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ESMO Patient Coalition Forum
Prostate Cancer:
Bridging the GAP in Europe
Europa Uomo: Coalition of independent patient led
prostate cancer groups.
Louis Denis
Brussels, 26.11.07
Prostate Cancer: The common problem
Our diversity in identity and culture which we like
to keep in the face of:
rising incidence (age)
outcome variations across Europe
optimal prevention and treatment
holistic patient-centered care
requires collaboration with all stakeholders in a
social health care system.
Europa Uomo, 2007
The Rudy Giulani Statement
Radio ad against universal health care.
“My chances of surviving prostate
cancer in the USA is 82% vs. 44% in the
UK under socialized medicine”
A scare tale that is false (the UK survival is
74.4%) a statistical illusion to be deleted with
the five year survival concept.
P. Krugman, IHTA, 2007
Prostate Cancer: Specific problems
Increasing burden to civil society and patients
numbers.
Uncertainty in optimal medical prevention
and treatment.
Outcome variations in Europe today.
Advocacy in holistic patient-centered care.
Europa Uomo, 2007
Incidence PCA & Bra in 2004-2006
Europe
Men PCa
2004
2006
Women Bra
Inc.
Mortality
Inc.
Mortality
202,1
68,2
275,1
88,4
301,5
67,8
319,9
85,3
Europa 25 * thousands, IARC
Background of this Tsunami
1. Microscopic cancer can be found from age
30 and is present in 50% of all men at age
50.
2. These cancers are indolent (sleeping) but
grow slowly. Detection is possible from
volume 0.2 to 0.5 cc (28 to 29 doublings)
over 20 years. We can detect up to 30% of
cancer.
3. However the PCa incidence is only 10%
with a mortality of 3% after 15 years.
OCA, 2007
Conclusions on Incidence
1. Prostate cancer is a chronic disease in
senior adults (peak inc, mort > 70 y.).
2. In PSA-screened cancers we find 53% of
these small cancers (ERSPC).
3. Overdetection is a fact but overtreatment a
mistake (PRIAS).
OCA, 2007
Uncertainty in Prevention/Treatment
1. Total PSA aspecific & variable
2. Biopsies and pathology difficult.
3. Choice primary treatment (Active
Surveillance)
4. Hormonal treatment (Watchful Waiting)
OCA, 2007
The Physician before Uncertainty
Cause:
Limitations in medical and/or
personal knowledge
Reaction: Retracts in personal discipline/
show of self-assurance
Solution: Reflect – Respect Others –
Communication
J. Groopman, How Doctors Think, 2007
The lost patient
Tsunami information
(Professionals, media, friends)
Outcome results
Statistics
PANIC
Loss of personality
The medical
labyrinth
EBM Guidelines
Nomograms
OCA, 2007
The Europa Uomo Strategy 1
Partnership with professional organisations:
1. Request for update on all aspects of prostate
cancer
European Association of Urology (EAU)
European Society of Medical Oncology (ESMO)
European Cancer Organisation (ECCO)
2. Support multiprofessional treatment
3. Open communication & collaboration
Europa Uomo, 2007
Example EAU – EU Collaboration
Key topics Prostate Awareness day 2007
1. BPH symptoms not related to cancer.
2. Early detection with PSA but rather PSA
kinetics as tools to identify risk.
3. These cancers do not always need treatment
(Active Surveillance)
4. Hormonal therapy impacts quality of life but
side-effects can be reduced.
EAU, 2007
Aims Europa Uomo on optimal
Prevention/Treatment
1. Develop individualized treatment based on
state of the art principles and personalized
patient care.
2. Help reduce overtreatment of prostate
cancer.
Europa Uomo, 2007
Outcome variations in Europe today
Need for appropriate, validated and
understandable information/communication
Appropriate = useful
Validated = objective
Understandable = direct
Europa Uomo, 2007
GAP TRUTH versus REALITY
Knowledge
Prevention
‘The
growing
gap’
Rich
Decision-sharing
Transparency
Real care
Treatment
Poor
Olympic Proposals
Neglect
OCA, 2007
Europa Uomo Strategy 2
Collaboration with European School of
Oncology (ESO) on:
Information
Communication
Education
Website Cancerworld.org online
Advocacy in holistic Patient Care
Europa Uomo Strategy 3
1. Personal physician “trust”
Privacy, Confidentiality, Dignity
Onco-psychology, social support
2. Collaboration Europa Donna
We go for an unisono advocacy under the
European Cancer Patient Coalition (ECPC).
Europa Uomo, 2007
Europa Uomo
Glosing the Gap Strategy
1. Partnership with professional
organisations (EAU, ESMO, ECCO).
2. Collaboration on information,
communication, education (ESO &
Cancerworld).
3. Unisono advocacy (ECPC, Europa
Donna).
Thank you for caring.
22.11.07