First of all, we have to acknowledge that the issue of disparities and discrimination in care is not only a challenge for cancer treatment; it has been a growing problem for decades throughout the entire EU healthcare system. It is also increasingly clear that the EU’s treaties need to be fundamentally amended in the area of cooperation between Member States on public health issues.
The COVID-19 pandemic has further highlighted this need. Until this change occurs, we in the European institutions can do little to what already exists. Every change would just be cosmetic. However, there are some challenges at European level that we can still address.
A common feature of both domestic and European strategies is the strong emphasis on cancer treatment and on working with patients. Early detection and rapid, affordable and effective treatment are a significant factor in prolonging life expectancy. That is right, however in my opinion, it is not enough.
“The EU strategy should not be just about successfully curing those who are already affected by the disease, but above all about preventing the outbreak of the disease”
Among all of these strategies, there is relatively little talk about working with risk groups, that is to say, people who may be future patients. The EU strategy should not be just about successfully curing those who are already affected by the disease, but above all about preventing development of the disease. I am of the opinion that a significant number of cancer cases can be prevented. There is room for prevention, elimination and reduction of behavioural risks.This is something that would turn both the national and EU strategies into a modern policy document.
Cancer prevention has a long way to go, as it is partly the result of long-term exposure to toxins (such as alcohol consumption or smoking). From this point of view, it is always necessary to intervene and reduce or even try to eliminate the exposure to these agents. Oncologists say that the development of cancer due to exposure to carcinogens from the external environment or risky behaviour takes on average 10 to 30 years.
We have two decades until 2040. This means that there is still time to slow down the growth of new cases. However, it is difficult to change individuals’ substance abuse behaviour, particularly in some social groups. Yes, I believe that a significant number of cancer cases are socially determined. More than 40 percent of all cancers are preventable through coordinated actions on individual, social, environmental and commercial health determinants.
Addiction is a behaviour that can be overcome through a range of regulatory, social and psychological tools. A key aspect of this approach is the possibility of using alternatives that are far from harmful. Our interventions should not only fall into the hands of preventive oncology, but also other medical disciplines such as addictology (addressing addiction) together with, for example, cardiology or pneumology (which, like oncology, address the consequences of addiction).
We should focus on groups living on the fringes of our society - excluded groups. Unfortunately, with these groups, the conventional techniques of controlling access to addictive substances often do not work, and it is necessary to focus more on reducing risks, which can lead to disease.
I believe that the addictions, not only addictions to prohibited substances, but also to alcohol and tobacco, are clearly tied to inequalities in society and the abuse of addictive substances is just a secondary, related problem. Although the goal of public health policy is complete abstinence from substance use, the reality is that this goal is almost impossible to achieve.
Unfortunately, these vulnerable groups will always abuse substances, no matter what we do. Our approach to this problem should therefore work with the concept of risk reduction, which means that people will do themselves significantly less damage by using much less harmful products and without developing addiction, which, however, requires long and systematic work.
“The issue of disparities and discrimination in cancer treatment at EU level is also caused by the lack of a joint health technology assessment (HTA) processe”
The issue of disparities and discrimination in cancer treatment at European Union level is also caused by the lack of a joint health technology assessment (HTA) process. There are currently huge differences in the implementation of HTA between Member States. On the one hand, France or Germany, have large offices with dozens of employees who conduct HTAs for new drugs almost immediately. On the other hand, there are smaller Member States, where HTA, is needed for the reimbursement of payment for a drug from public health insurance, is carried out by just two people.
Following years of delay, Member States must finally be pressured to address this issue and complete the joint health technology assessment regulation. The next step in reducing the number of differences in approach across Europe is to introduce joint purchases, at least for orphans and innovative medicines.
Mass purchases of Remdesivir and COVID-19 vaccines have shown us that this is possible to do at European Union level and that Member States only lacked the will to do so.