Paediatric Oncology Department, Gustave Roussy, Villejuif, France; Paris-Sud University, Orsay, France; European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium.
Policy Department, SIOP Europe, Brussels, Belgium.
Ann Oncol. 2021 Apr;32(4):560-568. doi: 10.1016/j.annonc.2020.12.015. Epub 2021 Jan 1.
Essential anticancer medicines are an indispensable component of multidisciplinary treatment of paediatric malignancies. A European Society for Medical Oncology (ESMO) study reported inequalities in the availability of anticancer medicines for adult solid tumours and provided a model for the present survey. The aim of this survey was to assess the accessibility of essential medicines used in paediatric cancer patients aged 0 to 18 years across Europe from 2016 to 2018.
A list of medicines was drawn with input from the European Society for Paediatric Oncology (SIOP Europe) Clinical Research Council referring to the World Health Organization Model List of Essential Medicines for Children (WHO EMLc) 2017. A survey was sent to nominated national clinician and pharmacist rapporteurs and parent associations in up to 37 countries; answers were obtained from 34 countries.
The full survey list contained 68 medicines, including 24 on the WHO EMLc 2017. Health professionals reported that 35% of all medicines were prescribed off-label in at least one country and that 44% were always available in >90% of countries. Only 63% of the EMLc 2017 medicines were reported as always available. The main determinant of unavailability was shortages, reported for 72% of medicines in at least one country. Out-of-pocket costs were reported in eight countries. Twenty-seven percent of orally administered medicines were never available in child-friendly formulations. Parents detailed individual efforts and challenges of facilitating ingestion of oral medicines as prescribed. Inequalities in access to pain control during procedures were reported by parents across Europe.
Children and adolescents with cancer in Europe experience lack of access to essential medicines. Urgent actions are needed to address shortages, financial accessibility, availability of safe age-appropriate oral formulations, and pain management across Europe.
基本抗癌药物是儿童恶性肿瘤多学科治疗不可或缺的组成部分。欧洲肿瘤内科学会（ESMO）的一项研究报告了成人实体肿瘤抗癌药物可及性方面的不平等，并为本次调查提供了模型。本次调查的目的是评估 2016 年至 2018 年期间欧洲 0 至 18 岁儿童癌症患者使用的基本药物的可及性。
根据欧洲小儿肿瘤学会（SIOP Europe）临床研究理事会的意见，参考世界卫生组织儿童基本药物清单（WHO EMLc）2017 年版，制定了一份药物清单。向最多 37 个国家的指定国家临床医生和药剂师报告员以及家长协会发送了一份调查，从 34 个国家获得了答复。
完整的调查清单包含 68 种药物，其中包括 24 种 WHO EMLc 2017 年版上的药物。卫生专业人员报告称，至少有一个国家的 35%的药物被开出处方，44%的药物在>90%的国家都能随时获得。只有 63%的 EMLc 2017 年版药物被报告为随时可获得。不可获得的主要决定因素是短缺，至少有一个国家的 72%的药物存在短缺。有 8 个国家报告了自付费用。27%的口服药物在儿童友好型制剂中从未可用。家长详细说明了为方便按规定服用口服药物而付出的个人努力和挑战。欧洲各地的家长报告了在手术过程中控制疼痛方面存在的不平等。
欧洲的癌症儿童和青少年面临基本药物可及性不足的问题。需要采取紧急行动，解决整个欧洲的短缺问题、经济可及性、安全适合年龄的口服制剂的可获得性以及疼痛管理问题。
