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Global Cancer Series – Presence of Medicines, Day 1 (Part 3) –

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A sneak peek at PharmaForum’s coverage of the first day of the eighth annual The Economist Global Cancer Series Conference in Brussels, Belgium, in November – where the focus was “Innovation, Equity and Excellence”. Following a discussion session on priorities for innovation and excellence in cancer care within Europe, with a primary objective of the conference “Excellent cancer and cancer control outcomes across the continent”, a presentation on “Cancer Inequalities – Facts and Data” was given by Francesca Colombo, Chief Health Officer at Organization for Economic Co-operation and Development (OECD).

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Colombo opens with the poignant statement that 40% of the differences in cancer incidence can be attributed to preventable factors, such as lifestyle. She said that lung cancer is the most common cause of cancer deaths among men, with smoking prevalent most among men in Europe, as well as in low-income groups. In fact, there is a 60% higher probability of men smoking in EU countries than women.

Colombo mentioned that another reason for the difference is within the health systems themselves, with income particularly affecting breast cancer screening in Romania, Bulgaria and Norway (breast cancer screening is 1.25 times more likely than people with higher incomes). However, other factors include the availability or lack thereof of cancer drugs. However, the resources only explain part of the differences in oncology performance, she said. On a regular basis, only about half of the data needed to guide policy and practice is measured.

Crisis control and cancer

The Colombo show was followed by a panel titled “The Future European Cancer Control in times of crisis. Moderated by Dr. Vivek Muthu of Marivek Healthcare Solutions and Economist Impact, the participants included: MEP Frances Fitzgerald; Youth Cancer Europe (YCE) Executive Director Katie Rizvi; Professor of Clinical Medicine Oncology and Radiotherapy and Head of the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland, Dr. Jacek Jasem; and Head of Oncology for Europe and Canada at AstraZeneca, Greg Rossi.

Fitzgerald opened the discussion. A member of the European Parliament since 2019, she has stated that what happens in any crisis is the exaggeration of existing inequalities. In trying to answer the question of how cancer care should continue to be prioritized on an ongoing basis, many medical voices have been heard, she said. But, at the same time, other health priorities were declining, and thus, the demands on our health services required catching up.

Fitzgerald stated that, as a politician, it is about preserving a voice in a crisis, anticipating the following problem: advance planning helps ensure that the voices of professionals and experts are kept at the fore. Secondly, collaboration is very important, she said. He is also the President of Transforming Breast Cancer Together, the collaboration creates a much better opportunity to meet needs and builds bridges between different levels.

Katya Rizvi commented that some of the most resilient entities are patient organisations, which provide very important intelligence and data. However, she said it was a “crawl” to hear about patient organizations during the pandemic. However, the more recent and ongoing crisis in Ukraine has made YCE the first responder in that country.

The Ukrainian situation and cross-border treatment

Dr. Jacek Jasim referred to the challenge that the Ukrainian crisis was and still is. right Now [as of 8th November]He said that 7 million Ukrainians have crossed the Polish border, and 2.5 million have settled in Poland. He explained that the treatment was not available in Ukraine, for one reason or another, or was stopped due to circumstances. Therefore, Poland had to provide the necessary care for cancer patients, and in fact, shortly after the outbreak of war, it was decided that refugees should receive the same care as Polish patients – despite their difficulties due to the lack of Polish documents.

In addition to the problems of residency, unemployment and the breakup of families – especially women and children, since men are not allowed to leave Ukraine – the management of cancer in refugees is different. Jasim said there is no screening available for cervical cancer in Ukraine, so the rates are much higher on average than the rest of Europe. In regards to children, they arrived in groups from hospital evacuees, and at one point a group of 30 people came.

There were problems with communication and psychology, he explained, and documentation was scant or missing. Their problem is also that treatments cannot be restarted, and must continue, and so with no documentation, contacting doctors in Ukraine is impossible either because the hospital no longer exists, or communication was otherwise difficult – Jassim emphasized that they could just do their best. As Vivek rightly described it: “heartbreaking”.

Industry learning from the epidemic

In terms of industry response in crisis, Greg Rossi returned to the pandemic experience, where the industry’s role was threefold: to innovate and deliver vaccines and therapeutics (for example, in B-cell malignancies). He said the industry was at its best, able to move quickly despite the challenges. Being on the cancer side of the business, Rossi has seen great value and innovation over the past 20 years — and much of that will be eroded by the pandemic.

More than a million cancer screening tests were not performed in 2020, which is a critical situation when early treatment of patients is so important to the possibility of a cure. They’re seeing a larger, later-stage disease and a worse outlook because of that, Rossi said. After working with the FBO and ESMP, it’s clear, he said, that patients need to engage with the health system when they develop symptoms.

Rossi mentioned that biomarker testing is essential to correct workup and diagnosis — but it was difficult for a lung cancer patient to get a bronchoscopy during an epidemic. He said radiologists have been busy understanding how to treat Covid patients. And he asked, what about home support treatments. There are ways to use telemedicine and toxicology management applications and systems that can be flexible in order to accelerate participation. In short, the current crisis is essentially a cancer pandemic in Europe, Rossi said, where a quarter of the cases are.

Equitable care for cancer patients across Member States

Rizvi went back to the war in facilitating Ukraine’s access to more flexible HP, but noted that this flexibility of patient movement had not been considered in relation to the Balkans, for example. She said property rights should be reassessed across EU member states.

Fitzgerald believes that the present moment is unique, and requires international cooperation. And I wondered how health can be integrated into the protection directive given to Ukrainians, providing them with almost the same rights as citizens of other countries? With a flexible and collaborative approach, she said.

At this juncture, Vivek enters that the crisis is an imperfect storm at the moment, with political instability in the member states, but conversely, the pan-European approach makes a lot of sense. Rizvi replied that there are no large-scale studies or crisis analysis plan in Europe for oncology. Jassim added that the rapid development of telemedicine during the coronavirus and telephoto imaging developed rapidly: online meeting to discuss the patient and implement home care are two solutions. He said home drug and laboratory delivery (which requires a small device connected to a smartphone) – could also help.

Rossi hypothesized that for equitable, high-quality cancer care, scale is needed. Without integrated, high-quality datasets, best practices cannot be identified, and variables cannot be identified. He said that integrated data at the regional level is very important, and Europe is lagging behind the United States in this. To this statement, an audience member said that the two cannot be compared, as there is no Europe united in health. To that, Rossi made it clear that he meant in relation to integrated datasets, not access; Finding the best possible framework for what works in cancer treatment.

Fitzgerald agreed, and Vivek stated that a balance must be struck between setting broad goals and letting sovereign states take their own priorities. If the European vision is to be counted, Fitzgerald replied, equality of care between countries is key: “What is in the best interests of citizens and patients, transcends national borders,” she said.

Regional considerations and fault line identification

Another question from the audience – this time from Parker Moss, Head of Ecosystems, Partnerships Officer at Genomics England – referred to the call for breaking down national, regional, and state boundaries in the United States. In England, Moss said, the genome systems are divided into seven regions, and Australia — although it has a much smaller population — has exactly the same number of regions, and different health practices and outcomes within those regions. So, does healthcare have a natural tendency to fragment, and if so, is there a way to fix this bug, he wondered.

Rossi responded by saying that one of the challenges is detecting unmet needs and asking if treatment needs to be ramped up or de-densified, entering biological details into databases and reinterpreting them at a useful level.

It should be a combined approach, Fitzgerald said. Given the inequality across Europe, there is no defense for not engaging at the macro level. She said it was clear that cancer care could not be offered purely nationwide. Jasim considered that solidarity is crucial in a crisis, and Rizvi added preparedness as well.

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