Cancer Treatment Abroad: Why the U.S. Remains the Final Destination for Chinese Patients

Editor’s Note: This article is reprinted from Sanlihe (WeChat Official Account: Sanlihe1), authored by Xing Baba, and republished by VCBeat with authorization.

Li Yong’s last television appearance was likely in late April of last year, when he partnered with Liu Tao on Zhejiang Satellite TV’s “The Familiar Taste 2.” He was then diagnosed with a health issue during a medical check-up in May and immediately traveled to the United States for treatment. The next official announcement the public heard about him was Ha Wen’s Weibo post titled “Forever Lost My Love.”

Li Yong passed away in New York. In a 2006 interview, The New York Times remarked that although he did not enjoy the freedom to mock political leaders on his show as Jay Leno did, he still expressed his rebellious spirit freely within the bounds of what was permitted—through flamboyant attire, memorable gestures, and the iconic card-tossing from his program Lucky 52.

"I’m not his fan, but I can’t help but appreciate this rebellion from within the system."

Online reports indicate that he was diagnosed with nasopharyngeal carcinoma, a cancer that is particularly prevalent in China and carries a high mortality rate. Perhaps due to its rarity combined with its aggressive nature, even seeking immediate treatment at the renowned Mayo Clinic after diagnosis proved futile.

Some mock the notion of Chinese patients seeking treatment in the U.S., but they are unaware—or indifferent—to the fact that for many critically ill patients, going to the U.S. represents their last hope.

According to data from Analysys, the number of Chinese patients seeking medical treatment overseas exceeded 600,000 last year, with more than 80% being cancer patients. The 2016 White Paper on Cross-Border Medical Health for China’s High-Net-Worth Individuals predicted that the cross-border healthcare market size would reach RMB 53.1 billion by 2020.

In terms of overseas medical products, as of 2017, critical care treatment accounted for approximately 40%, overseas health checkups for about 28%, assisted reproduction for around 15%, and medical aesthetics for roughly 12%. The primary destinations were developed countries such as the United States, Japan, and South Korea.

Over the past decade, overseas medical care, which initially served only a small affluent demographic, has evolved into a comprehensive global medical tourism industry chain. This ecosystem now encompasses services ranging from precision health screenings, remote diagnostics, and referrals for critical care to leisure travel; spans Asia, the Americas, and Europe; and caters to both high-net-worth individuals with annual incomes exceeding one million yuan and the general middle class.

High-net-worth individuals remain the key demographic. In the United States, the primary destination for cancer treatment, general cancer treatment costs range from $100,000 to $200,000. With monthly expenses for accommodation, meals, and transportation estimated at $8,000, a three-month course of treatment would require approximately $250,000 in total. The translation of domestic medical records and on-site communication abroad must be handled by professional medical personnel, which incurs significant costs. Additionally, using an intermediary agency would add around RMB 50,000 in consultation fees.

Spending nearly two million yuan in three months is not a figure that can be easily shouldered, especially since Chinese hospitals are no longer inferior to their U.S. counterparts in terms of early-stage cancer cure rates. For a patient with early-stage lung cancer whose lesions are detected promptly, the total cost of one year of treatment at Zhongshan Hospital in Shanghai, including all miscellaneous expenses, amounts to only 700,000–800,000 yuan.

Therefore, only by adding the qualifier “desperate” before “high-net-worth individuals” can we clearly see the gap between Chinese and foreign cancer treatments as reflected in overseas medical treatment.

First, there is a 224-fold disparity in per capita resources. According to statistics, China’s healthcare expenditure accounted for only 5.5% of its GDP in 2014, with cancer research comprising merely 0.1% of that healthcare spending. This translates to a per capita investment of just $0.42 in cancer research. In contrast, the United States spent 17.1% of its GDP on healthcare, with 1% allocated to cancer research, amounting to approximately $94 per person.

Here is a somewhat inaccurate yet highly intuitive example. In China, patients without personal connections must queue up early in the morning to register for appointments with specialist physicians; if they fail to secure a slot, they often have to pay scalpers 2,000–3,000 RMB for a ticket. After waiting for five hours, they may only get five minutes, or even just dozens of seconds, to speak with the doctor. Asking further questions? Not an option. In the United States, with a $500 consultation fee (and a 30% cash discount for uninsured foreign patients), a physician can spend an hour communicating with you in a cordial and amicable manner.

The gap in user experience is merely superficial; the substantive harm to patients’ interests stems from the decline in quality caused by the unequal distribution of medical resources.

The Mayo Clinic, which Li Yong chose during his lifetime, is one of the premier medical research institutions in the United States. In 2015, it had a staff of 35,000 and handled 1.58 million outpatient visits throughout the year. By comparison, Peking Union Medical College Hospital, also among China’s top medical institutions, had only 4,000 employees in 2015 yet managed to accommodate 5.1 million outpatient visits.

In the United States, where triage systems and community clinics are fully implemented, a patient’s condition is escalated through referrals by their family physician, ensuring that the attending physician is thoroughly briefed on the case before ever meeting the patient.

Meanwhile, a specialist at a Grade 3A hospital may need to attend to hundreds of patients in a single day, leaving only a few minutes on average for each ordinary patient. This precludes in-depth analysis and forces reliance on empirical judgment.

According to statistics from a referral agency, 60% of patients referred to the United States required changes to their treatment plans, with a misdiagnosis rate of 10%.

In Tencent Prism’s article “A Patient’s Account of Seeking Cancer Treatment in the U.S.: Why I Decided Against Receiving Cancer Care in China,” Mr. Meng’s daughter had both ovaries removed sequentially after being diagnosed with ovarian cancer by two hospitals in China. Only after being referred to the United States was it discovered that she had been misdiagnosed and actually suffered from a rare carcinosarcoma, leaving her filled with regret.

The diversity of treatment options is one of the reasons why desperate patients are referred to the United States. Such cases are not hard to find in patient diaries within online communities and in stories from those around us. Most of these patients, having been told by hospitals that there were no further treatment avenues available, turned to overseas options in search of a glimmer of hope. Generally, two scenarios arise.

First, under comparable domestic and international conditions, foreign hospitals offer more flexible and patient-centered treatment plans for individual patients. This contrasts with Chinese hospitals, which often adopt standardized, one-size-fits-all approaches to mitigate the risk of doctor-patient disputes. For instance, breast cancer cases requiring total mastectomy in China may be treated with breast-conserving surgery abroad; similarly, conditions necessitating multi-level cervical vertebrae replacement in China can often be managed with radiotherapy abroad to alleviate pain.

Second, there is the issue of pharmaceuticals, which represents the most widely accepted rationale for cancer patients considering overseas treatment. According to statistics, 80% of new drugs introduced after 2008 had not been launched in China by 2013. For instance, the immune checkpoint inhibitor PD-1 was only approved for marketing in China last month, a full four years later than in the United States. However, as soon as it gained approval in China, clinical trials for second-generation drugs had already commenced in the U.S.

In the article “My Lung Cancer Treatment in the United States,” the author, Mr. Lou, survived by enrolling in a clinical trial of the new drug Blu-667 after exhausting all conventional treatment options. Approaching 70 years of age, he endured considerable suffering from his disease, and his struggle to secure eligibility for the experimental therapy was nothing short of harrowing, marked by repeated bouts of despair. In China, patients facing similar circumstances would likely have long been advised to simply enjoy their remaining time and make peace with their fate.

In the United States, investigational new drugs have strict eligibility criteria, and patients who do not meet these requirements are unable to access them. Even so, many Chinese patients with no hope from conventional treatments still reside in apartments near MD Anderson Cancer Center in Houston and Massachusetts General Hospital in Boston, hoping to one day receive notification of their enrollment.

After all, according to statistics from the U.S. Clinical Trials Center, as of this September, out of 300,000 clinical trials registered globally, the United States accounted for nearly 40%, while China accounted for only 7%.

The good news is that Blu-667 has already been introduced by domestic companies. While a significant gap still exists between China and other countries in terms of medication access, this disparity is gradually narrowing. Just last month, 17 new drugs were added to the national medical insurance reimbursement list.

Advanced technology and well-developed hospitals are often the primary drivers prompting desperate patients to seek referrals to the United States; however, once treatment begins, they frequently experience significant cultural shock due to the strong service orientation and empathy demonstrated by foreign healthcare providers. This stands in stark contrast to the situation in China.

An article in the People’s Daily titled “China Is the Only Country That Treats Medical Care as a Business” argues that treating medical care as a commodity transaction is a profanity against life and an insult to doctors, criticizing the notion that patients consider themselves consumers in hospitals as a concept that alienates the doctor-patient relationship.

In the renowned post “Living: Six Months of Life-and-Death Struggles and Joys” on the Hangzhou 19th Floor Forum, the author recounts how doctors may tell patients inquiring about treatment options that without surgery, they would “first become paralyzed, then die,” and suggest they “go to Lingyin Temple to burn incense.” Before surgery, like products on an assembly line, patients lying in the corridor outside the operating room face immense uncertainty, with no one concerned about their feelings. During postoperative rehabilitation, failing to use more than a dozen packs of medicinal solutions daily as instructed invites disapproving glances from the attending physician.

In the same episode, “The Other Side of a Coin” critiques the high costs of U.S. hospitals while also being moved by the meticulous care demonstrated by hospital staff in patient intake, treatment, and care plan formulation.

Of course, all of this comes at a cost more than five to six times higher. Therefore, establishing proper consumption relationships and introducing competition are essential to prevent the doctor-patient relationship from deteriorating into a cold, transactional exchange.

There is a set of data showing that the five-year survival rate for cancer patients in China is 30%, while that in the United States exceeds 60%. This disparity reflects differences in medical standards and, to some extent, highlights varying levels of cancer awareness between the two populations.

In the United States, hospital clinics provide educational materials on early screening, and physicians educate patients to raise awareness of early detection and treatment. As a result, more than half of American patients are diagnosed at an early stage, whereas over 80% of cancer patients in China are already in the middle or late stages at the time of diagnosis.

The timing of cancer detection can mean the difference between life and death for patients.

Taking lung cancer, the current leading cause of cancer-related deaths, as an example, the World Health Organization (WHO) reported that an estimated 1.8 million people worldwide would die from lung cancer in 2018. In China, there are 780,000 new cases of lung cancer annually. The five-year survival rate for lung cancer in China is 16%; however, with early intervention and treatment, the survival rate can reach 80%.

An individual’s risk of developing cancer begins to rise sharply after the age of 40, peaking around age 80. However, the etiology of cancer is complex, and many cancers cannot be detected through routine health screenings in their early stages. This explains why a growing number of people, upon receiving a diagnosis, question: “Why did I still get cancer despite exercising regularly and undergoing annual check-ups?” Let’s face it—even Lee Chong Wei developed nasopharyngeal carcinoma.

As early as 2014, there were online news reports that Li Yong had vomited while recording a program. In a Weibo post with a commemorative and mournful tone, Ma Weidu also mentioned that Li Yong had once been so exhausted that he vomited bile. Additionally, Zhihu users working at China Central Television (CCTV) expressed sympathy for the host.

Perhaps if Mr. Li Yong had undergone targeted screening two years earlier, he would still be happily with his family today. After all, when nasopharyngeal cancer is detected at an early stage, the five-year cure rate can reach 95%. In fact, 90% of cancers are curable if detected early.

Therefore, prevention is merely a mindset for dealing with cancer, whereas targeted early screening represents the first step of substantive significance. Currently, the maximum cost of a PET-CT scan in China is no more than RMB 10,000, equivalent to approximately half a month’s salary for wage earners around the age of 40 in first- and second-tier cities.

"If you don't trust domestic technology, for an additional 20,000 to 30,000 yuan, you can go to Japan."

In recent years, medical checkups in Japan have begun to enter the public eye. Compared with the average cost of around $200,000 per person in the United States, the cost of cancer treatment in Japan is only about 250,000 RMB, merely 1.5 to 2 times that in China.

As one of the countries with the most advanced early cancer screening technologies in the world, Japan has seen a rise in experiential precision medicine products, driven by its geographic proximity and similar lifestyle habits to China. According to data from the Japan Policy Investment Bank, the number of Chinese tourists traveling to Japan for medical checkups is expected to exceed 310,000 in 2020.

In Japan, the per capita cost of premium health checkups is around RMB 30,000, which falls within the affordability range of the average middle class, in exchange for access to the world’s best early cancer screening services. For middle-aged individuals with limited financial means, spending RMB 30,000–40,000 could potentially save half a modestly priced apartment in a first-tier city—and, more importantly, their lives.

According to data from the National Health Commission, the five-year survival rates for certain specific cancers at hospitals in China have already surpassed or matched those in developed countries such as the United States. For instance, the current five-year survival rate for esophageal cancer in China is 40.5%, compared to only 20% in the United States. This also applies to cancers such as uterine corpus cancer and thyroid cancer.

With the accelerated inclusion of specialized drugs in national medical insurance, individuals in the upper-middle-income bracket—those below the ultra-wealthy but above the average wage earner—can devise a cost-effective treatment plan that offers better value than purely overseas care, provided they plan ahead.

For instance, one could first undergo a comprehensive medical examination in Japan to mitigate the risk of misdiagnosis, and then decide whether to receive treatment domestically or abroad based on the diagnostic results and financial considerations. If opting for an international approach, the options can be further divided into traveling abroad for treatment or remaining in China while adopting foreign treatment protocols.

Currently, renowned foreign medical institutions, such as Massachusetts General Hospital and MD Anderson Cancer Center, have reached international clients by establishing referral offices in China or partnering with domestic platforms to provide telemedicine services.

Through such intermediary agencies, pathological data are submitted remotely for foreign physicians to formulate treatment plans, which are then implemented in China.

With an accurate diagnosis, we can still adopt overseas treatment protocols while benefiting from domestic pharmaceutical pricing.

No matter how you approach this question, at least one of the following options must be selected (multiple selections are allowed): U.S. drugs, U.S. physicians, or U.S. medical devices. Regardless of where you begin your journey in cancer treatment, the United States is always the final destination.