When coverage is not enough: the case for strengthening uro-oncology Worldwide

Dear Editor, We appreciate the authors’ significant contribution to our understanding of the global disparities in healthcare resources and cancer burden. Their study offers valuable insights into the relationship between universal health coverage (UHC), healthcare expenditure, and cancer outcomes across 171 countries[1]. This research is crucial in identifying the role of healthcare resources in shaping cancer survival rates and mortality globally, and it provides a solid foundation for informing policy decisions aimed at reducing healthcare inequities. The study is in compliance with Transparency In the reporting of Artificial Intelligence – The TITAN guideline[2]. However, we believe the manuscript could be further strengthened by a more focused examination of specialized cancer care, particularly in urological oncology. Urological cancers, including prostate and bladder cancer, require highly specialized treatments that are often resource-intensive, involving advanced diagnostic tools and complex surgical procedures[3]. Yet, the study does not delve deeply into how disparities in healthcare resources affect outcomes in these specialized fields. A prospective investigation into how access to specialized urology departments, innovative treatment technologies, and multidisciplinary teams impacts patient outcomes in different regions would be invaluable. For example, the availability of robotic-assisted surgery, early detection programs, and advanced systemic therapies could be more directly linked to both survival and quality of life for urological cancer patients. To illustrate this point, we present in Figure 1 a visualization of the study’s reported associations between healthcare resources (UHC index and health expenditure) and key cancer outcomes. The pattern suggests that improved system-level investment is associated with better survival, supporting the notion that specialized cancer services – such as those required in uro-oncology – may benefit disproportionately from stronger healthcare infrastructure. Figure 1.: Associations between healthcare resources and cancer burden. Forest plot showing incidence rate ratios (IRRs) and 95% confidence intervals for the associations between (1) Universal Health Coverage (UHC) index and cancer incidence (ASIR), (2) UHC index and survival (1 − MIR), (3) current health expenditure as a percentage of GDP (CHE/GDP) and incidence, and (4) CHE/GDP and survival. Data visualized represent the exact IRR estimates reported in the published abstract of the study. Higher UHC and greater national health expenditure are associated with higher incidence (reflecting better detection) and improved survival, emphasizing the potential for system-level investment to support specialized oncology services, including urological cancer care. Building on this, we suggest that future research incorporate longitudinal data to track the evolving impact of healthcare infrastructure improvements over time[4]. This would allow for a better understanding of how investments in healthcare systems, particularly in specialized fields, lead to improved cancer outcomes. Given the rapid advancements in urological cancer care, tracking changes in survival rates as healthcare systems grow and adapt will offer important insights into the effectiveness of resource allocation in the long term. In addition, while the study employs the mortality-to-incidence ratio as a measure of cancer burden, expanding the analysis to include quality-adjusted life years (QALYs) or other patient-centered long-term outcome indicators could further enrich the findings[5,6]. This approach is especially relevant for prostate and bladder cancers, where treatment-related functional and psychological effects can be substantial. Evaluating healthcare resource allocation through these metrics would provide a clearer understanding of how disparities in specialized care affect both survival and overall well-being. We also recognize the importance of addressing gaps in healthcare access in low-resource settings. Future research could examine low-cost interventions such as mobile screening units or affordable diagnostic tools tailored for urological cancers. These targeted strategies may offer scalable opportunities to reduce the global burden of urological malignancies in resource-limited regions. In conclusion, while the study provides a crucial first step in understanding the links between healthcare resources and cancer burden, further research into specialized cancer care – particularly urological oncology – is essential to refine our understanding and improve outcomes. We look forward to seeing how these insights inform future investigations into global cancer care disparities.