Inequities in access to innovative cancer treatments across the European Union

This brief outlines the multifactorial causes of such disparities—economic, political, structural, and social—and highlights EU-wide initiatives aimed at reducing these gaps, with particular focus on Eastern and Southeastern Europe. All claims are based on the referenced studies listed at the end.

Cancer is the second leading cause of mortality in Europe, and recent advances such as targeted therapies and immunotherapy have contributed to improved survival rates. Nevertheless, access to these treatments varies widely among EU member states, exacerbating existing health system inequities (Apolone & Brunelli, 2023).

Geographic and systemic disparities

Studies show significant delays in access to innovative oncology drugs in Central and Eastern Europe compared to Western Europe. On average, the time from EMA approval to patient availability is 2.1 years, with notable variations between hospitals and countries (Vancoppenolle et al., 2023). National reimbursement procedures, limited health budgets, and the complexity of health technology assessment (HTA) processes often delay access (Wilking et al., 2019).

Key determinants of inequality

Socioeconomic factors: Low socioeconomic status, advanced age, and lack of health insurance remain major barriers to accessing modern cancer therapies (Jachmann et al., 2020).

Reimbursement policies: National HTA agencies and drug price negotiations differ substantially, affecting the availability and affordability of treatments (Oudard & Courbon, 2017).

Institutional capacity: The lack of standardized treatment centers, particularly in pediatric oncology, undermines the equity of care delivery (Kowalczyk et al., 2014).

European initiatives to reduce inequalities

Europe’s Beating Cancer Plan aims to reduce disparities through targeted investments in oncology infrastructure, research, and prevention efforts (Annette, 2023).

The European Cancer Inequalities Registry (ECIR) was established to monitor and report inequalities in cancer care and to guide future investments (Epidemic and Pandemic, 2023).

The European Cancer Patient Coalition (ECPC) advocates for patient engagement in healthcare policy-making and cancer research (De Lorenzo & Apostolidis, 2019).

While innovation in oncology offers new hope, only a subset of the European population currently benefits from it. Persistent inequalities in access—driven by political, economic, and structural barriers—must be addressed through coordinated and sustained implementation of European initiatives in order to achieve equity in cancer treatment.

For further reading:

Annette, L. (2023). Fighting the good fight: Europe’s Beating Cancer Plan

Apolone, G., & Brunelli, C. (2023). Quality of Life in Oncology: Measuring What Matters for Cancer Patients and Survivors in Europe: The EUonQol Project. The Journal of Ambulatory Care Management. Link

De Lorenzo, F., & Apostolidis, K. (2019). The European Cancer Patient Coalition and its central role in connecting stakeholders to advance patient‐centric solutions in the mission on cancer. Molecular Oncology, 13, 653 – 666. https://doi.org/10.1002/1878-0261.12448.

And, E., , P., Prevention, W., & , G. (2023). Monitoring inequalities in cancer prevention and care in Europe. The European Journal of Public Health, 33. https://doi.org/10.1093/eurpub/ckad160.1679.

Jachmann, A., Klingberg, K., Zapata-García, M., Srivastava, D., Exadaktylos, A., & Martin-Moreno, J. (2020). Barriers in access to cancer treatment in Europe: a systematic review of the European Literature. European Journal of Public Health, 30. https://doi.org/10.1093/eurpub/ckaa166.1126.

Kowalczyk, J., Samardakiewicz, M., Fitzgerald, E., Essiaf, S., Ladenstein, R., Vassal, G., Kienesberger, A., & Pritchard-Jones, K. (2014). Towards reducing inequalities: European Standards of Care for Children with Cancer.. European journal of cancer, 50 3, 481-5 . https://doi.org/10.1016/j.ejca.2013.11.004.

Oudard, S., & Courbon, F. (2017). Controversies and consensus in the innovation access for cancer therapy in the European countries: on the subject of metastatic prostate cancer.. Annals of oncology : official journal of the European Society for Medical Oncology, 28 2, 421-426 . https://doi.org/10.1093/annonc/mdw546.

Vancoppenolle, J., Franzen, N., Koole, S., Retèl, V., & Van Harten, W. (2023). Differences in time to patient access to innovative cancer medicines in six European countries. International Journal of Cancer, 154, 886 – 894. https://doi.org/10.1002/ijc.34753.

Wilking, N., Bucsics, A., Sekulovic, K., Kobelt, G., Laslop, A., Makaroff, L., Roediger, A., & Zielinski, C. (2019). Achieving equal and timely access to innovative anticancer drugs in the European Union (EU): summary of a multidisciplinary CECOG-driven roundtable discussion with a focus on Eastern and South-Eastern EU countries. ESMO Open, 4. https://doi.org/10.1136/esmoopen-2019-000550.