This article is part of the Global Policy Lab: Decoding Cancer.
What can we do to solve cancer? Thats the question POLITICOs Global Policy Lab has been exploring since we launched Decoding Cancer in October. Weve traveled around Europe, gathering experts around the table for candid, sometimes contentious policy brainstorms in Germany, France, Romania and Italy. And weve heard from readers of our weekly newsletters, where we discussed the most pressing challenges in research, treatment and long-term care — with a special emphasis on rooting out inequalities across the Continent.
When it comes to the EU, theres no shortage of ambitious talk. “I want Europeans to be the first ones to cure cancer,” declared Manfred Weber, the European Peoples Partys candidate for president of the European Commission. Meanwhile, the EU institutions are haggling over a budget deal that includes a moonshot-style “mission” to fight cancer.
But is “thinking big” the best way to address cancer? Thats not so clear. During the last six months, weve rarely heard experts get excited about moonshots. Whats emerged instead is a series of far simpler, more concrete ideas for tackling a disease expected to kill 1.4 million people in the EU in 2019.
Here are five simple solutions to cancer that came out of this Global Policy Lab:
1. Share data
The problem: Cancer registries are databases of who gets the disease, how theyre treated and what happens to them in the long run. Theyre key to understanding what is happening when it comes to cancer, whos at most risk of the disease and whether people are getting the appropriate treatment. Theyre also the only way we can compare one country to another. Unfortunately, countries, and even regions, collect this data differently, if they do at all. Sometimes, they dont even agree on the definition of a cancer diagnosis.
The solution: Brussels could help everyone get on the same page by coordinating what type of data is collected about cancer and how. That way, different countries registry information could be directly compared. The EU could support regional groups, like the Hungarian Pediatric Tumor Registry, that are trying to catch up, and nudge countries with existing registries to align their data with the new EU standard.
Bonus: Some of the latest cancer breakthroughs are so new that we dont know their long-term effects. Coordinated registries could help track changes for decades, and provide doctors with the latest information as they decide how and whether these new drugs should be used.
2. Cooperate on drug assessments
The problem: Cancer is radically altering the way we test and approve medicines. Therapies that target specific gene mutations usually only help a tiny number of patients. That makes it harder to test their effectiveness compared to other treatments and more difficult to understand how theyll work in the long-run before bringing them to market. A recent study suggested that only 51 percent of the 68 new cancer treatments in Europe between 2009 and 2013 proved to increase survival or quality of life.
New drugs are approved at the EU level, but its left to each country to figure out on their own how well they work, as a precursor to drug pricing negotiations. Many smaller countries say they dont have the expertise or resources to do these scientific evaluations. Depending on whom you ask, this either delays innovations from coming to market or lets ineffective treatments slip through (the reality is probably some combination of the two).
The solution: The EU has been gradually building up collaboration on drug evaluations — a process known by the (atrocious) technical term “health technology assessments,” or HTAs. The European Parliament has passed legislation that would increase cooperation, but it also needs the approval of the EUs national governments, which are bogged down in a debate over process and how to use the end result. The message from small countries is clear: If were going to fight inequalities in access to innovation around the EU, this HTA legislation has to be resurrected after Mays European Parliament election and an agreement quickly put in place.
The bonus: Pharma representatives and policymakers in attendance at our policy brainstorm both pointed to outcome-based payments as an appealing way to deal with uncertainty about new medicines. No ones figured out how to do this well yet, but streamlining how we evaluate drugs is a key prerequisite.
3. Promote specialized centers
The problem: Cancer is less likely to come back when treatment is provided at high-volume, specialized cancer centers. Its not surprising that surgeons with lots of experience with a type of tumor will do a better job than those who dont have as much practice. It also helps when multi-disciplinary teams of oncologists, radiologists, surgeons and other specialists can discuss a patients case and develop a coordinated approach. Yet national and regional health care systems around Europe have struggled to prevent local hospitals from going it alone on cancer care.
The solution: Our policy brainstorms featured calls for health officials to take a hard line. One option would be to withhold reimbursements. “Thats the only thing that a [hospital] administrator will understand,” said one cancer expert who joined us in Italy, where regions have essentially ignored an edict from the national health ministry to stop cancer treatments at hospitals that dont have high numbers of cancer patients. Finland has a novel approach to giving patients in rural areas far from specialized centers an informed choice. Groups of specialists in a particular type of cancer will discuss a patients case remotely, then lay out the ideal treatment approach — a sort of “buyer beware.” The patient can decide if its worth traveling a long distance for the best care. This is combined with strict legal guidelines about cancer care standards, so non-specialist hospitals treat cancer at their own legal risk.
The bonus: Specialized cancer centers are also ideal locations for long-term follow-up clinics, creating an easy transition for survivors of youth cancers who need to monitor the effects of their disease and treatment for the rest of their lives.
4. Focus on diagnosis
The problem: Even with all the new breakthroughs in treatment, early dRead More – Source