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Home » EU Health, Health, Healthcare Policy, Prostate Cancer

POLICY PRESCRIPTIONS: Fixing diagnosis and treatment of prostate cancer

Submitted by on 30 Sep 2015 – 09:00

Prostate Cancer (PCa) is one of the most urgent medical problems in adult males and is the most widespread and third deadliest cancer for men in the European Union. It is very well known that more men die with PCa than from PCa. However, from early diagnosis and screening to managing the disease, a lot remains to be done across the wider European region. In June this year, the International Centre for Parliamentary Studies (ICPS) brought together the key stakeholders in the field to address this burning health priority. Arvind Venkataramana, Research Director at ICPS analyses some of the policy recommendations initiated at the roundtable

20150623_113516Accompanying Europe in a fight to help more men survive prostate cancer and enjoy a better quality of life, the International Centre for Parliamentary Studies hosted a one-day Roundtable on Prostate Cancer on the 23rd of June this year in Brussels. Representatives from the European Comission, members of the MEPs against Cancer (MAC) European Interest Group, Europe’s most respected clinicians in the fields of urology, oncology and radiology, patient groups came together to discuss the screening, effective treatment and care for prostate cancer within the European member states.

The objective of the meeting was to build a consensus and put forward recommendations to key policy makers and governments in the European Union. Policy aside, this meeting also addressed current operational challenges, new technologies and procedures, changes in the regulatory frameworks in different countries and other key developments.
Solving the data crisis

The discussion centred around the lack of adequate data on the number and types of cases recorded in the EU. Although individual countries and their healthcare departments have their own records of patient registrations, there is currently no EU-led registration process in place. It is worth noting that the European Commission has recognised the question of lack of data exchange between countries. It is currently working to put a system in place to tackle it. All participants stressed the importance of generating and sharing good quality data when making future policy decisions on the subject.

Mortality statistics, for example, need to be readdressed, as prostate cancer is stated as the cause of death in many cases where the deceased has suffered from it but has died from other related diseases. Sweden and other Scandinavian countries were mentioned as good examples of accurate registrations and the EU should look to roll them out across the region. Some participants even pointed out the need for patients, and not just clinicians, to be a part of this registration process.

Another issue flagged within the roundtable was to do with linking data across different countries and the challenge it presents when mental health conditions are not explicitly stated in health reports. Again, policy makers need to put procedures in place to overcome this challenge.

Calling for a policy on screening

The discussion then shifted to the challenges of screening, detection, diagnosis and treatment. The general consensus amongst all participants was that more needs to be done to ensure that screening is available for everyone and not just high risk individuals.

As it stands, it focuses too strongly on age but it has to have a population-wide screening approach. New survey methods have also to be looked into by policy makers. The reason screening is critical is because it helps in early detection. Once the cancer has been detected, the focus can then shift to treatment. Efforts can then be directed towards containment and preventing it from causing other diseases. Policy around screening needs to be reassessed as recent studies have shown that prostate cancer leads to other potentially terminal diseases and lack of adequate screening has increased instances of this happening.

Self screening was suggested as an option for low and high risk individuals

However, it was noted that without the presence of a doctor or nurse, false-positive results could lead to unnecessary worry in the self screening method. There was a mixed response towards self screening techniques. Certain participants felt high risk patients should always consult with their General Practitioner (GP) while low risk patients should use self screening methods to start with but any anomalies should always be reported to their GPs. On the other hand, some other participants felt self screening could reduce the number of GP visits if all patients used a thorough and efficient tool.

From a treatment point of view there were varying views on approaches to contain as well as eliminate cancer cells in the body. Chemotherapy was one such option. Clinicians in the room stressed that chemotherapy was the only option when tackling cancel cells that turn aggressive. They further reiterated that there should be more EU funded research projects that look into other forms of chemotherapy with fewer side effects.

Fixing treatment protocols

EU policy makers need to look into and keep up to date with important technological and clinical developments and advancements to ensure patients get the best care.

For example, Biopsies have long been the only option for accurate prostate cancer screening. However, there should be more research conducted into reducing its side effects and exploring other screening techniques that are more holistic. Some participants shared some research they were undertaking across diverse population and ethnic groups in the development of new vaccines. Again, the discussion moved to the topic of funding and financing research projects. Others talked about gene therapy and its role in treating prostate cancer in advanced stages.

The controversial topic of robotics was discussed in great detail. It was acknowledged that although robotics can help attend to more patients, is an effective surgical tool and can be used for complex procedures, there are certain shortfalls that need to be addressed. These include cost of procurement and installation, increased recovery times and general distrust among patients.

E-health and telemedicine was also put forward as a means to supplement self screening

It has been very successful in parts of Africa and Asia among low income groups and it was suggested the EU should do more to tap into this resource. A team of multi-disciplinary experts need to help present a case to governments and clinicians on how to get the most of e-health and telemedicine.
Cutting edge drugs need to be recommended by academics and physicians to the European Medical Association (EMA) for approval. This process needs to be speeded up once all testing phases and trials have shown positive results.

Other topics discussed included the role of care and care workers in helping patients recover. Interestingly, a majority felt an area that was often ignored was staff training. This includes care workers as well as staff who operated screening and other machinery. The clinicians felt staff need to be able to assure patients of the safety and reliability of these machines when they are sent to them. Nurses should also receive specialised training when dealing with patients of Prostate Cancer.

More importantly, the EU currently has a shortage of radiologists and urologists which needs to be addressed

On a more personal level, the group discussed the mental and emotional impact of prostate cancer on patients and their families. Some in the group even shared their own personal experiences on the challenges in coping with it. Hospitals need to be better prepared to provide emotional support to patients and their families. This also means patients should be provided with all options of treatment and allowed to make the final decision. The topic of prevention was a popular one and there was general agreement that education was key.

The EU should do more to not just educate high risk individuals but also support programmes to educate schools and younger sections of the population. Homosexual, bisexual and transsexual individuals are at a higher risk of contracting prostate cancer so separate campaigns to address different demographies should be put in place.

The following key recommendations were proposed at the end of the roundtable:

- Early detection systems and processes need to be put in place to identify high risk cases as soon as possible so more can be done to prevent the disease from spreading
- The EU should put together an expert panel to advise policy makers on key developments in the area
- Policy around patient representation needs to be made watertight
- Screening should be an on-going process for over 60 year olds, as against a one time exercise and the EU needs to put processes in place to encourage high risk individuals to get tested more often
- There needs to be in place better collaboration between countries until an EU wide registration process is introduced
- The EU needs to look at new drugs that have recently cleared trials and test and should approve them as soon s possible
- Funding for further research should be looked into as a matter or urgency as there is a clear shortage in this area across the region
- Patient experience should be more holistic and should include post-treatment, family counselling and support
- Specialist training for nurses and GPs in prostate cancer should be improved
- We should take an unbiased look at new technologies and upcoming research for detection and ultimate cure.

The roundtable was then wound up with closing comments from the chair. The parting shot came from one surgeon who said that prolonging a patient’s life isn’t the cure to prostate cancer, we have to do more to eradicate it from his/her system completely

Participants of the roundtable included:

Chief Technology Officer, Chronix Biomedical, Chief Executive Officer/Chief Science Officer and Co-Founder, Chronix Biomedical, Director, National Cancer Control Programme (Republic of Ireland), MD-DG, European Commission / European Network of Cancer Registries (ENCR), Head of Department of Urology, Erasmus Medical Center, Board Member, President, European Association Predictive, Prevented and Personalised Medicine, European Prostate Cancer Coalition, Member of European Parliament (Romania), Member of European Parliament (Slovakia), Member of European Parliament (United Kingdom) and MAC Vice President, President, European Medical Association, MD, DG, Joint research Centre (JRC) – Institute for Health and Consumer Protection Public Health Policy Support, European Commission, Honorary Chairman, Department of Urology and Editor, ErasmeHospital, Chief Medical Officer Oncology, GE Healthcare, International Product Manager, Hitachi Medical Systems, Chair, PCa 2015 Roundtable, International Centre for Parliamentary Studies, Deputy Director General, Norwegian Cancer Society, Radiation-Oncology, Institut Jules Bordet, Chairman/Vice Chairman/Trustee, Leighton Hospital Prostate Cancer Support Ground/PCS North-West/Prostate Cancer Federation – TACKLE, Director Medical Affairs, Myriad Genetics, Director, National Cancer Control Programme (Republic of Ireland), Deputy Director General, Norwegian Cancer Society, Sana Klinikum Offenbach, Medical Director Oncology, Sanofi Oncology, Commercial Lead, Sanofi Oncology, Professor, Radiation Oncology, Chairman, The Out with Prostate Cancer Support Group, Director of Health Science Innovation and Enterprise, University of Surrey UK, Board member, University Hospital Gasthuisberg, Katholieke Universiteit (KU) Leuven / European Association of Urology (EAU), Consultant, Clinical Oncologist, University Hospital Birmingham.

The next edition of the prostate cancer roundtable will take place on January 26, 2016. If you wish to attend, please contact arvind.v@parlicentre.org