In a step to address this issue, the Federation of European Cancer Societies is holding a three-day patient programme to debate what improvements need to be made and of these what constitutes a priority and have to ensure that the right decisions are taken. The meeting provided the opportunity for all interested parties to join together to form a common voice, and highlighted key decision making tools that can be used to improve the outlook for patients.
As Professor John Smyth, Director of the University of Edinburgh Cancer Research Centre, UK, stated, "Our first step in addressing the issue of our overstretched healthcare system is listening to the concerns and expectations of healthcare professionals and patients. As politicians are ultimately the people who make the decision about healthcare directives, it is important that they are involved throughout the discussions so as to ensure they can make informed and educated decisions. But when it comes to deciding what priority should be given to improvements in cancer care, the public needs to be encouraged to play their part in order to provide an impartial, unbiased opinion."
A Decade of Discovery or a Decade of Despair…?
At present there are stark inequalities in patient access to quality care cancer treatment across Europe. A recently published pan-European study highlighted these differences revealing how patients in some countries such as the UK are required to wait significantly longer for access to new life saving drugs, compared to their Austrian, Swiss and Spanish neighbours. The different European nations' decision making processes concerning which new life-saving drugs should be made available and to whom, in addition to insufficient funds allocated to health are cited as the two main causes for this inequality.
Patients and healthcare professionals are demanding that this inequality is no longer left unaddressed and action is taken to bring Europe's healthcare systems into the 21st century. Both groups have shared opinions concerning where they think the current inequality in cancer care originates and both have key concerns that they wish the local and national authorities to act upon to meet the high expectations placed upon their healthcare system.
Patients Expectations
Today's modern society means that the medical world is now communicating with the informed patient. For most of Western Europe, patients' expectations are that all healthcare should be free and immediately available and this includes the availability of all appropriate treatments. Patients want to know everything they can about their illnesses and the treatments available and demand the right for a second opinion. As quality cancer care can mean the difference between life and death, patients feel it is only right that they have a freedom of choice when it comes to how their condition is treated and managed. Participating in the ECCO 13 Patients' Programme, Anders Jonasson, President of the Lung Cancer Organisation, Sweden and a lung cancer survivor spoke on behalf of many cancer patients across Europe when he commented, "When you are diagnosed with cancer, after the initial feeling of shock and fear subsides, you have this urgent desire to find out all you can about your condition. You become suddenly aware of your own mortality and knowing that your survival chances can potentially depend upon whether or not your local authorities can afford it is simply not good enough. It is becoming patently obvious that if something is not done about it soon, in the future your survival outlook will be largely determined not only by GDP but by your personal wealth in the event that local authorities are unable to afford the required infrastructure and access to treatment, it is up to the individual to find the money. Considering that Europe includes some of the wealthiest and leading nations in the world this is deeply worrying."
Key issues for healthcare professionals
Physicians place a similar importance upon access to information, recognising the need for regular updates in cancer treatment care and management. This is generally available throughout Europe through evidence-based medicine, journals, meetings and continuing professional development. However, physicians' expectations also include the facilities with which to deliver optimal cancer care, which are currently not available Europe-wide. Professionals expect to be able to communicate appropriately both with each other and their patients. Doctor-patient communication, however, is challenged both by inappropriate environments and increasing time pressures for consultation discussion. In addition, the possible future shortage of oncologists will make things even more complex.
This feeling was re-iterated at ECCO 13 by Professor Mike Richards, National Cancer Director at St Thomas's Hospital, UK who said, "Assigning priorities to the delivery of medical care in general and, given the rapidity of scientific advances, cancer care in particular, is an enormous challenge."
In the fight for better access to quality care, some of the improvements that healthcare professionals want to ensure; timely access to high quality screening and diagnostic tests, appropriate referral for specialist care, timely access to state-of-the-art services and treatment at all stages of the cancer journey and the provision of support for making informed choices.
Professor Richards added, "Each European nation faces the same challenges - an ageing population and the development of new healthcare technologies, with the subsequent increase in costs. All countries have to maintain a financially sustainable healthcare system whilst responding to the rising expectations of patients. To do this all those involved in designing, delivering and using these services - politicians, healthcare professionals and patients - need to share their knowledge and experience and work together."
It is important to remember that if European nations invest money into healthcare in the short term, they will awarded with long term financial benefits, as better technologies and treatment care will lead to both healthier people and a larger workforce, resulting in a stronger economy.
The Role of the Politician
One of the most interesting recent developments has been the creation of 'MEPs against Cancer (MAC) .' This strategy to be launched shortly has been designed to provide a platform where MEPs will work on cancer-related issues and where they will meet and discuss with patients and health professionals. The campaign signifies a change in approach, highlighting how it is no longer about just pressurising politicians, but involving them in the fight for justice for cancer patients. Thanks to MAC the MEPs will initiate and stimulate debate and support the different Member States and European Commission initiatives.
One of the primary aims behind MAC is to send a strong political signal that immediate and concerted action is needed to reduce cancer mortality rates and improve cancer treatment outcomes. To be launched in November, MAC will be committed to serving this purpose and to promoting action on cancer as an EU priority and harnessing European health policy to that end.
Speaking at ECCO 13, Mr Margaritis Schinas, Head of Cabinet of Markos Kyprianou, European Commissioner in charge for Health and Consumer Protection, wanted to update people on the ongoing elements in terms of long term policies concerning in cancer prevention, in addition to the initiatives for the future. He commented, "These policies include initiatives addressing the development and sharing of best practice in cancer prevention among the Member States. Such areas comprise the 'European Code against Cancer' addressing the European Citizen directly on his/her possibilities to prevent cancer, the 'Council Recommendation on Cancer Screening' recommending high quality screening programmes for breast, cervical and colorectal cancer together with the series of 'EU Guidelines on Best Practice in Cancer Screening', which have been developed under the 'Europe Against Cancer Programme' and which are now followed up by the European Cancer Network with support from the present public health programme (2003-2008). Last but not least the Commission supported the European Network of Cancer Registries, which is presently called the 'EU Network for Information on Cancer in Europe (EUNICE)'. This network provides the citizen, as well as the Member States authorities, with comparative high quality statistics on cancer incidence and mortality throughout Europe provided by the EUCAN database at the WHO/International Agency for Research on Cancer in Lyon."
Conclusions
The delegates in the FECS-ECCO 13 Patients' Programme issued guidelines based on their discussions calling on;
The EU Member States to:
The European Commission to:
The European Parliament & particularly MACs to:
The EU and national politicians and authorities to:
Cancer Facts
One in three people will be diagnosed with cancer during their lifetime and approximately one in four deaths in the EU are from cancer.
After cardiovascular disease, cancer is currently the leading cause of death in Europe. In 2004 there were an estimated 2,886,800 cases of cancer diagnosed in Europe. The most common forms of cancers diagnosed were lung (381,500, 13.2% of all incident cases), colorectal (376,400, 13%), and breast (370,100, 12.8%).¹
Among males in 2000, the highest cancer incident rates in the EU were in Hungary, a statistic that reflects the high incidence of lung cancer in Hungarian men. The lowest cancer incident rates were in Greece and Cyprus.
In the EU in 2000, the highest cancer incidence rate among women occurred in Denmark, which reflects the fact they have one of the highest incident rates of female breast and ovarian cancer in the EU. The lowest female cancer incident rate was in Cyprus and Greece.
5% of Europe's total healthcare expenditure is allocated to cancer, with only 10% budgeted for cancer treatments.
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