Cancer is the great health challenge of our time; a silent pandemic that, driven by a greater aging of the population, increases its numbers year by year throughout the world. In this context, making progress in improving diagnosis and treatment in Oncology should be a priority for governments. But, as stated in the XI ECO Forum, Organized by the Foundation for Excellence and Quality in Oncology, this advance must be made keeping two concepts in mind: quality and equity. These, as discussed by the experts, must be structured around specific strategies that advance at all levels and estates, and in a coordinated manner.
Europe is already working on it, as stated by the President of the ECO Foundation and Head of the Medical Oncology Service of the University Hospital Complex of Santiago de Compostela, Rafael López. The European Plan against Cancer, EU4Health and Cancer Mission are the three axes on which the European Union currently articulates its efforts in this field. Some initiatives that, as López explained, also identify those inequities and points for improvement.
Proof of this is the European Registry of Inequalities and the Country Cancer Profile 2023, as explained Dolors Montserrat, MEP of the European People’s Party (PPE). Some works that collect the situation of 17 countries analyzing geographical differences, inequalities by age and sex, or socioeconomic factors, as well as the difference in terms of prevention, diagnosis and treatment of cancer. And it is that, as pointed out Christine Redecker, team leader in health in all policies of the European Commissionthere are many differences between states that cover various reasons, such as lifestyles.
In Spain the challenges are clear, and that is how they were put on the table Alfredo Carrato and Jesús García-Foncillas, vice president and director of institutional relations of the ECO Foundation respectively; promoting prevention, education and screening and establishing an early oncological diagnosis is key in cancer. Some aspects that must be addressed from a close perspective and, as pointed out by Natacha Bolaños, manager of Global Alliances at the Lymphoma Coalition, always betting on a greater “co-responsibility” of each individual.
The new technologies
Digitization presents a scenario of great opportunities in the field of oncology. And it is that, as he explained Eloy Gómez, Vice President and Commercial Director of Oncology at GSK Spain, this can help, not only to eliminate bureaucratic barriers, but to improve existing innovative solutions. Data plays a special role here. These, as pointed out Javier de Castro, Head of Medical Oncology at La Paz University Hospital in Madridare essential to demonstrate the benefits and put the evidence of the innovations on the table.
Some data that, thanks to artificial intelligence, as pointed out Mark Lawler, board member of the European Cancer Organization, They can become a valuable tool to develop strategies that help establish greater equity.
These new technologies are precisely essential to move towards personalization in cancer treatment. This is how it was put on the table at the discussion table “Precision medicine and molecular diagnosis in Spain”. Moderated by Ruth Vera, treasurer of the ECO Foundation and head of oncology at the Gregorio Marañón Hospital in Madrid and Jesús García Mata, head of Medical Oncology at the Ourense Hospital Complex and trustee of the foundation, the speakers advanced in the needs that arise in this sense, with the focus placed on the need to share information and data between centers to elaborate a more complete and efficient diagnosis.
Santiago Ramón y Cajal, head of the Pathological Anatomy Service of the Vall de Hebron Hospital in Barcelona, recognizes that a lot of work is being done at the level of the autonomous communities, “but there is a lack of a national strategy.” Thus, he believes it is essential “to establish a public network of digital pathology, in order to improve diagnosis throughout the territory.” Fernando Lopez-Ríos, specialist in pathology at the Hospital 12 de Octubre in Madrid, incorporated a variable: communication. From his point of view, this “is one of the great barriers when talking about Precision Oncology.”
When talking about the personalization of cancer treatments, biomarkers play a fundamental role. The inclusion of these biomarkers in the portfolio of services of the National Health System (SNS) is a pending task, also identified by the European Union. And it is that, as explained Sergio Vázquez, head of the Medical Oncology Service at Hospital Lucus Augusti, is a fundamental aspect when talking about equity in cancer treatment.
In the same sense, he pronounced Henar Hevia, medical director at Janssen, who pointed to the need to “establish a common regulatory framework on pressure medicine”. And it is that, he pointed out, progress will only be made if homogeneous processes are established.
During the conference, the experts also highlighted the challenges that cancer presents in relation to hospital care. Thus, the panel discussion «New models of healthcare organisation», moderated by Vicente Guillem, Director of Institutional Relations of the ECO Foundation and head of the Oncology Unit of the Hospital 9 de Octubre in Valencia, together with Antonio Antón, trustee of the ECO Foundation and head of the Oncology Service of the Miguel Servet Hospital in Zaragoza, they made progress in the deficiencies and areas of improvement in the hospital organization in our country.
Pedro Pérez, patron of ECO and head of the Oncology Service of the San Carlos Clinical Hospital in Madrid, identified the need for “greater involvement from the administration in terms of management”. And it is that, from his point of view, in oncology it is necessary to reconsider the needs with a vision of the future.
The aging of the population makes it necessary, in the words of Ramón Salazar, general director of the Catalan Institute of Oncology, “invest resources in greater prevention because, otherwise, the system is in danger of not being able to offer the necessary assistance to all citizens in the future.” To do this, it would be a priority, he said, to rebuild primary care to ensure that rapid diagnosis works. The review of ratios of health professionals is another aspect to review.
This is precisely a point shared with Ignacio Durán, specialist at the Marqués de Valdecilla Hospital in Santander, for whom human resources are essential. “Establishing specific recruitment programs that can respond to the necessary needs and demands is key.” To do this, it advocates incorporating the doctor in the field of management.
And it is that, until now, as pointed out Mariano Provencio, head of the Medical Oncology Service at Hospital Puerta de Hierro in Madrid and also a patron of Fundación ECO, there is no specific knowledge on the levels of care management. The one who commands, he said, “must know what he commands because, without that knowledge, it is not possible to evaluate, plan or adopt future strategies.”
Avoid duplication
When talking about the challenge of equity in cancer, access to innovative treatments is a critical aspect and Spain does not have a hopeful scenario in this regard. In fact, more than a third (39%) of the oncology drugs approved by the EC between 2017 and 2020 are not financed in our country, as stated in the report “Reflection on the current situation in Spain and possible areas of improvement in the access of patients to oncological innovation”, prepared by the ECO Foundation.
Given these figures, experts call for adopting innovative models that make treatments available to patients who need them. And it is that, today the figures are alarming, as it was revealed Carlos Camps, Director of Scientific Programs at the ECO Foundation. Cancer drugs approved by the European Commission between 2017 and 2020, he recalled, have taken an average of 469 days to be financed in Spain.
Looking at other countries around us can be the solution to these delays. And it is that, as highlighted Iva Krizaic, Manager of IQVIA“innovative contracts used in other countries can speed up access”, focusing on specific strategies such as early access programs for treatments that bring significant improvements.
María Espinosa, pharmacist specializing in Hospital Pharmacy at Hospital Regional Universitario de Málaga and a member of the SEFH Oncology Pharmacy Group (Gedefo), advocates “establishing new processes that do not add more bureaucracy” and, therefore, greater delays.
Prioritizing and defining the criteria for incorporating this innovation are some of the challenges to be addressed. So, Juan Carlos Saorín, Head of Pricing at Rochecalls for “looking at other countries around us”, such as Germany, France or the United Kingdom, where processes are designed to shorten times.
For Javier García del Pozo, Deputy Deputy Director at the General Sub-Directorate of Pharmacy of the Ministry of Health, the key is to “propose how medicines can be accessible while generating evidence.” Thus, he considers it essential that comparisons between countries in terms of access are made with homogeneous criteria.
Avoiding duplication in evaluations is another barrier identified by the experts. And it is that, in our country, he exhibited, Enrique Aranda, Head of the Medical Oncology Service at the Reina Sofía de Córdoba University Hospital and secretary of the ECO Foundation, each community carries out its own evaluation of the drug, which adds time to an already delayed access.
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