ADDRESSING UNIQUE CHALLENGES AND UNMET NEEDS - MERCK KGAA
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SUPPORTING WOMEN WITH CANCER: Addressing unique challenges and unmet needs Insights into the unique challenges faced by women living with cancer and identification of actions that may help to improve their experiences and outcomes Findings from a 23-country research initiative September 2019
We can do better on
behalf of women
Cancer is one of the greatest health The Healthy Women, Healthy Economies
CONTENTS
burdens that women face today. It Policy Toolkit* provides guidance and
is the second leading cause of death support to a variety of stakeholders who
globally1 and the number of cancer can implement policy change. The Toolkit
cases continues to rise year-on- is built on the premise that reliable data
year,2 indicating the vast scale of and research are necessary to determine
the problem. the prevalence and risk factors of diseases
We can do better on behalf of women 3 that impact women and ensure that
Overcoming the unique challenges effective, transformative health programs
How we should respond as a community 4
that can stand in the way of women’s and interventions are developed and
Executive summary 5 potential matters to me, as it should operationalized.
to all of us. At Merck, we focus on
Survey methodology 6
developing and implementing solutions This report is a core part of the Healthy
Action point 1: Education 7 for health conditions and diseases that Women, Healthy Economies evidence
disproportionately affect women, and base. ‘Supporting Women With Cancer’
Action point 2: Screening program awareness and access 9
cancer is high on the list. presents a new 23-country survey
Action point 3: Access to support services 12 designed to shed light on the challenges
Cancer affects an increasing number of faced by women diagnosed with cancer.
Recommendations for change 16
women and this growing global burden The survey provides data that are key
Conclusion 17 constitutes one of the most significant to strengthening policies and programs,
health challenges of the 21st century.3 In highlighting the need for greater multi-
About Merck 18
2018, an estimated 8.6 million women stakeholder action to address significant
were diagnosed with cancer around the unmet needs in the areas of education,
world, with breast, colorectal and lung cancer screening and access to support
cancers accounting for 44% of these services.
cases.4,5 Cancer prevention and the
support of women living with cancer should Merck sees the bigger picture of how
be a global priority. It is for Merck. health and prosperity are intertwined for
women, and we will do our part to advance
According to the International Labour the Healthy Women, Healthy Economies
Organization, 865 million women across initiative to improve the potential of
the globe are not reaching their full women living with cancer globally.
potential to contribute to society.6 Many
of the causes are preventable. There Belén Garijo
are enduring obstacles women must Member of the Merck Executive Board
overcome, including health challenges that CEO Healthcare
impact economies around the world.
This is why I personally, and Merck as a
company and a community, are committed
to the global Healthy Women, Healthy
Economies initiative, which brings together
patients, governments, healthcare
professionals, employers, academics and
other stakeholders to improve women’s
health — so that they can thrive in all
aspects of their lives and communities.
*The Healthy Women, Healthy Economies Policy Toolkit can be accessed at:
http://healthywomen.apec.org/policy-toolkit/
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this brochure is under the sole ownership of Merck KGaA in Darmstadt, Germany.
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2 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 3
How we should Executive summary:
respond as a We must act now to improve education,
screening programs and support services
community for women living with cancer
For the last 10 years we have seen a The numbers speak for themselves but At Merck, we see the bigger
growing global understanding of the let me contribute my own thoughts on picture of how health and The survey identified three core areas where there is a greater need for
impact cancer has and will have on how we should respond as a community prosperity are intertwined for multi-stakeholder action.
future generations. to some of the headlines in this report. women and are committed to
making a positive contribution 1. Continued education to promote awareness of all cancers and their
There have been three United Nations 1. “Only 45% of women surveyed to improving both. risk factors amongst women
High Level Meetings on non-communicable reported they were aware of cancer
Regardless of a woman’s socio-economic demographic, the research showed
diseases (NCDs), agreements to global signs and symptoms before receiving Merck is the founding private
a greater focus is needed to improve knowledge and understanding of the
targets to be achieved by 2025, a their diagnosis” — we must deploy sector partner of Healthy Women,
signs, symptoms and risk factors of cancer, in particular those not widely
Resolution on cancer at the World Health every tool we have at hand to Healthy Economies, a global
considered ‘women’s cancers’ such as lung and colorectal cancer.
Assembly in 2017 and the inclusion of NCDs increase women’s awareness of cancer initiative that brings together
in the Sustainable Development Goals for symptoms. Not just of cancer types governments, the private sector
2030. If we act collectively on all these which are unique to women, but also and other stakeholders such as 2. Increased awareness of, and access to, cancer screening
global agreements and commitments, then of others like lung, colorectal and non-governmental organizations programs for all women to support earlier diagnosis
we will make great progress in reducing the stomach cancers. The UICC calls on (NGOs) and patient advocacy
The survey findings highlighted the need for increased access to, and
numbers of premature deaths from cancer the global cancer community to help groups to address women’s health
awareness of, cancer screening programs for all women, particularly those
and the other NCDs by a third by 2030. women better understand the signs so women—and by extension their
with a lower level of formal education, to support potential earlier diagnosis.
This ambition, however, is not without and symptoms of cancers and ensure families—can live better lives.
its challenges. that they present to their healthcare
Additionally, the survey results critically highlighted that improving women’s
practitioner at a stage which improves Bringing these significant
understanding of the benefits of early cancer detection could help to remove
At the Union for International Cancer their chances of survival. commitments together, Merck, with
some barriers to accessing screening programs.
Control (UICC), we strive to build a global input from the UICC, implemented
community which works collectively to 2. “Nearly half of women surveyed had the Supporting Women With Cancer
ensure that evidence-based solutions to never attended a cancer screening survey across 23 countries and more 3. Improved awareness and access to support services, plus the
reduce cancer incidence and increase program” — we must encourage than 4,500 women who had received further identification of where unmet needs persist
cancer survival are in place around the governments around the world a cancer diagnosis and undergone
According to the research, women clearly require improved awareness of and
world. We expect all countries to have a to implement national screening treatment. The survey was
access to financial, emotional, employment and fertility support to ensure they
robust and funded national cancer control programs which also raise the profile undertaken to better understand the
can maintain their daily lives following a cancer diagnosis. A perceived greater
plan, to develop information systems of cancers, encourage women to seek unique challenges women diagnosed
stigma was also experienced by women diagnosed with cancer compared to
so they understand their cancer burden advice and help identify more cancers with cancer face and where more
men, with women feeling burdened financially and across their work and family
today, and in the future, and that the earlier than we do today. We must societal support is needed.
responsibilities.
pathway to effective action involves increase the awareness of national
the active participation of players from programs and ensure outreach to the
Many women of childbearing age with cancer were not offered family planning
all sectors—governments, civil society, most vulnerable communities.
support and related guidance from their healthcare professional—despite the fact
academia and the private sector.
that half of those who did not receive this would have welcomed the support,
3. “Only 42% of women surveyed had
in retrospect. The research highlighted that in some regions there is significant
As others have said in this report, despite accessed support services” — this
opportunity to improve access to such advice.
the advances in reducing exposure is a challenge complicated by a
to risk factors, the existence of more lack of information, poor education,
Furthermore, the research showed an opportunity for employers to better
vaccination and screening programs and poverty, the existence of myths and
demonstrate, and in some cases improve, how employees are supported
breakthroughs in treatment and care, we misconceptions and, in some cases,
following a cancer diagnosis to help reduce related job security fears.
face a growing number of cancer cases hindered by cultural norms. Despite
and deaths from cancer each year. The these barriers, we know that great
This report highlights and recommends seven specific areas for further
main driver being an aging and growing progress can be made if medical
consideration and action. Should interested stakeholders be able to work
population and not making the progress at institutions, doctors and service
together to affect change in these areas, meaningful progress will no doubt
the pace we would like to see in reducing providers work more closely together
be made towards the goal of improving support for women throughout their
the world’s exposure to cancer risk factors. so that cancer patients receive the
cancer journey. Experience indicates that public-private partnerships are key to
holistic support they need.
addressing challenges, due to a mutual objective of business and governments
Today, more than 70% of cancer deaths
to generate sustainable growth to benefit their communities.
occur in low- and middle-income countries. I thank Merck for their continuous
The International Agency for Research on commitment to global cancer control.
Cancer (IARC) suggests that more than This report broadens our understanding
two thirds of new cancer cases will occur of the specific challenges faced by
in lower-middle income countries in the women with cancer and helps us shape a
coming decades—countries which are least sustainable and effective response.
able to respond to such a seismic change
in the health of their population. Dr. Cary Adams
Chief Executive Officer
In this report, Merck highlights some of Union for International Cancer Control
the challenges faced by women as the
cancer burden grows.
4 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 5
Survey methodology: Action Point 1:
An overview of the 23-country Education
research initiative The need to improve women’s knowledge
and understanding of cancer signs,
The Supporting Women With • 15-minute face-to-face and The topic of conversation was symptoms and risk factors
Cancer survey was conducted by online interviews were conducted also sensitive for some respondents,
Cello Health, a thought-leading across two countries (India therefore, there may have been
health advisory firm, to ensure and Indonesia). inherent differences in those who
Across countries and • Women with a lower level of formal tailored for older women can be
that findings were an accurate chose to partake in the survey
demographics, there is a need education had lower awareness of considered important.
representation of women’s Across the entire survey globally, compared to those who were less
to improve women’s knowledge risk factors associated with cancer
experiences. Women in the the sample was 4,585 women, with comfortable and opted out. The
and understanding of the risk compared to those with higher levels • Women in lower- and upper-middle
following 23 countries were surveyed: 200 participants per country except decision was also taken not to ask
factors, signs and symptoms of of education. The issue of female income countries were less aware
Argentina, Australia, Brazil, Canada, in Kazakhstan (n=201), Jordan or screen out respondents based on
cancer, in particular those that education is complex and, in many overall of the signs and symptoms
China, Colombia, France, Germany, (n=204) and South Korea (n=180). their date of diagnosis, to ensure
are not widely considered to be countries, tightly connected to of cancer, compared to those in
Ghana, India, Indonesia, Italy, Japan, The sample sizes were chosen to that a wide population was reached
‘women’s cancers’, regardless of gender equality and the alleviation high-income countries. While this
Jordan, Kazakhstan, Kenya, Mexico, collect a representative sample without restrictions.
income and level of education. of poverty.7 The research further disparity was anticipated due
Poland, Spain, South Africa, South in each country and allow robust
compounds the need to ensure to potentially limited resources
Korea, the United Kingdom and the analysis and comparison across There is a small risk that variation
The education of both women and women’s access to education is a dedicated to public health
United States. countries. The sample sizes were in research recruitment and data
men on cancer remains a key health continued global priority, in support awareness campaigns, it highlights
also selected to adequately allow for collection per market may have
promotion priority in most regions of improved women’s health and the the need to approach education
The research methodology was sub-analyses to take place, looking influenced the results. All markets had
around the world. However, the health of their economies. efforts in accordance with country
tailored across countries as needed at country income level, region, age, the exact same quantitative questions
Supporting Women With Cancer Gross Domestic Product (GDP).
to meet local requirements. education level, dependant status asked using the same script.
initiative highlighted that only • The older a woman was, the less Public health and cancer advocacy
and diagnosis delay status.
45% of the women surveyed likely she was to be aware of resources will vary country-to-
• 15-minute online quantitative This research was unable to collect
were aware of cancer signs and cancer signs and symptoms before country and there is a potential
interviews were conducted across Survey participants were required to information on resource availability
symptoms before receiving a diagnosis. With cancer incidence need to be even more targeted
16 countries (Argentina, Australia, be female, should have received a as this varies considerably depending
their diagnosis. increasing with age, education across geographies.
Brazil, Canada, China, Colombia, diagnosis and treatment for cancer on socioeconomic status, geography,
efforts that are specifically
France, Germany, Italy, Japan, and be aged between 18 and 80 and changes over time.
Mexico, Poland, Spain, South years old, with a minimum quota
Korea, the United Kingdom, for women living with cancer aged The Supporting Women With
and the United States). 18–40 years to aid analysis. Cancer survey explores the unique Women with a low level of education were generally less aware of cancer risk factors
challenges faced by women affected
• 15-minute face-to-face The research did not explore by cancer and identifies areas where
High level of Medium level of Low level of
quantitative interviews were topics qualitatively and as a result, knowledge and understanding may
Global education education education/none
conducted across five countries certain topics were not captured be increased, and areas where more
(Ghana, Jordan, Kenya, in great detail. support may be beneficial. Family history
77% 79% 79% 65%
Kazakhstan and South Africa). of cancer
Smoke /
68% 70% 69% 58%
smoking
The survey was conducted in Exposure to
50% 55% 50% 35%
hazardous chemicals
23 countries between
October and December 2018 Radiation
45% 52% 44% 30%
exposure
Hormone
38% 43% 38% 27%
medication
Excess bodyweight /
37% 44% 36% 26%
high BMI
Level of
37% 39% 36% 32%
alcohol intake
Air
31% 36% 30% 20%
pollution
Physical
29% 35% 27% 17%
inactivity
Reproductive
22% 29% 19% 16%
factors
Not aware
2% 1% 2% 3%
of any
6 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 7
The possible consequences of such
Action Point 2:
Screening program
Awareness of cancers with high death rates that affect both genders
low awareness of cancer risk factors,
(except for colorectal cancer) was low
signs and symptoms are significant.
This finding begs the question of
awareness
how we can better tailor resources to HIGH Global
achieve the needed degree of health
education and empowerment. Breast cancer Voted highest mortality 73%
estimated number of deaths worldwide for 2018)5
and access
Lung, bronchial and
Global mortality for females (WHO projected/
One area identified by the research 28%
tracheal cancer
warranting additional attention is
the focus on female cancers versus Colorectal cancer 17%
cancers that directly impact both
genders. The women surveyed Cervical cancer Voted second highest mortality 41%
perceived predominantly female
or female-only cancers—such Stomach cancer 10%
The need to increase awareness
as breast, cervical and ovarian
cancer—to have the highest
mortality, while significantly
Liver cancer 12% of, and access to, cancer screening
underestimating cancers with
the highest mortality amongst
Ovarian cancer Voted third highest mortality 34%
programs for all women, to support
both genders—for example lung,
colorectal and stomach cancer.
Blood cancers
Head and neck cancer 5%
16%
the potential of earlier diagnosis
• Awareness of high mortality
cancers was below average in Kidney cancer 4%
Cancer screening program access • Age does not appear to be a • For women 60 and over, the most
women with a lower-level of
and awareness must be increased significant influencing factor in often cited reason for having
formal education (people who had Skin cancer 9%
for all women, especially for those women accessing cancer screening never attended a cancer screening
some schooling or no schooling)
in lower-middle income countries programs (47% of women aged program was being unaware of
for the majority of cancer types. Thyroid cancer 4%
LOW or with a lower level of formal 18-59 had attended a screening such programs in their area (33%),
education, in order to support the program, compared to 59% of while women aged 41-59 and
• Awareness of cancers with high Not aware of any 2%
potential for earlier diagnosis. women aged 60-79). This finding 18-40 cited that they did not think
mortality that affect both genders
shows women of all ages must be they needed to attend (33% and
(except for colorectal cancer), and
Of those women surveyed in the better informed and encouraged to 29% respectively). These findings
not just women, was low across all
Supporting Women With Cancer access screening programs in their hint at the potential to do more to
education levels. Several types of obesity-related
initiative, nearly half (47%) had never areas. Undoubtedly, the availability promote screening initiatives at a
cancer only affect women, so even Low awareness of cancer symptoms
attended a cancer screening program. of screening will be a barrier for local community level. It’s vitally
The cancers with the highest though there is a growing number has been shown to be associated
women in some countries, however important that opportunities are
mortality in women according to the of people of both genders who are with longer delays in seeking medical
• Women with lower levels of formal the findings also suggest more capitalized on to improve this
World Health Organization (as of severely overweight, this is likely to help in multiple countries, especially
education were less likely to access needs to be done to increase older age group’s uptake of
2018) are breast, lung and colorectal, have a greater effect on the incidence for those living in rural and remote
a screening program, irrespective participation in screening initiatives screening availability.
and they have estimated that 30- of cancer among women than men.10 areas.11 Although access to, and the
of country GDP, with 54% having already established.
50% of cancer cases diagnosed every quality of, cancer treatments are
never attended one. The issue of
year are preventable.5,8 The women important determinants of outcomes,
female education, as it correlates There was no significant difference between younger and older generations of
surveyed as part of the Supporting some studies have observed higher
Merck in partnership with the to awareness and recognition of women attending a cancer screening program
Women With Cancer research delays in the presentation of rural
American Cancer Society released cancer signs and symptoms and the
initiative perceived the cancers with patients to a healthcare professional.11
a report at the 2016 World Cancer uptake of screening, is significant
the highest mortality to be breast 18-40 years 41-59 years 60-79 years
Congress focusing on the increasing and will require sustained major
cancer (73%), cervical (41%) and Via the Find Cancer Early campaign,
impact of cancer in low- and international efforts to continue its
ovarian cancer (34%). researchers in Australia were able
middle-income countries, both on improvement. In the short-term,
to show that by taking a very local,
women’s health and their economic the research shows that female
It could be fair to hypothesize that community-based approach they
participation. The report emphasized public health initiatives must
this awareness situation is a result could successfully improve knowledge
that while the societal and economic be increasingly focused on how
of highly impactful female cancer
costs of cancer are considerable and
of cancer symptoms in remote
to reach women, in order to be 47% 53% 47% 53% 59% 41%
advocacy and education.7 This is areas, possibly leading to changes in
even catastrophic, the burden of effective and resonate with women
encouraging, but it also suggests behavior. More than a quarter of those
disease, loss of life, and economic across all levels of formal education.
there remains work to do in the who were aware of the campaign
hardship is not inevitable. For more
extension or creation of education reported seeing a general practitioner
information, visit https://www.cancer.
programs for women that address as a result of their exposure.11
org/research/cancer-facts-statistics/
all cancers, not just those
global-burden-of-cancer-in-women.
that only women are typically Simple community-based education
html. Has attended a screening program
diagnosed or linked with. interventions, in rural areas
and specific urban populations, Has NOT attending a screening program
Other research has highlighted the hold significant potential for the
importance of educating women improvement of understanding
specifically on weight management cancer signs and symptoms.
as it relates to cancer risk. According
to some predictions, cancer rates will
increase nearly six times faster in
women than in men over the next 20
years, with obesity partly to blame.9
8 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 9
Reasons women did not attend a cancer screening program (CSP) Reasons why people thought their diagnosis was delayed
High-income Upper-middle Lower-middle
Global
Global countries income countries income countries
Did not think they needed to attend 32% Cancer missed
43% 54% 39% 19%
by HCP
Unaware of any CSPs in my area 30%
Not taking symptoms
35% 28% 34% 52%
Only became aware of CSPs post-diagnosis 26% seriously
47% 53%
I was not interested in attending 16% Scared to find out
20% 10% 25% 38%
that I had cancer
I was scared to find out that I had cancer 12%
Delayed HCP visit due to
15% 16% 12% 18%
I did not meet the criteria (e.g. age) 9% work commitments
Has attended a
My employment commitments stopped me 7% screening program Delayed HCP visit due to
14% 8% 15% 29%
cost concerns
Has NOT attending a
Unable to afford it e.g. cost of attending / travel 7%
screening program Screening program issues
e.g. unable to attend, 12% 9% 8% 23%
My childcare responsibilities stopped me 5%
didn’t meet criteria
The care facility / hospital is too far to travel to 4% Delayed HCP visit, unsure
11% 6% 12% 22%
would take me seriously
I felt too embarrassed to attend 4% (n=2291)
Delayed HCP visit due to
10% 7% 9% 17%
Top 11 reasons for those who did not attend childcare responsibilities
Delayed HCP visit due to
7% 4% 8% 14%
Awareness of cancer screening While screening programs differ Delays in diagnosis were more unpaid caregiving duties
programs must be improved to country-to-country and by cancer common for women in lower-
support earlier diagnosis of type, too high a number of women middle income countries. The three Care facility / hospital
6% 4% 5% 12%
cancer in women. are not participating in the screening most significant reasons included was too far to travel to
initiatives that are available. More higher rates of women in these
Women who did not attend cancer can always be done to increase countries not taking their symptoms
screening programs were significantly screening efforts but equally, if not seriously (52%), fearing a diagnosis
management approaches. With the
more likely to report thinking their more importantly, increasing uptake (38%) and delaying a visit to their
research showing that the barriers
cancer diagnosis had been delayed must be a priority. healthcare professional due to the
to screening are vastly different
(38%). The barriers to accessing cost involved (29%).
across demographics, it is critical that
screening services included lack of The barriers to participating in existing
behavior change efforts are focused
awareness and understanding of the screening initiatives will also vary, not Nearly half of the women (49%) aged
at a community level. Simple health
role of screening, fear of diagnosis or only across countries but across areas 18–40 were more likely to face delays
promotion efforts to highlight where
embarrassment around the procedure within them. It is crucial that uptake in diagnosis compared to other age
and how screening opportunities can
and logistical challenges related to is continuously monitored, evaluated groups, mainly due to not taking their
be accessed also have a meaningful
attending tests and cost. and assessed, with consideration symptoms seriously (43%).
role to play.
given to what more could be done
at regional, national and community Other research has shown that
Correlation between women who had levels. For example women in some women who were aware of the
not attended a screening program and parts of Asia may be concerned about merits of early cancer detection were
I started working in
perception around delays in diagnosis revealing parts of their body to a more likely to take proactive control
colorectal cancer (CRC) 20
healthcare provider.12 Measures to of their susceptibility.12
years ago and I have been
Has NOT attended a screening program help address such reservations might
dedicated to building and working
include always matching the gender of All of these statistics point to the
alongside patient advocacy groups to
patients and healthcare providers to need to improve understanding of
educate the public and policymakers
ease potential embarrassment.12 the importance of early detection,
15% specifically what it can mean for
on CRC. Despite my experience and
understanding of the disease, I,
outcomes as well as treatment
like many other people worldwide,
47% delayed screening. However, last year
I started feeling under the weather
38% The Journal of Medical Screening The pattern of increased screening and I was concerned I had developed
studied the impact that British attendance mirrored the pattern of CRC. Deciding to face my fears, I
reality TV star Jade Goody’s death media coverage related to Jade’s visited a gastroenterologist to have a
from cervical cancer in 2008 had diagnosis and death. It is likely that colonoscopy. The colonoscopy changed
Report cancer diagnosis on screening attendance. Jade’s the increased screening resulted in a my life. Three transitioning polyps,
was delayed diagnosis and ultimate death as a number of lives being saved.13 one in the advanced stage, were found
result of the disease was the subject and removed. Now under surveillance,
Report cancer diagnosis was
of significant media coverage. As time has passed though, the effect I will attend regular screenings to
NOT delayed
has diminished, and current reports reduce my risk of developing CRC. I
Does not know if cancer About half a million extra cervical suggest that screening is now at a can’t stress enough how important it
diagnosis was delayed screening attendances occurred in 20-year low, indicating that just as is to get screened and, if there is a
England between mid-2008 and mid- awareness can dramatically rise, it risk, attend a colonoscopy!”
2009, the period during which Jade was can also fall, despite the risk, and
diagnosed and died.13 Among these potential repercussions. Jolanta Gore-Booth
screenings, suspected neoplasia was Chief Executive Officer,
identified in 370 women.13 Digestive Cancers Europe
10 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 11Action Point 3:
Access to
Age impacts the support services that women typically access
18-40 years 41-59 years 60-79 years
support services One-to-one counseling sessions
Cancer patient support groups
40%
39%
39%
34%
34%
36%
The need to improve women’s capacity Family or group
38% 26% 16%
to maintain daily life via better access counseling sessions
Online patient support groups /
to support services tailored for forums / resources
29% 22% 15%
their circumstances Local cancer charities 27% 18% 18%
National cancer charities 24% 17% 18%
All women should have access It was also noted that younger program and were significantly more
to healthcare solutions and be women were more likely to access likely to experience treatment cost
aware of the options available support services compared to older burden. They were also more likely Religious support groups 28% 19% 13%
to them to protect their health women (60–79 years). to have to leave formal employment
and well-being. Further tailored because of their diagnosis.
services are needed for women Those with caregiving Telephone cancer support lines 15% 10% 9%
looking for financial, emotional, responsibilities, including those Unsurprisingly, the financial burden
employment or fertility support caring for elderly / sick relatives, was most felt in lower-middle
to ensure they can maintain children or other members of the income countries, with 74% of
their daily lives following a community, were much more likely women believing that cancer and
Has attended / used
cancer diagnosis. to use support services versus those its treatment had impacted their
a support service
who did not, highlighting that these personal finances.
Only 42% of women surveyed had women likely feel a greater need for Has NOT attended / used
accessed support services. Those support in general. In order to enhance and improve a support service 36%
who had, mostly stated that one-to- the lives of women diagnosed with 60% 40% 45% 55% 64%
one counseling and support group Only one-in-five women believed cancer, we must reduce the severe
attendance were the services they they receive enough support to detriments to women’s health caused
most used. manage family responsibilities or by trying to balance family and
fit work around their cancer. Those workplace responsibilities. It is critical
Differences were seen across the with a delayed cancer diagnosis were that as a global society we support
types of services that women were significantly more likely to report their women who work—both paid and (n=817) (n=889) (n=455)
more likely to access. Those aged lives had been impacted overall. unpaid—and create supportive work
18–40 were more likely to access environments and health systems
a broader range of support service The need to look carefully at the that can help women achieve greater
types, while older women were pressures felt by women with work-life integration and improve
least likely to access most forms of caregiving responsibilities following a their overall health and well-being.
Women’s perceptions around the support available to manage family and work following a cancer diagnosis
support, especially group counseling cancer diagnosis further was evident
or online help. —those with dependants were less
likely to have attended a screening
High-income Upper-middle Lower-middle
Global countries income countries income countries
Women’s use of support services 12%
…enough help with 20%
32% 36% 26% 29% 25%
managing their 38%
family / caregiving
Global
responsibilities
48% 52% 45% 37%
One-to-one counseling sessions 37%
Cancer patient support groups 36%
42% 58% Family or group counseling sessions 24%
...enough support to 14%
Online patient support groups / forums / resources 20% 20%
be able to fit work
31% 33% 27% 26% 27%
or other important 37%
Local cancer charities 20%
commitments
around their
National cancer charities 19%
cancer treatment
49% 53% 48% 35%
Has attended/used
and care
a support service Religious support groups 18%
Has NOT attended/used
Telephone cancer support lines 10%
a support service (n=2141) Agree Neither agree nor disagree Disagree
12 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 13Parenting concerns also have a A mother’s emotional well-being has Perceived stigma also impacts There is more that could be done Most women were worried about Women in lower-middle income
significant impact on the mental and been found to be significantly linked how women are able to manage to empower employers to better the negative impact of informing countries were the most concerned
emotional health of women living with whether she had communicated their daily lives following a cancer demonstrate, and in some cases their employer of their diagnosis, about changes being made to their
with cancer, particularly advanced with her children about her illness and diagnosis. Women noted feeling improve, how employees are supported being particularly concerned about employment status once their
cancer.14 With cancer being a leading her concerns about how her illness will burdened financially and across their following a cancer diagnosis—especially potential changes being made to their employer knew of their diagnosis.
cause of death for parenting-age financially impact her children.14 work and family responsibilities. A to help alleviate job security fears. All employment status or how they are Additionally, more than half of
women in some of the world’s quarter of all women felt they were public and private organizations have perceived at work. women (52%) in lower-middle
most developed countries, it’s not The pressures evidently felt by stigmatized more than men as a a role to play in creating equitable income countries employed part time
a surprise that parenting concerns mothers following a diagnosis suggest result of their cancer. In lower- environments where women and men One-in-five women (20%) chose not to were unable to work full time due to
have proven to have a negative part of the solution is helping them middle income countries more than can work, without sacrificing their inform their employer of their cancer their cancer, compared to one third
influence on quality of life.14 learn how to communicate with their half felt that stigma was more acute health. National policies and programs diagnosis, further cutting them off from of women citing the same in upper-
children, promote resilience in them for women. (new and existing) should also be potential support that could have been middle income countries.
and plan for their family’s future, championed to ensure those living with provided. However, one third of women
especially if their illness worsens. a cancer diagnosis receive support. (34%) who did inform their employer
received no support from their
workplace following their diagnosis.
Extent and types of support provided by employer (% of women living with cancer who informed employer about cancer diagnosis)
Women living with cancer believe they are more stigmatized than men with cancer
High-income Upper-middle Lower-middle
High-income Upper-middle Lower-middle Global countries income countries income countries
Global countries income countries income countries
None 34% 38% 32% 10%
17% 17% Provided paid leave for
25% 29% 32%
43% 43% 40% 47%
Women with 32% 36% treatment
cancer are more
stigmatized than 52% Provided unpaid leave
men with cancer 47% 31% for treatment
16% 14% 13% 41%
43% 39%
Employer paid for
10% 5% 11% 48%
cancer treatment
Agree Neither agree nor disagree Disagree
Childcare support 5% 2% 6% 26%
The research showed that Those who were offered family In July 2019, Merck launched a Provided flexibility
1% 2% 2% 0%
family planning support and planning and fertility advice from support website with the intent at work
fertility advice needs to be healthcare professionals found to provide the latest scientific
proactively offered by healthcare it helpful, importantly with the information to healthcare Provided financial
1% 1% 2% 1%
professionals to all women information impacting treatment professionals in the advancing field support (unspecified) (n=1642)
of childbearing age living choices for more than 57% of of fertility, while also supporting
with cancer. women overall and 74% of women women, men and couples who
in lower-middle income countries. are looking for information about
Among those women of childbearing fertility and / or undergoing fertility
Persistent pain and the
age, only 45% were offered family These findings suggest there is a real treatments.
fatigue mean that you have
planning advice by a healthcare need for standardizing the offer of
to take more and more
professional. High-income countries family planning and fertility advice For more information see
time off work, the risk of losing your
were revealed to be the least likely across the healthcare professional www.fertility.com
job increases which in itself is very
to offer family planning advice (as community. As an interim measure,
stressful, either you go and not feel
recognized by 55% of women) other less formal approaches can
well and not be focused but that would
and 48% of women of childbearing be considered at the national and
be noticed, or if you take sick leave
age who were not offered fertility community levels, including the
which would put ideas in their head
or family planning advice across encouragement of oncology nurses
that you’d be laid off”
geographies stated they would to play a more active role in directing
have liked to receive the advice. women to family planning and
Survey participant from France
fertility advice.
Less than half of the women living with cancer of childbearing age were offered fertility or family planning (FP) advice by a
I had to change job.
healthcare professional
I worked as a teacher
before. I am very tired.
High-income Upper-middle Lower-middle
I have to go to clinic very often. I
Global countries income countries income countries
need money for treatment of thyroid
7% 5% 10% 6% because they don’t treat thyroid
Were offered diseases here in Kazakhstan”
fertility/FP advice
Survey participant from Kazakhstan
35% Were NOT offered
47% 55% 40% 52% fertility/FP advice
46% 38%
59% Would rather
not say
14 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 15Recommendations Conclusion
for change There is always an opportunity to do more
on behalf of women, but we can improve
What more can we do for
their support systems with the resources
women living with cancer?
we already have
Improving the understanding of Cancer is a huge burden for men
These areas include short and long-term recommendations:
the challenges faced by women and women everywhere with
who are impacted by cancer is the health and prosperity clearly
Short-term
fundamental first step to address intertwined, but there are unique
and deliver the changes needed to factors impacting women that
1. Promote wide-scale education to improve women’s understanding of
drive better societal outcomes. need to be addressed.
the benefits of early cancer detection and existing screening programs,
specifically to support increased uptake of screening.
This report highlights several Understanding the unique challenges
critical areas that warrant careful that women face when living through
2. Ensure women of childbearing age living with cancer have access to
and immediate multi-stakeholder cancer provides interested stakeholders
fertility and family planning advice, due to the potential impact of
discussion, further assessment great opportunity to lessen the weight
cancer treatments on their fertility. For example, training nurses on the
and most importantly—action. of a diagnosis via the provision of
role they can play to advise patients to make informed decisions on
tailored societal support.
fertility preservation, or other options that may be available.
The findings of the extensive
Healthy Women, Healthy Economies
Long-term Supporting Women With Cancer
Originally conceived in 2015 within research initiative provide insights
the Asia-Pacific Economic Cooperation 3. Review existing awareness programs and adapt as necessary to support to inform meaningful discussion and
and in collaboration with the more women identifying the risk factors, signs and symptoms of all subsequent action on how we can
governments of the United States cancers, in particular those associated with high incidence and / or collectively support women impacted
and the Philippines, Healthy Women, mortality, and those that are incorrectly perceived to be of greater risk to by cancer to live their lives as best
Healthy Economies aims to identify men than women. as possible.
and implement policies that advance
women’s health and well-being to 4. Advance multi-stakeholder engagement to consider how government Merck is committed to working with
support their economic participation. health promotion resources can be leveraged and targeted at different diverse stakeholders to find solutions
audiences, with particular emphasis on influencing women with low levels to help turn insights into meaningful
Merck is the founding private sector of formal education, recognizing it is this demographic with the greatest outcomes for women living with cancer.
partner of Healthy Women, Healthy need for improved awareness of cancer risk factors, signs and symptoms.
Economies and is expanding and
making it part of its commitment by 5. Consider how the healthcare community and stakeholders can be called
supporting research to quantify the upon to provide women of childbearing age with family planning and
impact and forming collaborations to fertility advice, as an essential part of the cancer management pathway,
advocate for change. or direct women to reliable resources and support structures to obtain
this information.
The Healthy Women, Healthy
Economies initiative strives to 6. Explore a further tailored approach to support services, based on an
unleash the economic power of analysis of uptake, recognizing that different demographics of women
women by bringing governments, need and want different support options. In some cases, provide different
employers and other interested levels of support, and prioritize services accordingly. For example, focus
stakeholders such as NGOs and on providing services needed by the prevailing demographic, such as
patient advocacy groups together tailoring services to older women in areas where there is a higher need.
to help to improve women’s health
so women—and by extension their 7. Create employer education programs that equip workplaces with
families—can join, thrive and rise the tools and resources to support women through and beyond a
in their communities and live cancer diagnosis.
better lives.
16 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 17About Merck
Merck, a leading science and The company holds the global rights
technology company, operates to the name and trademark “Merck”
across healthcare, life science and internationally. The only exceptions
performance materials. Around are the United States and Canada,
52,000 employees work to make where the business sectors of Merck
a positive difference to millions of operate as EMD Serono in healthcare,
people’s lives every day by creating MilliporeSigma in life science, and
more joyful and sustainable ways to EMD Performance Materials. Since its
live. From advancing gene editing founding 1668, scientific exploration
technologies and discovering unique and responsible entrepreneurship
ways to treat the most challenging have been key to the company’s
diseases to enabling the intelligence technological and scientific advances.
of devices — the company is To this day, the founding family
everywhere. In 2018, Merck remains the majority owner of the
generated sales of €14.8 billion in 66 publicly listed company.
countries.
For more information,
visit www.MERCKgroup.com
Merck in oncology
Cancer has a huge impact: In 2018, 9.6 We are inspired by curiosity, science
million people are estimated to have and, most importantly, patients,
died from cancer and that number is combining a creative approach with our
expected to increase.1 relentless drive to transform the way
cancer is treated.
This drives us to develop innovations
that matter most to people living
with cancer.
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18 GBPSIM/NPR/0819/0218 Supporting Women With Cancer: Addressing Unique Challenges and Unmet Needs 19You can also read
