How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?

Denis Horgan; Anne Marie Baird; Mark Middleton; Zhasmina Mihaylova; Jan P. Van Meerbeeck; Jens Vogel-Claussen; Paul E. Van Schil; Josep Malvehy; Paolo Antonio Ascierto; France Dube; Michael Zaiac; Jonathan A. Lal; Grażyna Kamińska-Winciorek; Marco Donia; Thierry André; Marta Kozaric; Pia Osterlund; Dan Lucian Dumitrascu; Luca Bertolaccini

doi:10.3390/healthcare10091618

How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?

Denis Horgan, Anne Marie Baird, Mark Middleton, Zhasmina Mihaylova, Jan P. Van Meerbeeck, Jens Vogel-Claussen, Paul E. Van Schil, Josep Malvehy, Paolo Antonio Ascierto, France Dube, Michael Zaiac, Jonathan A. Lal, Grażyna Kamińska-Winciorek, Marco Donia, Thierry André, Marta Kozaric, Pia Osterlund, Dan Lucian Dumitrascu, Luca Bertolaccini

Department of Oncology

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Cancer is the second leading cause of mortality in EU countries, and the needs to tackle cancer are obvious. New scientific understanding, techniques and methodologies are opening up horizons for significant improvements in diagnosis and care. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. This paper, mainly based on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM), looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology and the wide disparities in health systems. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing broader and more equal access to the best available care for all European citizens.

Original language	English
Article number	1618
Number of pages	21
Journal	Healthcare (Switzerland)
Volume	10
Issue number	9
DOIs	https://doi.org/10.3390/healthcare10091618
Publication status	Published - Aug 2022
Publication type	A1 Journal article-refereed

Keywords

access
cancer
citizens
EU Beating Cancer Plan, EBCP
healthcare
molecular diagnostics
patient
personalised medicine
policy framework
reimbursement
screening
treatment
unmet medical need

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Leadership and Management
Health Policy
Health Informatics
Health Information Management

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3390/healthcare10091618Licence: CC BY

healthcare-10-01618-2Final published version, 300 KBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202212139100Licence: CC BY

Cite this

Horgan, D., Baird, A. M., Middleton, M., Mihaylova, Z., Van Meerbeeck, J. P., Vogel-Claussen, J., Van Schil, P. E., Malvehy, J., Ascierto, P. A., Dube, F., Zaiac, M., Lal, J. A., Kamińska-Winciorek, G., Donia, M., André, T., Kozaric, M., Osterlund, P., Dumitrascu, D. L., & Bertolaccini, L. (2022). How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma? Healthcare (Switzerland), 10(9), [1618]. https://doi.org/10.3390/healthcare10091618

@article{496adee5d5c447a0938a002f1f9c2434,

title = "How Can the EU Beating Cancer Plan Help in Tackling Lung Cancer, Colorectal Cancer, Breast Cancer and Melanoma?",

abstract = "Cancer is the second leading cause of mortality in EU countries, and the needs to tackle cancer are obvious. New scientific understanding, techniques and methodologies are opening up horizons for significant improvements in diagnosis and care. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. This paper, mainly based on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM), looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology and the wide disparities in health systems. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing broader and more equal access to the best available care for all European citizens.",

keywords = "access, cancer, citizens, EU Beating Cancer Plan, EBCP, healthcare, molecular diagnostics, patient, personalised medicine, policy framework, reimbursement, screening, treatment, unmet medical need",

author = "Denis Horgan and Baird, {Anne Marie} and Mark Middleton and Zhasmina Mihaylova and {Van Meerbeeck}, {Jan P.} and Jens Vogel-Claussen and {Van Schil}, {Paul E.} and Josep Malvehy and Ascierto, {Paolo Antonio} and France Dube and Michael Zaiac and Lal, {Jonathan A.} and Gra{\.z}yna Kami{\'n}ska-Winciorek and Marco Donia and Thierry Andr{\'e} and Marta Kozaric and Pia Osterlund and Dumitrascu, {Dan Lucian} and Luca Bertolaccini",

note = "Funding Information: The needs for tackling cancer are obvious—and Europe{\textquoteright}s Beating Cancer Plan (EBCP) can certainly contribute to solutions, with its funding of more than EUR 4bn [1] and pathways to additional financing via EU programs on research and on regional and recovery funding. There is no question of the volume and gravity of the needs. Cancer is the second leading cause of mortality in EU countries after cardiovascular diseases [2]. Every year, around 2.6 million people are diagnosed with the disease, and it kills another 1.2 million people [3]. The overall economic burden of cancer in Europe is estimated at more than EUR 100 billion annually. In addition to putting pressure on individuals, national health and social care systems and state budgets, this disease also affects productivity and economic growth [3,4]. New scientific understanding and new techniques and methodologies are opening up horizons for great improvements in diagnosis and care [5]. However, take-up is uneven, research needs and potential outstrip currently available resources, manifestly beneficial practices—such as population-level screening for lung cancer—are still not generalised, and the quality of life of patients and survivors is only beginning to be given attention it merits. The EU can help the Member States in need of evidence-based policy making to ensure that all EU citizens have equal access to high-quality cancer prevention, screening, diagnostics, treatment, and aftercare. Nevertheless, cancer is not just one disease [6], and different forms of cancer present different challenges, which should be taken into account in any policy discussion. Over and above the general actions that can help in the overall combat against cancer, there are particular needs within specific types of cancer [7]. This paper looks at some of those specifics in the interest of planning a way forward. Part of this exercise also involves taking account of the specific nature of Europe and its constituent countries, where the complexities of planning a way forward are redoubled by the wide variations in national and regional approaches to cancer, local epidemiology, and the wide disparities in health systems, on which much improvement depends—including notably the supply-side considerations of resources and expertise for testing, treatment, reimbursement, or infrastructure and the demand-side considerations of incidence, take-up and awareness. This conundrum is the rationale for this paper, based largely on a series of multistakeholder expert workshops organised by the European Alliance for Personalised Medicine (EAPM) earlier in 2022 and examining the possibilities for mobilisation of common efforts to identify gaps and promote improvements across the cancer field, with particular attention to lung cancer, breast cancer, colorectal cancer and malignant melanoma (MM). The time is right to develop cooperation via the EBCP, Horizon Europe, and other EU policy instruments, in synergy with the Member States, regions, and cities, and with foundations, civil society and industry. This could ensure maximum benefit from the available resources, in terms of EU funding from Horizon Europe for Research and Development (R&D) actions, deployment through other Multiannual Financial Framework (MFF) instruments, national/regional financial support, and the de-risking of private investments. In commercial settings, we often see companies that are more operationally efficient acquiring other companies of at least similar or bigger size to improve their operating ratio and hence improve the company performance. This exchange of efficiency, also called bootstrapping, could be one of the major remits of the EBCP. Despite all the differences between cancers and national and regional resources and approaches to cancer care, there is a common objective in pursuing wider and more equal access to the best available care for all European citizens. However, the big challenge that is still present for patients with cancer is the equity of access to screening and therapeutic innovations [8]. Furthermore, much of the mechanisms to achieve this require national as much as—or more than—EU action. Archetypically, even though marketing authorisation in Europe is a centralised process through the European Medicines Agency (EMA), the reimbursement process of innovative therapeutics still occurs at a national level [9]. The job of Europe in much of this is to promote collaboration, demonstrate best practices, encourage improvements and leverage learning out of the recent pandemic. The EBCP aims to ensure that 90% of the eligible EU population are offered screening and, more importantly, that citizens respond to screening for breast, cervical and colorectal cancer by 2025 [10,11]—an admirable objective. Early detection through screening can help save lives, but meeting that goal depends on national action, as screening programmes are set up and run by the member states. Screening has a big role to play in other cancers, too—not least lung and melanoma, as detailed below. However, performance here is a clear example of where the action is needed because inequalities to access persist among the Member States. The number of at-risk people being tested varies among the Member States, ranging (for cervical cancer, for instance) from 25% to 80%, as a function of national priorities, resources and commitment [12]. There are significant inequalities among the population within the countries of the European Union in the areas of early detection, diagnosis, treatment and quality of patient care. A proactive approach is essential to make cancer treatment as successful as possible, with as few side effects as possible, and to ensure long-term survival. However, as detection methods become more sensitive, it can be difficult to distinguish insignificant changes from lesions that will lead to life-threatening cancer. Family history and screening for variants such as BRCA1, BRCA2 and CDH1, are currently used to identify individuals at high risk of cancer development. However, recent advances in the epidemiology and genetics of cancer and the routine availability of relevant information through electronic health records mean that for several cancers, it is now possible to use multifactor assessment to provide a more personalized cancer risk for all individuals. After the individual{\textquoteright}s risk profile is identified, it can be offered either a specific test for a particular type of cancer or a broader test to look for signals for multiple cancers. Blood sampling provides an alternative approach to proximal sampling directly from or near relevant tissue. An ideal solution would be a single early detection cancer test for multiple cancers, for example, in body fluids such as blood, which could be performed on anyone over a certain age at regular intervals. Such a test should be sensitive enough to detect cancer at an early stage and specific enough to minimize false positive results and determine the likely site in the body. The main limitation of the current biopsy approach is that the number of genes that recurrently mutate in cancer is very low. Another issue is how to know how many markers are needed to detect cancer at an early stage. The authors estimated that an analysis of 500 cancer-specific markers would be required to achieve a similar level of susceptibility in other solid tumors as was shown in the detection of Epstein-Barr Virus DNA in Nasopharyngeal Carcinoma. Some of the other innovative technologies that can be used for early cancer detection are nano tools, new optical modalities for medical imaging, ultrasound imaging for affordable cancer diagnosis, optical imaging and photoacoustic tomography. Future approaches should aim to establish methods for enrichment and easier detection of ctDNA and circulating cancer cells in plasma or urine. By combining more data from clinical data examinations, simple laboratory tests, genomes, proteomes and metabolites screening, intelligent algorithms will be needed to put reasonable numbers into data, find patterns that elude the human eye, and even identify new biomarkers. Since pioneering work on the classification of skin cancer and lung cancer, numerous papers and opinions have explored the benefits and challenges of using artificial intelligence (AI) in the early detection of cancer. It is necessary to ensure that the AI is connected to user-friendly software and to address the incentives and barriers to adopting the AI from patients and clinicians. AI will not eliminate the need for doctors and experts to interpret the findings but will cut the cost and time required to diagnose the disease and will consequently allow doctors to spend more time developing effective and holistic treatment protocols [1,3,13]. Funding Information: Conflicts of Interest: Paolo A. Asciero has/had the following conflict of interest not related to the work under consideration: consultant/advisory role for Bristol Myers Squibb, Roche Genentech, Merck-Sharp & Dohme, Novartis, Merck Serono, Pierre-Fabre, Astra Zeneca, Sun Pharma, Sanofi, Idera, Sandoz, Immunocore, 4SC, Italfarmaco, Nektar, Boehringer-Ingelheim, Eisai, Regeneron, Daiichi Sankyo, Pfizer, Oncosec, Nouscom, Lunaphore, Seagen, iTeos, Medicenna, Bio-Al Health, ValoTX. He also received research funding from Bristol Myers Squibb, Roche Genentech, Pfizer, Sanofi. Travel support by Pfizer. Thierry Andre declared honoraria/consulting or advisory role from Amgen, Astellas Pharma, AstraZeneca, Bristol Myers Squibb, Chugai, Clovis, Gritstone Oncology, GlaxoSmithKline, Haliodx, Kaleido Biosciences, Merck&Co., Inc., Pierre Fabre, Roche/Ventana, Sanofi, Seagen, Servier; travel, accommodations, expenses-MSD Oncology, BMS; Jens Vogel-Claussen has/had the following conflict of interest not related to the work under consideration: research funding/honoraria/consulting or advisory role from Federal Ministry of Education and Research, Siemens Healthineers, Novartis, Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline. Anne-Marie Baird is the President of Lung Cancer Europe (LuCE). This is an unpaid volunteer role. LuCE has received funding from Amgen, Astra Zeneca, Bayer, Blueprint Medicines, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi-Sankyo, Lilly, Merck, MSD, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Janssen, Novocure, ThermoFisher. Josep Malvehy declares fees for advisory boards, lectures in symposia and research grants from Almirall, BMS, Sunpharma, Pierre Fabre, Amgen, Castle bioscience, AMLO bioscience, ISDIN, Roche Posay. Marco Donia has received in the past three years honoraria for lectures from Roche and Novartis, access to online conference material from Merck Sharp Dome, access to proprietary data from Bristol Myers Squibb and Genentech and advisory fee from Achilles Therapeutics. Paul Van Schill: external expert and advisory board AstraZeneca, Janssen, MSD, Roche; treasurer BACTS (Belgian Association for Cardiothoracic Surgery); president-elect IASLC (International Association for the Study of Lung Cancer). France Dube is an employee of Astra Zeneca. Grazyna Kaminska-Winciorek has/had the following conflict of interest not related to the work under consideration: consultant/advisory role for MSD, Takeda; Travel support by Pierre Fabre, Roche, Bristol Myers Squibb; Speaker{\textquoteright}s honoraria: Pierre Fabre, Novartis, Sanofi, Amgen, MSD, Takeda. Michael Zaiac is an employee of Novartis pharmaceuticals. D.H. and M.K. are employees of the European Alliance for Personalised Medicine, which receives funding from both the public and private sectors. Publisher Copyright: {\textcopyright} 2022 by the authors.",

year = "2022",

month = aug,

doi = "10.3390/healthcare10091618",

language = "English",

volume = "10",