Country context

Vietnam has transformed its economy from one of the poorest in the world in the mid-1980s, with a poverty rate of 60 percent, to a lower middle-income country, with a poverty rate of 3.8 percent in 2020. Over the last couple of decades, health outcomes, such as under-five mortality, have steadily improved, but non-communicable diseases (NCDs) have emerged as a persistent challenge, accounting for the most deaths and disabilities across the Vietnamese population. The Vietnamese population is rapidly aging, a demographic trend that exacerbates the challenge of preventing and managing NCDs, including lung cancer, because the risk of developing the disease increases with age. Lung cancer mortality and incidence has risen since the 1990s, highlighting the growing burden of the disease (Figure 1).

Lung cancer is the predominant cancer among men, with incidence of 31.5 cases per 100,000 population, and the second most diagnosed cancer among women, with incidence of 11.0 cases per 100,000 in 2022. Smoking is the primary risk factor for men, with a 2019 study indicating that 79 percent of lung cancer cases among men were linked to smoking. In sharp contrast, only 11 percent of lung cancer cases among women were linked to smoking. Other risk factors include secondhand smoking, hereditary factors, and exposure to air pollution, which is of particular concern in Vietnam, where the level of air pollution is five times higher than the WHO recommended limits for air pollutants.

The socioeconomic impacts of lung cancer in Vietnam are multidimensional and varied. A 2014 study estimated that non-small cell lung cancer (NSCLC) cost Vietnamese society over VND 3.517 trillion, equivalent to USD 165 million at the time. While more recent data on the economic burden of lung cancer in Vietnam is scarce, research indicates that cancer generally can create new and exacerbate existing financial burdens. For example, a study on cancer impact in 2017 reported that more than one-third (37.4 percent) of Vietnamese households with a cancer patient are driven into poverty, with a higher risk among older patients, despite the vital role of the national health insurance system. A 2019 report indicated that 80 percent of cancer services were covered by the national health insurance, although only half the costs of medicines were covered. Moreover, prevention and early detection measures, such as lung cancer screening and tobacco counselling, were not covered by health insurance. A 2023 study on colorectal cancer reported that the national health insurance benefits package does not cover preventive services for cancers, including lung cancer, unless patients already show symptoms associated with the disease. This gap in coverage represents a key challenge, which needs to be addressed to effectively reduce lung cancer in Vietnam.

Assessing policies and programs

Vietnam’s National Strategy on the prevention and control of cancers and other NCDs for 2015-2025 was updated into a National Plan in 2022, integrating mental health measures. Led by the Ministry of Health, the Plan lays out ambitious targets for increasing awareness, prevention, diagnosis, treatment, and management of all NCDs by 2025. For example, all local governments are expected to have implementation plans for the prevention and control of NCDs by 2025. Moreover, at least 80 percent of adults over age 40 must have received information on early detection guidelines for NCDs and particularly for cancers. Additionally, 85 percent of provinces are required to have cancer prevention and control facilities, and 40 percent of people with common cancers should be detected at an early stage, according to the National Plan. Measures to strengthen communication, capacity, and delivery systems at the community level are also specified in the National Plan. To finance its implementation, the National Plan delineates budget sources, including central and local state budgets for health, public investment sources, health insurance funds, and resources from the cigarette prevention and control programs.  

Vietnam has cancer management guidelines in place, but the government has yet to implement any national guidelines or programs for lung cancer screening. According to a 2019 scoping review, pilot screening programs for breast, oral, and colorectal cancers have been conducted in the past; however, expanding cancer screening programs beyond the pilot phase and to other types of cancer, including lung cancer, has proved challenging due to limited resources, lack of trained personnel at the local level, and lack of national insurance coverage for cancer screening. As of 2021, 70 to 80 percent of lung cancer patients were diagnosed at advanced stages, demonstrating the critical need for better prevention and early detection approaches to reduce incidence and improve prognosis.

According to a 2021 report, Vietnam’s public health care system only meets 30 to 40 percent of cancer care demands, indicating significant gaps in coverage for patients. Vietnam has five specialized hospitals for cancer and 70 oncology departments across central and provincial hospitals, which are not readily accessible to patients in rural areas or to those who rely on district hospitals and community health centers. Biomarker testing, which involves searching for DNA mutations, such as EGFR, ALK, and ROS1, is covered by the national health insurance. However, only a few hospital laboratories conduct these tests. Moreover, patients must pay out-of-pocket if they seek biomarker testing for BRAF, HER-2, MET, KRAS, or PIK3CA in hospitals. Despite these challenges, the availability of national insurance reimbursement for diagnostic methods such as CT scans and MRIs (magnetic resonance imaging) have contributed to an increase in lung cancer detection among patients, with about 15 to 30 percent of cases detected through these scans. Further, in an effort to address health care system gaps, the Ministry of Health is actively collaborating with private and nongovernmental organizations through initiatives like the Healthy Lung Programme. This program focuses on asthma, chronic obstructive pulmonary disease, lung cancer, and pediatric respiratory illnesses, with objectives to increase public awareness, improve the quality of outpatient management, and provide training for health care professionals.

In 2012, Vietnam enacted a law on tobacco prevention and control, introducing smoke-free zones, tobacco advertising restrictions, and tobacco taxes, with revenues channeled into a tobacco control fund. More recently, the government released the 2023–2030 National Strategy on Tobacco Harm Prevention and Control, which aims to reduce smoking rates, increase smoke-free spaces, increase tobacco taxes, and enact regulations on the use of e-cigarettes, heated tobacco, and shisha products across Vietnam. Moreover, in 2022, the government adopted the National Environmental Protection Strategy 2030, setting out objectives on environmental protection, pollution prevention, and achieving a carbon-neutral economy by 2050. Effective implementation of these anti-smoking and environmental protection strategies is key to mitigating the diverse factors that contribute to lung cancer risk.

FIGURE 2

GRIP: Gains, Risks, Innovations, Prospects in Policies and Programs

Opportunities ahead

Vietnam has laid the groundwork in terms of policies and programs to combat lung cancer, integrated into its broader National Plan for NCDs, as well as various laws and strategies aimed at reducing lung cancer risk factors. It has set clear NCD targets, including for risk factors such as smoking and increased vulnerability of older populations to NCDs, for the next decade. The government has also established partnerships with multiple stakeholders, including private health care companies and multilateral institutions, to complement public-sector efforts. Given the rising demand for cancer care in the foreseeable future, some companies have begun expanding to Vietnam to provide next-generation sequencing testing. However, the impacts of these developments are constrained by available resources, especially at the local level, with Vietnam’s national health insurance unable to adequately cover lung cancer screening and guarantee advanced diagnostic and treatment methods.

Lung cancer prevention and treatment efforts in Vietnam could benefit from exploring innovative financing models to grow and improve the health care available to patients. For instance, the SeALady Cashback credit card donation program, led by a private bank and an NGO, could be expanded to include more companies and increase lung cancer funding. Under this program, for every VND 1 million spent in credit card transactions, the bank allocates VND 2,000 to a breast cancer fund. Moreover, the revenue generated from taxes on tobacco-related products could be funneled into a cancer health insurance fund.

Addressing the needs of cancer survivors is another critical area that warrants attention. Dr. Thanh Huong Tran Thi, Director of the Vietnam National Institute for Cancer Control, pointed out in a 2023 symposium video that the country has made headways in cancer control policies and plans, but it has yet to develop a comprehensive program for cancer survivors. Survivorship care entails a multidisciplinary approach that includes psychosocial support, routine screenings, and management of any side effects, while also integrating family and caregivers into the care plan. Finally, given its demographic trends, Vietnam faces an urgent need to focus on lung cancer risk associated with an aging population to effectively prevent, detect early, and manage the disease. These measures can be integrated into broader initiatives to promote healthy aging.