Attention must be paid to lung cancer and the toll it takes

Good afternoon, health colleagues, and welcome to the European Alliance for Personalised Medicine (EAPM) update. Today, we are talking about the EU’s efforts against lung cancer, and EAPM’s work in this regard, writes EAPM Executive Director Dr. Denis Horgan.

‘Unnecessary loss of life’ 
At a time when the coronavirus infection is already inflicting a frightening death toll on the world from a previously unknown health threat, Europe cannot afford to tolerate another unnecessary and large-scale loss of life from a disease that has long been well recognized: lung cancer. But institutional neglect is causing unnecessary loss of life, according to oncologists, pulmonologists, radiotherapists, technology developers and patient representatives from across Europe. This was highlighted in an EAPM roundtable focused on persistent delays in promoting the lung cancer screening programmes that could save thousands of life-years.

In Europe, lung cancer is the leading cause of cancer-related morbidity and mortality, causing more than 266,000 deaths each year - 21% of all cancer-related deaths. That's not quite as high as Covid's death rate in 2020, but these lung cancer deaths are not a one-off crisis that has provoked an unprecedented mobilisation to bring it under control. Lung cancer deaths are happening relentlessly year after year, and are likely to continue to do so for decades to come - unless incisive high-level decisions are taken to challenge the trend.

A straightforward proposition
Over the past two decades the evidence has become overwhelming that screening can transform the fate of lung cancer victims. Disturbingly, however, EU member states still hesitate over its adoption, and it remains low on policy priorities nationally and at EU level. In consequence, funding for it, and reimbursement of screening services, remain patchy and inadequate, and it is not yet integrated satisfactorily into healthcare systems.

The proposition is straightforward. Lung cancer is currently both the most commonly diagnosed cancer (accounting for 11.6% of all cancer diagnoses) and the leading cause of cancer-related mortality (18.4% of overall cancer mortality) in both men and women worldwide. Every year, at least twice as many people die from lung cancer as from other common malignancies, including colorectal, stomach, liver and breast cancer. The majority of patients with advanced lung cancer die within 5 years of diagnosis. But patients identified with stage early disease have at least a 75% chance of survival over 5 years. 

Screening is particularly important for lung cancer because most cases are discovered too late for any effective intervention: 70% are diagnosed at an advanced incurable stage, resulting in the deaths of a third of patients within three months. In England, 35% of lung cancers are diagnosed following emergency presentation, and 90% of these 90% are stage III or IV. To substantially reduce lung cancer mortality over a longer period, early detection using low-dose screening in asymptomatic individuals can offer life and quality of life-years to individuals currently condemned to unidentified progression of disease to an incurable stage.

The tools are there to improve the situation. Since 2016, EAPM has called for Lung Cancer Screening Guidelines to be included in the update of the Council Recommendation of 2 December 2003 on cancer screening.

The need for a clear message from the European Parliament
The European Parliament’s own initiative report on cancer — produced by the now-defunct special cancer committee (BECA) after a year’s worth of meetings — was the result of delicate compromises and plenty of horse-trading. That risks all coming undone as MEPs from outside of BECA look to introduce amendments to the text and water down language around alcohol. 

Leading the charge are European People’s Party group MEPs Herbert Dorfmann and Dolors Montserrat who object to what they see as overly harsh language on the topic of knocking a few back. That has provoked former BECA members into waging a defensive campaign to protect the text they authored. You can read the full story here. 

According to the WHO’s latest survey, cancer screening and treatment was disrupted in the last quarter of 2021 by up to 50% in all countries reporting.

Health ministers meet
Europe’s health ministers, after a day-long meeting with foreign ministers on Wednesday (9 February), are back for round two today (10 February). While discussions with their foreign ministry colleagues centered on vaccine sharing and international cooperation ahead of the African Union summit next week, today’s talks concern a topic closer to home: the ongoing Health Union plans. 

Innovation fund revamp
Innovation Commissioner Mariya Gabriel is set to present the path forward for the EU’s €10.1 billion innovation fund after it was close to paralyzed for almost two months. The EU established under the Horizon Europe programme a fund to support innovation, either in research or closer to market, at startups, and the work programme finally got the green light last week. The EIC’s startup fund (the EIC Accelerator) can take stakes in startups for a higher amount than the current cap, which is €15 million. 

European Parliament COVID-19 committee vote could happen in March
A vote on a special committee of the European Parliament that is tasked with gathering lessons from the COVID-19 pandemic is planned for March. The Conference of Presidents — composed of the European Parliament president together with the political group chairs — would meet to sign-off on the committee’s mandate and number of members on March 3, under the timetable projected in the document. A session of the European Parliament would then vote on it on 8 March.

New EMA centre to improve drug reviews  & RWE
The European Medicines Agency (EMA) has set up a new centre to collect and mine more public health data from EU member states to improve the review of new drugs and provide them more quickly to patients. So-called Real World Evidence (RWE) from hospitals and physicians’ practices have been used before for regulatory reviews of drug candidates, but advances in data processing technology offer a far greater potential. 

In a statement on Wednesday, the EMA said it had set up the Coordination Centre for the Data Analysis and Real World Interrogation Network, or DARWIN EU, to provide RWE requested by EMA itself and member states’ regulators. Likely starting later this year, the centre would also answer requests by national bodies that determine the benefits and reimbursement prices of new drugs, Peter Arlett, Head of Data Analytics and Methods Task Force at EMA, told Reuters.

Health Union
The EU’s health union project is a step in the right direction but there’s more work to be done, think tank Bruegel has said. It pointed to antimicrobial resistance, health systems resilience and health data as areas where an EU-wide approach is justified in the sphere of health. 

Given that the spread of communicable diseases in one region threatens its neighbours, that is an obvious starting point for the health union. “All countries have an interest in coordinating efforts and sharing information,” reads the report. The strengthening of EU agencies like the EMA and ECDC, and the creation of HERA, are logical outcomes. EU-level audits of national health emergency plans would be a step in the right direction, as would coordination in the fight against AMR.

EU warily sees 'stabilization' of COVID wave 
The European Union is cautiously welcoming a "stabilization" of the latest wave of the coronavirus pandemic but knows it must do more to help poorer nations, especially in Africa with jabs, officials said Wednesday. "Saying that we have turned the corner... is not a phrase that at least I would use," EU health commissioner Stella Kyriakides told reporters while attending a joint meeting of EU health and foreign ministers in Lyon, France.

 "We are seeing in the last seven to eight weeks a stabilization in the number of hospitalizations and mortality... and we are seeing in some member states that they have reached the peak with the Omicron strain of the virus," she said. But, she added, "we need to continue to be cautious," given the curveballs the coronavirus and its successive variants have thrown over the past two years. Italy's health minister, Roberto Speranza, echoed the wariness—saying "the game is not closed"—but said that "all European countries are moving towards the management of a new phase" of the pandemic.

 The Lyon meeting on Europe's response to the pandemic was the first time the bloc's foreign and health ministers got together to discuss the shared action taken. Much of their discussion was on what can be done to further help countries still trailing far behind the EU's 72% full vaccination rate.

And that is everything from EAPM for this week – stay safe and well, have an excellent weekend, see you next week.

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