ArticleThe oncologist2026
Global disparities in the availability and reimbursement of systemic therapies for renal cell carcinoma: results of the International ARON-AID Survey.
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142 authors.
Yuksel UrunDepartment of Medical Oncology, Ankara University Faculty of Medicine, Ankara 06620, Türkiye.ORCID 0000-0002-9152-9887
Kannan SridharanDepartment of Pharmacology & Therapeutics, College of Medicine & Health Sciences, Arabian Gulf University, Kingdom of Bahrain.
Anca ZguraDepartment of Obstetrics-Radiotherapy, Alexandru Trestioreanu Institute of Oncology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.ORCID 0000-0002-2370-5762
Anas ZayedDepartment of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
Martin Ignacio Zapata LaguadoDepartment of Clinical Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.
Tarkan YetisyigitDepartment of Medical Oncology, Bahrain Oncology Center, Muharraq, Bahrain.ORCID 0000-0002-4622-4742
Akihiro YanoDepartment of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Mike WenzelDepartment of Urology, University Hospital Frankfurt, Goethe University, Frankfurt, Frankfurt am Main, Germany.ORCID 0000-0002-4338-0889
Nuno VauUrologic Oncology, Champalimaud Clinical Center, Lisbon 1400-038, Portugal.
Deniz TuralDepartment of Medical Oncology, Koç University School of Medicine, Istanbul, Turkey.
Karine TrindadeOncocentro Ceará (Rede D'Or), Fortaleza, Brazil.ORCID 0009-0006-4947-0304
Ben TranDepartment of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Frederic Ivan Leong TingSection of Medical Oncology, Department of Internal Medicine, Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod 6100, Philippines.ORCID 0000-0002-9161-4918
Arnoud J TempletonFaculty of Medicine, University of Basel, Basel, Switzerland.
Hideki TakeshitaInternational University of Health and Welfare Hospital, 852 Hatakeda, Narita-shi, Chiba 286-8520, Japan.ORCID 0000-0002-1512-6904
Kaisa SunelaFinnish Medicines Agency, Tampere, Finland.
Vinicius Carrera SouzaOncologia D'OR, Salvador, Brazil.ORCID 0000-0003-3216-7713
Mopa Alina SooroJiangsu Key Laboratory of New Drug Screening & Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing 210009, China.
Andrey SoaresLatin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.
Shankar SivaDepartment of Radiation Oncology and Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia.ORCID 0000-0003-2840-0658
Ashish SinghDepartment of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu 632004, India.
Glauco SilveiraCentro Oncológico do Triângulo, Uberlândia, Brazil.
Shamik ShahDepartment of Nephrology, King Hamad American Mission Hospital, Kingdom of Bahrain.
Emmanuel SerontDepartment of Medical Oncology, Cliniques Universitaires Saint Luc, Brussel, Belgium.
Fabio A SchutzLatin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.ORCID 0009-0000-6464-5391
Maitê de Liz Vassen SchurmannANIMI-Unidad de Tratamento Oncológico, Lages, SC, Brazil.
Timothy SchieberDivision of Medical Oncology, Department of Internal Medicine, University of Kansas Cancer Center, Westwood, KS, United States.ORCID 0000-0002-2016-7508
Sarah ScagliariniDepartment of Medical Oncology, AORN "A. Cardarelli,"Naples, Italy.
Amalya SargsyanImmune Oncology Research Institute, 7 Nersisyan, Yerevan 0014, Armenia.
Carlos Salinas SimonettiMedical Oncology Service, Bradford Hill, Santiago de Chile, Chile.ORCID 0000-0001-6607-3008
Marine RushanyanYeolyan Hematology and Oncology Center, Yerevan, Armenia.
Giandomenico RovielloDepartment of Health Sciences, University of Florence, Florence, Italy.ORCID 0000-0001-5504-8237
Alejo Rodriguez-VidaHospital del Mar Research Institute, Barcelona, Spain.
Orion Erenhu Rodriguez GonzalezEscuela Militar de Graduados de Sanidad, Batalla de Celaya 202, Lomas de Sotelo, Militar, Miguel Hidalgo, Ciudad de México 11200, Mexico.
Robin RobertsUWI School of Clinical Medicine and Research, Nassau, The Bahamas.
Astrid A M Van der VeldtDepartment of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.ORCID 0000-0003-0446-1907
Mimma RizzoMedical Oncology Unit, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, Bari, Italy.
Alessandro RizzoS.S.D. C.O.r.O. Bed Management Presa in Carico, TDM, IRCCS Istituto Tumori "Giovanni Paolo II,"Bari, Italy.ORCID 0000-0002-5257-8678
Alexandr PoprachMasaryk Memorial Cancer Institute, Brno, Czech Republic.
Alina PirshtukDepartment of Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
Alvaro PintoDepartment of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain.
Erin PierceHonorHealth Research Institute, 10510 N. 92nd St., Suite 100, Scottsdale, AZ 85258, United States.
Jose Mauricio PeñalozaCentro Oncológico Integral, Neuquén, Argentina.ORCID 0009-0006-0551-9452
Martino PedraniIstituto Oncologico Svizzera Italiana, Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona 6500, Switzerland.
Se Hoon ParkSamsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.ORCID 0000-0001-5084-9326
Ibukun Adewumi OkunadeBowen University Teaching Hospital, P.O. Box 15, Ogbomoso, Oyo State, Nigeria.ORCID 0009-0003-0252-5564
Karen Flora OdoungaService Pharmacie, Institut de Cancérologie de Libreville, Libreville, Gabon.
Julio NoriegaFox Chase Cancer Center, Philadelphia, PA 19111, United States.
Edriss NoorzaiPeninsula Health, Hastings Road, Frankston, VIC 3199, Australia.
Maria Tereza Nieto CoronelOncopalia.MyA Center, Medical Oncology Departament, La Paz City, Bolivia.ORCID 0000-0002-5606-6434
Jiri NavratilMasaryk Memorial Cancer Institute, Brno, Czech Republic.
Zin W MyintDivision of Medical Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY, United States.
Vladan MutavdzicDepartment of Oncology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia.
Olivier MukukuDepartment of Maternal and Child Health, High Institute of Medical Techniques, Lubumbashi, Democratic Republic of the Congo.ORCID 0000-0001-6902-7023
Robert MugaruraDepartment of Surgery, Kabale University, Kabale District, Uganda.
Fernando Sabino Marques MonteiroLatin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.
Abdikarim Hussein MohamedKaafi Hospital, Mogadishu, Somalia.
Daniel MmerekiFaculty of Health Sciences, Division of Radiation Oncology, University of the Witwatersrand, Johannesburg 2193, South Africa.
Carlo MessinaOncology Unit, UOC Oncologia ARNAS Civico Benfratelli di Cristina, Piazza Nicola Leotta 4, Palermo 90127, Italy.
Bohuslav MelicharFaculty of Medicine and Dentistry, Department of Oncology, Palacký University Olomouc and University Hospital, Zdravotníků 248, Olomouc 775 20, Czech Republic.
Pitchou Mukaz MbeyDepartment of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
Ernesto MaturanaPontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Santiago, CL-8320000, Chile.ORCID 0009-0008-0148-8139
Diana MatthewsVelindre Cancer Centre, Velindre Road, Whitchurch, Cardiff, Wales.
Francesco MassariARON Research Foundation ETS, Galleria del Commercio n. 6, Macerata, Italy.
Esther MartínezHospital Universitario de Jaén, Jaén, Spain.
Priyamvada MaitreRadiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), and Tata Memorial Hospital (TMH), Homi Bhabha National Institute, Mumbai 400094, India.
Patrick MaisonDepartment of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.ORCID 0000-0001-8327-8929
Beaud Conrad Mabika NdjembidoumaDepartement of Medical Physics and Radiotherapy, Akanda Cancer Institute, Libreville, Gabon.ORCID 0000-0001-6873-1887
Kevin LuDepartment of Urology, Kaohsiung Medical University Hospital & College of Medicine, Kaohsiung Medical University.
Jiakun LiDepartment of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
Haoran LiDivision of Medical Oncology, Department of Internal Medicine, University of Kansas Cancer Center, Westwood, KS, United States.
Luciana de Moura LeiteAC Camargo Cancer Center.
Aly-Khan A LalaniDepartment of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Canada.
Zsófia KüronyaUrogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.ORCID 0000-0001-8500-5924
Jakub KucharzDepartment of Uro-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Arnaud Boris KoumbaDepartment of Nuclear Medicine, Akanda Cancer Institute, Libreville, Gabon.
Ray Manneh KoppClinical Oncology, Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia.
Jindrich KopeckyDepartment of Clinical Oncology, and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.ORCID 0000-0002-4126-0410
Alba J Kihn-AlarcónResearch Department, Liga Nacional Contra el Cáncer & Instituto de Cancerología, 6a Avenida 6-58, Cdad, de Guatemala 01011, Guatemala.ORCID 0000-0003-4431-5998
Özge KeskinMedical Oncology Department, Bahrain Oncology Center, King Hamad University Hospital, AlMuharraq, Bahrain.
Kymbat KabdullinaDepartment of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan.
Álvaro JuarezDepartment of Urology, Jerez University Hospital, Jerez, Spain.
María José Juan FitaDepartment of Medical Oncology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain.
Denis Leonardo JardimOncology Center, Hospital Sírio-Libanês, São Paulo, Brazil.
Laurianne Grégoria JamesDepartement of Medical Physics and Radiotherapy, Akanda Cancer Institute, Libreville, Gabon.
Enrique GrandeDepartment of Medical Oncology, Quirónsalud Madrid, Spain.ORCID 0000-0002-0134-4732
Alfonso Gómez De LiañoMedical Oncology Department, CHU Insular-Materno Infantil, Las Palmas, Spain.
Patrizia GiannatempoDipartimento di Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Marwan GhosnDepartment of Hematology-Oncology, Hotel-Dieu de France University Hospital, Beirut, Lebanon.
Cinthia GaunaInstituto Nacional del Cáncer, Capiatá, Paraguay.
Maria Natalia Gandur QuirogaDivision of Genitourinary Medical Oncology, Instituto de Oncologia Ángel H. Roffo, Buenos Aires, Argentina.ORCID 0000-0001-7034-0842
Kazutoshi FujitaDepartment of Urology, Faculty of Medicine, Kindai University, Osaka, Japan.ORCID 0000-0002-6774-7497
Marcelo Roberto Pereira FreitasCentro de Pesquisas Oncológicas-CEPON, Florianópolis, SC, Brazil.
Ondřej FialaARON Research Foundation ETS, Galleria del Commercio n. 6, Macerata, Italy.
Mauricio Fernandez LazzaroDepartment of Uro-Oncology, Fundacion COIR, Mendoza M5500, Argentina.
Glenda M Falcon PachecoInstituto Regional de Enfermedades Neoplásicas del Sur, Arequipa, Perú.
Theophilus Olaide EsanFederal Teaching Hospital, Ido-Ekiti, Nigeria.
Deborah Tolulope EsanFaculty of Nursing Sciences, College of Health Sciences, Bowen University, Iwo, Nigeria.ORCID 0000-0002-3896-8207
Danelo Du PlessisDivision of Urology, Faculty of Health Science, University of Stellenbosch, Cape Town 7505, South Africa.ORCID 0000-0002-4331-1728
Silvia Neciosup DelgadoDepartment of Medical Oncology, National Institute of Neoplastic Diseases, Lima, Peru.
Simon J CrabbCancer Research UK Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom.ORCID 0000-0003-3521-9064
Rafael Correa CanoDepartment of Geriatric Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán,"Ciudad de México, México.ORCID 0000-0001-8957-2993
Luis CorralesDepartment of Medical Oncology, Center for Cancer Research and Management (CIMCA), San Jose, Costa Rica.
Jixiang ChenDepartment of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
Federico CayolSección de Oncología, Servicio de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.ORCID 0000-0001-9794-2173
Clarissa Cavalin SilvaGrupo Oncoclínicas, São Paulo, SP, Brazil.
André Paternò Castello Dias CarneiroLatin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.ORCID 0000-0002-0906-2713
Georgiana Anca CaprinciuOncologie (Clinica), Affidea-Sema Parc Bucuresti, Romania.
Saul CamposLatin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.
Thomas BüttnerDepartment of Urology, and Paediatric Urology, University Hospital Bonn, Bonn, Germany.
Sebastiano ButiARON Research Foundation ETS, Galleria del Commercio n. 6, Macerata, Italy.
Nedal BukhariOncology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Tomas BuchlerDepartment of Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
Maria T BourlonHematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Hatice BolekDepartment of Medical Oncology, Ankara University, School of Medicine, Ankara 06590, Turkey.
Martin BoegemannDepartment of Urology, University of Muenster Medical Center, Muenster, Germany.
Mehmet A BilenDepartment of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
Laura Bernal VacaServicio de Oncología, Clínica Universitaria Colombia-Clínica de Marly, Bogotá, Colombia.ORCID 0000-0002-8394-2698
Diogo Assed BastosHospital Sirio Libanes, Sao Paulo, Sao Paulo, Brazil.
Philippe BarthelemyDepartment of Medical Oncology, ICANS, Strasbourg, France.
Samvel BardakhchyanImmune Oncology Research Institute, 7 Nersisyan, Yerevan 0014, Armenia.
Maria Alexandra BarbuDepartment 8-Radiology, Oncology, Hematology, Faculty of Medicine, "Carol Davila" University of Medicine, and Pharmacy Bucharest Romania.ORCID 0000-0001-9177-3305
Jalal BaransehOncology Wing, RAMBAM Health Care Campus, Haifa, Israel.
Aristotelis Bamias2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Alex BakengaDepartment of Medical Oncology, and Hematology, Uganda Cancer Institute, Kampala, Uganda.
Georgia AngueraDepartment of Medical Oncology, Hospital de La Santa Creu i Sant Pau, Barcelona, Spain.
Martin AngelClinical Oncology, Genitourinary Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina.ORCID 0000-0002-1463-8887
Carolina Alves Costa SilvaGonçalo Moniz Institute, Fiocruz, Salvador, Bahia, Brazil.ORCID 0000-0003-1920-142X
Teresa Alonso-GordoaMedical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.ORCID 0000-0002-8966-7236
Fahad AlmugbelCancer Center of Excellence, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
Roula AlmuftiMedical Oncology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
Thiago Lins AlmeidaGrupo Oncoclínicas, São Paulo, SP, Brazil.ORCID 0000-0001-7852-7177
Altay AliyevDepartment of Oncology, Liv Bona Dea Hospital, Baku, Azerbaijan.ORCID 0000-0002-2024-7751
Carlos AliagaServicio de Oncología, Centro Oncológico Aliada, Lima 15036, Peru.ORCID 0000-0003-0237-7058
Umair AleemDepartment of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Withington, Manchester, M20 4BX, United Kingdom.
Erman AkkusDepartment of Medical Oncology, Ankara University Faculty of Medicine, Ankara 06620, Türkiye.
Luis Garcia AceitunoLatin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.
Syed Hani AbidiDepartment of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan.
Halima AbahssainOncology and Medical Specialties Department, Valenciennes General Hospital, Valenciennes 59300, France.
Francesca TartariARON Research Foundation ETS, Galleria del Commercio n. 6, Macerata, Italy.
Javier Molina-CerrilloARON Research Foundation ETS, Galleria del Commercio n. 6, Macerata, Italy.ORCID 0000-0003-4616-0598
Matteo SantoniARON Research Foundation ETS, Galleria del Commercio n. 6, Macerata, Italy.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRenal Cell Carcinoma (RCC) represents a growing global health burden, with rising incidence and mortality worldwide. Despite major therapeutic advances, access to novel systemic treatments remains uneven across countries and regions.
methodsWe conducted a cross-sectional, web-based international survey to assess the availability and reimbursement status of 20 innovative systemic therapies for RCC. Responses were collected from 144 clinicians, including medical oncologists, radiation oncologists, urologists, and nuclear medicine specialists, across 58 countries. Analyses examined associations between national income level, gross domestic product (GDP), and treatment availability.
findingsThirty-six percent of the countries analyzed had at least 15 of the 20 therapies available. Full reimbursement for at least 15 of the selected innovative therapies was reported in six countries (10%), while 21 countries (36%) fully reimbursed 10-14 therapies and 13 countries (23%) reimbursed 1-9 therapies. In contrast, no full reimbursement for any of the assessed therapies was reported in 18 countries (31%). Higher national income level was significantly associated with greater availability of innovative therapies (Kruskal-Wallis test, P < .0001). Armenia (0.709), Greece (0.685), and Israel (0.666) exhibited the highest GDP-adjusted Drug Availability Index (DAI), whereas India (5.195), Nigeria (4.612), and Morocco (3.794) demonstrated the greatest number of available therapies per US$1000 of GDP per capita.
interpretationAccess to innovative systemic therapies for RCC remains highly unequal at the global level, with reimbursement posing a major barrier even where drugs are available. Internationally coordinated efforts addressing health policy, infrastructure, and equitable pricing are urgently required to ensure that advances in RCC treatment translate into improved outcomes for patients across diverse economic settings.
Indexed as
Carcinoma, Renal CellHealthcare DisparitiesHealth Services AccessibilityKidney NeoplasmsCross-Sectional StudiesGlobal HealthHumansSurveys and Questionnairesaccess to curesARONdrug availabilityeconomic burdenreal-world datarenal cell carcinoma
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PMID
42836687What OpenQuestion holds
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