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

To continue with pharmaphorum’s coverage of Day One of The Economist’s 8th Annual World Cancer Series congress in Brussels, Belgium this week – where the foci were “innovation, equity, and excellence” – after the opening addresses came a panel on the priorities for innovation and excellence in cancer care within Europe. After all, the essential aim of the conference has been “universally excellent cancer control and cancer outcomes across the Continent”. And so, with Bartosz Arlukwiez, chair of the special committee on beating cancer (BECA) of the European Parliament, unable to attend (although he did provide a pre-recorded message of apology), the panel proceeded into discussions.

Moderated by Dr Vivek Muthu of Marivek Healthcare Solutions and Economist Impact, the in-person panel consisted of Christopher Fearne, deputy prime minister and minister for health for the Government of Malta; Dolors Montserrat, Member of the European Parliament (MEP); Catherine Elliott, director of research and partnerships at Cancer Research UK; and Nicoletta Luppi, managing director of MSD Italy.

The priorities for innovation and excellence in cancer care within Europe

Having noted that by 2035 it is predicted that there will be a 24% increase in cancer diagnoses, Arlukwiez, BECA’s chair, stressed within his recorded apology message that the patient is the guiding principle and that there must be equality of treatment across the EU. With these thought in mind, Dr Muthu asked Montserrat to begin.

Stating her pleasure over the congress being live and in-person, rather than via a screen, the MEP remarked that it was a big opportunity for all. COVID-19, she said, taught a lot of lessons and they should take those lessons now and push for a true EU for health. With all the freedoms that do exist within Europe, she remarked, now was the time for health. Europe is different from China or the US, she said: they don’t have ‘universal health’.

After all, the EU Beating Cancer Plan was initiated before the pandemic and the tools that exist now – precision medicine, high-performance computing, AI – all of these are essentials for equitable access and innovative medicine. Science and technology, she said, are crucial, they are the main allies in the fight for health.

Expressing a desire that a shared passion for innovation and excellence within cancer care should be put at the centre of policies in order to establish resilience and competitiveness, Montserrat did note that sustainability was also important across the 27 EU member states.

Horizon Europe and cancer care post-2020

What she also highlighted was the European Commission’s proposal for cancer screening. With ten times more budget than before, Montserrat reminded attendees that cancer was one of the five main missions of the Horizon Europe programme, which picks up from where Horizon 2020 left off. The other four missions being climate change, marine environment, smart cities, and food security, it is clear the term ‘sustainability’ was not idly thrown into what she had to say.

In health and cancer, as well as Europe’s pharmaceutical strategy – what needs to be focused upon is prevention. We can talk all the time, Montserrat said, but now is the time for action: early diagnosis, access to the best treatments, innovation, in addition to protection of intellectual property (IP), and after that biosimilars and generics.

However, experience of the healthcare system differs between regions. It is not the same to live in the Pyrenees, said the MEP, as it is to live in Madrid or Barcelona, where the big hospitals are. They have to consider social impact. Furthermore, labour measures need to be taken into consideration: the cancer survivors, they need help to find work again.

Overall, it is an incredible plan, but it needs the ministers of health to implement it in the 27 EU member states. Together, Montserrat encouraged, we can do it.

Dr Muthu wanted next to build upon what had been said and invited Christopher Fearne to speak. Fearne decided to use his ‘three minutes’ to share an idea that is currently working in Malta.

Excellence in cancer care is not just survivorship, but patient outcome

Fearne urged the audience to remember that surviving cancer is not the last step. Setting aside a percentages mindset when considering efficiencies of treatments, although oncologists might be happy that the cancer has been cured, what if the patient dies of something else? That’s not a good outcome for the patient, he said. Therefore, the design is flawed.

As soon as ‘cancer’ is mentioned, a big and complicated journey begins, Fearne continued. There are oncologists, physicians, surgeons, and patients might miss appointments or not be doing something that they should be doing during treatment. This is why the Maltese Government has set up ‘nurse navigators’, an innovative cancer care service that “brings a personalised, integrated approach to care both during and after treatment”, according to the World Health Organization (WHO).

The Maltese situation and nurse navigators

Set up over the past five or six years, it is a relatively inexpensive programme (in the grand scheme of things) and is run at the national level, where full-time nurses who are trained and specialised in one particular cancer, such as breast or lung or rectal, and when cancer is first mentioned to the patient, the appropriate nurses are put in contact with them via nurse navigators (one patient has at most two nurses). They then guide the patient through the cancer care system. In this way, Fearne said, the life of the patient is made so much more certain. People get quicker access to specialists, also. Someone is, in short, doing the patient’s worrying for them.

With this “broad picture of European aspiration and EU toolkit” in hand, in Dr Muthu’s words, the moderator summarised the holistic concept of excellence being put forward, where innovation goes beyond, that small step further. Wanting next to explore the place of research in this discussion of equity and innovation excellence, he invited Catherine Elliott to speak.

Elliott informed those in attendance that for the next five years, with about £5 billion in funding for pipelines across a network of research and institute centres in clinical trials, that the aim is for everyone to live a life free of cancer. The key, she said, is working in partnership. And in the UK over 30% of clinical trials funded has one European partner at least. After all, cancer research is global and innovation, too, is global. Whatever our politics, she pressed, we have to do this together.

The British situation and research equity

In the UK, there are stark inequalities, whether those are of ethnicity, gender, from economic deprivation, or other cause. When the Cancer Control Panel talks about prevention – regarding tobacco or alcohol, air pollution or obesity – the same issues are being seen time and again. These have to be tackled, Elliott said. In order to do this, the differences have to be captured and they have to be understood to point of their source.

Risk factors can be genetic, environmental, or can come from lifestyle choices: research that addresses these needs to be funded, so as not to perpetuate or exacerbate those inequalities, Elliott explained. She suggested that underserved communities be worked closely with and self-sampling tests implemented.

Additionally, is the issue of the lack of diversity within the scientific workforce itself. This was what had prompted recent scholarship investments for black PhD students, Elliott said, as well as encouragement of ethnic minority students into research. For, she questioned, if senior research isn’t diverse, what hope is there?

At this juncture, Dr Muthu noted that it was often easy to put equity down as simply being an implementation issue, but that Elliott had highlighted this importance on making clear that equity must begin at the research level.

The responsibilities of pharma

Nicoletta Luppi was the final panellist invited to speak and she began by stating that industry can only start with what we have and what we don’t have at this present moment and go from there. Nonetheless, with regards to research, we are living in a renaissance age, she argued, in terms of prevention, as much as treatment.

This includes vaccines which prevent diseases, such as for HPV papilloma, which is already part of the European plan. With 90% of adolescents that should be vaccinated by 2030, Luppi deems it an opportunity. Indeed, MSD was nominated for its equitable access to the HPV vaccine in its supply to everyone, according to the guidelines.

Nevertheless, she opined that we also live with another truth: industry doesn’t share common data. It always starts by projecting data at congresses, but only in a sense of comparing ‘apples with pears’; that is, different data from different countries.

The Italian situation and the issue of regional data

Luppi remarked that data in Italy is regional, and that any comparison made seems ever to come too late. However, what Covid brought with it was the digital lesson: in-time, real-time data for comparison and interoperability. And this is what is needed not only to work together, but faster, too. It must be remembered that whenever ‘data’ is referred to, it is not just the possession of data, but screening, diagnosis, and treatment as well. Hence, the electronic record should be available across the breadth of patient diversity, she said.

Pharma needs to continue to invest in M&D. We are still in a pandemic, but the World Cancer Series congress itself would not have been possible without pharmaceutical companies investing heavily in research on SARS-CoV-2. IP is oxygen for research like that, Luppi stated, and a return in investment will be seen in the long-term. “We need to sustain congresses like this one,” she urged.

Every life counts

Luppi’s final opening remarks were that without the Cancer Registry (an information system designed for the collection, storage, and management of data on persons with cancer), discussions would be about something that cannot be measured and, if you can’t measure and have data from all EU members, she asked, how can progress be made? Only by working together can the industry move ahead and win. There might be several pharma initiatives, but investment in partnership, in the best minds, is what will result in the best outcomes across Europe.

Patient access ranges from 22% to 81% across EU member states. Sometimes, Luppi said, the problems are not on the first part of the path, but the last miles, and so what is needed is collective data, on which to act upon.

Dr Muthu concluded that it was a case of harnessing the private sector when certain technology needs to be invented, but that cancer is an ongoing emergency of same magnitude year-on-year, before inviting questions from the audience.

Misinformation within cancer care

The first question sought to know whether misinformation was an issue of similar magnitude to cancer as it had been during the pandemic. Christopher Fearne responded with the analogy of imports, from shoes to washing machines, to a drug from Greece, say, but that wouldn’t be feasible because one can’t speak or read Greek. However, we live in a digital age, he said. Everyone has a mobile: now is the age of electronic patient information; now is the time for electronic labelling. Therefore, in the Greek drug scenario, an individual can merely scan the barcode and access all the information needed on their mobile. Similarly, a doctor in Belgium wanting to use an orphan drug manufactured in Hungary doesn’t need to understand Hungarian. It is crucial that digitalisation comes in, and language barriers are broken down in the European Union.

Catherine Elliott added that the technology has to be accessible. Covid foregrounded the risks and benefits of tech innovation. There are masses of disinformation seen not just with cancer, but with every medical condition. What is needed is an amplification of trusted and verified information – and trusted partners have to be worked with in order to achieve this. She used Cancer Research UK as an example of this.

Dolors Montserrat mentioned that QR codes are now put on drugs for purposes of EU languages, but that this also defends the environment, avoiding, as it does, the need for paper instruction or information. Nicoletta Luppi agreed, saying that at the moment pharmaceutical strategy has an opportunity to reduce bureaucracy, too, electronic capabilities potentially meaning fewer presentations and thereby a reduction in the time it takes for the patient to have access to the treatment. It is, therefore, a lever for optimising implementation, an incentive for innovation.

Luppi repeated that IP is the best incentive, again said that it was ‘true oxygen’, and noted that everyone is part of the same table discussion, where the best solutions can be offered and shared and the best strategies can be designed: the pandemic is proving that IP is working, she said, whereas bureaucracy is not working. The only way to succeed is by working together.

Aggregated data and closing remarks

A second question came from Youth Cancer Europe, which asked how Cancer Research UK prioritises clinical trials and biomedical research, noting that there are a lot of initiatives where patients are at the table. In response to this question, Elliott brought up the paediatric case, where with cancer in children they identify specific needs, gaps, and challenges, and hold standing panels of public and families and carers over long periods of time, after which there are specific volunteer groups. She confirmed that, “right from the start”, families are involved in discussions.

The final question (from a cancer researcher) noted how AI can find targets, but wondered just what kind of data is critical for industry. Luppi immediately said aggregated data is the critical data, in addition to in-time information. Quality data, also: “apples with apples, and pears with pears”. Furthermore, identifying the big needs, with patients at the centre.

To close, Dr Muthu enquired what his panellists’ mast remarks were. For Fearne, it was sustainability (“The elephant in the room.”); for Montserrat, it was that everyone is a stakeholder within the European Union, and it must be “without fear, without mind borders, and without competency loss”. Elliott said simply, “partnership” and Luppi replied shorter still, “value”.