Cancer – it’s on everyone’s minds these days. As a medical oncologist, why do you think it’s important to talk about tackling cancer?
Cancer, as we all know, is a complex disease that affects every one of us in one way or the other. Globally, cancer is responsible for one in six deaths, while one in five of us will face a cancer diagnosis during our lifetime. In Europe, cancer was responsible for 1.9 million deaths in 2018 alone, resulting from 3.9 million cancer cases. These numbers are set to increase exponentially in the coming years if we do not change the status quo. The WHO estimates that, by 2040, there will be 29.4 million new cancer cases, compared to the 18.1 million in 2018 worldwide – this is a 60 percent increase in around two decades.
The complexity of the disease and its corresponding treatment, which has to be tailored to every patient based on their individual needs and their health, makes it important for us as medical oncologists to work harder to provide the best possible care to our patients. As a medical oncologist myself, as well as the President of ESMO, it’s my responsibility, as well as that of my Society, to ensure that patients receive the best care possible.
How? By ensuring that our 25,000 and growing membership has access to the latest information concerning advancements in the treatment and changes in the standard of care; by ensuring all oncologists have access to our freely available, evidence-based and robust Clinical Practice Guidelines; and by arming our members, including patient advocates, with the right information on public policy.
What about the EU’s beating cancer plan and the importance of prevention?
Europe’s Beating Cancer Plan is a milestone in the history of EU policy. Although there is an immediate threat from COVID-19, diseases such as cancer remain the major threat across society. With cancer being the second-leading cause of mortality in Europe, in a race to become number one, the timeliness of this plan is very welcome.
A recent WHO report states that “every year effective cancer control is delayed, the response becomes more expensive”. We are not just talking about the medicines, we are talking about the basics of an effective cancer control plan: prevention, diagnosis, treatment, quality of life and survivorship and palliative care. The first step in effective cancer control is to take stock of what we have; only then will we be able to tackle the disease confidently.
Prevention is key to this, especially as approximately 40 percent of all cancer cases are preventable. In terms of numbers, if we start investing in prevention now, we can prevent around 12 million cases globally by 2040. 12 million is not an insignificant number, but this is contingent upon EU Member States and countries around the world investing in prevention policies.
"The WHO estimates that, by 2040, there will be 29.4 million new cancer cases, compared to the 18.1 million in 2018 – this is a 60 percent increase in around two decades"
With cancer being at the forefront of the access to medicines debate, what are your thoughts on this topic?
As a doctor who uses these medicines to treat cancer patients, this isn’t an easy question. Science, advancements in science, and the desire to find a ‘cure’, is our goal. This is what we all are working towards: making cancer a manageable disease. I practice in Switzerland, a country where we rarely discussed the cost of an anticancer medicine. We work under the assumption that if we prescribe a medicine, our patient will receive it because our system can afford it. We did not ration, nor did we think about alternatives. We only thought about the best possible treatment for our patients.
However, over the past few years, we have come to the realisation that the system, as it has functioned in the past, may not be able to sustain itself – not in Switzerland, not in the EU, but globally. To tackle the issue of sustainability of healthcare systems, ESMO decided to take a two-fold approach.
First, we created a robust tool, the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS), which helps to prioritise medicines and address the challenges of appropriate use of limited resources to deliver cost-effective and affordable cancer care.
Second, we are working on an economic model that aims to provide a geographically-adapted value based reimbursement for cancer medicines. With the current discussion surrounding the draft proposal for a Health Technology Assessment (HTA) Regulation, perhaps cancer medicines could be used as a pilot for joint clinical assessments, given that we have a robust, impartial tool, recognised by the World Health Organization and several HTA bodies across the world.
Shortages of inexpensive, essential medicines has been a hot topic in recent months. Do you think this is an important issue in the access to medicines debate?
We believe that the debate on access needs to be viewed from two perspectives: one focusing on the accessibility of innovative, expensive medicines, and the other focusing on the availability of inexpensive, essential medicines, i.e. generic, off-patent medicines. The shortages of inexpensive, essential medicines are not only due to price, but rather due to the production, supply and availability of these medicines and their active pharmaceutical ingredients, among other reasons. These medicines are crucial, because they are used in the treatment of most cancers, and without them, new, innovative treatments are incomplete.
To find solutions to this challenging issue, we worked with the Economist Intelligence Unit on a Cancer Medicines Shortages report as well as five country profiles – all of which indicated that shortages of these medicines exist in every country in the European Union. Only a supranational solution at EU level can mitigate this growing public health emergency, and we are glad to see that the EU institutions and the upcoming German Presidency have prioritised this issue.
"Only a supranational solution at EU level can mitigate this growing public health emergency"
What should the eu focus on next?
Equal access to optimal healthcare: that’s what we all should be focusing on. Not only for cancer, but for all disease areas, because health is a fundamental human right and every EU citizen has the right to have the same level of care. Patients are the driving force and inspiration behind our activities, however we realise that there are still many discrepancies in access to cancer care within the EU.
We need to use this momentum and work together to reduce the disparities by harmonising the standard of care across the EU (e.g. by assessing the implementation of evidence-based clinical practice guidelines), starting with cancer as a pilot. We need to work together if we are to attain the goals of the United Nations and WHO of achieving Universal Health Coverage by 2030, with a comprehensive set of safe, affordable, effective and high-quality medicines and a well- trained workforce.