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EAPM: Fighting for lung cancer patients in the upcoming EU Beating Cancer Plan – The time has come

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Welcome, health colleagues, welcome one and all to the European Alliance for Personalised Medicine (EAPM) update – in the midst of all the bad news that humanity has had to suffer during the past year now, at least, there is a chance for some good news. As of today, 3 February, the European Commission is formally launching the Europe Beating Cancer Plan, with World Cancer Day tomorrow. Taking into account the week, EAPM has a busy time ahead with an event today relating to serological testing from 9h30–11h CET and the release in the coming week of a country fact-sheet that provides a state of play of tackling lung cancer at a country level. The aim here is to spur concrete implementation of actions to tackle cancer at a country level, writes EAPM Executive Director Dr. Denis Horgan. 

Fact-sheets frenzy 

As you would expect, EAPM will be involved from the bottom up – the Alliance will be launching 15 fact sheets related to the biggie, lung cancer, which has the continent and world’s highest mortality rate in the next few weeks. The plan will be unveiled around noon today in a press conference with Health Commissioner Stella Kyriakides and Commission Vice President Margaritis Schinas. The ambition is to create a linked-up EU strategy to tackle the disease, and our update below provides rationale why there should be a focus on lung cancer.

In our engagement with expert groups on lung cancer over the past six months, this has represented pathologists, lung specialists, the regulatory field, health systems, industry representatives and patient perspectives. Experts were from Slovenia, Greece, Portugal, Germany, Denmark, Italy, Belgium, Netherlands, Switzerland, Sweden, Poland, Bulgaria, Czech Republic, Croatia, Israel and Spain.

But before I go into lung cancer, let me give a shout out that this morning, at 9h30, EAPM is organizing a virtual round table on serological testing - serologic tests look for antibodies in your blood. They can involve a number of laboratory techniques. Different types of serologic tests are used to diagnose various disease conditions. This is another very important issue, taking place as it is on the eve of World Cancer Day and the launch of the Commission’s Europe Beating Cancer Plan. All attendees are welcome, click here to register, and see the agenda here.

Cancer Plan budget and factsheets on lung cancer

Much of the content of lung cancer factsheets is informed by our muti-stakeholder input is on future proofing, geared towards both Europe and country level. Given the current global attention to the demands of an adequate healthcare system and the heightened interest in public health in general, it’s clearly time to address what can be done to ensure that the health systems of the future are resilient enough to not only handle shocks such as a global pandemic, but also respond those underlying forces that are shaping future healthcare needs for lung cancer. 

As discussed in the European Parliament yesterday (2 February), the plan, which aims to create an EU-wide strategy to tackle cancer, from prevention to diagnosis and treatment, will be funded to the tune of €4 billion, drawing on money from a variety of sources, including the EU4Health programme, as well as the EU’s digital and research budgets.This will hopefully be an excellent spur to all the good intentions of the Beating Cancer Plan

And, yes this was echoed by our experts, that it’s certainly time to explore how governments can allocate resources between competing public health demands to tackle lung cancer, and how available technologies can help - and how much more the EU should get involved directly in the health of its hundreds of millions of citizens that have and may get lung cancer in the future,

The below section provides a snap-shot of the upcoming points that will be addressed in these factsheets.

Lung cancer screening

Lung cancer Low Dose Computed Tomography screening has been demonstrated to reduce mortality from the disease in both men (8-26%) as well as women (26-61%) and international specialists urge its implementation in Europe, although the economic impact remains to be explored. Questions also remain over tailored recruitment strategies, risk-based eligibility, risk-based screening intervals, volume CT scan and nodules management protocols, and co-morbidity reducing strategies. More guidelines are needed, for identification of high-risk populations, stringent cut-offs for nodules detected at follow-up, use of volume CT scanning, and links between national reference centres for quality control.

During the engagement, we took a survey of the experts, starting with asking, in their respective countries, what progress was being made towards a targeted programme for lung cancer screening? 4.5% said it was fully implemented, 13.6% said partially implemented, 27.3% said progress was planned but not as yet started and, as it stands, 54.5% said it was not as yet planned. 

Early use of advanced diagnostics 

Improving outcomes in lung cancer depends heavily on early and accurate diagnosis including staging, permitting rapid appropriate treatment and reducing the risk of metastatic disease. Technological advances are making accurate diagnosis easier and safer, and avoiding the risks of empirical treatment of suspected but pathologically unconfirmed lung cancer.

Next-generation sequencing (NGS) is arguably one of the most significant technological advances in the biological sciences of the last 30 years. The second generation sequencing platforms have advanced rapidly to the point that several genomes can now be sequenced simultaneously in a single instrument run in under two weeks. Targeted DNA enrichment methods allow even higher genome throughput at a reduced cost per sample. Medical research has embraced the technology and the cancer field is at the forefront of these efforts given the genetic aspects of the disease. 

In addition, Comprehensive genomic profiling (CGP) is a next-generation sequencing (NGS) approach that uses a single assay to assess relevant cancer biomarkers, as established in guidelines and clinical trials, for therapy guidance. CGP allows labs to achieve comprehensive coverage of pan-cancer content.

In our survey, we asked the experts concerning their key centres, which proportion are accredited to perform NGS/CGP? 52.6% said most, 31.6% said all of them, 5.3% said none, and 10.5% said that they did not know, so this was a largely positive result.

Integration of Single gene/Panel testing/NGS in clinical practice and cost-effectiveness

Reimbursement of advanced diagnostics strongly influences usage in clinical practice, and funding remains a problematic issue.In our survey, respondents said that the proportion of Key Centres had the capabilities and infrastructure to perform NGS/Comprehensive Genomic Profiling was 19% (all), 42.9% (most), 28.6% (a minority) and 4.8% (none). For Limited Genomic Profiling, the results were 35% (all), 35% (most), 25% (a minority) and 0% (none).

Personalized treatment decisions through multi-disciplinary (molecular) tumor boards 

An adequate testing scenario also requires the availability of genetic counseling, anatomical pathologists, molecular pathologists, bioinformaticians, and technicians, and with access to multidisciplinary tumour boards. Molecular tumour boards have a vital role in integration of testing into diagnostic-therapeutic pathways, interpreting genomic information and complex signatures, and delivering clinical recommendations.

 The diverse picture for patient access to multidisciplinary teams was reflected in the survey, which asked in your country, to what extent are multi-disciplinary tumour boards employed for lung cancer patients? 63.6% said as standard, and 36.4% said it was dependent on the institution. 

Furthermore, respondents were also asked as to at which levels do patients in your country typically have access to multidisciplinary expertise through molecular tumor boards? 27.3% said it was at a national level, 45.5% said it was at a regional level, 4.5% said there was no access at all, and 22.7% said that they did not know.

Policymaker action is required to ensure patient access to lung cancer treatments through a widening range of mechanisms. 

Opportunity to access molecular guided treatment options

Access to these opportunities will depend on recognition in guidelines of molecular guided treatment options (MGTO), and on mandatory big-data collection, publication and sharing, as well as on value-based funding. In the survey, when asked whether health care providers in your country are able to prescribe and get individual reimbursement for scientifically-supported molecular guided treatments, beyond the current label, 54.5% said yes they were, 22.7% said no, and 22.7% said that they did not know.

Managing health care spend by shifting towards value-based reimbursement

To align quality and value with reimbursement, effective outcomes measurement and reporting are needed, including patient-level outcomes such as survival, quality of life, and functional status. Patient goals and choices should be placed at the centre of decision-making by incentive models that align the imperatives for patients, providers, and payers, based on real-world data (RWD) and a range of epidemiological, clinical and genomic data.

Data and advanced analytics

Integrating and analysing -omics, other patient data (eg imaging), treatment information and clinical and patient reported outcome data can deliver valuable insights for research and clinical development, and for access and reimbursement decisions and clinical care pathways. In an ideal world, this data would be anonymized and widely accessible to allow collaboration in improving the care pathway.

In the survey, when asked how well does the IT infrastructure in your country (nationally, at institutional level) support sharing of patient data as part of multidisciplinary tumour boards, 4.5% said very well, 36.4% said fairly well, 36.4% said not very well, and 2.7% said not at all.

When asked how many Key Centres are able to connect personal, diagnostic and outcome data for lung cancer patients, 9.10% said all, as standard, 68.2% said that it was dependent on the institution, 13.6% said none, and 9.1% responded that they did not know.

General and overall outcome

As a final survey query, respondents were asked within the overall national health strategy in your country, how would you describe the current prioritization of lung cancer care – 22.7% said it is given a high priority within the health strategy, 31.8% said it is given medium priority within the health strategy, and 45.5% said it is given low priority within the health strategy.

Within the framework of Europe Beating Cancer Plan and the support of the cancer community, the fight against lung cancer plan can be successful.

And that is all for this EAPM update – as already indicated, don’t hesitate to join the serological testing round table, taking place this morning at 9h30 – click here to register, and see the agenda here, and you can look forward to reading all about the round table’s findings. 

Breast cancer

Europe Beating Cancer Plan can be a 'game changer' in tackling the deadly disease

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Every year, 3.5 million people in the EU are diagnosed with cancer and 1.3 million die from it. Over 40% of cancer cases are preventable. Without a reversal in these trends, it will become the leading cause of death in the EU, writes Martin Banks.

The European Parliament’s Special Committee on Beating Cancer is currently working on its own report by way of response to the recommendations contained in the new EU Cancer Plan on prevention.

The EU says Europe needs to stop cancer in its tracks by attacking it at source. 

That is why the beginning of 2021 has been marked by a significant milestone: the launch of Europe’s Beating Cancer Plan.

The Cancer Plan is Ursula von der Leyen Commission’s flagship initiative for EU health policy. The European Parliament reciprocated this ambition by setting up a special committee to develop concrete steps to fight cancer. 

Key to all this are the measures included in the Cancer Plan’s prevention pillar. The EU says that any potential gaps in terms of prevention must be urgently identified and addressed by actions in terms of legislation. 

One measure taken by some Governments across Europe are so-called "sin tax" policies to encourage better choices although  some question whether these have actually worked.

Most agree that the success of the Cancer Plan depends on understanding if regulation is working and what more can be done. 

The EU Plan was the focus of a special virtual hearing on Wednesday involving MEPs and a range of experts.

A keynote speaker at the online discussion included Deirdre Clune, an EPP member from Ireland and Member of the Committee on the Internal Market and Consumer Protection.

Clune is also a member of parliament’s special beating cancer committee, set up last September which will prepare parliament’s own report and response to the commission cancer plan proposals. 

It had hearings last year on lifestyle issues, including tobacco consumption.  

She said: “The plan is to cut consumption drastically by 2040 via measures such as taxation, education and plain packaging. The statistics on cancer are stark and these tell their own story but a lot can be done on a practical level, for example, via taxation.

“Yes, we will come up against many pushbacks a lot of the suite of the commission proposals, for example, in cutting down on eating red meat. But the point is that we must focus on preventable cancers.”

Europe’s Beating Cancer Plan seems to propose adopting the sin tax approach, especially for alcohol and diet. Ireland has previously been a driving force with its legislation on this with the Public Health Alcohol Act and now sugar taxes but some argue this seems to have backfired with poorer communities being hit the most.

When asked if she thinks this is the right approach, the MEP said, “A sin tax is always a sensitive issue but education is part of this too. In any case, I am not sure that it is just poorer communities that have been the only ones most affected. But even if you have higher taxes on alcohol you still need to do a lot about thing like low cost selling, for example, the 3 for price of 1 deals which have now been legislated against.

“But it has to be said that all such things at least raise a public awareness around alcohol harm and consumption and serves to maybe stop people in their tracks to think about these things.I accept the jury is still out though (on a sin tax).

She added: “During the crisis there has been more drinking done privately at home and increased taxation can be effective, be it on alcohol or tobacco.”

Tomislav Sokol, an MEP from the EPP and Member of the Committee on the Internal Market and Consumer Protection, said he was “surprised” to learn that up to 40pc of cancers are preventable.

He said: “The biggest problem is tobacco with 27percent of cancer deaths being attributable to tobacco compared to 4 percent due to alcohol.

“This is an enormous amount so this is a top priority for us.

“The European Cancer Plan is  the 1st systematic document which tries to cover all this and which also has a strong emphasis on prevention. it is a big step forward.

“The plan is very ambitious, for example, the aim to have less than 1pc tobacco use by 2040.”

The Croatian member said: “But we must have much higher taxation on tobacco and alcohol.This will be the silver bullet. But there will be a big backlash from interest groups in getting everyone on board.

Turning to harm reduction issues, he said alternative tobacco products had “more or less been put in the same basket for increased taxation as cigarettes.

“But this is divisive because the European Commission has taken a generally negative stance towards alternative products.”

He added: “Even so, much of the scientific evidence and the experts does not and do not share such negativity. They say that harm reduction measures can help while the ECJ says there is no certainty about  the effects of harm reduction. We must give consumers a real choice but I believe that the plan is a good starting point for these discussions.”

He said the special cancer committee was in process of preparing a report on prevention and a special study on vaping.

German member Michael Gahler, President of the Kangaroo Group which hosted the event, described the cancer plan as “ambitious” but that it was “top health priority”.

The MEP, who moderated the debate, said: “Up to 40% of us are likely to be affected by cancer so this presents a very serious issue. The WHO says 30-40" of cancers are preventable and there is clear evidence that  it can  help a lot when people  modify their lifestyles. That is why we need to invest in innovations that will help people change their lives and both the public and private sectors need to take joint responsibility here.

"Citizens should be motivated to choose to do regular exercise and avoid substance abuse, be it alcohol or tobacco. This, I believe, is better than,say, introducing a sin tax or just telling people what not to do.

“We should be following a science based approach - that will help us.”

Despina Spanou, Head of Cabinet for commissioner Margaritis Schinas, warned: “This (the cancer plan) is going to be a topic of tensions between governments and the  EU but these tensions have eased in recent years because people are more willing to talk about lifestyle changes.But the plan also looks not just at prevention but treatment, diagnose and  cancer survivors.

“The ambitious aim is for a tobacco-free Europe and this too will create tensions. There can be many government measures but at the end of the day we need an educated consumer who sees why tobacco consumption is harmful.

“Frankly, tobacco does not makes sense to me: it is an addiction and needs to be fought with a hardline approach. We need to tackle this at its heart: diagnosis and treatment.”

Dr Nuno Sousa, deputy director for the National Programme on Oncological Diseases, Directorate-General for Health in Portugal, said: “Lifestyle changes can promote a significant change in the growth of cancer but this will only become evident in a 5-10 year period. Past and current interventions to control tobacco consumption should be the roadmap for future proposals.

"Taxation is not the only issue and it is important to also explore controlling the marketing of, say, tobacco products.  That is the template to be followed. Education is also the key – if we provide the consumer about the pros and cons of different tobacco products we can make a change without the need for increased taxation."

The Portuguese Tobacco Control Law appears to encourage risk and harm reduction when it comes to smoking and using alternatives when conventional methods do not work. This, though, would seem at odds with the Cancer Plan which looks at regulating vaping (which the UK and France have both said helps with quitting smoking).

The Portuguese plan says that health services, regardless of their legal nature, such as health centers, hospitals, clinics, doctors’ offices and pharmacies, should promote and support information and education for the health of citizens with regard to the harm caused by smoking and the importance of prevention and smoking cessation.

Sousa, in a Q and A session, was asked about Portugal’s response to the Cancer Plan and if it supports the Commission’s approach of sin taxes.

He replied,: “Our approach is going to be in line with the commission recommendation, that is, that there should be no leeway provided for vaping or other forms of tobacco consumption. That is also part of our national tobacco control programme. This also states that tobacco alternatives should not be seen as being  any less harmful.”

Another speaker was Thomas Hartung, of the Johns Hopkins University Bloomberg School of Public Health.

Speaking via a link from Baltimore, he was asked about “gaps” in the cancer plan and if there should be more emphasis on harm reduction.

Hartung, who is on leave of absence from the commission, said that comparing the two systems, the EU and US was “interesting”, adding: “I hope the EU plan will also look at what is happening on this in the US and elsewhere.”

He said: “Put simply, people are afraid of chemicals but the good news is that this is starting to change.”

The WHO, he said, says that 40% of cancers are environment caused and tobacco will cause 1 billion early deaths this century. If someone starts smoking at the age of 18 they will live ten years less than those who don’t.

He believes e cigarettes can be a possible “game changer” saying that such products carry only a 3-5% risk of cancer.

“Tobacco is still a risky product but if some, by vaping, can get off cigarette smoking for good as a result that is good.

“A perceived problem is vaping kids although it is better they try e cigs than the real thing. I lost my dad to lung cancer so I am not a fan of any of these products.”

He said flavours of e-cigarettes was “one of the big problems”, not least as there are so many of them - 7,700 different flavours. Another issue is additives, he said: “Therefore we need to test flavours to identify all possible risks.

“There is a strong opportunity with the cancer plan but we need to do it carefully.”

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Lung cancer screening is ready to rescue thousands from death: Can the EU take action?

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While Europe mulls multiple praiseworthy schemes to limit the damage inflicted by cancer, one of the most promising avenues is being neglected – and many Europeans are dying unnecessarily as a consequence. Lung cancer, the biggest cancer killer, is still on the loose, largely unchecked, and the most effective method for combating it – screening – is unaccountably being ignored, writes European Alliancce for Personalised Medicine (EAPM) Executive Director Dr. Denis Horgan.

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. But detecting disease long before symptoms appear permits treatment that forestalls metastasis, drastically improving outcomes, with cure rates above 80%.

Over the last 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.

A valuable opportunity to remedy this deficiency is in the offing. Before the end of 2020, the European Commission has unveiled Europe's Beating Cancer Plan, a major opportunity to guide national actions. It will be, in the words of Commission President Ursula von der Leyen, "an ambitious cancer plan to reduce the suffering caused by this disease.” Preparatory drafts suggest it will offer a powerful, coherent and almost comprehensive response to the havoc that cancer wreaks on lives, livelihoods and quality of life across Europe.

Almost comprehensive. Because on the potential for lung cancer screening to save lives, it has little to say. The document is commendably strong on prevention, where there is, as it points out, important scope for improvement, with up to 40% of cancer cases being attributed to preventable causes. It also highlights screening as a vital tool in colorectal, cervical and breast cancer. But screening for lung cancer – which alone kills more than those three cancers combined - receives only a few passing references in the draft text, and no endorsement commensurate with the impact of its implementation at scale. This threatens to leave LC screening in its current under-exploited status in the European Union, where although the disease is the third leading cause of death, there is still no EU recommendation for systematic screening, and no large-scale national plan.

The case for action

The most recent studies add to an accumulation of evidence of the merits of LC screening over the last two decades. A just-published IQWiG study concludes that there is a benefit of low-dose CT screening, and "the assumption that screening also has a positive effect on overall mortality seems justified." Some studies show it saves an estimated 5 in 1000 people from dying of lung cancer within 10 years, while others warn that 5-year survival among all patients with lung cancer is barely 20%. Every year, at least twice as many people die from lung cancer as from other common malignancies, including colorectal, stomach, liver and breast cancer. In Europe it causes more than 266,000 deaths yearly - 21% of all cancer-related deaths.

Late presentation precludes for many patients the option of surgery, which – despite continuing improvements in other forms of therapy – is currently the only demonstrated method to improve long term survival. The concentration of patients among smokers adds a further urgency to the introduction of systematic screening. Efforts to discourage and reduce tobacco use will have effects only over the longer term. Meanwhile, the best hope for the millions of smokers and former smokers – predominantly among the most disadvantaged populations of Europe – is in screening. But this is precisely the population that is hardest to reach – reflected in the fact that fewer than 5% of individuals worldwide at high risk for lung cancer have undergone screening.

The prospects for change

Europe’s Beating Cancer Plan (BCP) holds out the prospect of many improvements in tackling cancer, and its vision embraces admirable principles – including the merits of screening, technology and enlightened guidance. It foresees "putting the most modern technologies at the service of cancer care to ensure early cancer detection." But as long as it hesitates over endorsing screening for lung cancer, a major opportunity will remain neglected.

The BCP acknowledge that live are saved by early detection of cancer through screening. They speak approvingly of population-based screening programmes for breast, cervical and colorectal cancer in national cancer control plans, and of ensuring that 90% of the qualifying citizens will have access by 2025. For screening of these three cancers, they even envisage reviewing the Council Recommendation, and issuing new or updated Guidelines and Quality Assurance schemes. But lung cancer screening enjoys no such priority in the BCP, which are limited to allusions, to a "possible extension" of screening to new cancers, and to a consideration of "whether the evidence justifies an extension of targeted cancer screening."

As Europe enters the third decade of the century, significant evidence has already justified action to implement LC screening. It is not the time to be debating whether the evidence is sufficient. The evidence is in. "There is evidence of a benefit of low-dose CT screening compared to no screening," says one of the recent studies. The NLST study demonstrated a relative reduction in lung cancer mortality of 20% and a 6.7% reduction in all-cause mortality in the LDCT arm. 5-year survival in patients diagnosed early (stage I-II) can be as high as 75%, especially in patients who have a surgical resection. Earlier diagnosis moves the focus from palliative treatment of incurable disease to radical potentially curative treatment with a resultant transformation of long-term survival. LuCE claims that five-year survival rates for NSCLC could be 50% higher with earlier diagnosis.

Historic objections to LC screening – in terms of risks of radiation, overdiagnosis, and unnecessary interventions, or uncertainties over risk models and cost effectiveness – have been largely answered by recent research. And given the commitment of the BCP to put research, innovation and new technologies at the service of cancer care ("the use of technology in healthcare can be a lifesaver", says the latest draft), it might well provide for further studies to refine and clarify the areas where LC screening can be even further improved, and the necessary infrastructure and training be consolidated.

Maximizing the opportunities for diagnosis too

There are other aspects of BCP linked directly or indirectly to screening which could – and should – enhance early detection and accurate diagnosis of lung cancer. Draft texts already make mention of exploring "early diagnosis measures to new cancers, such as prostate, lung, and gastric cancer." By providing more precise information on tumours, lung cancer screening has opened the way to more personalized treatment for lung cancer and provides fertile ground for further innovations in technology, image analytics and statistical techniques, and future image interpretation will be increasingly assisted by computer-aided diagnostics. The EU's parallel Mission on Cancer is expected to generate new evidence on the optimisation of existing population-based cancer screening programmes, develop novel approaches for screening and early detection, and provide options to extend cancer screening to new cancers. It will also contribute to providing new biomarkers and less invasive technologies for diagnostics. The new ‘European Cancer Imaging Initiative’ will facilitate the development of new, enhanced diagnostic methods to improve quality and speed of screening programmes using Artificial Intelligence, and promote innovative solutions for cancer diagnostics. A new Knowledge Centre on Cancer will function as an ‘evidence-clearing house’ for early detection through screening. An upgraded European Cancer Information System will facilitate the assessment of cancer screening programmes through improved data collection on cancer screening indicators. The analysis of interoperable electronic health records will improve understanding of disease mechanisms leading to the development of new screenings, diagnostic pathways and treatments.

These are encouraging concepts, and could – if implemented – assist the refinement of early detection and diagnosis. But it would be even more promising if the recognition of improved access to biomarker testing on diagnosis and progression extended to treatment, and to advancing the emergence of personalised medicine. The BCP could be the context for a more systematic development of biomarker testing. Perhaps data on variations in testing rates could be included in the envisaged cancer inequalities registry.

Similarly, taking advantage of other technology advances in treatment could give patients still greater chances of survival and of quality of life. In addition to the critical role played by radiology in screening, radiotherapy itself has advanced substantially during the past two decades, with new technologies and techniques allowing ever more accurate, effective, and less toxic treatments, thus allowing shorter and more patient-friendly regimens. It is now established as an essential pillar in multidisciplinary oncology. And as with all the other opportunities in better screening, diagnosis and treatment, appropriate coverage in healthcare budgets and reimbursement systems is essential if good intentions are to be converted into action.

Conclusion

What is essential is that LC screening programs be implemented in a comprehensive and coherent and consistent manner, rather than arising as a by-product of sporadic ordering of scans by providers without a programme infrastructure in place. Given the potential for such a large number of lives to be positively impacted by a timely diagnosis of early-stage treatable disease, the initiation of these programmes should be given the highest priority by healthcare institutions and providers. The new EU Cancer Screening Scheme envisaged in the BCP should have its vision extended beyond breast, cervical and colorectal cancer screening to lung cancer. The Commission proposal to review the Council recommendation on cancer screening is a positive step forward.

The challenge now is to act, and to implement LC screening – and in so doing, to save lives and prevent avoidable suffering and loss across Europe. If the EU does not take advantage of initiatives such as BCP, long-overdue improvements in lung cancer care will be deferred again, with the worst impact felt in Europe's most disadvantaged populations. Policy makers should recognise this unexploited potential, and should respond by driving implementation.

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Can we beat cancer? Europe’s Beating Cancer Plan moves forward

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The only constant in public affairs is change and in cancer, it is no different: Policy formation everywhere and on every issue has to take account of this reality, or it will fail to deliver the best answers. And in beating cancer, of literally vital interest to European citizens, the best answers need to be sought right now if the future is to live up to expectations. The EU Beating Cancer Plan is tackling this issue holistically by optimizing a changing context for the benefit of patients and health-care systems in Europe, writes European Alliance for Personalised Medicine (EAPM) Executive Director Dr. Denis Horgan. 

It is easy to demonstrate that change is a constant as in health and with COVID 19 now.  But can Europe itself shift its dimensions and its character as it has for millennia – now much faster than ever, and often for the better to tackle the potential in science, the willingness of the healthcare community including industry with the support of patients, to curb the epidemic of cancer.  

The potential is great for cancer patients and citizens. The benefits from advanced approaches to healthcare, such as personalised medicine as set out in the plan, will increase as the approach moves from single-test to multitarget profiling of the population, and ultimately to whole genome sequencing. 

A more efficient allocation of health-care resources can be achieved through sharper focus on prevention and prediction of disease, as well as through improving disease management, and the avoidance or delay in more expensive care costs. An effective strategy allows a forward-looking perspective on the value of genomics to the healthcare system. It supports the testing infrastructure towards the development of whole genome sequencing, with benefits to a wide range of conditions, and particularly rare diseases. 

But it requires policy decisions. Realising the potential requires a readiness to take a fresh look at challenges – and to run a fresh search for solutions. So for personalised medicine to get off the ground, for instance, it will be essential to move away from ‘trial-and-error’ prescribing and embrace the more considered initial prescription of optimal therapies. And for benefits of this sort to be delivered, the environment has to keep up with innovation. 

With  its  policy  objectives,  supported  by ten  flagship  initiatives and multiple  supporting actions,  the  Cancer  Plan  aspires to  help  member  states  turn  the  tide  against  cancer.  

Key flagships will be launched, such as the new ‘Cancer Diagnostic and Treatment for All’ initiative, to be launched by end of 2021, which will help improve access to innovative cancer diagnosis and treatments. It will use the ‘next generation sequencing’ technology for quick and efficient genetic profiles of tumour cells, allowing Cancer Centres to share cancer profiles and applying the same or similar diagnostic and therapeutic approaches to patients with comparable cancer profiles. The initiative will ultimately help optimise cancer diagnosis and treatment and reduce unequal access to personalised medicine in cancer care, greatly benefiting patients.   

These are key issues that we worked with our members such as the European Society of Medical Oncology as well as the broader agenda to put on the political agenda. Various academic publications supported this policy. 

On imaging, it was announced that the European Cancer Imaging Initiative will be set up in 2022 to develop an EU ‘atlas’ of cancer-related images, making anonymised images accessible to a wide range of stakeholders across the ecosystem of hospitals, researchers and innovators. 

This was the key issue that we have worked with the European Society of Radiology over the years to bring he attention to this unmet for more coordination at the EU level. 

Lest we forget registries, in 2021, the Commission will establish a Cancer Inequalities Registry. It will identify trends, disparities and inequalities between member states and regions. Alongside regular qualitative assessments of the country-specific situation, the Registry will identify challenges and specific areas of action to guide investment and interventions at EU, national and regional level under Europe’s Beating Cancer Plan.

Of course, partnership will be launched and there will be a new Partnership on Personalised Medicine, due to be set up in 2023 and funded under Horizon Europe, will identify priorities for research and education in personalised medicine, support research projects on cancer prevention, diagnosis and treatment, and make recommendations for the roll-out of personalised medicine approaches in daily medical practice. 

As a preparatory action to the Partnership, the Commission will establish a roadmap to personalised prevention, identifying gaps in research and innovation, and will support an approach to map all known biological anomalies leading to cancer susceptibility, including hereditary cancers. 

This is a critical area that we have put on the political agenda since 2011 and engaged at the country level to make this a reality. 

Building on this, the Commission will launch, the ‘Genomic for Public Health’ project. The project will complement the 1+ Million Genomes Initiative, which has cancer among its main use cases, and is expected to give secure access to large amounts of genomic data for research, prevention and personalised medicine purposes. Actions under the project, funded by the EU4Health programme, will also target the identification of genetic predisposition of individuals to develop cancers, opening new perspectives to personalised risk-assessment and targeted cancer prevention. 

On disease specific issues such Lung Cancer: The Commission will make a proposal by 2022 to update the Council Recommendation on cancer screening to ensure it reflects the latest available scientific evidence. Extending targeted cancer screening beyond breast, colorectal and cervical cancer to include additional cancers, such as prostate and lung.

With the European Respiratory Society as well as with Lung Cancer patients, we have been advocating for this since 2015 with an EU Presidency conference supported by the Maltese Presidency of the EU. 

Moving ahead in such circumstances will depend on the readiness of Europe's politicians and policymakers and prescribing physicians to open up to new ideas, to acknowledge that their way may no longer be the only way, and to contemplate a degree of voluntary collaboration that has until now been largely embryonic.

 On the basis of the debate so far, with only limited progress towards cooperation even on health technology assessment, national sovereignty continues to reign supreme in many member states. Common work does already take place in a limited fashion in some areas and there are some enlightened spirits who are showing a more imaginative approach to the questions that have arisen. But overall it is proving difficult to establish the balance in which the merits of cooperation are seen to weigh as much as the desire for national autonomy.  

The EU Beating Cancer Plan has the potential to allow us to move ahead.   

The prize of adaptability will be better care. But it is a prize that will be won only if national authorities and traditional professionals are prepared to play. If they are not, they will not only lose the prize. They will condemn Europe's cancer patients and citizens to a declining share of innovation and the benefits that go with it in terms of economic prosperity and quality of life. 

The choice is available now. But it will not remain available indefinitely. Europe is living in a changing world, and if it does not choose to change, the world will change around it. 

The aim of Europe’s Beating Cancer Plan is to tackle the entire disease pathway structured around four key action areas where the EU can add the most value: (1) prevention; (2) early  detection;  (3)  diagnosis  and treatment;  and  (4)  quality  of  life  of  cancer  patients  and survivors. 

However, the key will be translating the aims into actions. 

EAPM and its members will be there to support the Commission and members through bottom-up policy support. The EU Beating Cancer Plan is available here.

Have the best weekend possible, and keep safe.

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