clinic. Whether an employee can stay in their job during cancer treatment. Whether a family has to go into debt to pay for cancer care. Whether a patient can find support when life feels overwhelming. And whether a person at the end of life can spend more time at home, surrounded by loved ones, rather than in a hospital corridor waiting for another test.
When a journal like The Lancet Oncology devotes a Commission to the human crisis in cancer, it sends a strong signal that these “human” issues are not soft extras but central to what good cancer care should look like in our clinics, wards and communities! The challenge now is to translate the global messages of this Commission into local action in our healthcare facilities, NGOs, workplaces and communities. That is the conversation that I will continue in my next column.
