Economist Impact: World Cancer Series – pharmaphorum in attendance, day one (part iii)

Taking a brief look back to pharmaphorum’s coverage of Day One of The Economist’s 8th Annual World Cancer Series congress in Brussels, Belgium, in November – where the foci were “innovation, equity, and excellence”. After a panel on the priorities for innovation and excellence in cancer care within Europe, with the essential aim of the conference “universally excellent cancer control and cancer outcomes across the Continent”, came a presentation on ‘Inequalities in cancer – facts and data’ by Francesca Colombo, head of the Health Division at the Organisation for Economic Co-operation and Development (OECD).

Colombo opened with the impactful statement that 40% of the differences in cancer cases can be attributed to preventable factors, such as lifestyle. Lung cancer is, she said, the most common cause of cancer deaths for men, as smoking is more prevalent among men in Europe, as well as in low-income groups. Indeed, there is a 60% higher likelihood of men smoking across EU countries than women.

Another cause of difference exists within health systems themselves, Colombo stated, with income particularly affecting breast cancer screening uptake in Romania, Bulgaria, and Norway (breast cancer screening is 1.25 times more likely to be taken up by higher-income people). Other factors, however, include the availability or otherwise of cancer drugs. Nonetheless, resources only explain part of the differences in oncological performance, she said. Regularly, only about half of the data needed to inform policy and practice is measured.

Crisis and cancer control

Colombo’s presentation was followed by the panel, ‘The future of European cancer control in a time of crisis’. Moderated by Dr Vivek Muthu of Marivek Healthcare Solutions and Economist Impact, the panellists included: MEP Frances Fitzgerald; CEO of Youth Cancer Europe (YCE) Katie Rizvi; Professor of clinical oncology and radiotherapy and head of the department of oncology and radiotherapy, Medical University of Gdansk, Poland, Dr Jacek Jassem; and Head of Europe and Canada oncology at AstraZeneca, Greg Rossi.

Fitzgerald opened the discussion. A Member of the European Parliament since 2019, she stated that what happens in a crisis is that existing inequalities get exaggerated. In attempting to answer the question of how cancer care can continue to be prioritised on an ongoing basis, many medical voices were heard, she said. But, at the same time, other health priorities were going down the scale and, therefore, the demands on our health services require a catch-up.

Fitzgerald stated that, as a politician, it’s about keeping a voice in a crisis, and anticipating the next problem: pre-planning helps to ensure the voices of specialists and experts are kept at the forefront. Secondly, collaboration is highly important, she said. Also chair of Transforming Breast Cancer Together, collaboration creates a far better chance of needs being met and builds bridges between the various levels.

Katia Rizvi commented that some of the most agile entities are patient organisations, which supply very important intelligence and data. However, it was a ‘hustle’ for patient organisations to be heard during the pandemic, she said. Nonetheless, the more recent and ongoing crisis in Ukraine saw YCE being the first responder in that country.

The Ukrainian situation and therapy across borders

Dr Jacek Jassem noted the challenge that the Ukrainian crisis had been and continues to be. Now [as of 8th November], he said, 7 million Ukrainians have crossed the Polish border, and 2.5 million have settled in Poland. Therapy wasn’t available in Ukraine, for one reason or another, or had been interrupted due to circumstances, he explained. So, it was that Poland had to provide the necessary cancer care and, indeed, soon after the war started, it had been decided that refugees would have the same care as Polish patients – despite the difficulties faced by having no Polish documentation.

In addition to accommodation problems, unemployment, and broken families – mainly women and children, given men haven’t been allowed to leave Ukraine – the management of cancer in refugees is different. There is no screening available for cervical cancer in Ukraine, so the rates are much higher on average than the rest of Europe, Jassem said. As far as children were concerned, they arrived in groups from evacuated hospitals, at one point a group of 30 coming in.

There were communication and psychology problems, he explained, and documentation was scarce or missing. Theirs is also the issue that therapies can’t be restarted, they have to be continued, and so with no documentation and contacting doctors in Ukraine impossible because either the hospital didn’t exist anymore, or contact was otherwise challenging – Jassem asserted that they could only do their best. As Vivek rightly termed it: ‘heart-breaking’.

Industry’s learning from the pandemic

Regarding industry response in crisis, Greg Rossi returned to the pandemic experience, wherein industry’s role had been threefold: innovation, delivering vaccines, and therapies (for example, in B-Cell malignancies). The industry, he said, had been at its finest, able to move quickly despite the challenges. Being on the cancer side of the business, Rossi has seen huge value and innovation over the past 20 years – and much of that will be eroded because of the pandemic, he noted.

Over a million cancer screening tests were not carried out in 2020, which is a critical situation when the early treatment of patients is crucially important for the potential to cure. So it is, Rossi said, that they’re seeing bulkier, later stage disease and a worse prognosis because of that. Having worked with FBO and ESMP, it’s clear, he said, that patients need to engage with the health system when they’re symptomatic.

Rossi mentioned that biomarker testing is necessary for the right work-up and diagnosis – but it was difficult for a lung cancer patient to get a bronchoscopy during the pandemic. Radiologists were busy, he said, understanding how to treat Covid patients. And what of home support treatments, he asked. There are ways to use telemedicine and toxicity management apps and systems can be flexible in order to accelerate engagement. In short, the current crisis now is “basically a pandemic of cancer in Europe”, Rossi said, where a quarter of cases are.

Equitable cancer care across member states

Rizvi returned to the war in Ukraine’s facilitation of more flexible HP access, but noted that such patient movement flexibility was not being seen as regards the Balkans, for example. A re-evaluation of equity across EU member states should take place, she said.

Fitzgerald believed the present moment is unique, demanding international collaboration. How, she asked, can health be built into the protection directive given to Ukrainians, providing them nearly the rights of citizens in other countries? By a flexible and cooperative approach, she said.

At this juncture, Vivek interjected that crisis is an imperfect storm at the moment, with political instability in member states, but equally, a pan-European approach makes so much sense. Rizvi replied that there aren’t large-scale studies or a crisis analysis plan in Europe for oncology. Jassem added that the rapid development of telemedicine during COVID, and teleological imaging, rapidly developed: meeting online to discuss a patient and implementing home care are solutions. Delivery of medicines and home laboratories (requiring a small device connected to a smartphone) –also could help, he said.

Rossi posited that for equitable and high-quality cancer care, measurables are needed. Without high-quality, integrated data sets, best practices can’t be identified, nor can variables. Integrated data at a regional level is very important, he said, and Europe is falling behind the US in this. To this statement, an audience member said the two couldn’t be compared, as there is no united Europe in health. To this, Rossi clarified that he meant with regard to integrated data sets, not access; looking for the best possible framework for what works in cancer.

Fitzgerald agreed, and Vivek stated that a balance needs to be struck between setting out broad objectives and allowing sovereign states their priorities. Fitzgerald replied that if the European vision is to count for anything, then equality in care between states is fundamental: “what’s in the best interest of citizens, of patients, goes beyond national boundaries,” she said.

Regional considerations and fixing the fault line

Another question from the audience – this time from Parker Moss, chief ecosystems, and partnership officer at Genomics England – noted the call for breaking down national and regional boundaries, and state boundaries in the US. In England, Moss said, genomics systems have been broken down into seven regions, and Australia – although it has much smaller populations – has exactly the same number of regions, and different health practices and outcomes within those. Therefore, does healthcare have a natural tendency to fragment and, if so, is there a way to fix that fault, he asked.

Rossi responded by saying that one of the challenges is findings the unmet needs and asking whether treatment needs to be intensified or de-intensified, getting the biological detail into the databases and reinterpreting at a useful level.

Fitzgerald said it had to be a combined approach. Given the inequalities across Europe, there’s no defence to not engage on the macro level. Evidently, cancer care can’t be delivered purely nationally, she said. Jassem interjected that solidarity is critical in a crisis, and Rizvi added preparedness, also.