Access to Cancer Medicines: How Waits and Gaps Differ Around the World

Whether a person with cancer can get a medicine depends heavily on where they live. Across the EU, cancer medicines approved in 2021–2024 took an average of 655 days after approval to become available in public health systems (usually, to be listed for reimbursement), from 113 days in Germany to over 1,000 in Estonia, Lithuania and Romania. In many low- and middle-income countries the problem is older and simpler: oncologists report that even long-established essential medicines, most first approved before 2000, are not reliably available, or must be paid for in full by the family.

A cancer medicine reaches a person only after a chain of steps: regulatory approval, a decision by the health system to pay for it, a supply that arrives on time, a hospital that can give it, and a price the household can survive. A break anywhere in that chain shows up at the bedside as a delay, a substitute, or a gap. None of that is a choice made by the person with cancer. This study pulls together the main international evidence on where the chain breaks, using the latest European access survey (published May 2026), the 2025 WHO Model List of Essential Medicines, and surveys of oncologists and medicines-access reporters across more than 80 countries.

In Europe, the wait for a new cancer medicine runs from about four months to nearly three years

The most detailed cross-country measure of access to new medicines in Europe is the Patients W.A.I.T. Indicator, run by IQVIA for the European Federation of Pharmaceutical Industries and Associations (EFPIA), the trade body of the companies that make these medicines, so it is a declared-interest source. The latest edition, the 2025 survey published in May 2026, tracks 168 medicines centrally approved in the EU between 2021 and 2024, including 56 cancer medicines, with data correct to 5 January 2026^[1]. For most countries, "available" means the medicine has entered the public reimbursement list.

On the EU average, 51% of those cancer medicines (28 of 56) were available, up from 50% in the previous survey. The average time from approval to availability rose to 655 days, from 586 days in the previous year's survey. The report finds that cancer medicines "continue to experience the longest access timelines among the major product groups": the average for all medicines was 597 days^[1].

The spread between countries is wide. Germany averaged 113 days and had 51 of the 56 cancer medicines available. Romania (1,060 days) and Estonia (1,064 days) each had 11 available, and Latvia 5^[1]. Within the UK, England averaged 342 days with 33 medicines available (59%), and Scotland 347 days with 27 (48%); for England, Scotland and Switzerland the clock starts at their own national authorisation rather than the EU's, so their figures are not strictly comparable with the EU countries'^[1].

Three cautions apply. First, this is an industry-commissioned survey, and its measure counts every newly approved medicine equally; it does not weigh how much each one adds, and a health system may reasonably decline to pay for a medicine its assessors judge poor value. Second, "available" includes medicines offered only with restrictions or case by case, which made up 19% of cancer medicines on the EU average. Third, a short average can sit alongside few medicines: Latvia's 764-day average covers only 5 of the 56. The report itself describes gaps "of more than two years between markets"^[1]. What the data show clearly is that two people with the same diagnosis, in different European countries, can face years of difference in when a newly approved medicine becomes an option within their public health system.

The medicines oncologists rate most essential are mostly old, and still out of reach in many countries

Outside Europe's high-income systems, the more pressing gap is not new medicines but established ones. In 2021, Fundytus and colleagues asked 948 oncologists in 82 countries which cancer medicines they considered most essential and whether those medicines were available^[2]. Of the 20 medicines most often chosen, 19 were already on the WHO Model List of Essential Medicines, 12 were cytotoxic chemotherapy agents, and 13 had first been approved by the US Food and Drug Administration before 2000. These are, for the most part, long-established medicines.

Even so, universal availability of each of those 20 medicines was reported by only 9–54% of respondents in low- and lower-middle-income countries, compared with 13–90% in upper-middle-income countries and 68–94% in high-income countries^[2]. The ranges reflect the 20 different medicines; for some, fewer than one in ten respondents in the poorest countries reported them as universally available. The authors concluded that access to core cancer medicines faces major barriers worldwide.

Governments' own reports to WHO point the same way. In WHO's 2019 survey of national capacity for noncommunicable diseases, 29% of low-income countries reported that cancer medicines (chemotherapy) were generally available in the public health sector, against 96% of high-income countries^[3].

The WHO Model List is meant to guide national choices. Its 24th edition, published in September 2025, considered seven applications covering 25 cancer medicines and recommended only those shown to prolong life by at least 4–6 months; the list now holds 523 medicines for adults and 374 for children^[4]. But the model list only matters once countries adopt it. An analysis of the national essential medicines lists of 135 countries with national income below US$25,000 per person (2015) found that, of 16 cancer medicines added to the WHO list in 2015, low-income countries' lists included a median of 1, against 10 in the high-income countries within the study's income ceiling; the number listed was correlated with national income and with the number of physicians per head^[5]. Being on a list is a first step, not a guarantee that a medicine is bought, stocked and free at the point of care.

Where a medicine exists, the cost often falls on the family, and the risk of catastrophic costs follows national income

Availability on a shelf is not the same as access. The European Society for Medical Oncology (ESMO) Global Consortium Study, updated with data from 2023 and published in 2025, gathered reports from 317 field reporters and 231 peer reviewers across 126 countries on whether cancer medicines are available and what people pay for them^[6]. It found that in most high-income countries people can obtain cancer medicines without significant out-of-pocket spending. In lower-middle- and low-income countries, 40% of the traditional chemotherapy agents on the WHO Essential Medicines List were available only at full cost to the patient^[6].

The oncologists' survey measured the consequence. For the 20 most essential medicines, 13–68% of respondents in low- and lower-middle-income countries said that patients faced a substantial risk of catastrophic expenditure (spending that pushes a household into hardship), compared with 2–41% in upper-middle-income countries and 0–9% in high-income countries^[2]. A systematic review of 13 studies of cancer medicines in low- and middle-income countries (2015–2020) found wide variation in prices between brands and countries, and reported that unaffordable medicines sometimes lead to treatment being abandoned^[7].

When treatment stops because the money runs out, that is a failure of financing, not of the person or the family. The evidence locates the problem in how health systems pay for cancer care, and in which medicines they choose to cover in full. For the wider costs of cancer for households, including lost work, see cancer, money and work.

For children with cancer, the gap is just as wide, and one model is working to close it

Childhood cancer medicines show the same pattern. A 2022 survey of 159 childhood cancer specialists in 44 countries found that 87% of the medicines they rated as priorities (27 of 31) were already on the WHO Essential Medicines List for Children^[8]. Universal availability of the top medicines was reported by 9–46% of respondents in lower-middle- and low-income countries, 25–89% in upper-middle-income countries and 67–100% in high-income countries. A risk of catastrophic expenditure was reported by 8–20% of respondents in the lower-income group and by none in high-income countries^[8]. With 159 respondents across 44 countries, these are indicative ranges rather than precise national estimates.

In December 2021, WHO and St. Jude Children's Research Hospital launched the Global Platform for Access to Childhood Cancer Medicines, to provide "an uninterrupted supply of quality-assured childhood cancer medicines"^[3]. By February 2026 it worked with 12 participating countries and aimed to supply medicines for about 120,000 children over five to seven years. In Ecuador, more than 300 children and adolescents had received treatment through it since February 2025, from a range of over 70 medicines and formulations for chemotherapy and supportive care^[9]. These are programme figures, not outcome data, but they show that coordinated, reliable supply of established medicines can be organised across countries. The childhood cancer evidence study covers survival differences in more depth.

Price is a poor guide to benefit, which makes access decisions harder

High prices are one reason health systems delay or decline new cancer medicines, and the evidence suggests prices do not track how much a medicine helps. A 2020 analysis of 65 cancer medicines found that monthly treatment costs in the USA were a median of 2.31 times those in four European countries (England, France, Germany and Switzerland). For medicines for solid tumours, there was no significant association between monthly cost and clinical benefit, measured on the ESMO Magnitude of Clinical Benefit Scale, in any of the five countries^[10].

Benefit at the time of approval is also often uncertain. Of 68 cancer indications approved by the European Medicines Agency in 2009–2013, 35% showed a significant improvement in overall survival when approved, with a median gain of 2.7 months, and 10% showed an improvement in quality of life. After a median of 5.4 years' follow-up, 51% had shown a significant improvement in survival or quality of life, and for 49% the benefit remained uncertain^[11].

This matters for reading the European waiting times fairly. Some delay reflects health technology assessment doing its job: weighing evidence and negotiating price. Some reflects slow processes, budget limits and supply decisions. The available data cannot separate the two, which is why the WHO's choice to list only cancer medicines with at least 4–6 months' survival benefit^[4] is a useful anchor: it focuses scarce budgets on medicines with substantial benefit.

What the evidence asks of us

• Make the established essentials universal first. Most of the medicines oncologists rate as essential are long-established, mostly first approved before 2000, and already on the WHO list^[2]. Governments and funders can close much of the gap by adopting the WHO Model List into national lists, buying those medicines reliably and making them free at the point of care.
• Remove full-cost payment for essential chemotherapy. That 40% of traditional EML chemotherapy agents are available only at full cost in lower-middle- and low-income countries^[6] is a financing decision that can be changed, and the risk of catastrophic expenditure shows what it costs families^[2].
• Scale pooled supply models. The childhood medicines platform shows quality-assured supply of established medicines can reach public hospitals in participating countries within a few years^[9]. Similar approaches could be tested for adult essential medicines, with outcomes published.
• In Europe, publish and shorten the steps that are slow for no clinical reason. Gaps of more than two years between countries^[1] should be explained, country by country, with timelines for assessment and pricing made public so that delays caused by process, not evidence, can be seen and reduced.
• Pay for benefit. Since price does not track clinical benefit^[10], purchasers can use validated benefit scales and the WHO survival threshold^[4] to prioritise, and require confirmatory evidence where benefit at approval is uncertain^[11].
• Measure access, not just approval. Independent, regularly published data on availability and out-of-pocket cost in every country, such as the ESMO global study^[6], let charities and communities hold systems to account.

Access to medicines is one part of a wider gap in cancer care between countries; see the global cancer gap for radiotherapy, pathology and workforce, and the full cancer research library for related studies.

Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "net survival" are used in the sense the cited source defines them.

Why we're publishing this

People living with cancer, their families and the charities that support them often meet access problems one case at a time: a medicine that is approved but not yet funded, a prescription that cannot be filled, a family asked to pay for treatment in full. The international data show these are not isolated cases but patterns, set by country, income and health-system decisions. We have brought the main sources together so that charities and campaigners can point to the evidence when they ask for faster, fairer access. The case is theirs; the figures are here to support it.

How to read this data

The figures come from different kinds of evidence and should not be merged into one ranking. The European waiting-time data are an industry-commissioned survey of reimbursement status, with country definitions of "available" that differ; they say nothing about whether each eligible person received a medicine, and they count all new medicines equally whatever their benefit. The global availability figures come from surveys of oncologists and reporters, who describe what they see in their own setting; respondent numbers in some countries are small, and low- and lower-middle-income countries together supplied only 17% of the oncologists' survey. The WHO figure of 29% versus 96% is governments' own assessment in the 2019 WHO country capacity survey, which asked whether chemotherapy in the public sector was "generally available", defined as reaching 50% or more of patients in need^[12]; it says nothing about which medicines, or about children specifically. The ESMO 2023 update and the oncologists' survey were read at abstract level only. The price and benefit studies cover medicines approved in particular periods (2009–2013 in Europe; a cohort of 65 medicines in the 2020 analysis) and may not describe later approvals. Where a range is given (for example 9–54%), it spans the different medicines surveyed, not a confidence interval.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

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9. Pan American Health Organization. Cooperation expands access to childhood cancer medicines and technical resources. PAHO, 13 February 2026. paho.org/en/news/13-2-2026-cooperation-expands-access-childhood-cancer-medicines…
10. Vokinger KN, Hwang TJ, Grischott T, et al. Prices and clinical benefit of cancer drugs in the USA and Europe: a cost-benefit analysis. Lancet Oncology, 2020. europepmc.org/article/MED/32359489
11. Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13. BMJ, 2017. europepmc.org/article/MED/28978555
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