Category Archives: News

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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Bold policies for progress north and south

anna portrait  picWorking in silos has long been a problem within the cancer community, as people engaged in increasingly specialised fields struggle to remain aware of the bigger picture. So it can be important, on occasion, to bring the different constituents together around a single agenda.

One might have wondered, however, whether the World Oncology Forum, which gathered almost two months ago in Lugano, Switzerland, might not have been a little over-ambitious in setting an agenda that focused on two topics that are poles apart in almost every respect, including the geographical.

The first of these, fixing the ‘broken model’ of new drug development, is a priority issue for the northern hemisphere. The second, addressing unmet need for the most rudimentary detection, treatment and palliative care, is the priority in the South. The opportunity to explore these challenges and the associated policy implications, within a single gathering, however, turned out to be remarkably constructive.

wof collage Hearing about some of the best examples of low- to middle-income countries that have taken well-planned, system-wide, sensibly financed steps to get the widest possible access to the best possible early detection, treatment and follow-up showed just how much can be achieved for cancer patients, even with modest resources, by simply getting the fundamentals right.

While hearing about the cost, both in health expenditure and overtreatment, of squeezing out additional survival benefit for patients in better resourced health systems brought home how unsustainable current approaches to developing new treatments are becoming, even for world’s wealthiest countries. The message that came out was about priorities.

  • Don’t waste resources on expensive equipment and therapies if the money can be better used getting the fundamentals right for everybody who needs them.
  • Don’t waste resources on developing new therapies unless they aim high – which means tackling resistance rather simply chasing cancer cell evolution from dependence on one mutated pathway to the next.

Bold policy initiatives that champion the public interest will be needed at international and national level to achieve what must be achieved. The task of the 35 assembled experts, leaders and innovators in their own fields, was to spell out the core elements of such initiatives.

As keynote speaker Paul Workman, chief executive of the UK Institute of Cancer Research, points out in the video below, the level of agreement among participants was remarkable, given the differences in their geographic and professional backgrounds and the strong views held by all.

The exact wording of the final policy appeal is currently being finalised. It will be published on this blog and in the March issue of Cancer World, which will carry a full report of this remarkable meeting. It will also feed into a discussion at the ‘Davos’ World Economic Forum on meeting the challenge of the global cancer epidemic, if and when the organisers confirm that the issue has made it onto the final agenda at the end of January 2015.

Slides from most of the presentations are available now on the ESO website (access requires you to register with Club ESO).

(How) do you use social media? We investigate

social-networks

ESO and our magazine Cancer World wanted to find out whether, by engaging more with social media, we could make it easier for people in the cancer community to interact with us and with one another.

We therefore contacted everyone on the ESO, e-ESO and Cancer World email lists, to ask them about whether they use social media, and if so how. The survey population included everybody who has ever attended an ESO educational event or conference (plus others signed up to Club ESO), everyone registered for e-ESO’s e-grandround and e-oncoreview webcasts, and everyone on the Cancer World email list.

The 660 responses we received represent a broad spectrum of ages, disciplines and countries. They are probably not, however, broadly representative of oncology professionals in general. The population as a whole is self-selected, having already chosen to engage with ESO and/or Cancer World, and those who responded are likely to be more involved with social media than those who did not.

Nonetheless, we feel the results offer a very interesting picture of social media use among a section of the professional cancer community, including some surprises.

Respondents come from all walks of the cancer community:

Who?
Almost half are medical oncologists, followed by surgical oncologists, radiotherapists, patient advocates, cancer nurses, pathologists, psycho-oncologists, and radiologists.

Where?
More the two-thirds are from Europe.

How old?
They covered a wide age range: the 31–40 and 41–50 age groups accounted for around 30% of respondents each, with around 20% in the 51–60 age group.

We asked: who uses social media?

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85% said yes

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15% said no

Interestingly older respondents were just as likely to use social media as younger ones. Lack of time and relevance were listed as the main reasons for not using it.

We asked how and why respondents use social media
We were pleasantly surprised by the response:

What best describes you use

 

Two out of three respondents who said they use social media, use it to keep up with developments in their field – not surprising.

But many of them are also using social media to interact with other people:

  • to interact professionally: more than half
  • to be part of a community and join discussions: 1 in 3
  • to initiate discussions: 1 in 5

how active are you

While 4 out of 10 respondents  say they use social media only to read what others have posted, almost half of  comment on what they read, 4 in 10 ‘like’ or share links to what others have posted, and a surprisingly high 1 in 4 contribute their own posts.

More than half belong to some form of online group, such as a LinkedIn, Facebook or Google group or email forum, or they follow a blog.

Preferred platforms
We asked which platform people use for ‘professional use only’ or ‘professional and personal’ use

linkedinLinkedIn is by far the most popular, used by almost 75% of respondents (more than 50% of them for professional reasons only)

YouTube-iconYouTube comes next at 54% (just over 10% for professional use only)

 

FB-f-Logo__blue_29Facebook comes in at nearly 44% (less than 3% of them for professional reasons only)

 

Followed by

btn_g_red_pressed.png-27Google+ at around 40% (10% professional only)

 

Twitter_logo_blueTwitter at 30% (11% professional only)

 

This is the first survey we know of investigating social media use among cancer professionals in Europe.

Even allowing for above average engagement among our survey population as a whole, and among respondents in particular, we were surprised and encouraged at the number of oncology professionals who use social media to interact, to join conversations and to start their own.

This survey was conducted as part of an effort to improve our own level of interaction, to play more of a role listening to and sharing what others in the community are saying, as well as spreading the word about conversations that we are promoting through this blog – Conversations for Collaboration and Change – and our magazine Cancer World.

The results of the survey can be found in more details Social Media Survey Results

Join the conversation!
If you’ve not visited this blog before, we hope you will take a look at what we’ve posted in its first few weeks. If you like what you see, we hope you will follow us and join the conversation.

You can follow The Cancer Blog, and contribute your own insights, experiences and comments, via LinkedIn (join the Cancer World group), Twitter (@ESOncology) or Facebook (ESOncology).

If you follow us, we will follow you, and share what you post where it is relevant to our followers, so together we can promote more inclusive and interactive discussion about how to achieve our common goals.

You can also sign up directly to receive alerts about new posts by entering your email address in the subscribe box, on the left-hand side.

Heads up: it may be best to do nothing

Simon Crompton

Simon Crompton

 

It’s always strange emerging from the single-mindedness of a conference to breathe the outside world’s unconcerned air. I doubt there was a person attending the British Medical Journal’s recent “Preventing Overdiagnosis” conference in Oxford who didn’t come away with the sense that overdiagnosis and its consequences is one of the biggest challenges facing health providers globally.

 

But beyond the concern of a handful of international experts – many of whom were gathered in Oxford – awareness and concern among the international cancer community seems low. Yes, most of us know that there are risks as well as benefits to breast cancer screening, and that PSA testing for prostate cancer can lead to unnecessary tests and treatment. But does that result in changes to practice? Does every one of us need to sit up and listen a bit more?

The papers presented at the conference certainly suggested “yes”. As keynote speaker Ilona Heath, a former President of the Royal College of General Practitioners, said: “Susan Sontag’s kingdom of the well is being absorbed into the kingdom of the sick, and clinicians and health services are busy ushering people across this important border in ever-increasing numbers. The costs, personal, social and economic, are enormous.”

The issue of overdiagnosis doesn’t just hover over breast cancer and prostate cancer.

The conference heard evidence that it is an issue in melanoma. An analysis of data by America’s National Cancer Institute, presented at the conference, showed that melanoma incidence has been increasing since 1975 while mortality has remained stable, strongly suggesting overdiagnosis.

Or take ovarian cancer. The conference heard about concerns that improved testing with blood tests and ultrasound are leading to increased detection of borderline ovarian tumours that might never present clinically in the lifetime of a woman.

Or thyroid cancer. A population-based study of thyroid cancer patients in Ontario, Canada between 2000 and 2008 shows that this relatively benign cancer is increasing at an “epidemic” rate. The increase seems to be confined to more affluent areas, and closely related to the availability of diagnostic ultrasound.

The suggestion is that, without sophisticated diagnostic techniques, large numbers of people with these diseases would have died of something else without even knowing they had cancer. They might have avoided distressing decisions, painful tests, potentially disabling treatments.

Such interpretations of data can prove controversial. Some evidence is strong, some is preliminary to say the least. But it undoubtedly opens up important questions for all those involved in the detection and treatment of cancers. It asks us to look up from a heads-down determination to track down and destroy cancer, and question whether sometimes – quite often – doing nothing is the best course.

It’s not an easy thing to do. Cancer World will be exploring the issues in its next three editions.

Welcome

Welcome to The Cancer Blog, dedicated to speeding up progress in cancer care.

If you play a role in helping improve the lives and prospects of cancer patients, we hope you will follow us and join the conversation. Here is why:

  • Opportunities to make a real difference to cancer patients are being missed because our efforts are too fragmented.
  • The explosion in scientific knowledge and information will deliver more and faster for patients when we all work more effectively together to reach patient-centred goals.
  • Better communication and collaboration is needed between all of us involved in researching, developing, regulating and evaluating new therapies and diagnostics, and in organising, planning and delivering care.

This blog is a place for conversations that can lead to the collaboration and change that is so urgently needed.

Why us?

Promoting a more joined-up approach to improving the lives and prospects of cancer patients has been a hallmark of ESO since we were founded in 1982.

We have a wide reach. We have strong roots among Europe’s cancer clinicians, thousands of whom have attended ESO training courses, and we have developed strong relations with the wider cancer community through Cancer World and also through joint work for instance in the European Partnership for Action Against Cancer and the World Oncology Forum.

Communicating across boundaries is what we do. For the past 10 years our magazine, Cancer World, has offered a unique platform for exploring some of the most tricky and intractable challenges in cancer from a wide range of perspectives.

We have commitment and resources. The Cancer Blog will be produced by ESO’s media team – journalists who explore the science and the humanity of cancer and the strategy and organisation of efforts to combat it. We have developed a wide pool of contacts, and are focused on providing coverage of people and stories that makes a real difference to patients and survivors. We will also feature regular comments and guest posts from leading voices from the cancer community.

Join the conversation!

You can follow The Cancer Blog, and contribute your own insights, experiences and comments, via LinkedIn (join the Cancer World group), Twitter (@ESOncology) or Facebook (ESOncology). You can also sign up directly to receive alerts about new posts by entering your email address in the subscribe box, on the top left-hand side.

Please follow us, and we will follow you, so together we can promote more inclusive and interactive discussion about how to achieve our shared goals.

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