Download 7th ESMO Patient Seminar during the 33rd ESMO Congress´

7th ESMO Patient Seminar during the 33rd ESMO Congress
Saturday, 13 September 2008
Sunday, 14 September2008
the Stockholm International Fairs, Stockholm, Sweden
Cancer treatment in the future: The political perspective
We have gathered here in order to point out at the problem of cancer,
one of the most frequent causes of death in Europe, which can be
prevented. This problem concerns a triangle of people- patients,
professionals and politicians. Individuals, who stand beyond this
triangle, must remain outside. As a professional I know what patients'
needs are, in particular because I pay attention to the newly discovered
technologies and latest developments in the area of health. The results
of the developments in the field of medical science are amazing and
the progress is astonishing. However, the problem is insufficient
application of these modern methods, as they are extremely expensive.
As a politician I know that not everything that is needed can be
delivered. Each government has, besides the Minister for Health also
the Minister of Finance. And I must say, if there is something that a
Minister for Health hates, it's the budget.
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Lack of resources allocated to health is probably the main cause of the
differences in the survival rates for various types of cancer in the EU.
The studies presented on the European level, such as EUROCARE-3
and EHCI, reveal the differences, which, by some diagnosis, decrease
the chance to survive remarkably, up to 27%.
We all know that there is a big gap between the diagnostics, the
treatment and the access to medicines between the old 15 Member
States and the new 12 ones. In some countries cancer patients stand a
lot better chance of survival than in the others. The situation is most
alarming in the new Member States.
Prevalence and survival rates for every type of cancer are lower in
Western Europe compared to the East. If we take a look on the
strategic approach of EU for the period 2008-2013 „The White Book
– Together for Health", we take this fact as unacceptable. The
reduction of inequality in Europe should be proclaimed as one of the
main goals.
This fact reflects EHCI but also the statistics of OECD, where it's
obvious that the best results are reached in the states with better
saturated health service, coming either from the state resources,
insurance companies or private ones.
Cancer is expected to increase to epidemic proportions all across
Europe. But because of increased mobility of many young people
from Eastern Europe to the West, situation in Eastern Europe,
worsened by the process of ageing populations, will be even more
complicated than elsewhere.
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Why is there such a disparity between the Member States? Why, in
the European Union are cancer patients still denied rights that most of
us believe to be fundamental?
It would be worth looking in detail at what accounts for survival
differences. The reasons vary from cancer to cancer. In colorectal
cancers, good quality surgery is known to be critical in avoiding
recurrences.
In
breast
cancer,
expert
surgery,
radiotherapy,
chemotherapy and appropriate drugs all play a role. Catching the
cancer early and getting the diagnostic work-up right are enormously
important. Evidence showing the relative contribution made by each
factor on survival rates would be very helpful for policy makers
deciding where to concentrate their resources. Moreover, the
researchers found that generally in the more prosperous countries of
Northern and Western Europe the trend was downwards for cancer
incidence; the exceptions were for obesity-related cancers such as
colorectal and postmenopausal breast cancer, and for tobacco-related
cancers in women, such as lung cancer.
Incidence and mortality from tobacco-related cancer decreased for
men in Northern, Western and Southern Europe, they increased for
both sexes in Central Europe and for women nearly everywhere in
Europe. With the exception of smoking-related cancers, mortality
trends generally in most cancers were moving downwards for most of
Europe.
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First we should identify countries, which are able to get drugs and
which aren't, which countries are able to give adequate radiotherapy,
chemotherapy and high-quality surgery and which countries aren't.
I mentioned the access to drugs. Despite the proven benefits of new
innovative treatments options, patients across Europe do not have
equality of access to these cancer drugs and the speed at which
patients can benefit from them depends to a great extent upon the
country in which they live.
Nineteen countries, representing almost 75% of Europe's population,
were included in the report 'A pan-European comparison regarding
patient access to cancer drugs'. Austria, Spain, and Switzerland are
shown to be the leaders in terms of early adoption and availability of
new cancer drugs whereas other countries, such as the UK, Czech
Republic, Hungary, Norway, and Poland lag behind.
Patients have to wait too long to obtain the benefits of newer therapies
and the biggest hurdle to the uptake of new drugs is the proactive
allocation of financial resources and budget in the health care systems
by policy and decision makers.
While new therapies generally increase health expenditure, the value
they bring to patients in terms of survival and treating their cancer
must be recognized. Research undertaken in the U.S. by Dr. Frank
Lichtenberg of Columbia University suggests that access to more and
newer cancer drugs improves survival rates.
Over the past 20 years, studies have produced a lot of comparative
data on cancer, but often it has been one-dimensional and fragmented.
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We rarely see the changes in cancer incidence, survival and mortality
discussed in a systematic way for different tumours and in different
countries. For the sake of prevention and organisation of treatment, it
is vital to correctly interpret trends in cancer rates. To identify how to
move further, we have to emerge from the current data, the real
statistics. Allowing national data to be compared with results
elsewhere can be a very powerful driver for change – some countries
have re-organised their entire cancer services prompted by European
comparisons, for example. We all share common health objectives in
Europe – these reflect common values shared throughout the Union.
But everyone has difficulties in achieving those goals.
Providing comparable data and analysis, sharing best practice,
allowing practical cooperation to bring together expertise through
networks of centres of reference, for example – all of these are
actually very important and quite powerful tools.
Furthermore, the number of people surviving longer after a diagnosis
of cancer is increasing constantly in Europe. For people who survived
cancer is from psychological and financial point of view important to
return to their work. When they return, some of them have highly
supportive employers, who help them ease the change from patient
back to employee. Others get back to the routine without any help
from their company or organization. At some workplaces, wrong ideas
and false fears about cancer cause job-related problems that survivors
must overcome. The discrimination is based on false knowledge about
the illness and its treatment. There are various kinds of discrimination,
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but the most used are cutting salaries and financial benefits or
increasing number of refused job applications. Therefore, it is very
important to protect the survivors against this kind of discriminations.
We need to push the employers to accept the new status of employees
and provide them reasonable accommodation such as flexible working
hours, reassignment to the vacant positions or lighter duties. Also for
those, who are unable to work after finishing their treatment we must
provide the sustainable living conditions. These people suffered
enough from atrocity of illness and they don't deserve to be pushed on
the edge of the society.
According to Commission's public health director Andrzej Ryś, the
Commission has also promised to draft a cancer action plan for next
year. There are many expectations for Community action in this area –
we will need to consider how far we can respond within the current
budget, and whether we need to look again at the overall allocation of
funds.
We can hope that also a new Directive on the application of patients'
rights in cross-border healthcare, first presented on 2 July 2008, would
help us to tackle with cancer, especially with the help to patients.
The proposal, once adopted, would give EU citizens the right to seek
non-hospital care, such as dental care, visits to the optician or medical
consultations, in another member state without prior authorisation.
The patient would need to pay for the care first and then seek
reimbursement from his statutory national system. The reimbursement
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will be made for costs of care which, had they been provided on
national territory, would have been paid for by the social security
system.
As for hospital care, which according to the Commission is defined as
requiring at least one night of hospitalization, member states may put
in place a system of prior authorization for reimbursement in two
cases. First, if the care could have been provided and reimbursed in
the home country and second, if the outflow of patients is such that it
puts in risk either the finances of the national social security systems
or the planning of hospital capacity.
In early drafts of the proposal, patients did not need prior
authorization from their national systems either for hospital or nonhospital care. However, the Commission felt that such a proposal
would not gather enough support from the European Parliament or the
Council to be finally adopted.
The draft directive asks member states to establish national contact
points for cross-border healthcare and provide citizens with
information on their right to seek care abroad. It also states that nonnationals enjoy the same rights regarding access to care as nationals
and thus prohibits any discrimination based on nationality or indeed
any other grounds.
Regarding the enhancement of cooperation between EU-27 national
health systems, the draft proposes mutual recognition of prescriptions
issued in another member state and the establishment of European
reference networks of care providers in order to allow access to
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specialised care for all and develop economies of scale. Member states
are also expected to enhance cooperation on eHealth by adopting
measures to make healthcare ICT systems interoperable and share
their efforts regarding the management of new health technologies,
including health technology assessment (HTA).
Overall, the directive is set to clarify the right of patients to seek
health care in another EU country while being reimbursed by their
national system.
I would like to assure you - patients and its organizations, that the
quality of the medical staff is indubitable. Even the current Congress
reflects that doctors are interested in treatment of their patients
according to the latest results of science and technology. That leads us
to another problem of the EU, which is that Europe is investing by
40% less into research and development than the US. Many of the
next generation scientists and doctors are leaving to the US and only a
third out of 400 000 European sciences and technology graduates who
now work in the US intend to return home.
The implementation of demanding high-tech standards depends on the
resources invested into health service and care.
Europe must focus on primary prevention and health promotion,
secondary prevention with proven screening programmes, more
equitable access to optimal treatment and integration of all cancer care
services, and sustained and consistent support for advanced
independent research.
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Agreeing on principles that should be the standard of care, like access
to information, privacy, confidentiality and dignity, access to medical
records, prevention, prior consent to treatment or innovative cancer
care is one thing, but putting those standards into operation is
something else. It is easy to say that everybody should have access to
high-quality care and that treatment must go hand-in-hand with
prevention, but if the infrastructure and resources don't exist, it's very
hard to implement it. We all agree that prevention can save lives but it
requires, besides an investment to technical equipment also an
investment to human factor.
Unless we all become political leaders in the fight against cancer and
demand from our governments to allocate the necessary resources to
it, government priorities will be in a different place. As politicians we
have an important role to play in making Europe’s fight against cancer
more visible, but politicians only put forward the ideas, which are
communicated to them from patients and the public. Politicians,
patient groups and physicians must speak with a united voice.
Fragmented and split approach will not help to achieve sufficient
resources in the fight against cancer.
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