Cancer care is advancing quickly, but access to diagnosis, treatment and support remains deeply uneven. In this episode of Connecting Citizens to Science, Professor Eva Kantelhardt and Professor Richard Sullivan discuss equity in global oncology, exploring how cancer systems can be strengthened through fair financing, better data, locally led research, patient voice and approaches that reflect the realities of different health systems and communities.

In this episode:

Prof. Dr. Eva J. Kantelhardt – Professor of Global and Planetary Health; Gynaecologist, Martin-Luther-University Halle (Saale), Germany

Professor Eva J. Kantelhardt is Professor of Global and Planetary Health and a gynaecologist at Martin-Luther-University Halle in Germany. Her work focuses on cancer care in sub-Saharan Africa, bringing together population health, community involvement, primary health care, diagnostic and treatment services, and survivorship care. Her research and implementation work focuses on prevention, early detection and care, with particular attention to locally appropriate and culturally accepted approaches.

Professor Richard Sullivan – Professor of Cancer & Global Health, & Director, Institute of Cancer Policy and Director, Centre for Conflict & Health Security at King’s College London

Professor Richard Sullivan is Professor of Cancer and Global Health at King’s College London, where he is Director of the Institute of Cancer Policy and Director of the Centre for Conflict & Health Security. His work focuses on cancer services and systems, from surgical capacity building to national cancer planning reforms. He works with cancer healthcare professionals, patient organisations, policymakers and cancer planners, and is currently leading the World Bank Group cancer strategy.

Useful links

• Centre for Conflict & Health Security
• Institute of Cancer Policy

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Dr. Kim Ozano: Hello and welcome to Connecting Citizens to Science.

I'm your host, Dr Kim Ozano, and this is a podcast where we explore

global health and development.

Across 2026, we've been putting a spotlight on equity; who benefits

from progress, who is still being left behind, and what does it take to make

health systems work better for the people that they are meant to serve?

And today's focus is global oncology.

Cancer is often discussed through the lens of scientific progress, talking

about new diagnostics, new treatments, and new possibilities for care.

But behind that progress is a growing question about whether health

systems can keep pace with need.

Prof. Eva Kantelhardt: I think the good news is that people are getting

older, and the issue is that also means there will be more patients

diagnosed with cancer, especially also in low and middle-income countries.

Dr. Kim Ozano: This challenge becomes even sharper when we think about equity.

It's not only about what is possible in cancer care, but whether people

can access that care and practise, and whether systems are financed

in ways that make that possible.

Prof. Richard Sullivan: The major issue now faced around the world

is fair and transparent financing for strengthening cancer systems.

Dr. Kim Ozano: In this episode, we ask what equitable cancer

care looks like in practise.

How can cancer systems be strengthened in ways that are locally led,

evidence informed and responsive to the communities they serve?

Joining me today are Professor Eva Kantelhardt and

Professor Richard Sullivan.

Eva and Richard, welcome to Connecting Citizens to Science.

We're really excited to have this debate today on global oncology.

So, I think let's start by helping both me and our listeners understand

global oncology a little bit more.

What do we need to know in terms of current innovations

and challenges in this area?

Prof. Eva Kantelhardt: Yes, good morning.

My name is Eva Kantelhardt.

I'm professor for global health, and I'm also a gynaecologist working at Martin

Luther University in Halle, Germany I think that, especially in countries

which have not yet experienced a high burden of patients with cancer, they

are now facing an increasing number.

And in such countries, health systems are already burdened and strained,

and they do have limited resources.

So, the challenge is how to integrate cancer care into this

health system which is existing.

We have seen that there is very individual challenges starting from early

detection, from diagnostic services, from treatment, as well as survivorship care.

I think that innovation at the moment is very much in the area of like eHealth

technologies, artificial intelligence, and I can see that there are certain

areas where this fits in very well.

We have, for example, seen that virtual pathology, as well as diagnostic

services with artificial intelligence are something that can really be implemented,

and that is something that can be done also in low-resource settings.

And it has started to be utilised in some areas already.

Dr. Kim Ozano: That's a great snapshot.

Thank you so much.

So innovations around eHealth and AI, pathology and that whole kind of treatment

pathway is what's being looked at.

I think it's really interesting as well, Eva, that you have raised the

importance of countries struggling with their current health systems,

but the cancer care is growing and the need for it is growing quickly.

So, Richard please help us build on that.

Prof. Richard Sullivan: Yes, absolutely.

I'm Richard Sullivan.

I'm a Professor of Cancer and Global Health and Director of the Institute

of Cancer Policy at King's College London, in London I just wanna pick up

what Eva was saying about the burden.

So, not only is the burden increasing for a lot of these emerging transitioning

economies, but the transitions they're going through are completely unique.

They're totally different from what we went through in the Western world.

They're dealing with this kind of what we call a double burden of

disease, where they're getting not just cancer and other non-communicable

diseases, but they're still dealing with infectious disease, relatively

high child and maternal mortality.

So, it makes their transitions much, much more complicated.

We're also seeing a huge, massive increase in technical advances in cancer, whether

it's chemotherapy medicine, surgical technologies, radiotherapy, pathology.

And that's being felt across all emerging economies, and of course, along with

that goes huge public expectation.

There is an expectation that these countries' patients will enjoy

the benefits and fruits of this massive innovation that's taken

place over the last 50 years.

But as Eva said, on the other side, we've also got this

incredible multi-speed world.

We often talk about cancer control in low and middle-income countries, which when

you think about it is pretty meaningless.

You're putting Chad and China into the same group, and even within

individual countries, there's huge difference in transitions.

When you look at the demographic leviathans like Nigeria, and India,

and Brazil, the differences between the transitions in individual

states in those countries is huge.

And e- each country now is having to grapple with this

polycrisis, permacrisis world.

So, it's not just cancer that's stressing the politics, and the

financing, and public expectations.

It's climate change.

It's resurgence of infectious diseases.

So, what we see is obviously cancer is a major burden; social, clinical, economic

for countries at the same time as lots and lots of other things going on, and

these incredibly rapid transitions, which means that it's very hard for the

politics and policy to catch up with them.

Dr. Kim Ozano: It sounds huge.

And I think what's interesting here is that you've brought out how every

single country is unique in their delivery and their health system,

so it's definitely not a kind of one-size-fit-all, and we can't roll it

out that way or even think that way.

And we're used to thinking like that in global health and understanding that I

think more and more we're talking about locally led bottom-up systems as well.

But Eva, perhaps you could talk a little bit more about that, and how you're

managing these competing priorities for health systems and how you've been

navigating that with your research.

Prof. Eva Kantelhardt: I um, really have the pleasure of collaborating with

colleagues from sub-Saharan Africa across very many disciplines, and across many

countries, and this has really leveraged a lot about how we think about how the

systems could be changed because there are overarching themes as well as very

individual problems, as Richard has really nicely pointed out, I think.

Our approach is to really go for participatory research.

And I can say, yeah, we are here in Halle also a part of the International

Collaboration for Participatory Research.

Together, with the African colleagues, we really think that there must be

an African-centered community-driven approach to actually improve cancer care.

And we have started co-creating interventions, because there's one

thing to have a solution, but the other one is to bring it to the

people and have the people accept it.

There must be evidence about effectiveness, as well as of course,

people and communities taking it up.

We have done quite a number of research within the African

Cancer Registry Network.

For example, we had 15 or up to 20 cancer registries in 20 countries

where we looked into access to care.

We interviewed patients and we really found out interesting points that within

countries there are huge differences, but also across countries, like in

higher income countries, like Gabon, there was a very considerable access

to care, but patients said that acceptability is really a problem.

They had fear, and obviously there must be more culturally

adapted explanation, information, and counselling of the patients.

Of course, accessibility also highly dependent on finance.

Prof. Richard Sullivan: Yes, just picking up what Eva was saying there

about the individualism of countries and the evidence that feeds into

the planning for those countries.

At the moment, to be honest with you, if you look at the research agenda, most

of it is focused in discovery science and biopharmaceutical research, and

the work in context-specific areas, implementation science or operational

science, participatory research that needs to be carried out in these

countries is few and far between, and there just isn't been the focus by

the research funding organisations in supporting that sort of work.

And I think that feeds in, I think, to a lot of the World Bank thinking on this,

which is that at the moment, when you look at a lot of national cancer control plans,

often they're what we call mimics.

They've been written to try and mimic almost what we see in high-income

settings, and it doesn't really reflect the reality of what's going

on in the countries in terms of capacity and capability and the

current state of outcomes, which you know, as Eva said, is unique for

individual countries and those things change, by the way, a lot over time.

And so there's this recognition now from the World Bank that what we need

to do is do a much more closer focused cancer planning, which is relevant

for that country over the forward period, say, over the next five or

10 years that also supports locally driven research in this sort of area

that will inform future planning.

What's I think, going to really change things is when the financing comes

through to support this sort of work.

But to be honest, no country is going to be able to develop its cancer system

without doing some form of this type of participatory research, and policy

work, and health services research to actually inform local contexts.

At the moment, we are extrapolating data from all over the world to

'model out', in inverted commas, the situation in lots of countries.

And even within the cancer registers, as Eva knows well, the coverage

still is absolutely shocking.

We've been talking about proper cancer registration for what, Eva, 30 years?

We keep saying, "You need to fund this. This needs to be domestically

funded. We need international funding." And it's glacial, the progress.

It's been absolutely glacial.

So, people are happier to allow organisations to make up the modelling

numbers, than they are to actually pay for the data to be properly

captured in a good quality register in a country, which by the way, is the

absolute backbone of cancer control.

I think there's that recognition by the World Bank and from other major

supernational organisations that the 'business as usual' model we've had

over the last 20 years is not really moving the agenda forward at the pace

it needs to be to catch up with the size and the burden of the cancer problem.

Prof. Eva Kantelhardt: I really think that's absolutely to the point.

I have to say we did some studies on a sample cohort and seeing how much

treatment did patients actually get or not, and how was their survival.

That's from Sub-Saharan Africa kind of as an example.

It's not that one country does super and the others don't it's highly diverse.

Even in middle-income countries.

We did a study with patients who were actually di- diagnosed between 2010 and

'12, and now again, we did similarly a study between 20 19 and 2021, just

before COVID, and assessed how high was the proportion of patients actually

receiving guideline concordant treatment where we did use the regional guidelines.

And the good news was that we did see, with all methodological

limitation, but we did see an increase in proportion of patients who had

let's say care with minor deviation.

But still there were this proportion, which is obviously

not accessing care at all.

So I think that's what you're saying about yeah, having local solutions.

Prof. Richard Sullivan: I guess when we stand back and look at systems, it's

very hard because the sheer complexity of cancer with childhood cancers,

blood cancers, the adult solid cancers.

We tend to focus on three different cancer types as being indicators for how well

the system's doing, and that's cervix because, it's a pelvic disease, breast,

obviously, and interestingly bowel cancer because bowel cancer is rising rapidly

in lots of transitioning countries, and it affects both men and women.

And all of these three require very good surgery, good

radiotherapy and systemic therapy.

It's tri-modality therapy as we call it.

So, they're quite good at telling you how well the system's doing.

And Eva said it… the issue has been if you stand back and look at the data, there

are countries that have done really well,

and then you get all these countries which are either flatlining or going down.

In some cases, the going down is because of conflict and political instability.

In other cases,.

they've not matured their health systems.

It's not a problem with cancer.

The problem is actually foundationally and fundamentally that the health

system is not being financed, properly governed and developed.

Cancer reflects all the strengths and weaknesses of our welfare and our

healthcare system, and if you can't get those foundations right, you

can have the best cancer plan in the world, nothing is going to improve.

And I think, Eva, I think it's fair to say in a lot of sub-Saharan African countries

the problem isn't the will behind the cancer control, it's the foundational

bits of basic surgery, basic chemotherapy, basic pathways for diagnosis.

That's my sense when you start looking and unpicking this, that we focus so much on

the cancer expenditure when the problem actually rests in the, what we're spending

on the social determinants of health, what we're actually spending on the

basic building blocks of health systems.

And I think, if you start looking at it that way around you can start

unpicking what the problems are and start to point towards where solutions

are and where you need patient and political activism to actually

improve things because that's the key.

Dr. Kim Ozano: So, if we're looking at the building blocks of health

system strengthening as a core foundation to build global oncology

and to improve those stats in, in, in not just those cancers, but others.

Eva, you talked about working across disciplines because often we hear

the same problems, but we see the silos in, in, in disease categories.

Can you tell us a little bit more about how working across different

parts of the system can help build stronger foundations for cancer care?

Prof. Eva Kantelhardt: I have one interesting example when we asked

colleagues in Kampala, in Uganda, if they would be willing to do some

interviews with patients to find out how and if they accessed care

and what were barriers, et cetera.

And then in fact, because for some reason there wasn't really a person to

do it, the oncologist actually did that.

After that study, he called I think 50 patients or something, he said, "Eva,

that was so interesting," because those were population-based sample, and it

was in fact, he was calling the patients who actually didn't come to his office.

And this was for me, also highlighting how if you really have more discussions across

these different areas, it really helps.

And I think, of course, yes, there are countries where you have kind of cancer

societies, where you have anthropologists, where you have nursing, where you

have on- oncologists, of course but I think this really has to develop.

And when you have a country where you have 10 oncologists and

five pathologists, what to do?

That also has to be in a reasonable way.

I see that there are more people with more education in so many countries.

That's one point, where I think that's an open door.

The other point is I see much more private.

First I was really sceptical, how do you assure quality in areas which is not so

much regulated by government, it's not so easy, but this has definitely improved the

access to diagnostic services, and I think that's one of the key elements as well.

And the other one is also that I would say that education and involving all

levels of healthcare workers is very important, because if you have like a

health centre in a country with a young population where half is under age 15,

that health centre, maybe one breast cancer turns up a year, and bringing the

care to the people is difficult in such vast countries where you also have so

many young people who are not affected.

On the other side, of course, the huge numbers eventually lead, for example,

to numbers like Ethiopia, where you have 10,000 maternal death and 10,000

women dying from breast cancer, so it really has come up as a major problem.

Those are women taking care of families and who are huge part of communities.

Having adequate teaching and knowledge gained throughout the health system

is really also one point where we have to find adequate and local solutions.

Dr. Kim Ozano: It comes back to those building blocks again, doesn't it, around

regulation, and Richard, access to data you've said this is, absolutely vital.

We can't respond unless we know the situation.

I think I would just like to talk a little bit about that.

These building blocks are even more complex in conflict

and crisis-affected settings.

That's an area you work in, Richard.

Do you want to talk to us a little bit about how that's different?

Prof. Richard Sullivan: The estimates are there are around 2.8, 2.9

billion people live in fragile, violence or conflict impacted areas.

But I think it's important to unpack that a little bit.

There are areas where there is a frank war going on and particularly the

border between Russia and Ukraine at the moment, for example, Iran, et cetera.

And then there are those individuals and countries that are caught up in

conflict because they are host countries.

So particularly when we think about the internal war within Sudan, with

external actors pushing patients across into Egypt, into Chad, into Rwanda.

What we saw from the civil war within Syria pushing patients into

Lebanon, Jordan, and up into Türkiye.

So all of these are very different ecosystems, and so, when we've been

thinking about what cancer control means, you have to go on one extreme, you're

talking about cancer control within INGOs, international non-governmental

organisations, like the International Committee for the Red Cross, Médecins Sans

Frontières, and what is a basic limited package that you can put in to these

deployments, all the way through to how do you support the Jordan's and the Turkey's

when they are having to look after tens of thousands of additional cancer patients,

in addition to their own citizens, in countries that had limited capacity

and capability in the first place.

So it, it's a really interesting problem because, the UN system does

not have an easy solution to this.

We don't, we haven't thought through the models of care for this.

What are basic models of care that we ought to be paying for?

And there's a lot of work that still needs to be done in this particular area

because unfortunately what we're seeing around the world is conflict and fragility

is just growing and it's becoming more and more a part of everyday life, whether

it's in the Sahel region in Sub-Saharan Africa, the narco wars in Latin America.

But this is going to require a very different mindset to financing, to care,

and also particularly to transnational care because you see a lot of people

moving borders backwards and forwards.

So it's lessons learned and actually coming up with a essentially a

very different package for cancer control because it is beyond

the national cancer control.

Dr. Kim Ozano: I think that's crucial in our discussions around equity

to care as well, and transitional populations is one that's gonna have

to be a focus moving forward also.

But we are running out of time already.

So, I think just a last reflection on how you've been working with

patient-centered organisations.

How are they involved in things like the cancer strategy for

World Bank and other strategies?

Prof. Eva Kantelhardt: I am very impressed how in all countries where we are working,

there are patient organisations, survivors speaking up and giving a positive

reflection to really work on that vicious cycle in villages where a woman sees

another woman having her breast taken off, losing her hair, and then dying anyway,

will not lead to that woman going early when she feels a lump in her breast.

So this point really needs local and yeah, let's say outspoken patient organisations.

We have produced videos, and we have produced songs, and yeah,

very innovative ways of spreading information that cancer can be cured.

Of course not all, and that is something very difficult to

understand because, of course, there are probabilities and predictions.

And bringing that together to such diverse communities is not easy.

But I can say, there are yeah, very engaged patient organisations, and

I think the stigma is reducing, and patients are speaking up.

And they are involved in cancer control plans, which I have seen,

but maybe, Richard, you have other levels where you can see this maybe?

Prof. Richard Sullivan: Yeah, it's interesting is I think you're spot on,

Eva, about the women's engagement in this and the improvement in patient

advocacy particularly driven by women.

And again, I think that speaks volumes to the elimination of

cancer of the cervix programmes, the global breast programmes, et cetera.

Where the deficit occurs actually is in men as advocates,

and it's been remarkable.

Even in the West still, it's dominated by women in terms of the advocacy programmes.

So, for a lot of countries, trying to get the men to be activists as

well is going to be really important.

I think when we took a gendered view of cancer, particularly things like

prostate cancer which we talk very little about, and has massive impact

globally, bringing men into the fold and getting them to be political activists,

and to be pushing policymakers I think would make the next big move forward.

But I agree, like Eva, I'm very hopeful of the future where that's concerned

because my colleague, Dr Julie Tourode, who reads all our patient advocacy work,

will say it vastly improved compared to what it was like 10 years ago.

Dr. Kim Ozano: That's a really good place to close our

discussion on a positive there.

But we like to end our episodes with a piece of advice.

So, we have people working or beginning to work in this

discipline of global oncology.

What advice would you give to them when they really want to focus

on improving equitable access to cancer care around the world?

Prof. Eva Kantelhardt: The first point is to actually listen and to hear what

are the actual challenges and, yeah, try to get data try to get evidence and how

to go for the low-hanging fruit or to how to really make a change according

to how really people want it to.

Dr. Kim Ozano: Thank you.

So, really listen and respond to what people want.

I think that's a great message.

Richard, a take home message please.

Prof. Richard Sullivan: Yeah, I think for this to improve,

I think there's the three Es.

The experience, actually building up experience of all these different

systems and understanding how they do and don't work and what

the different challenges are.

Building up expertise in particular areas, hugely important, whether

you want to be a health economist, a gynaecologist working in complex systems.

And then also ability to read the evidence and actually not start from

the beginning again, because, there's a lot of evidence that's built up

that people often fail to grasp.

And I guess finally is work long-term with your friends around the world.

At the end of the day, it is all about collaboration with friends

and an idea of mutuality and solidarity, and do things together

because it's the right thing to do.

Dr. Kim Ozano: Fantastic.

So, use the evidence that's there and build long-term

relationships and work together.

I really like that message.

So, thank you very much both for contributing to this discussion,

and I really enjoyed learning about all the work that's been going on.

Richard, we look forward to the strategy that's coming out, and Eva, also to

your publications and learning around that patient focus and participatory

research, that helps us to make sure that the systems are developed how people

want them and that they respond to the context where they're being delivered.

This conversation reminds us that progress in cancer care cannot be measured

by new technologies or treatments.

It depends on whether health systems are financed, governed, strengthened

in ways that respond to local realities, and whether patients and

communities are part of shaping care.

If this episode has been useful, please help continue the conversation

by following Connecting Citizens to Science wherever you get your podcasts,

and sharing it with anyone interested in global health, cancer care equity,

or health system strengthening.

Until next time, stay connected.