Although it might be tempting to compare the outcome of Nixon’s projected war on cancer to that of the political cold war that was being pursued relentlessly at the time—tense, inconclusive, and enormously costly—Douglas Hanahan’s paper reminds us of some of the successful sorties that have been made against cancer in the intervening four decades. Notable victories have been achieved against some diseases, such as testicular cancer and childhood acute lymphoblastic leukaemia; oncologists have arguably led the way in medicine by devising targeted therapeutic agents and developing biomarkers to guide diagnosis and treatment; and cancer screening and vaccination programmes have been deployed at vast scale in high-income countries.
Palliative care for patients with cancer has emerged as an important subspecialty in high-income countries in the past 20—30 years, but the need for such care is now recognised to be much broader, both medically and geographically. The Atlas estimates that the 19·2 million adults requiring palliative care worldwide suffer from a wide range of disorders, including cardiovascular diseases (about 38% of the total), cancer (34%), and chronic obstructive pulmonary disease (10%), with the remainder including patients with AIDS, diabetes, and neurodegenerative and other diseases. 22% of adults in need of palliative care are estimated to be in high-income countries, with 70% in middle-income countries and only 8% in low-income countries. Some 96% of the people requiring palliative care are adults, with the remaining 6% being children, about 1·2 million in total.
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