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Home » EU Health, Healthcare Policy, Lung Cancer

Experts urge policymakers to start planning for lung cancer screening

Submitted by on 16 Oct 2018 – 13:45

Despite significant advancements in diagnostics and treatments in recent years, major barriers exist in accessing these treatments across Europe. Being conscious that the EU must raise greater awareness of the disparities in lung cancer treatment, the International Centre for Parliamentary Studies recently brought together key stakeholders to review current lung cancer policy in Europe, address hurdles and barriers, identify new research opportunities and promote ambassadorship for lung cancer screening

Lung cancer is the fourth most common cancer in Europe, accounting for approximately 20.8% of all cancer deaths. It remains the leading cause of cancer deaths worldwide, with 376,000 deaths in 2012 in Europe alone. The landscape of lung cancer treatment is rapidly evolving. Over the last decade, great progress was made in expanding the knowledge and understanding of molecular drivers of cancer in order to develop a new era of lung cancer treatments. The introduction of immune therapies to treat lung cancer has changed the face of the disease, extending both durable remissions and prolonging survival.

Despite recent advances in surgery, chemotherapy and radiotherapy, seven out of eight patients die within five years of diagnosis.

Significant barriers in accessing these treatments still exist, in the form of high regulatory hurdles and access for new medicines and diagnosis at a late stage, with five-year survival rates remaining low in Europe. Furthermore, there is a lack of specialised multidisciplinary structures to ensure adequate lung cancer patient care.

Being conscious that the EU must raise greater awareness of the disparities in lung cancer treatment, the International Centre for Parliamentary Studies (ICPS) gathered EU policymakers, medical and clinical professionals, academic experts, healthcare players and patient groups to examine the ongoing challenges of managing lung cancer in Europe.

Chaired by John Bowis OBE, former MEP and Minister of Health (United Kingdom), the Lung Cancer Roundtable 2017 brought together representatives from across 12 European countries to examine a wide range of issues from prevention and screening, need for greater EU collaboration, reimbursement for treatment and data-sharing to patient treatment.

Followed by a series of policy updates from the European Parliament, European Commission and WHO Europe, delegates at the roundtable had a unique opportunity to appraise the efforts of the policymakers and provide solutions to some of the most pressing challenges in managing and treating lung cancer in Europe.

One of the major themes discussed during the day related to the need for an EU-wide population-based screening for lung cancer.

Currently, there are seven trials taking place in Europe, with the largest and most ambitious plan being the Dutch-Belgian Lung Cancer Screening trial NELSON.

Europe’s largest sufficiently powered randomised lung cancer screening trial was designed to determine whether low-dose CT screening reduces lung cancer mortality by ≥25% compared with no screening after 10 years of follow-up.

Whilst several delegates believed that the best way to reduce the high incidence of lung cancer is through primary prevention or targeting tobacco consumption, they unanimously agreed that lung cancer screening within clinical trials or in routine clinical practice is crucial for the future of the prevention of the disease.

However, in order to have optimised population-based screening, delegates raised  a few key questions such as: how can we increase patient involvement? What should be the minimum requirement? How should we target the population? What should be the risk model? Would it ever be possible to share all patient data in Europe? Do we have the human resources to conduct such a study?

Delegates recommended the implementation of a central European registry, including bio and image banks. They all agreed that there are a lot of challenges, but the central problems are the lack of advocacy, funding, human resources and the planning for implementation.

Unequal access to diagnosis and treatments remains one of the crucial hurdles in the European fight against lung cancer. Delegates called on policymakers to implement, as soon as possible, effective and long-term measures to prevent and manage lung cancer in Europe, and table a few significant recommendations to improve management of the killing disease.

1. Europe should implement higher taxes in all countries to avoid cross-border shopping and use the same packaging across the continent. The set of rules should be harmonised to be more effective. Profit from these taxes should then be used to raise awareness about improving treatment modalities.

2. While advanced treatment options such as targeted therapies and immunotherapy are bringing new opportunities to the lung cancer landscape, access to molecular testing and availability of treatment differs in individual member states. We should create a platform to build harmonisation of treatment guidelines.

3. Relative to other cancers, lung cancer is associated with the highest economic costs, accounting for 15% of total cancer care costs. It is followed by breast cancer 12%, and colorectal cancer, 10%. Disparities in access and high costs of innovations should be urgently addressed.

4. There is a crucial need to raise awareness among policymakers about disparities in accessibility to diagnosis and treatment. Policy stakeholders should ensure that lung cancer patients gain timely diagnosis and access to the latest treatments.

5. One of the main reasons for disparities in diagnosis and treatment is due to separate regulatory frameworks to approve diagnosis and treatment. There is an urgent need to harmonise the regulatory pathway for diagnostics and treatment.

6. Radiotherapy remains an effective treatment to prolong the lives of lung cancer patients in Europe, yet there are vast disparities in the use of radiation therapy across the continent. European stakeholders should encourage a policy to increase access to high-quality radiotherapists.

7. Research into lung cancer has increased by just 1.2% since 2004 and the relative commitment to lung cancer research has actually fallen in most countries over the past ten years. There is a crucial need for a rapid increase in funding to address the lack of lung cancer research.

8. A majority of lung cancer research (53%) is focused on medicines, genetics and biomarkers, with just 1% of research going into understanding and improving palliative and support care and quality of life issues. More research should be focused on diagnosis, screening and improving patient care.

9. There’s a clear need for increasing patient awareness about the science behind finding a cure for lung cancer, targeted medicine and advanced therapies.

10. Policymakers should inspire data scientists and medical communities across Europe to use artificial intelligence to improve lung cancer screening technology.

11. It is crucial to understand data’s role in diagnostics and use it in our game. There is a need to explore the opportunities in data, regulate data sharing and streamline the use of unstructured medical data to improve early diagnosis and treatment of lung cancer.

12. Finally, Europe should increase the presence of patient representatives, as new treatment modalities cannot be built without taking into account the requirements of lung cancer patients.

Delegates at Lung Cancer Europe 2017:

Clinical Head pathological anatomy, TOGA – Thoracale Oncologie Groep Antwerpen, Chest Physician/Expert in Diagnostics and treatment of lung cancer, University Medical Center Groningen, Professor, Department of Oncology and Pathology, Karolinska Institutet, Director of Research, Roy Castle Lung Cancer Research Programme, The University of Liverpool, Professor and Chairman – Institute for Pathology, University Hospital Cologne, Physisian & Researcher, Charles University, MEP – EPP (Slovakia), European Parliament, Pulmonologist, CHU UCL Namur, Medical Doctor, Professor of Pneumology, Curie Sorbonne University of Paris VI, Senior Attending Surgeon, University Hospital Zurich, Pathologist, Clinical Centre of Serbia, President, European Society of Thoracic Surgeons, Policy Officer, Tobacco Control Team, European Commission, Expert Tobacco Control, Belgian Foundation against Cancer, Lung Cancer coordinator, H. Clinic; Barcelona University, Chief Thoracic Surgery, H. Clinic; Barcelona University, Chest – Radiologist, University Hospitals Leuven – Radiologye Senior Advisor, World Health Organization Chief Medical Officer, Tesaro, Oncology Medical Director Europe, R&D, AstraZeneca, Government Affairs Senior Manager, Western Europe & Canada, AbbVie, Head of Patient Advocacy and Communications, Takeda Oncology, Global Medical Affairs Lead – Tepotinib & Lung Cancer Portfolio, Merck KGaA