Join our European Week Against Cancer campaign with the hashtag #eCANtribution

eCAN EWAC campaign

The European Week Against Cancer (EWAC) is an annual campaign that runs from 25th to 31st of May under the leadership of the Association of European Cancer Leagues (ECL). During the event, all individuals, and cancer and health-focused organisations are invited to join the campaign and let their voices be heard in the fight against cancer in Europe.

In this context, eCAN has created its own campaign for the occasion under the title #eCANtribution. The aim is to spread the word about how the local/regional institutions that take part in the Joint Action work to improve the integration of telemedicine and remote monitoring in health care systems for cancer prevention and care.

The European project will present, through short videos, some of its partners and the actions they make to contribute to the main objectives of eCAN: reduce cancer care inequalities across the European Union and improve effectiveness, efficiency and quality in cancer prevention and care, particularly for cross-border emergencies and health crises, such as COVID-19.

As the week progresses, the various statements made by eCAN participants in the framework of the European Week Against Cancer will be published below.

And you, how do you contribute to tackle cancer in Europe?

eCAN’s Steering Committee unveils the first achievements of the Joint Action

Some participants of the second eCAN Steering Committee Meeting

The Steering Committee meeting of eCAN has been held today, May 11th, in a virtual format and with more than forty participants from beneficiary and affiliated entities. The meeting has served for the different Work Packages to present the progress achieved on the first quarter of 2023 and share their upcoming assignments. 

The reunion has been welcomed by Matthias Schuppe, responsible for preparing DG SANTE’s work on the ‘Europe’s Beating Cancer Plan’, Maren Hunds, member from the European Health and Digital Executive Agency (HaDEA), Dheepa Rajan from the European Observatory on Health Systems and Policies and Caroline Berchet, health economist at the OECD Health Division. The four professionals have spoken at the beginning of the meeting, stressing the importance of the JA and the possibility of establishing synergies in the near future with other entities and European initiatives. 

While all the Work Packages were able to share their progress, the bulk of this Steering Committee focused on the two pilots that eCAN is developing in teleconsultation and telemonitoring, which should be launched on June. 

eCAN’s first achievements 

Following the agenda, OECD and WHO/OBS, as eCAN observers, highlighted their supporting role to the overall project’s progress. The JA has been selected as example of project linked to quality of life in an exhibition of European projects organised by DG SANTE within the framework of the European Week Against Cancer (EWAC). 

WP8’s presentation has been focused on stakeholders’ identification and engagement. The colleagues from Greece have organised and taught four workshops for eCAN participants between April and May. As for the upcoming tasks, WP8 will soon conduct a gap analysis and assess the training needs of patients, caregivers, and clinical experts. They will also develop an educational framework and training materials. 

Andrea Pace, from the IRCCS Regina Elena Cancer Institute (IFO-IRE) has conducted both presentations of Teleconsultation (WP5) and Legal, ethical framework and cybersecurity (WP6), focused on the initial development of the JA’s pilots. 

Halfway through the Steering Committee, the Telemonitoring team (WP7) has also given some insight into its work until now. This includes partially completing the landscape of remote surveillance of patients and the ongoing development of the telemonitoring system to start pilots testing. In fact, they show several mock-ups of the application that will be used to monitor patients participating in the study. 

Progress on sustainability, evaluation and communication 

The past and following months have also been addressed by the entities belonging to Austria, Poland and Spain, and they have discussed the risks, gaps and opportunities that they expect to experience in the upcoming weeks.  

The Sustainability Work Package (WP4) has finalised all preparations on the Country Factsheets, documents that compile information on different territories’ preparedness, legislation and initiatives on cancer and digital health. They have been verifying the available data over the past months and country factsheets will soon be sent for external validation. 

The team responsible for the Evaluation (WP3) is about to finalize the second progress report and is preparing the cost and consequence analysis framework together with the protocol for the SWOT analysis. Both milestones are scheduled for July 2023. 

Finally, the Communication team (WP2) has presented their campaign for the European Week Against Cancer (EWAC) and showed the recent content published on the website (interviews, news, newsletters…) and social media, with TikTok emerging as one of the most prominent social networks for eCAN. The Spanish team has already submitted two deliverables, the most recent one being the updated version of the Communication and Dissemination Plan. The main ahead tasks for the communication team include preparing the first Annual Report and start organising the project’s final conference. 

Towards the first half of the Joint Action

The Joint Action “Strengthening eHealth including telemedicine and remote monitoring for health care systems for cancer prevention and care”, launched in September 2022, is approaching its first year. 

The summer months will be crucial for its progress and evolution, as many important milestones will be reached, with the start of the pilots being the most important one. At the same time, the first anniversary of eCAN will also serve to take stock of what has been achieved so far and to preview the outcomes that this European initiative could provide. Such progress will be monitored and explained in more detail at the next Steering Committees. 

eCAN workshop series concludes with meetings on empowerment and EU networking

Wordcloud of the main topics discussed during the last eCAN workshops by AUTH

The third and fourth workshops of eCAN Work Package 8 have brought together 14 and 23 participants, respectively. On the one hand, participants have been asked to broaden the eCAN ecosystem beyond the European scale and to consider local, regional or national approaches when spreading the word about the Joint Action.  

On the other hand, eCAN partners have engaged in an open dialogue to understand the needs of stakeholders (patients, carers, clinicians) for the forthcoming piloting phase, identifying the needs across various Work Packages, and devising effective strategies for implementing educational materials. The ultimate objective was to equip participants with the necessary tools to effectively address these needs. 

Beyond and within the EU  

“We need to expand our work, not only for dissemination purposes, but also to extend our network with partners and countries that are not part of eCAN, such as Germany. We are trying to improve telemonitoring and teleconsultation across Europe, so we need them to collaborate and listen to us to engage at another level” said Despoina Mantziari, from the Laboratory of Medical Physics and Digital Innovation at the Aristotle University of Thessaloniki (AUTH), organiser of the meetings.   

This outreach would introduce eCAN to communities outside its ecosystem and, through synergies and collaborations, could capitalise on the knowledge produced by the Joint Action Work Packages and foster interactions with others for future collaborations (experience sharing, policy development opportunities…).  

Empowerment for a better eHealth 

A central theme that resonated throughout the last workshop has been the concept of patient empowerment. The World Health Organization (WHO) defines it as a process that grants individuals greater control over decisions and actions affecting their health. This principle is a cornerstone of global health and social care strategies. 

Mantziari further elucidated the essential components encompassed within this concept. These components include respecting the unique needs, preferences, and autonomy of patients, ensuring access to appropriate and personalized treatments, and actively involving patients in decisions related to their health. Patient empowerment also entails facilitating access to safe, high-quality services and support, as well as providing reliable, relevant, and comprehensible health information. Involving patients in health policy development is also essential to ensure that services are designed with patient-centricity at the core. 

Roadmap for Stakeholder Engagement 

With the conclusion of the workshops, the members of Work Package 8 now face several important tasks. Their immediate focus is to conduct a preliminary gap analysis. This will be followed by a thorough assessment of the training needs of patients, caregivers, and clinical experts. Additionally, a comprehensive framework of educational activities and training materials will be developed for both patients and caregivers/clinical experts.  

The completion of these assignments will pave the way for a more robust stakeholder engagement strategy, fostering collaboration, and enabling eCAN to advance its mission of improving eHealth practices.  

Policymakers’ involvement stars the second eCAN workshop led by 3rd RHA of Greece

The second workshop from eCAN’s Work Package 8 has brought together a total of 26 participants interested in how to involve policymakers in a research project like this Joint Action. In particular, the aim of this second online gathering was to share practical strategies for coordinating and implementing effective recruitment and engagement of policymakers. 

As in the previous workshop, Despoina Mantziari, from the Laboratory of Medical Physics and Digital Innovation at the Aristotle University of Thessaloniki (AUTH), organised and led the meeting. During her intervention, Mantziari stated that, when approaching this type of actors who belong to different entities and work at various scales, “an interdisciplinary strategy is necessary”. 

“It is important to remember that in projects such as eCAN we do not only work to achieve the objectives of the consortium, but we aim to expand our work and propose real solutions to be implemented in society”, said the WP8 member. 

Barriers to engage with policymakers 

Securing the commitment of policymakers is no easy task and there are certainly significant obstacles to overcome. These barriers relate to the policy-making process (lack of a culture of dialogue, primacy of political priorities, poor long-term policy planning, inflexible and non-transparent policy processes, etc.) and to the institutional set up (limited resources, weak incentives and limited capacity to engage in evidence-based policymaking). 

In the face of these some of these barriers, what project members can do is to draw up a skills map, identifying the context and scope of each policymaker, so that the approach to these actors is transparent and as clear as possible. The clearer the roadmap and the role they should play, the more willing policymakers will be to help, according to Mantziari. 

Two workshops ahead 

There are still two workshops scheduled in the calendar for eCAN participants. The first one is titled ‘Liaison with EU-wide networks: Spread the message across the EU’ and the last one ‘Empowerment Tips&Tricks: Rights and coping frames’. Both will offer a broader view on how to understand and approach stakeholders’ engagement. 

eCAN participants meet to learn how to engage patients and professionals in research projects

A total of 29 participants have joined the first eCAN’s internal workshop on improving stakeholders’ engagement in research projects. This event had the aim of sharing practical strategies for coordinating and performing effective patient and healthcare professionals’ recruitment and engagement, based on Patient and Public Involvement (PPI) principles and previous experience in working in Research and Innovation initiatives with cancer patients and healthcare workforce. 

The Lab of Medical Physics and Digital Innovation at Aristotle University of Thessaloniki (AUTH), one of the work package 8 members, organised and led the online workshop. The Lab’s research associate and eCAN member Despoina Mantziari has started presenting the preliminary results from the Stakeholders Mapping survey that WP8 developed in order to identify relevant stakeholders for this Joint Action. 

Preliminary survey’s results show different levels and types of involvement among stakeholders. WP8 has identified some strengths and barriers related to the formation of a sustainable and inclusive community of multiple stakeholders for the eCAN project. While policymakers and the scientific community are usually engaged in most parts of the process, citizens and healthcare professionals’ collaboration is not as frequent and active as it should be. 

In this regard, Mantziari has highlighted how important is to recruit citizens for testing and validating research activities. She has explained some of the key elements that professionals should keep in mind when it comes to engage patients. Open communication, transparency and being specific about the research needs and the patient’ role is essential to cultivate trust.  

Since sixteen different countries participate in this Joint Action, participants need to consider the cultural and socio-economic situation of each territory. Diverse realities may affect the engagement level in different ways, therefore all tips and strategies for involving stakeholders should be adapted to the context in which they are developed. 

Next workshops 

Apart from patients’ involvement, Mantiziari remarked how important is to keep professionals motivated and engaged. Their background and expertise are crucial to build trust with patients and for the success of the project.  This workshop will be followed by three more sessions. Next 28th of April, the Lab will hold a workshop on ‘Collaboration with policymaking actors: How to maximise the impact of your work’. In that session, WP8 will explain the importance of getting policymakers involved in a research project such as eCAN.

Later on, the team will organise two more events: ‘Liaison with EU-wide networks: Spread the message across the EU’ and ‘Empowerment Tips&Tricks: Rights and coping frames’. Both will offer a broader view on how to understand and approach stakeholders’ engagement.

Wendy Yared (ECL): “Not all cancers are inevitable, and we need to encourage everyone to understand it”

Wendy Yared at the Conference on cancer of the Swedish Presidency of the Council of the EU

INTERVIEW

There are high expectations that digital tools can contribute to a lower incidence of cancer, although we are still testing and evaluating many of them. What is certain, however, is that technology will not be enough if we do not change our lifestyle habits. We have already heard this with climate change, with the energy crisis, with our consumption patterns… and cancer is no stranger to this.

This idea is also advocated, among others, by Wendy Yared, Director of the Association of European Cancer Leagues (ECL) with more than 25 years of experience in public health and health policy. The organisation she leads brings together national and regional cancer societies that cooperate and exchange information to curb the impact of cancer at European level.

Question: In Europe, we are making great efforts to reduce the incidence of cancer, but how can we do even more?

Answer: We need to put more emphasis on cancer prevention so that we can save more lives. I am always surprised that many people are still not aware that up to 50% of all cancers are preventable. This means that not all cancers are inevitable, and we need to encourage everyone to understand it.

Why have not we paid more attention to prevention until now?

Only 3%, or even less, of health budgets are devoted to prevention. And I am not just talking about cancer prevention, but about prevention in general. When there are few resources and attention, there are not enough actions to reduce the incidence of these diseases.

Moreover, cancer takes decades to develop, so if there is a current improvement in its incidence, it is due to the efforts that were made decades ago. Maybe what we are doing now is very good and sufficient, but we will not be able to see numbers improve significantly for another twenty or thirty years. The good news is that now, at the EU level, there is a lot more attention towards cancer control and policymakers are being convinced about of its importance.

Considering the available data about the growing incidence of cancer, how is ECL looking at the future?

First, it is important to know how reliable the data and the sources are, but it is certain that the ageing of Europeans plays an important role. For our part, we are trying to maintain cancer high on the EU agenda, because this has not always been the case.

We must be patient, but there are reasons for hope, such as increased budgets for cancer control and a bigger awareness in Europe. I am confident that we will see a decrease in cancer incidence soon, especially with the increased EU support in recent years.

“I am confident that we will see a decrease in cancer incidence soon, especially with the increased EU support in recent years”.

Nowadays, it is known that our habits and the risk of suffering cancer are linked. Why is it so difficult to raise awareness of this idea among people?

Each risk factor responds to specific behaviours and, as a result, there are different challenges in each of them. For some risk factors, such as tobacco use, we have more information on why it is so hard to modify our habits, but we also know actions that work, such as taxation. If there are high prices, it will be more difficult for people, especially youth, to get hooked.

Cancer leagues need the support of governments to improve policies and raise awareness, considering that we do our best with fewer resources than industry, which widely promotes its unhealthy products (tobacco, alcohol, sugary drinks, sunbeds, etc.).

How can we convince them to lead healthier lifestyles?

The International Agency for Research on Cancer (IARC) is now in the process of updating the European Code Against Cancer. They are evaluating what works and what does not in each cancer area while considering the most updated evidence. It is important to keep renewing the messages regularly so that people are reminded of them. And finally, as mentioned before, it is important to have policies that encourage citizens to make the healthiest choices.

Can you give us some insight into the upcoming fifth version of the European Code Against Cancer and how do you plan to increase its dissemination?

There will likely be new recommendations that will be added to the current fourth edition.  Discussions are ongoing to align with current evidence, such as including boys for the Human Papilloma Virus (HPV) vaccinations.

Regarding the dissemination, we will continue to engage the member leagues of the ECL and other partner international organisations to spread the word about the ECAC, since they have direct contact with patients and civil society.

The ECAC and other initiatives focus on what we can do as individuals to reduce cancer risks, but do we ask the same commitment from producers (alcohol and tobacco companies, food industry…)?

We can ask but I have little confidence that they will have any significant level of commitment. While some companies may show that they try to make a difference, not all of them do what they promise. It is simple: it is not their job and they want to sell and make a profit. We have different priorities and that forces us to seek a balance between all the actors involved.

If producers truly wish to help, they could give a portion of their profit to support healthcare systems, because if they are going to make people sick, at least help them get better too.

“While some companies may show that they try to make a difference to reduce cancer incidence, not all of them do what they promise. It is simple: it is not their job and they want to sell and make a profit”.

In terms of digital tools for cancer care, it is very common to mention mobile apps, but can you give other examples of these tools? Is there one that stands out above the rest?

When we talk about digital tools, we also include smartwatches, the Internet of Things, robotic surgery, pathologists… but none of them stand out among the other tools for now. We have to wait for the results that all of them are promising and bringing. The internet and websites, if we count them as digital tools, are the most promising because of their accessibility, durability and reach.

How can digital tools help us to deliver cancer services more efficiently and reduce existing gaps?

The patient must be well-informed to be able to choose which option he or she prefers and to have flexibility in this regard. Beyond highlighting the benefits of these tools, such as reduced travel time and the guarantee that the doctor is always there, even if not physically, what is really important is to give the patient the possibility to choose between virtual or face-to-face care for their particular needs.

What are the barriers that healthcare professionals need to overcome?

The pandemic has shown that there is a new way of working in healthcare and has helped professionals change their mind-set on the value of digital health. Not everyone was trained with these technologies when they were studying, like surgeons, for example, so their learning curve has been steep and fast. They also have had to learn how to talk to patients through the screen when there are difficult things to tell. Professionals need to be convinced that this adaptation can be useful to them and make their work easier.

And regarding the management of health information?

Hospitals use different systems to manage their data, so harmonisation of information and platforms across healthcare institutions remains a challenge. We need to ensure that these systems are interoperable within and across our borders.

Patients can be nervous about sharing their data, because sensitive information can be grounds for discrimination if it gets out or is leaked, so these systems need to be secure and the patient needs to be assured of the confidentiality of their information.

What added value can eCAN bring in the context of digital tools?

eCAN aims to put on the table some recommendations on teleconsultation and telemonitoring at European level, which I believe is vital to clear up doubts and ensure that everyone interprets the regulations in a harmonised way. But for this to happen, it is first necessary to raise awareness among policymakers, which is also what eCAN is trying to do.

Why do we have healthcare systems if we don’t include patients in the policy-making process?

OECD representatives: Caroline Berchet and Candan Kendir

INTERVIEW

Candan Kendir (OECD): “Who can know better than people who have first-hand experience with healthcare about how to improve the delivery of health systems for better outcomes and experiences?” 

Caroline Berchet (OECD): “There are large inequalities in access to technologies […] Policymakers should ensure that all people can use and access to health technology. Digital health literacy is key”.

Could you imagine being the main character of a theatre play but being ignored by all actors and actresses during the whole performance? That is exactly what happens when the patients’ voices and visions are not included in the policy making processes that have an impact on healthcare delivery.

The Organisation for Economic Co-Operation and Development (OECD) knows the importance of considering what patients have to say for improving the design of healthcare policies and policies themselves. Candan Kendir (Health Policy Analyst, OECD) and Caroline Berchet (Health Economist, OECD) see the need of changing the way policies have been elaborated so far and have shared their vision and insights with the eCAN project in that respect.

Question: Latest cancer prevention and care policies include patients’ voices in the policy-making process. Why is this approach taken?   

Candan Kendir: Patients and caregivers can provide their experience and knowledge to health policy making and research. In the end, the ultimate goal of healthcare is to provide care to people. And keeping that in mind, who can know better than people who have first-hand experience with healthcare about how to improve the delivery of health systems for better outcomes and experiences?   

However, bringing patients’ perspective into policy making is still very rare across countries. For instance, an OECD work published in 2021 to evaluate patients-centredness in healthcare systems found that only 11% of the participating countries included patients’ voices in key policy-making areas.   

When did policymakers start to take a people-centred approach for improving the health systems’ quality in Europe? 

Candan Kendir: We cannot talk about a milestone event which leads to all these conversations, but we know that years ago this was not even part of the discussion. It was when several international organisations and associations started having patients in their councils or in their advisory bodies that a patients-centredness approach emerged. All that led to now have patients sat in advisory bodies or working groups in Health Ministries. 

Are there any national or regional examples that we can consider touchstones to base future work on?   

Candan Kendir: There are a few good examples across Europe. However, it is not only about including or engaging patients in policy making, but also about how to do it. We need to agree on when they are needed and which level of implication they will have, because they cannot be everywhere; they have limited resources, time and capacity.   

When I think about good examples in Europe there are two countries that come to my mind immediately. One of them is Czech Republic. In 2018, they established a Patients Council consisting of patients’ organisations that works in collaboration with Patient Rights’ Units in the Ministry of Health. Basically, each time there is a new area of work in the Ministry of Health, patient rights’ units think about the kind of involvement patients can have in the issue. These groups gather very regularly, and they also meet with the Ministry of Health once a year, if I’m correct.   

What about the second country? 

Candan Kendir: Another example is in the Netherlands, at the Netherlands Institute for Health Services Research (NIVEL). They created a council of people with over 11,000 members. NIVEL consults this group regularly for key policy areas that the Ministry of Health is working on, based on the topics and the interest they are forming new subgroups from this council and agree which topics they will address, their role, their involvement during the process…I’m pretty sure there are many examples such as those, in Europe and outside of Europe.

The OECD has launched the Patient-Reported Indicator Surveys (PaRIS) initiative in 2018. These surveys included patients and healthcare providers in the designing process. How is the patients’ attitude towards this new approach of a people-centred health system? 

Candan Kendir: We have a very engaged groups of patients and providers in the PaRIS initiative, because the initial proposal came from a bottom-up initiative of a task force, integrated by patient representatives, patient organisations, and primary care provider organisations as well. These people worked together on the study, design and development of the PaRIS Survey. After that, in 2018, we convened a Patients Advisory Panel, with whom we have regular contact. It has been 5 years since we have this patient panel, and I can say that these 10 patient organisations are still engaged. They participated in all steps of the designing and development process, and that was key for their engagement.   

“On our end, people-centred approach requires a lot of time and resources. On the patients’ end, because most of times they are not paid for these kinds of activities, they need to use their own budget or resources”.

Which are the main challenges about including the patients’ voice in the policy making process?   

Candan Kendir: On our end, people-centred approach requires a lot of time and resources. On the patients’ end, because most of times they are not paid for these kinds of activities, they need to use their own budget or resources. Another challenge is the difficulty of coming to a consensus with all different stakeholders. Sometimes when you work with a group of experts in a survey like this, they would like to add more questions because it is interesting from a research perspective, whereas for patients it might be a burden to answer all those questions. You need to find a common ground to bring all these people together and even if we cannot make everyone happy, we need to make sure that they all understand the reasoning behind the final choice that we were making   

Caroline Berchet: An important stake from including the patients voice in the policy making is to make sure the care provides value to patients. From an economic perspective, this allows to reduce wasting in health care expenditure which is critical today given the limited resources that we face. Still today, care fragmentation for people having chronic conditions is too high, having implication on efficiency and health outcomes. 

How is it possible to achieve a representative “patient’s voice” that does not leave anyone behind? And how can this measure help to tackle inequalities seen across the European Union?    

Caroline Brechet: From a methodological point of view, it is important to make sure that you have representatives from all population groups, so for example by educational level, income level, migration status as well those living in rural or other under-served areas. 

Candan Kendir: Yes, it should be upon to all, and it should be also transparent, so no one could think that they did not have the opportunity to contribute. These are two key elements, but on top of that there are hard-to-reach populations that require extra measures. Wales, for example, wanted to ensure that the voices of people from deprived and vulnerable population groups were included in the PaRIS survey, so they decided to go there and talk to people and primary care providers in the region. Being inclusive and transparent are the key things, but sometimes it is necessary to take an extra step. Same thing for people with low health literacy level, for instance. 

And outside the PaRIS initiative, which measures does the OECD take to be inclusive and transparent to avoid inequalities when improving the quality of the healthcare systems? 

Candan Kendir: When we were preparing the EU Cancer Country Profiles, we had consultations with stakeholders, expert groups and patient organisations. We did not have a formal body of patients that we included in the initiative itself, but we asked European Member States whether they communicate with national patient organisations for cancer prevention and care. Of course, today there are many European projects with Work Packages led by patient organisations themselves. I think this is also another good example, not only involving patients in the projects that we are doing but also partnering with patients’ organisations who can advise us in certain aspects.   

Caroline Berchet: At the OECD the question of inequalities is actively addressed. For example, several recent flagship reports present socio-economic inequalities in health status, in access to care or in risks factors to health. Monitoring inequalities is the starting point to shed light on how different population groups are doing, to monitor trends in health inequalities and deploy targeted responses. 

One of the documents that shows inequalities across countries are the EU Cancer Country Profiles. What are the report’s highlights on this regard?  

Caroline Berchet: In terms of key findings, I would say that cancer inequalities are large across Europe, but also within countries. Policy actions should target groups on lower socio-economic groups, and among men population. We saw for example that the cancer mortality rates are on average 75% higher among men than women across the EU, that is a large disparity.    

The second type of inequality within countries that we can observe is related to educational level. In almost all EU countries, cancer mortality rates among low education groups are higher than those in higher education groups. At the same time, cancer mortality rates among higher education groups are rather similar across countries, but there is a lot of heterogeneity in cancer mortality among the lowest education groups. Focusing on low socio-economic groups will help to reduce overall inequalities in cancer mortality across countries.   

What would you say that are the main inequalities across the EU in terms of digital health?  

Caroline Berchet: There are large inequalities in access to technologies, although technologies are key to provide access to care and reduce disparities. One important thing to mention here is that policymakers should ensure that all people can use and access to health technology. Digital health literacy is key.

“The eCAN project will provide some good information on EU practice and evaluate some pilot project’s outcomes that will be useful for sharing experiences across countries”.

The OECD got the status of observer at the eCAN project. How can eCAN and the OECD collaborate in the short and long term?   

Caroline Berchet: In the short term, the collaboration with eCAN is a great opportunity for nurturing the work the OECD and the European Commission are doing. The eCAN project will provide some good information on EU practice and evaluate some pilot project’s outcomes that will be useful for sharing experiences across countries. In the longer term, one way of collaborating is to work on the series of Country Cancer Profiles that are produced for each EU member States, plus Norway and Iceland.   

Candan Kendir: We know that you’ll implement pilot projects regarding cancer care in telemedicine and you will do an evaluation of it. Patient-Reported Outcomes and Experiences are one of the most important aspects to consider in this evaluation. The experience that we have developed at the OECD over the past years on measurement and reporting analysis will be also valuable for eCAN. On the other side, it is interesting to get the results of this evaluation and see the differences and interpretations that we can make when looking at different works. 

The views expressed and arguments employed herein are solely those of the author(s) and do not necessarily reflect the views of the OECD or its member countries. The Organisation cannot be held responsible for possible violations of copyright resulting from the posting of any written material on this website.

The use of telemedicine skyrocketed during the COVID-19 pandemic

The use of telemedicine, or remote clinical consultations, was limited in most countries before the pandemic, held back by regulatory barriers and hesitancy from patients and providers. In early 2020, as COVID‑19 massively disrupted in-person care, governments changed the playfield and acted decisively and broadly to promote the use of this discipline.  

Consequently, the number of teleconsultations reached unprecedented numbers, playing a vital role in maintaining access to care, but it wasn’t enough to offset reductions in face-to-face care. This is one of the conclusions reached by a recent study published by the Organisation for Economic Co-operation and Development (OECD), entitled “The COVID-19 Pandemic and the Future of Telemedicine“. 

The document also proposes policy priorities for using telemedicine in the near future like learning more about which patients are using remote care services, why they are using these services and what happens after they use them. It is as well highlighted the need to investigate whether telemedicine payment and prices are creating economic signals and incentives that promote value for money. Finally, foster integration between remote and in-person care services is needed so that these are fully coordinated and part of a seamless care pathway. 

Telemedicine before the SARS-CoV-2 

Prior to the pandemic, nine countries (Estonia, Hungary, Iceland, Ireland, Korea, Luxembourg, Mexico, Türkiye and the United States) allowed only in-person medical consultations. While it was possible to use telemedicine services in other states, many governments had specific requirements to telemedicine that effectively disincentivised its use. And although the number of services was growing in territories such as Australia, Canada and Portugal, teleconsultations were only between 0.1% and 0.2% of all appointments, according to the study. 

Among the nations that participated in the OECD Survey on Telemedicine and COVID‑19, 23 out of 31 are currently allowing teleconsultations to be performed by health workers other than doctors, six more that before the pandemic (Estonia, Germany, Iceland, Luxembourg, Portugal and the United States). 

Doctor teleconsultations in OECD countries, 2020. / OECD

Despite the rapid adoption of policies to promote the use of telemedicine, only seventeen countries state that rules and regulations governing the provision of telemedicine services are well established and clear. 

An uncertain future 

During the pandemic, eight countries (Belgium, Czech Republic, England, Estonia, Hungary, Korea, Latvia and Luxembourg) have begun paying for teleconsultations through government/compulsory schemes, and other eight (Belgium, England, Estonia, Germany, Hungary, Ireland, Latvia and Switzerland) have done the same for remote patient monitoring services. 

However, many of the changes that have enabled greater use of teleconsultations during the pandemic are temporary and have not become permanent. For example, in sixteen OECD countries, changes to regulations are transitory and subject to ongoing or periodic review, just like changes regarding financing in twelve states. 

Given the circumstances, it is unclear whether remote care substitutes for or complements in-person care, and whether telemedicine adds value when it does not deliver extra benefits and could be replaced with cheaper alternatives with identical or better outcomes.

Reference:

OECD. “The COVID-19 Pandemic and the Future of Telemedicine”. OECD Publishing (2023)

EU Country Cancer Profiles point out large inequalities in cancer mortality rates between and within EU countries

EU Country Cancer Profiles point out large inequalities in cancer mortality rates between and within EU countriesOECD

The first Country Cancer Profiles under the European Cancer Inequalities Registry state significant inequalities in cancer mortality rates between and within EU member states. These reports reveal that varying exposure to risk factors for cancer and the different capacity of healthcare systems to provide timely and free access to early diagnosis, as well as high-quality cancer care and treatment, partly explain these inequalities. 

The Country Cancer Profiles consist of a concise yet comprehensive analysis of cancer burden and policies in the 27 EU states, plus Norway and Iceland. The documents were launched last 1st of February 2023 at the ‘Cancer – Equity, excellence and innovation: modern cancer care for all’ conference, co-organised by the European Commission and the Swedish Presidency of the Council of the European Union.  

During the event, the Head of the Health Division at the Organisation for Economic Co-Operation and Development (OECD), Francesca Colombo, highlighted some of the report’s key messages. All of them rely on the idea that “there are large and unacceptable inequalities across the European Union. No matter what indicator you look at, you will find differences across countries, differences across population groups; and much of these is something on we can act”, emphasised Colombo. 

Inequalities across the European Union

The difference in mortality rates becomes substantial when comparing central and eastern European countries to the remaining EU countries. Even within the same state, relevant inequalities across population groups are visible. According to Caroline Brechet and other OECD representatives, “cancer mortality rates are 75% higher among men than women across EU countries”, while “less educated individuals have higher mortality rates for nearly all types of cancer than their more highly educated counterparts”.  

Addressing these disparities requires national and international efforts to identify the EU’s main challenges regarding cancer continuum care, targeting population groups, sharing best practices between member states and boosting comprehensive prevention policies. 

As Colombo mentioned, policies on alcohol consumption are real examples that take a comprehensive approach and can be translated to the cancer field. In the case of alcohol, there is the PPPP approach, which combines Police enforcement to limit alcohol-related injuries, Protecting children from alcohol promotion, Primary health care and Pricing policies. 

The gender gap is still visible 

Looking at the report’s graphics and numbers, Francesca Colombo explained that cancer mortality rates have decreased over time in almost all member states. However, there are countries in which the efforts for reducing cancer mortality are not enough and where the gender gap is still visible. 

Although male mortality levels have decreased more than women over time, some countries present significant gaps. In this sense, Nordic countries perform better, showing more gender equity. 

Graphs on cancer mortality rates by country and gender indicate that female mortality levels among countries tend to be shorter than those we can find in data on men’s mortality. This fact suggests that efforts to reduce mortality among men need to be done in order to reduce the overall mortality rates. 

Graphic from OECD

Cancer mortality rates of men and women across EU countries. / OECD

Low social economic groups suffer higher cancer mortality rates 

The profiles also ratified how determinant socio-economic inequalities are in cancer mortality. The Head of the Health Division at the OECD suggested that prevention policies and interventions need to focus on social-economic disadvantaged groups and lower-educated groups.  

In this sense, the OECD representative explained that a large part of gender and socio-economic gaps are linked to modifiable risks factors for cancer, such as poor lifestyle, smoking, obesity or alcohol consumption. Colombo reiterated that addressing those inequalities “is probably where we can make the further gain”. 

References:

Berchet, Caroline, Dedet, Guillaume, Klazinga, Niek, and Colombo, Francesca. “Inequalities in cancer prevention and care across Europe”. The Lancet Oncology. 24,1: 10-11. (2023)  

OECD. “EU Country Cancer Profiles“. OECD Publishing. (2023) 

eCAN advocates for access to health prevention and care on World Cancer Day 2023

This 4th of February, World Cancer Day, the eCAN Joint Action joins the three-year campaign #CloseTheCareGap and advocates for providing access to health prevention and care all over the world. Within its frame of work, as a European research project, eCAN is committed to closing the current care gap among EU countries by strengthening eHealth in cancer.

According to the European Beating Cancer Plan, “a number of indicators show major differences in cancer prevention and care between and within Member States”. As well known, early detection through different means (such as screening) is the best way to increase the chances of beating cancer. However, access to these prevention programmes varies considerably among countries. For example, national cancer programmes’ coverage of the target population ranges from 6% to 90% for breast cancer screening. The inequalities in access to prevention programmes evidence there is much work to provide equal access to health prevention and care.

Such difficulty does not only affect screening access but the entire disease pathway. eCAN aims to contribute to the cancer control continuum by boosting preparedness among the cancer care workforce in the virtual consultation and monitoring, improving healthcare workforces’ response in light of pandemics and crises, enabling cross-border cooperation, and reducing cancer care inequalities between rural and urban areas. Counting with the support of technological tools will enable to close the care gap in terms of prevention, early-detection, timely treatment and recovering.

Taking action is essential to respond to near-future projections on cancer incidence. According to estimated data, 2.7 million cases were diagnosed in the EU in 2020, which is expected to grow by a fourth by 2035. This means that in only 12 years, over 10 million people in the EU will be diagnosed with cancer each year.

The sheer scale of these numbers shows the dimensions of the problem. That is why the Europe’s Beating Cancer Plan is a key pillar for the European healthcare systems, since it also guides the development of national strategies focused on precision health, early-detection and the creation of a comprehensive health data space.

Reimagining healthcare systems 

The 35 organisations involved in this Joint Action believe the sooner cancer is detected, the better the access to adequate treatment. Reimagining the healthcare system and harnessing the new digital tools at people’s disposal for developing new ways of receiving medical assistance and monitoring is the vision this joint action follows and will work until September 2024.

The use of these digital tools will play a key role in strengthening healthcare systems before possible pandemic outbreaks. COVID-19 has evidenced the need of telemedicine in order to not only preserve cancer control continuum, but to also help cancer patients’ mental health. According to a Dutch study, almost one in three breast cancer patients and survivors reported that their emotional functioning and mental health declined from pre-pandemic levels.

 

References:

Bargon, Claudia, et al. Impact of the COVID-19 Pandemic on Patient-Reported Outcomes of Breast Cancer Patients and Survivors. NCI Cancer Spectrum, Volume 5, Issue 1. (2021)

OECD/European Union, Health at a Glance: Europe 2022: State of Health in the EU Cycle, OECD Publishing. (2020)