Tag Archives: access

Extreme oncology in Romania

Geta Roman is a Bucharest-based freelance journalist writing about history and medicine. For more than 10 years she was a health editor for Romanian newspapers Cotidianul and Evenimentul Zilei

Geta Roman is a Bucharest-based freelance journalist writing about history and medicine. For more than 10 years she was a health editor for Romanian newspapers Cotidianul and Evenimentul Zilei

Being an oncologist in Romania is an extreme job. Being a patient with cancer in Romania is an extreme experience.

We have 250 oncologists to care for at least 500,000 people with cancer (the figures are uncertain because the National Cancer Registry is not up and running). Our hospitals are crowded, we lack medication, many patients waiting for chemotherapy or radiotherapy, and doctors and nurses are overwhelmed. At the same time, oncology is a field rife with corruption, with the patient caught in the middle.

The National Health Insurance and Ministry of Health are trying to find solutions: more money has been offered to doctors who work in emergency departments, and the private sector is now involved in providing radiotherapy and chemotherapy treatments, paid for by National Health Insurance. But it’s nowhere near enough to resolve the crisis in our cancer services.

The young doctors who are preparing to take the place of the older generation when they retire, and the older doctors who are forced to care for more patients than they can handle, propose the same solution for resolving this crisis: more money for doctors’ salaries, to keep them from leaving the country.

An experienced oncologist earns around €1,000 per month working in the public health system, while the younger ones earn only around €300-400 depending on their experience.

Flori Vladutescu is a Resident doctor in her second year in one of the biggest hospital in the country. She chose to become one because of the impact of cancer on her own life: her mother died from breast cancer when Flori was only four years old, and in the past years she has given close support to her sister, who was diagnosed with stage III breast cancer. She would like to know whether they have the breast cancer gene mutation, but the tests are too expensive, and are not covered by the public system.

Right now, Flori has decided to stay in Romania to care for people with cancer. She’s been promised a job in Giurgiu, 60 km from her hometown, Bucharest. “Cancer patient are special, more sensitive, you have to work with them to solve the physical problems, but you need a special attitude. I learnt that from my oncology teachers, who are also different – nicer, more human…” says Flori.

Initially she had intended to leave the country after finishing her residency. But she changed her mind, and is set on taking the job in Gurgui. “I’ve already gone there. I met the doctor who I will work with, and I saw all those patients who need help. I felt for them.” Her biggest challenge, she says, will be how to manage financially. “Half my salary will go on petrol, if I choose to commute from Bucharest every day” She think she may look for somewhere more local to stay.

“Half my salary will go on petrol”

The doctor in charge of the oncology outpatient clinic in Giurgiu, Florin Onisim, says that poor organisation ends up wasting doctors’ time, making an impossible job even more impossible. A new system of electronic registration was implemented over the past year, but no additional staff were recruited to input all the data. “It is extremely bureaucratic,” says Onisim. Before this system, I was able to see 70 people daily, now only around 30–35,” he says.

People living in and around Giurgiu are relatively lucky in one respect – they live not far from Bucharest, which has the biggest concentration of public and private cancer services in the country, so most of them have the option to travel to find an expert.

The situation is worse in other parts of the country. In Vaslui, one of the poorest cities, along the eastern border of Romania, the county hospital – which caters for a population of 375,000 – has no oncologist at all. In Resita, a city with 65,000 people, in the west part of Romania, the only oncologist in the area is responsible for the more than 8,000 patients recorded in the cancer registry.

Every time the local authorities try to hire oncologists, they face the same obstacle: no doctors are interested in going there, because of the low salaries offered by public hospitals. They prefer to join the exodus of more than 10,000 doctors who have gone to work in other European countries since 2007, when Romania became an EU member. Or they stay and work in the private sector in Romania.

The solution to both is better payments for doctors.

Cancer patients receiving chemotherapy at a major Bucharest hospital

Cancer patients receiving chemotherapy at a major Bucharest hospital

The EU’s cancer community: better with the UK?

Marc Beishon

Marc Beishon

Next week the people of the UK will vote on whether to remain in the European Union or leave it, a decision that could have far reaching implications for the future of the European ‘project’. In the UK, there has been increasingly bitter exchanges between the two camps about whether the country (or indeed the four constituent countries) will be better or worse off if there is a leave decision, and many misleading and often untrue financial figures have been put forward as ‘fact’.

While there has been little debate on what general shape the EU will be in following a UK exit, there has been some revealing discussion about some aspects of European-wide cooperation, notably research, and cancer research in particular. There has often been debate about how good Europe is at uniting cancer research to rival the powerhouse that is the US, and now some are arguing that the UK, as the leading biological research nation in Europe, may undermine progress if it were to leave the EU, and could also harm its own efforts to raise healthcare standards.

Writing in Lancet Oncology, five senior cancer and biomedical researchers, including Nobel laureate Paul Nurse, note that the UK has learnt about better care from other European countries, given it has lagged in outcomes for some time; has participated in more than 80% of cancer projects funded by the EU’s 7th framework programme; and generally, “the benefits of these collaborative European approaches so far have been major and can still increase, and are greatly facilitated by the EU”. But while much collaboration should continue, UK researchers may not be able to access EU funding, and free movement of cancer researchers between the UK and Europe could be halted.

Also in Lancet Oncology, Josep Tabernero and, Fortunato Ciardiello – the latter the current president of the European Society of Medical Oncology (ESMO) – argue that the broader aims of spreading research monies from the Horizon 2020 seven-year science programme, the biggest EU research programme in history, around Europe could be at risk from ‘Brexit’. They say too that the European Medicines Agency, currently based in London, would have to find a new home. “Post-exit uncertainty would inevitably affect European oncology research and care and would necessitate a lengthy period of adaptation as we grapple with the aftermath,” they say.

It is certainly also possible that EU institutes such as the Joint Research Centre, which carries out much work on areas such pan-European cancer information databases and the European Commission Initiative on Breast Cancer, could suffer.

But Angus Dalgleish, professor of oncology at St George’s University of London, has pointed out that the seven of the top nine universities are in the UK, which is unlikely to change, and European collaboration in science has been in place long before the post-Lisbon Treaty EU. “Examples abound, such as CERN, the European Molecular Biology laboratories, the European Organisation for Research and Treatment of Cancer (EORTC) and the European Space Agency,” he says. “It is a myth to think that if we left the EU we wouldn’t be part of these great collaborations, which already include many countries that are not in the EU, such as Switzerland, Norway and Israel.” (Note though that Dalgleish is also a member of the UK Independence Party.)

He would probably point too at Cancer Core Europe, the new group of elite cancer centres in Europe, including Cambridge, that is pushing ahead with large scale collaborative research.

And certainly there has been much frustration with the EU, in particular with the much criticised clinical trials directive of 2001. But that was reformed in 2014, and then just recently the European Parliament has adopted the EU General Data Protection Regulation (GDPR), which ESMO describes as “crucial” for the future of cancer research as it includes one-time consent for retrospective research on clinical data and biological tissues, and aims to harmonise the different frameworks governing health research across the EU’s member states. Under the current Juncker commission in Brussels there is also a commitment to weed out unnecessary regulation.

If the UK does vote to leave, there will be several years of negotiation and perhaps the country will continue to participate in EU research programmes as before, and it will certainly have to conform to regulations such as the GDPR in international work that involves Europe.

But whichever way the vote goes, one positive result is that Europe’s cancer community has come under renewed focus from several angles – workforce, research and care – even if its value under the EU umbrella is contested.

“The purse is closed!” – this is no way to run a hospital

Rosa Giuliani, medical oncologist, S. Camillo-Forlanini Hospital, Rome, Italy

Rosa Giuliani, medical oncologist, S. Camillo-Forlanini Hospital, Rome, Italy

 

As a medical oncologist my primary interest is in helping patients to live longer and better. The best part of my job is the integration of clinical and molecular views: see the problem in the clinic, look for answers in the lab, bring back the solution to patients. I wish it could be as simple as that.

Research & development have a price, which is often difficult to understand. Why new drugs and devices cost that much, and not a penny less, is a complicated conundrum for many of us. The EU regulatory and reimbursement systems, the lack of a universal health policy through Europe and the profound economic crisis are regularly debated.

While I was at ECCO participating in debates on the need to promote equity and defeat disparities in access to precision medicine in Europe, hospital managers where I work notified the oncology department that the budget allocated to cancer drugs expenditure was over:no “expensive” drugs could be purchased until the budget for the new year will be discussed in January. The purse was closed. Meetings followed, some very unpleasant; poor use of resources by medical staff was implied, not even too subtly. Of course, this prompted self-examination: am I a good oncologist? Am I following guidelines? Am I spending money for my pleasure to give drugs?

After this last question, I realized that I was losing my mind and luckily, I returned to my senses. I respect rules, I need rules, I love rules. I appreciate fair rules. Budget negotiations at local hospitals are as obscure as the procedure of setting prices at EU or national level. A rule, which lacks of transparency, is not fair. The fact that the rules are set and dealt by people who are not prepared to manage the process, is terribly wrong. The overwhelming gap between cancer politics at EU Headquarters, where precision medicine is being promoted, and cancer politics at local level, where the only interest is that 2+2 should be equal to 3, because 4 is already too expensive, is frightening.

Money is an important part of the equation: resources are not infinite and their rational employment is of utmost importance. The process of drug development is not cost-effective, and many managers are not, because they have not been adequately prepared to deal with a different type of economy. Cancer medicine cannot be dealt as if providing water or electricity.

The global curriculum for being a good medical oncologist has dramatically changed in the past 10 years. Medical oncologists in 2015 cannot neglect molecular biology, health policies, precision medicine and so on. The same change should happen with managers who allocate resources for health politics, especially at hospital level. Being a good accountant does not suffice anymore, just as being exclusively a good clinician is not enough. Another level of knowledge and preparation is needed. And honestly, sometimes, a little bit of emotional intelligence would not do any harm.

We welcome contributions to this blog. If you have a topic you would like to write about, please send your post to Corinne Hall – chall@eso.net You can find our guidelines here – How to write a blog

 

 

 

 

Smoke gets in your eyes

Simon Crompton

Simon Crompton

The title of Europa Donna’s annual London symposium last week was “New directions in breast cancer”. By the end of the evening, possible new directions were clear, but the route to take was not.

One of the two speakers was Daniel Leff, a cancer surgeon from Imperial College London, who addressed the difficulties of defining the correct margins when surgically removing breast cancer. The object had to be, he said, reducing the chances of reoperation.

He tantalised the audience with the question: “Can surgical smoke be informative?”

Potential of spectrometer analysis

Researchers at Imperial have used mass spectrometers to analyse the smoke arising from tissue incision with electrosurgical knives – a technique known as Rapid Evaporative Ionisation Mass Spectrometry (REIMS). Different types of cell produce different chemical concentrations when burned, so the chemical profile can indicate whether the tissue being cut is cancerous or not.

Identification of cancerous tissue using the technique during surgery, said Leff, was 93% accurate.

It’s a truly impressive technological development, that has potential to radically reduce reoperation rates for breast cancer.

The cost question

But how much did the machinery cost, asked a member of the audience? Half a million pounds, answered Leff. And how much did a pathologist cost? The answer was not given, but the point was made…

Pathologists already have advanced (and cheaper) techniques which can accurately indicate to surgeons which areas are cancerous and which are not. The question, said audience members, was why they were not being used. Leff himself acknowledged that pathology analysis using frozen section and touch imprint cytology were highly effective ways of determining the extent of breast disease and reducing the need for re-excision. But they are not widely used in the UK.

Novelty intoxication

On the systemic therapy side, Stephen Johnston, Professor of Breast Cancer Medicine at the Royal Marsden Hospital, spoke of the real promise of the drug Palbociclib as a first-line treatment for ER-positive breast cancer, and (in combination with Fulvestrant) as a second-line treatment as well. The cost of Palbociclib? Around £90,000 for one year’s treatment. The pressing question of how such expensive drugs are to be made widely available was raised, but not addressed.

New directions in breast cancer are exciting, involving, often inspiring. But we know how easy it is to become intoxicated with novelty and infatuated with technology. Sometimes, it isn’t new directions we need to hear about, but what is already here but under-utilised – and how we can best use what is proven, affordable and practicable to benefit the greatest number of women possible, as soon as possible.

Europa Donna, the European Breast Cancer Coalition, has a Facebook page.

 

 

 

 

 

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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Why should older patients pay the price of failures of holistic care and HTA?

roger WilsonA debate between two medical oncologists over whether younger patients should get priority when it comes to access to very expensive drugs with the potential to prolong life was recently published online by Cancer World. In this guest post, Roger Wilson, a patient advocate and Honorary President of Sarcoma Patients Euronet, argues that giving patients a voice in these discussion is the only way to move on from these “simplistic, inward looking  solutions”.

The push to use age as a determining factor in drug funding permissions is blatantly discriminatory. There are better methods and measures for discerning eligibility, if only someone researched them properly.

The pharma industry is not interested in this research. Its business model (which determines its approach to pricing) is encouraged by the current inadequacy of HTA and political decisions such as England’s Cancer Drugs Fund. Indeed the latter encourages higher prices.

When the current UK government came to power in 2010 they vowed that by 2014 we would have a value-based approach to funding decisions. Its nearly 2015 and there is no sign of it but as there was no research into how value could be defined let alone measured, its no wonder we are back to simplistic thinking about age.

The core issues here are about the holistic treatment of a patient. Just looking at the disease (albeit hosted by a person) does not take into account the needs of the whole person. This debate should be about integrating supportive care into oncology practice, about losing the barriers between palliative care and oncology, about educating patients on the balance between cure and end-of-life care so that when disease is truly incurable patients make rational decisions themselves.

Another cycle of chemo given to a dying patient is immoral. Living and dying have to become palatable points for discussion. This will deliver benefits for individuals and society and could well cut drug costs. While politicians, healthcare administrators, academics and doctors are the main voices on this issue simplistic inward-looking solutions will result.

Get patients involved, introduce some earthy common sense.

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).

Speeding up global access to detection and care

 

Dr Rengaswamy Sankaranarayanan

Dr Rengaswamy Sankaranarayanan

Rengaswamy Sankaranarayanan, special advisor on cancer control and head of early detection and prevention at IARC (the WHO’s International Agency for Research on Cancer), Lyon, will lead the session on Access to effective and affordable treatments in middle- and low-income countries at the World Oncology Forum, Lugano, October 23–25. In this guest blogpost he talks about the policy recommendations he will be arguing for.

I’M LOOKING FORWARD to speaking at the World Oncology Forum about new healthcare financing models that are extending access to effective early diagnosis and treatment of cancer in many low- to- middle-income countries. I would like to see the Forum issue recommendations that can catalyse the pace of this transformation and deliver a very blunt message to governments and international development agencies.

Some success stories

The last few years have seen important progress in access to healthcare, particularly in middle-income countries. I would like to see this replicated in low-income countries.

Thailand, for instance, started introducing universal healthcare from 2002. Today, anyone living anywhere in Thailand, can access care seamlessly across public health services.

Initially under the Thai scheme, people were required to make a single, small copayment – 30 Baht or around $1 – the first time they see a healthcare professional for a particular complaint. That payment would cover the entire journey that follows, including diagnostic tests, treatments and follow-up. This co-payment was abolished in 2007, and universal health care became free for poor people.

Despite initial fears that the health system would collapse, it is working well. One important reason is that the government is investing a substantial amount of its GDP into healthcare. Another is that the “30-Baht” scheme mainly covers people from the very poorest rural communities – those employed by the government and the private sector have their own insurance systems.

Not only has it considerably improved access to healthcare in Thailand, it has also regulated the market, because the system will only pay for standard procedures. Since then, many other middle-income countries have implemented successful schemes to widen access to healthcare, including Turkey, India and Malaysia as well as many of the larger countries in Latin America, such as Mexico, Brazil, Colombia, Peru, Argentina and Chile.

Spreading the success: two recommendations

1. Cancer control must be a national responsibility

Countries like Thailand have shown it is possible through a variety of models to provide sustainable good-quality health services on a subsidised basis for a large proportion of people, while recovering healthcare costs from those who can afford it.

However, we also need to learn from our failures. In sub-Saharan Africa, for instance, health services have barely improved, there are no health financing systems, and access to healthcare has not improved at all.

I think one of the major reasons for this is the amount of external assistance they receive, which has blunted internal investment and internal drive and internal planning.

We need to make governments realise that healthcare is their own responsibility, and the systems and investments they have to make should be their own, and should come from their own national budgets. The way to do this is to substantially increase the GDP proportion that is contributed to healthcare from national budget.

So one message I would like to come out of the World Oncology Forum is that:
International organisations and funding agencies should insist that the countries they help must predominantly use national resources to develop and sustain their own national healthcare services.

 2. Cancer control needs a joined up approach

Another lesson we need to learn is that countries need to approach cancer control as a whole, linking prevention, early detection, treatment and palliative care. In Latin America, for instance, screening with the Pap smear was carried out for many many years, with very little impact on disease. Everyone blamed the poor cytology, but the bigger problem was that most women with the positive cytology never had a diagnosis made and never received treatment.

Governments and international agencies need to take a more comprehensive view across the entire spectrum of cancer control.

I think we have lessons to learn here from the comprehensive approach taken by the GAVI alliance, which has been very successful in terms of immunisation coverage and reducing child mortality. So another key message I would like to see coming out of the World Oncology Forum is:
We need to think in terms of a global alliance for cancer care continuum.

 Other key issues

Other key issues I will be asking the World Oncology Forum to consider include:

  • The urgent need to secure universal access to basic early diagnosis and treatment services
  • Opportunities for working within the wider efforts to tackle “non-communicable diseases”
  • Reversing the worrying trend towards adopting expensive and unnecessary imaging investigations, very expensive, very high-tech radiotherapy equipment and techniques, and expensive chemotherapy regimens and targeted drugs whose additional benefit has not been well demonstrated.

I look forward to the discussion

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An essential cancer medicines list for Europe

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Martine Piccart

Patients are still waiting to feel real benefit from the rapid advances in knowledge and technologyseen over the past decade. This October, 50 experts from across the globe involved in researching, developing, evaluating and delivering new therapies will meet to develop consensus recommendation on who needs to do what tospeed the development of effective treatments. The meeting is one of a series of World Oncology Forum summits organised by ESO in collaboration with the Lancet.


How can we improve access to important new cancer therapies? Martine Piccart – president of ECCO and past-president of ESMO, argues the case for a WHO-style essential drugs list for Europe.

WHEN I BECAME PRESIDENT OF ESMO (European Society for Medical Oncology) in 2012, I had on my agenda to visit countries of eastern Europe, because I was shocked by statistics indicating that even inside Europe there are significant differences in cancer outcomes between the western and eastern parts.

Of course there are huge discrepancies between Europe and Africa, for instance, but that this exists inside Europe came as a shock, so I decided to travel to the countries and talk to the oncologists there.

I will be talking at WOF about what I learned from them about their efforts to improve access to new therapies, and how that prompted ESMO to develop a rating scale to evaluate the magnitude of benefit of new anti-cancer drugs for solid tumours.

Which would I choose?

The idea is to help oncologists focus their lobbying efforts on the most important therapies, and also to strengthen their bargaining position, because they can show that the therapies they are asking for are considered to be very important by the wider medical oncology community.

It’s taken us more than a year to come up with something that we are beginning to be happy with. And we’re now awaiting input from patient organisations about rating impact on their quality of life.

It’s a first attempt at getting a community of oncologists to look at all the very expensive drugs that we have seen in development in the last 10 years and really asking the question: if I have to choose only a few, which ones am I going to choose.

Potential dangers

As I will explain, this was an interesting exercise. When you start something like that you think it is going to be easy, but then you discover that it is actually incredibly complicated and there are potential dangers. For instance, we don’t want it to be used by governments in an aggressive way, to decide that they are only going to pay for one or two top-scoring drugs and never for the others.

What I hope to present at WOF is the reasoning behind the development of the scale, and how we went about it, and why we think it will be important. And I’m looking forward to the discussion.

Convincing governments

More generally, I hope that WOF won’t just look at what needs to be done, but also how to convince governments and politicians to take the necessary action.

We need to be able to show them how outcomes for citizens in their country compare with what is being achieved in other parts of Europe, to bring home the consequences of lack of access to the right treatments – and this is not just about new drugs but also the basics of high-quality surgery and radiotherapy. I think this kind of language is more powerful for politicians than simply going to them and saying we need money and we need new innovative treatments

These sorts of comparisons require high-quality cancer registries with homogenous cancer data – something I was shocked to find out still doesn’t exist in many European countries. So I think more support for high quality registries must be one of the messages from this WOF.

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