Lung cancer screening is ready to rescue thousands from death: Can the EU take action?

Welcome, health colleagues, welcome one and all to the European Alliance for Personalised Medicine (EAPM) update – in the midst of all the bad news that humanity has had to suffer during the past year now, at least, there is a chance for some good news. As of today, 3 February, the European Commission is formally launching the Europe Beating Cancer Plan, with World Cancer Day tomorrow. Taking into account the week, EAPM has a busy time ahead with an event today relating to serological testing from 9h30–11h CET and the release in the coming week of a country fact-sheet that provides a state of play of tackling lung cancer at a country level. The aim here is to spur concrete implementation of actions to tackle cancer at a country level, writes EAPM Executive Director Dr. Denis Horgan. 

Fact-sheets frenzy 

As you would expect, EAPM will be involved from the bottom up – the Alliance will be launching 15 fact sheets related to the biggie, lung cancer, which has the continent and world’s highest mortality rate in the next few weeks. The plan will be unveiled around noon today in a press conference with Health Commissioner Stella Kyriakides and Commission Vice President Margaritis Schinas. The ambition is to create a linked-up EU strategy to tackle the disease, and our update below provides rationale why there should be a focus on lung cancer.

In our engagement with expert groups on lung cancer over the past six months, this has represented pathologists, lung specialists, the regulatory field, health systems, industry representatives and patient perspectives. Experts were from Slovenia, Greece, Portugal, Germany, Denmark, Italy, Belgium, Netherlands, Switzerland, Sweden, Poland, Bulgaria, Czech Republic, Croatia, Israel and Spain.

But before I go into lung cancer, let me give a shout out that this morning, at 9h30, EAPM is organizing a virtual round table on serological testing – serologic tests look for antibodies in your blood. They can involve a number of laboratory techniques. Different types of serologic tests are used to diagnose various disease conditions. This is another very important issue, taking place as it is on the eve of World Cancer Day and the launch of the Commission’s Europe Beating Cancer Plan. All attendees are welcome, click here to register, and see the agenda here.

Cancer Plan budget and factsheets on lung cancer

Much of the content of lung cancer factsheets is informed by our muti-stakeholder input is on future proofing, geared towards both Europe and country level. Given the current global attention to the demands of an adequate healthcare system and the heightened interest in public health in general, it’s clearly time to address what can be done to ensure that the health systems of the future are resilient enough to not only handle shocks such as a global pandemic, but also respond those underlying forces that are shaping future healthcare needs for lung cancer. 

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As discussed in the European Parliament yesterday (2 February), the plan, which aims to create an EU-wide strategy to tackle cancer, from prevention to diagnosis and treatment, will be funded to the tune of €4 billion, drawing on money from a variety of sources, including the EU4Health programme, as well as the EU’s digital and research budgets.This will hopefully be an excellent spur to all the good intentions of the Beating Cancer Plan

And, yes this was echoed by our experts, that it’s certainly time to explore how governments can allocate resources between competing public health demands to tackle lung cancer, and how available technologies can help – and how much more the EU should get involved directly in the health of its hundreds of millions of citizens that have and may get lung cancer in the future,

The below section provides a snap-shot of the upcoming points that will be addressed in these factsheets.

Lung cancer screening

Lung cancer Low Dose Computed Tomography screening has been demonstrated to reduce mortality from the disease in both men (8-26%) as well as women (26-61%) and international specialists urge its implementation in Europe, although the economic impact remains to be explored. Questions also remain over tailored recruitment strategies, risk-based eligibility, risk-based screening intervals, volume CT scan and nodules management protocols, and co-morbidity reducing strategies. More guidelines are needed, for identification of high-risk populations, stringent cut-offs for nodules detected at follow-up, use of volume CT scanning, and links between national reference centres for quality control.

During the engagement, we took a survey of the experts, starting with asking, in their respective countries, what progress was being made towards a targeted programme for lung cancer screening? 4.5% said it was fully implemented, 13.6% said partially implemented, 27.3% said progress was planned but not as yet started and, as it stands, 54.5% said it was not as yet planned. 

Early use of advanced diagnostics 

Improving outcomes in lung cancer depends heavily on early and accurate diagnosis including staging, permitting rapid appropriate treatment and reducing the risk of metastatic disease. Technological advances are making accurate diagnosis easier and safer, and avoiding the risks of empirical treatment of suspected but pathologically unconfirmed lung cancer.

Next-generation sequencing (NGS) is arguably one of the most significant technological advances in the biological sciences of the last 30 years. The second generation sequencing platforms have advanced rapidly to the point that several genomes can now be sequenced simultaneously in a single instrument run in under two weeks. Targeted DNA enrichment methods allow even higher genome throughput at a reduced cost per sample. Medical research has embraced the technology and the cancer field is at the forefront of these efforts given the genetic aspects of the disease. 

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In addition, Comprehensive genomic profiling (CGP) is a next-generation sequencing (NGS) approach that uses a single assay to assess relevant cancer biomarkers, as established in guidelines and clinical trials, for therapy guidance. CGP allows labs to achieve comprehensive coverage of pan-cancer content.

In our survey, we asked the experts concerning their key centres, which proportion are accredited to perform NGS/CGP? 52.6% said most, 31.6% said all of them, 5.3% said none, and 10.5% said that they did not know, so this was a largely positive result.

Integration of Single gene/Panel testing/NGS in clinical practice and cost-effectiveness

Reimbursement of advanced diagnostics strongly influences usage in clinical practice, and funding remains a problematic issue.In our survey, respondents said that the proportion of Key Centres had the capabilities and infrastructure to perform NGS/Comprehensive Genomic Profiling was 19% (all), 42.9% (most), 28.6% (a minority) and 4.8% (none). For Limited Genomic Profiling, the results were 35% (all), 35% (most), 25% (a minority) and 0% (none).

Personalized treatment decisions through multi-disciplinary (molecular) tumor boards 

An adequate testing scenario also requires the availability of genetic counseling, anatomical pathologists, molecular pathologists, bioinformaticians, and technicians, and with access to multidisciplinary tumour boards. Molecular tumour boards have a vital role in integration of testing into diagnostic-therapeutic pathways, interpreting genomic information and complex signatures, and delivering clinical recommendations.

 The diverse picture for patient access to multidisciplinary teams was reflected in the survey, which asked in your country, to what extent are multi-disciplinary tumour boards employed for lung cancer patients? 63.6% said as standard, and 36.4% said it was dependent on the institution. 

Furthermore, respondents were also asked as to at which levels do patients in your country typically have access to multidisciplinary expertise through molecular tumor boards? 27.3% said it was at a national level, 45.5% said it was at a regional level, 4.5% said there was no access at all, and 22.7% said that they did not know.

Policymaker action is required to ensure patient access to lung cancer treatments through a widening range of mechanisms. 

Opportunity to access molecular guided treatment options

Access to these opportunities will depend on recognition in guidelines of molecular guided treatment options (MGTO), and on mandatory big-data collection, publication and sharing, as well as on value-based funding. In the survey, when asked whether health care providers in your country are able to prescribe and get individual reimbursement for scientifically-supported molecular guided treatments, beyond the current label, 54.5% said yes they were, 22.7% said no, and 22.7% said that they did not know.

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Managing health care spend by shifting towards value-based reimbursement

To align quality and value with reimbursement, effective outcomes measurement and reporting are needed, including patient-level outcomes such as survival, quality of life, and functional status. Patient goals and choices should be placed at the centre of decision-making by incentive models that align the imperatives for patients, providers, and payers, based on real-world data (RWD) and a range of epidemiological, clinical and genomic data.

Data and advanced analytics

Integrating and analysing -omics, other patient data (eg imaging), treatment information and clinical and patient reported outcome data can deliver valuable insights for research and clinical development, and for access and reimbursement decisions and clinical care pathways. In an ideal world, this data would be anonymized and widely accessible to allow collaboration in improving the care pathway.

In the survey, when asked how well does the IT infrastructure in your country (nationally, at institutional level) support sharing of patient data as part of multidisciplinary tumour boards, 4.5% said very well, 36.4% said fairly well, 36.4% said not very well, and 2.7% said not at all.

When asked how many Key Centres are able to connect personal, diagnostic and outcome data for lung cancer patients, 9.10% said all, as standard, 68.2% said that it was dependent on the institution, 13.6% said none, and 9.1% responded that they did not know.

General and overall outcome

As a final survey query, respondents were asked within the overall national health strategy in your country, how would you describe the current prioritization of lung cancer care – 22.7% said it is given a high priority within the health strategy, 31.8% said it is given medium priority within the health strategy, and 45.5% said it is given low priority within the health strategy.

Within the framework of Europe Beating Cancer Plan and the support of the cancer community, the fight against lung cancer plan can be successful.

And that is all for this EAPM update – as already indicated, don’t hesitate to join the serological testing round table, taking place this morning at 9h30 – click here to register, and see the agenda here, and you can look forward to reading all about the round table’s findings. 

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