EAPM update: How to put Europe Beating Cancer Plan into practice

Factsheets to the rescue

EAPM has, for the past six months, been very hard at work on developing country-oriented factsheets with leading experts in the field and looks to combat lung cancer across key pillars.   Stakeholders' views on national barriers and enablers in tackling lung cancer were obtained via an online survey during seven structured expert panels. Stakeholder groups represented pathologists, lung specialists, the regulatory field, health systems, industry representatives and patient perspectives.

Factsheets covered the following countries and are available here: Slovenia, Greece, Portugal, Germany, Denmark, Italy,  Belgium, Netherlands,  Switzerland, Sweden, Poland, Bulgaria, Croatia, Israel and Romania. 

As far as the factsheets are concerned, each concentrate on seven core aspects of lung cancer care, which are as follows:

1.     Screening programmes

2.     Access to molecular testing

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3.     Personalised treatment decisions

4.     Early and broad access to personalised treatments

5.     Remote monitoring and personalized interventions

6.     Data empowerment and advanced analytics

7.     Prioritization within national health strategy

In addition, each factsheet for each country provides a policy checklist in conclusion. 

Working together

The European Commission will be looking to seek consensus from member states’ health ministers to move the action plan forward, and it will be an interesting challenge to observe the levels of co-operation from member states on health-related matters following on from the coronavirus pandemic. While member states are in control of health policies, there has nevertheless been divergence between them concerning the COVID-19 responses prepared by the Commission. 

Whether member states will align with the ambition as set in cancer plan with the action committee on cancer within the European Commission is unclear but, given that Eurostat's latest data shows that lung cancer is the third leading cause of death in the EU-27, exceeded only by ischaemic heart disease and cerebrovascular disease, one can only hope that the relevant policymakers and institutions will be able to work together.

The toll from lung cancer cannot be underestimated – it kills more than 80 in 100,000 men in Europe and more than 20 per 100,000 women – and for women that figure is rising. It is far more lethal than other cancers, accounting alone for more than a fifth of all cancer deaths, with other leading cancers - colorectal, breast or pancreatic cancer – at half the rate of lung cancer or less.  

This is a major problem for all member states but is particularly acute in some: Hungary recorded the highest standardized death rate from lung cancer in 2017 (89.2 deaths per 100,000 inhabitants), followed by Croatia (68.4 deaths per 100,000 inhabitants), Poland and Denmark (67.0 and 66.8 per 100,000 inhabitants respectively).

The predominant cause of the lethality of lung cancer is late presentation: 70% of lung cancer cases are diagnosed at an advanced and incurable stage, resulting in the deaths of a third of patients within three months. A leading study shows that from 2009 to 2015, 57% of patients had distant metastases at diagnosis, only 16% of patients had localized disease, and the five-year survival rate among all patients with lung cancer was 20.6%. In England, 35% of lung cancers are diagnosed following emergency presentation and of these 90% are at later stages. 

According to EAPM, mechanisms are available to reduce the morbidity and mortality of lung cancer, but health systems are slow to take advantage of them. Europe’s citizens and patients would benefit from wider adoption of risk-based screening, early use of advanced diagnostics, early access to the growing number of personalized treatment options, better patient follow-up and remote monitoring, and systematic exploitation of data. 

With the correct application of new technologies and methods, the principal beneficiaries will be today’s – and still more, tomorrow’s – patients and their carers and entourage. And correctly implemented, these technologies could even allow health-care spending and even national economics to gain from a reduction in the consequences and even in the incidence and mortality of lung cancer.

Hence, member states should engage fully in the action plan and engage in discussions at an early stage. They should represent their views before officials take over the action plan and begin drafting implementation actions with the other institutions.

Conclusion and recommendations

The fight against lung cancer, for many years one of the most intractable healthcare challenges, and still a major killer, is on the threshold of new victories. A combination of  scientific advances, new technology and new practices brings within reach early diagnosis, effective treatment, and more sustainable allocation of healthcare resources.

It remains for EAPM and lung-cancer stakeholders to continue pushing for political commitments and for structures that provide for evidence based decision-making exploiting the most advanced technologies. The EU Beating Cancer Plan offers scope for tailored interventions to advance the lung cancer agenda.

The overarching key to progress now will be implementation of the action plan, and thankfully, the EAPM factsheets provide a very useful and accessible starting point as to how this can take place. The fact sheets are available here: Slovenia, Greece, Portugal, Germany, Denmark,  Italy,  Belgium,  Netherlands,  Switzerland, Sweden, Poland, Bulgaria, Croatia, Israel and Romania. 

Have the best weekend possible, and keep safe.