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

A radical vision to beat prostate cancer in Europe

Submitted by on 14 Jul 2017 – 09:30

An increasing trend in the incidence of prostate cancer (PCa) has been observed in almost all European countries over the last few decades. There are no population-based, organised programmes for PCa in Europe as existing detection tests do not meet the criteria for screening. Men with suspected low-grade disease are often offered Active Surveillance (AS), however progress to treatment happens only when their biopsy results show the cancer has become more aggressive. There’s new evidence every day of next-generation cancer drugs extending survival while maintaining the quality of life of cancer survivors. Promising new therapies have arrived at the market, yet what explains the gaps in patient access? Diane Rolland, International Program Manager, International Center for Parliamentary Studies discusses several important points to be raised concerning prostate cancer management and control for the future.

Addressing some of these pressing gaps within prostate cancer policy making in Europe, the International Centre for Parliamentary Studies convened the 7th edition of the EU Prostate Cancer Roundtable in Brussels in January 2017. Chaired by John Bowis OBE, Former Member of Parliament and Minister of Health (United Kingdom), it brought together Members of the European Parliament, Representatives from the European Commission, top medical and clinical professionals in the fields of urology, oncology and radiology, academic experts and patient groups. The objective of this meeting was to examine current policy guidelines and strategies on managing more effectively prostate cancer within the European member states and to arrive at a shared set of policy priorities that affect the prevention, detection of risk, diagnosis, and management of prostate cancer – the most common cancer in men.

The informal group of healthcare policy makers and stakeholders from the industry developed a series of proposed changes in prostate cancer policy making to be considered by the decision makers in Brussels. While not thoroughly exhaustive, they are key orientations to support policy making.

Followed by a re-cap of the key policy recommendations presented during an earlier chapter of the EU Prostate Cancer Roundtable and the consequential changes over the year, this year’s discussion was commenced with a launch of the European Association of Urology’s White Paper on Prostate Cancer. Translated in 50 languages, the 22-page White Paper is a set of recommendations and evidence-based guidelines for urological specialists, creating support for patient advocates and facilitating active collaboration with other medical disciplines to lower the risk and mortality rate of this most frequent cancer in men.

What should the EU do differently with prostate cancer?

Besides discussing the need for EU-wide screening, improved accuracy, the rate of awareness of existing treatment guidelines, treatment inequalities, the policy makers present at the roundtable discussed the role of personalised medicine, the use of intelligent surgical assistance systems and the need for technologies to support patients and reduce appointments through e-health and m-health.

Discussing the value of robotic surgery in prostate cancer treatment, surgeons agreed that it helped in improving recovery and the quality of lives, however they raised an issue relating to costs and treatment disparities.  An issue was raised about the costs involved and again, the disparities between health insurances and reimbursement and accessibility between countries. While surgeons started using machines only in 2000, there is still no evidence whether robotic assisted surgery is better than other types of surgery, whether it is cost effective or if it is making the surgeon better. At the moment, the European Commission is funding a trial aiming for patients to use their mobile phone to receive information about their treatments.

Though significant advances have been made in the EU fight against cancer, more remains to be done. In December 2003, health ministers collectively adopted the European Council Recommendation on cancer screening to implement a national population-based screening for different types of cancers including breast and colorectal.

Participants in this year’s roundtable unanimously agreed that such similarities with other cancers should be used in discovering how we can broaden it to PCa screenings. In the same vein as other cancers, national screening programmes should be implemented with suitable standards for prostate cancer.

Prostate cancer is a considerable healthcare problem that would benefit from a uniform EU-wide risk adapted early detection programme. Current estimates show that 1 in 7 men in Europe will develop detectable prostate cancer before the age of 85. Incidence rates across European countries vary in unexpected rates, with the variation attributed to an unequally implemented detection programme.

There was also a general agreement that eradicating the stigma surrounding prostate cancer could play an integral role in reducing the number of men who are killed by the disease. Delegates agreed that we should help them identify symptoms, speak about the health of their prostate, and eventually help them take control of their health.

Key recommendations for better policy making:

At a time when cancer survival, including that of prostate cancer, is increasing, it is important to recalibrate our goals and develop a strategy that leads to the cure of prostate cancer. The recommendations listed below have been arrived at through focused discussions and proposals from all stakeholders present at the 7th edition of the EU Prostate Cancer Roundtable:

• The EU needs to support initiatives to tackle prostate cancer in the same way as it does with other cancers;

• Better assessment of other therapies: robotics, radiotherapy, brachytherapy, surgical techniques should be made;

• There is a need for a more objective look at the cost of the diverse treatments for prostate cancer and reflection of cost-effectiveness when comparing the accessible modalities;

• Brachytherapy facilities should be provided in a uniform manner across Europe so that all potential patients can have access to it;

• We have to bridge the training and guideline gap between experts and primary physicians;

• Timely treatment access: It is crucial to treat the patient according to their individual health status and not according to their numerical age;

• The EU should implement appropriate pricing and reimbursement across the continent;

• Reference centres are vital from a treatment and diagnostic perspective and must have sufficient clinical capacity in experts;

• Advanced and metastatic disease and treatments: multidisciplinary approach is required to improve the patient’s quality of life;

• PSA tests should be reimbursed for patients across Europe and we should encourage GPs to learn how to interpret them;

• There has to be a more efficient use of palliative care to improve the quality of life of patients and families;

• There has to be a uniformity in manpower and infrastructure in all areas of the diagnostic pathway across Europe;

• Pharmaceuticals should better identify sub sets of patients for each treatment modality, and not market it to everyone at great expense to public purse. There needs to be better agreement between them and clinicians;

• The research on eHealth possibilities should be increased in order to create more economic means of diagnosis;

• Practitioners should discuss how to address the late effects of therapy, second disorders and psychological effects before discharge;

• Prostate cancer treatments cannot be viewed in isolation from healthcare systems. As demand on the latter is likely to go up considerably faster than the level of investment into healthcare systems, getting more for less will become vital.

 

Participants at the Roundtable included:

Associate Professor, Physician, Aalborg University Hospital, Radiation Oncologist, Academic Medical Center, Vice Chairman, Association Nationale des Malades du Cancer de la Prostate (ANAMACaP), Bayer, Regional Market Access, Secretary General and Head Of The Department – Uro Oncology, Oncology, Belgian Association of Urology, Chief Executive Officer, Chronix Biomedical, Chief Medical Officer, Chronix Biomedical, MD Professor, Copenhagen University Hospital, Chairman, Eberhard Karls University, Vice-President Medical Affairs, Elekta, Radiologist, Erasmus University Medical Center Rotterdam, Chairman, Europa Uomo, President, Europa Uomo Switzerland, Director, European Cancer Patient Coalition, Policy Officer, European Parliament, Scientific and Policy Officer in charge of cancer research, European Commission, Executive Vice President, Exact Imaging, Business Lead, Ireland & EMEA Prostate Marketing Manager, Genomic Health, International Reimbursement and Market Access Manager, Genomic Health, Government Affairs, Janssen, Clinical Oncology, Janssen, Urologist, St. Antonius-Hospital, Medical Researcher, Kom op tegen Kanker – Fight against Cancer, Radiation Oncologist, Mater Private Hospital of Dublin, Director, National Cancer Institute Vilnius, Head of Centre, Coordinator of JA Cancon, National Institute of Public Health, Director, NHS European Office, PhD Student, Norwegian University of Science and Technology – NTNU, Oslo University Hospital, Member of the Executive Committee, Società Italiana di Urologia – SIU, EAU Adjunct Secretary General – Education, University Hospitals of the KU Leuven, Medical Professor, University of Bonn (UKB), Consultant, Wales Cancer Network, Technical Officer, World Health Organisation.

The next edition of the Prostate Cancer Roundtable will be taking place in 2018. If you wish to attend, please contact information@parlicentre.org