Monthly Archives: January 2015

WOF @ Davos: reigniting the ambitions of the Paris Charter Against Cancer

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Martine Piccart, President of the European CanCer Organisation, ECCO

Cancer – the search for medical breakthroughs and responding to global needs – will this year feature for the first time ever on the agenda of the World Economic Forum in Davos.  ESO’s Franco Cavalli will be attending both sessions to promote calls from the World Oncology Forum for bold action to massively extend access to cancer detection, treatment and care, and improve the ‘ecosystem’ for developing and evaluating new therapies. In this guest blogpost, Martine Piccart, President of ECCO,  traces the spirit of the World Oncology Forum back to the Paris Charter Against Cancer, and talks about what she would like to come out of the sessions at Davos.

 

 

In 2000, President Jacques Chirac signed the “Charter against Cancer” in front of 200 cancer specialists from all around the world. This landmark event, initiated by Professor David Khayat, stimulated many countries to put in place their “national” cancer plans. Unfortunately, and yet predictably, this collective enthusiasm to seriously address a major threat to the wellbeing of citizens of the earth not only did not reach all countries but progressively died down.

The European School of Oncology revived this crucial movement when it initiated the World Oncology Forum under the chairmanship of Dr Franco Cavalli.  This initiative has again united leading cancer experts from different disciplines and different parts of the world to discuss the greatest challenges of the fight against cancer in the 21 century and prioritise possible solutions to an improved control of the “cancer epidemic”.

ECCO is engaged in similar strategic thinking that builds on its unique and very broad multidisciplinary platform to find more efficient ways to treat and care for cancer patients.

These efforts are critical in a world which is shockingly fragmented in the availability of essential cancer-fighting tools and resources and most importantly:

  • Well-developed cancer registries – too many countries still lack these and, as a result, are unable to monitor the advance of the cancer epidemic and the variable impact of cancer prevention measures or cancer therapies.
  • Adequate radiotherapy equipment (which is even non-existent in some parts of our supposedly modern world).
  • Access to cancer drugs – it is unacceptable to see problems with access to old but effective drugs which no longer generate a “profit” and at the same time witness the growth of a “two-level” patient care reality where only a minority of patients are able to receive the most innovative but very expensive targeted anticancer drugs.  There is a need for prioritization here, as not all these “innovative” drugs have been shown to deliver clinically meaningful benefits.

A revised partnership model involving academia, industry and governments is urgently needed as it will generate a healthier context with shared risks in the fascinating but difficult translation of basic science discoveries into improved and more personalized patient management.  I hope the spotlight on cancer at the World Economic Forum will accelerate the creation of just such a partnership model.

Davos: another milestone in global efforts to control cancer

anna portrait  picWorld leaders from governments, industry and civic society will gather in Davos next week to discuss how to respond to some of the most pressing issues facing the world today.

It is the annual meeting of the World Economic Forum, and this year the question of how to stem the rising tide of suffering and death from cancer will be on the agenda for the first time.

Two sessions are scheduled.

The first is an interactive dinner session on the Friday evening (Jan 23rd), titled: Cancer, Pathway to a Cure – What are the breakthroughs in cancer prevention and therapy?

This session offers an opportunity to ask questions about whether the research, development and regulatory “ecosystem” that we are relying on to deliver a cure for cancer is really fit for purpose. Where is the current succession of therapies – many using similar approaches to deliver incremental benefit at ever higher costs – really taking us? How can we reconfigure the business model to promote more innovative, ambitious approaches that can overcome the problem of drug resistance?

The second is a working session on the Saturday morning (Jan 24th), titled: Globalisation of Non-Communicable Diseases.

With governments across the world already committed to reducing preventable deaths from non-communicable diseases including cancer by 25% by 2025 (65th World Health Assembly, 2012), this session offers a welcome opportunity to put on the table the bold actions that must be taken at national and international level if governments are to have any chance of delivering on the commitments they made.

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Doubtless there will be many Davos participants who will bring their own agendas to the cancer sessions. Among them will be Franco Cavalli, chair of the World Oncology Forum – a gathering of leading cancer researchers, clinicians, and policy makers, convened by ESO in 2012 and 2014, in collaboration with The Lancet, that has already spelt out the bold actions that are urgently needed at national and international level to turn the tide on cancer.

These actions are defined in the Stop Cancer Now! appeal and two more detailed appeals, which fit neatly in with the two Davos sessions, on “Speed up progress towards a cure”, and “Treat the treatable”. Cavalli, who played a major role in getting cancer onto the Davos agenda, will be arguing strongly for these policies at the two cancer sessions.

Davos is traditionally important as a forum where constructive conversations can take place between specialists – eg from the world of cancer – who have a deep understanding of a particular problem, and people who have the power and responsibility to take the action required to find solutions.

This year, it is an opportunity to get the message across to world leaders that “business as usual” is not an option in the face of a cancer epidemic that is costing the world $2 trillion each year, and to begin to turn the policies that the cancer community has been calling for into actionable items on the agendas that matter.

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The real problem with genetic testing: time

Simon Crompton

Simon Crompton

A decade ago only those with a family history of disease would consider having their DNA tested for disease risk. But who can avoid considering it today? In many countries there is constant pitching from commercial companies offering tests “that determine an individual’s likelihood of disease” or provide “a complete picture of your risk involving 50 or more than 400 genes that can cause cancer” (to quote publicity from one company).

Are we ready for this? Last month Science magazine ran an excellent article by Jennifer Couzin-Frankel, describing her entry into the brave new world of genetic testing as she attempted to find her risk of breast and ovarian cancer – given recent research indicating that those of Ashkenazi Jewish descent were at increased risk even without family history.

She discovered a miasma of uncertainty as a growing number of mutations, many of as yet unknown relevance (unlike BRCA mutations) are discovered and tested for. Clinicians talked of their worries that genetic sequencing technology has advanced so quickly that it is well ahead of treatment plans to act on it, leaving doctors with no answers to the important questions patients ask as a result of findings.

At the end of her testing, because of the knowledge she has gathered as a health journalist, Jennifer Couzin-Frankel could make an informed interpretation. She decided that, on current knowledge, a deletion of 15 DNA nucleotides on her CHEK2 gene did “not merit my mental energy”.

Waiting for the biggest traffic jam in history

But can everyone to make such balanced judgements? Making sense of DNA sequencing for the public is going to be a challenge for the cancer community. And as John Burn, Professor of Clinical Genetics at Newcastle University, said at a recent British Medical Journal conference: “You ain’t seen nothing yet.” He pointed to the immense gains to be made from DNA sequencing, but expressed his anxiety that the “biggest traffic jam in history” was about to hit health services: “We are going to be inundated with millions of variants and we are going to have to make sense of them.”

Journalists and other communicators are going to play a part in helping the public interpret the deluge of information. But it’s difficult enough guiding people through relative risk even when the risk factors are well defined.  Can journalists really equip large numbers act wisely on results of gene tests where the implications are not even clear to clinicians?

Making information useful

If the genetic information is to be genuinely to be useful, rather than simply a source of anxiety and unnecessary interventions, people will need detailed, personalised and time-consuming discussions. How likely is this to happen?

Even if the gene-testing organisations provide genetic counselling, it will inevitably fall to health services to help people through most difficult decisions. Unfortunately, the fact is that lack of time with patients is the most consistent source of frustration among physicians, surgeons, nurses, psychologists and every other profession involved in cancer, (at least, that’s the impression I’ve gained over many years of interviewing them). The need to see the next patient or lack of support infrastructure consistently gets in the way of nuanced discussions about the implications of tests, treatment options and patient worries.

Finding ways to create time and human resources for support and decision-making is already one of the biggest priorities for many cancer services around the world. How much more pressing – and inevitably problematic – is it going to become as genetic testing creates more and more patients, and with increasingly complex decisions to make?

 

 

 

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