Despite vast improvements in cancer care, challenges remain in driving forward cancer prevention strategies and ensuring inequalities concerning access to care are minimised. Richard Price, Head of Policy at the European Cancer Organisation, tells us more.
The European Cancer Organisation is a not-for-profit federation bringing together hundreds of entities – from professional and patient groups to treatment and research centres – to create more effective, efficient, and equitable cancer care across Europe. While great strides have been made in improving prevention and treatment, disparities remain between and within EU countries regarding access to care as well as public awareness of key risk factors. To discuss this, we reached out to Richard Price, Head of Policy at the European Cancer Organisation.
What have been some of the most significant milestones in the improvement of cancer research and patient care across the EU since your organisation was founded?
The European Cancer Organisation was founded in 1981 by a famous breast cancer surgeon from Italy called Professor Umberto Veronesi. He was trying to help solve the problem that while there had been welcome increasing levels of specialisation in the main treatment modalities of medical oncology, radiation oncology and surgical oncology, an unintended consequence was difficulty in collaboration between the professionals jeopardising the provision of the best cancer care for the patient. Since then, there has been significant improvement in that regard. Multidisciplinary team meetings are now much more inclusive of all relevant disciplines within a cancer clinic throughout most, if not all, of Europe. Technology has also played a part by enabling more specialists to join these team meetings and for vital information to be shared effectively. But there are still challenges and the European Cancer Organisation is working to address them. To further improve the culture and productivity of multi-disciplinary teamwork, and supported by EU4Health funding, we have created an inter-speciality cancer training curriculum. Called INTERACT-EUROPE, it will help to ensure that different professionals are more aware of the different roles and responsibilities of everyone on a team, and when they should be reaching out to their colleagues.
Aside from COVID-19, what are the most pressing challenges facing cancer treatment and research?
As we have seen, there have been impressive new developments in so many areas of cancer care, whether it be from ways to detect cancer earlier, ways to improve the diagnosis of cancer and more personalised treatments for each patient. There have also been improvements in the way people are supported after their treatments. All of that is very positive, but it has come with more and more inequality of access. Some patients in Europe are benefiting from all of these developments, but too many are not. That is a structural challenge related to the resources in any given country, but it is also related to tackling inefficiencies where funds are not being utilised wisely to produce the best possible returns. That means gaining a solid understanding of investments that bring the best returns and realising the value of investing in workforce development too.
We have seen improved diagnostics thanks to enhanced digital technology and the introduction of Artificial Intelligence, allowing sophisticated software to better identify cancer from an image, the type of cancer it is, and how it is going to respond to different forms of treatment. The whole imaging side is racing ahead and showing great potential.
As for advances in treatment, genomics is another area where we are seeing real progress. But here again, we will not achieve the full benefit if we do not have enough pathologists and technologists to make it work. And if we think about the particular landscape of Europe and the financial challenges many countries face, we could be doing more to help them work together to improve their infrastructures to deliver new innovations in treatment and care together. Genomic tumour testing, for example, could be supported by networks between hospitals and cancer care centres across countries to provide the laboratory technology and infrastructure that is required to bring this kind of technology to the patients.
There remain large inequalities in cancer mortality rates between and within EU countries; what are some of the key issues regarding equal access to care? How far would you say healthcare inequalities are responsible for the rise in cancer cases across Europe?
One of the big issues in cancer inequalities is mortality rates, and it deserves much more attention. We now see some cancers where we are achieving impressive results, with survival rates of 80% or higher for some cancer types when the cancer is detected before late stage. But for other cancers, there has been remarkably little progress in survival rates. Poor prognosis tumours deserve greater political and research interest, including lung cancer, pancreatic cancer, and ovarian cancer. Amending incentives within the system could, for example, better promote research in those fields.
Regarding the rise in cancer cases, this is closely related to cancer being associated with ageing, and, of course, we have an ageing population across Europe. But other trends are troubling, especially when it comes to known risk factors. Smoking rates in Bulgaria are around 30% of the population, 25% in Greece, versus less than 5% in Sweden. So, we have more cancer cases than we should have because we are not taking enough action on preventable causes. And then we are also seeing some trends that need to be investigated. As one example, many industrialised countries are now seeing a rise in colorectal cancer among young adults. The reasons for this should be investigated at a European and international level as a shared challenge.
The EU has been working to reduce the burden of cancer for decades, most notably in terms of tobacco control and protection from potentially carcinogenic substances. Are there currently any significant fields of risk which could benefit from similar targeted campaigns?
Alcohol consumption is a very significant factor in cancer incidence and yet is not fully understood by the public to be a risk factor in the way that tobacco is understood to be. One of the things that the European Commission is trying to do, but is facing stiff resistance, is to have a requirement for health warnings on the labels of alcohol products. There is a vigorous campaign by the alcohol industry against that, which seems to be having an impact in the European Parliament and elsewhere. This opportunity to improve cancer prevention policy is therefore under threat by producer interests.
Data suggest that 10% of all cancers in men, and 3% of all cancer cases in women, are attributable to alcohol consumption. These are often cancers of the larynx, oesophagus, colon, rectum, liver, and breast cancer for women.
Some studies show that drinking three or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers. There is also evidence that drinking alcohol increases the risk for prostate cancer.
The World Health Organization now says there is no safe level of alcohol consumption. And that can sometimes trigger a very defensive response, not only from the industry but from citizens in general. We are seeing members of the European Parliament complaining that the European way of life is under attack and other extravagant claims. We have a duty, as we have for tobacco, to improve the public’s understanding of the risks of alcohol consumption and to provide people with the facts.
How important is collaboration between services in addressing the threat of cancer? Could health and care providers benefit from more centralised resources and data?
Collaboration between services is of particular importance in many different ways and in many different aspects of cancer care. One example, as people live longer with cancer, we need to improve collaboration between primary and secondary cancer care. Services that can be effectively provided to cancer patients in the home or community setting increase convenience, reduce some of the economic burdens of the disease (such as time required away from work) and can also enable the costs of cancer care to be spent more intelligently. But that requires improvements in the way patient data is shared between health service providers. The European Union is playing an important role, launching several initiatives to improve cross-border sharing of health and research data, and for service provision. Notably, that includes a European Health Data Space, which is currently under consideration by the European Parliament. It is important that any such system, though, has strong governance with the inclusion of healthcare professionals and patients to ensure trust in how the data is being used.
Head of Policy
European Cancer Organisation
This article is from issue 25 of Health Europa Quarterly. Click here to get your free subscription today.