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.

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

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.

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

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)

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

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)

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

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)

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

The Steering Committee meeting offers a glimpse to eCAN’s future

The First Steering Committee meeting offers a glimpse to eCAN's future

The Steering Committee meeting of the eCAN has been held today, January 30th, in a virtual format and with more than fifty participants belonging to beneficiary and affiliated entities. The meeting has served for the different work packages to present the progress achieved during the first five months of the Joint Action and share their planning until July 2023.  

In addition, the reunion has also given rise to some important announcements, such as the interest of the Organisation for Economic Cooperation and Development (OECD) to establish possible synergies with eCAN. These would include knowledge exchange and dissemination related to cancer inequalities or stakeholders’ involvement, as well as the possibility of getting support to improve the sustainability of the European project. 

Apart from the OECD, members from the European Health and Digital Executive Agency (HaDEA) have also intervened at the beginning, expressing their support to achieve the objectives of the JA. 

The first stages of the JA 

Following the order of the agenda, the vertical work packages Teleconsultation (WP5), Legal, ethical framework and cybersecurity (WP6), Telemonitoring (WP7) and Stakeholder engagement (WP8) have been the first ones to present, with a quick review of the work carried out in the first months and the challenges faced related to the project pilots and the identification of interested parties. 

The following months have also been addressed by the entities belonging to Italy, Cyprus and Greece, where they have discussed the risks, gaps and opportunities that they expect to experience until the summer of 2023. Ultimately, each work package has pointed out the inputs needed from the rest of the eCAN participants during this period. 

In the second part of the meeting, the transversal work packages Coordination (WP1), Communication (WP2), Evaluation (WP3) and Sustainability (WP4) have followed the same scheme, also delving into the status of their deliverables and the tasks to be developed until July. In addition, the Communication team has shown awaited features of the website, like the newsletter or the social networks accounts, as well as specific audio-visual materials designed to accompany important dates such as World Cancer Day, the 4th of February. 

After the respective presentations of all the WP leaders and the final exchange of questions and answers between the different attendees, emphasis has been placed on the opportunities for collaboration between the JA areas and the need to strengthen the flow of multilateral communication between all the entities implied.  

Milestones for the next months 

The Joint Action “Strengthening eHealth including telemedicine and remote monitoring for health care systems for cancer prevention and care”, started in September 2022, has still a long way to go until its end at the final months of 2024. 

However, this next five months will be crucial for its progress and evolution since many important milestones should be achieved: the Stakeholder analysis, the updated version of the Dissemination and Communication plan, the Progress Report, the pilot projects protocol and the start of the patients’ enrolment, etc. 

Such progress will be presented in more detail at following Steering Committees. 

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

The EU4Health Programme includes four projects on cancer prevention and care

The EU4Health Programme includes four projects on cancer prevention and care

The eCAN Joint Action (JA), along with PERCH, CraNE and JANE are the four cancer research initiatives that the EU4Health Programme has decided to include in its 2021-2027 Programme. The budget assigned to eCAN is near to 4 million euros and it will be devoted to strengthen eHealth including telemedicine and remote monitoring for health care systems, cancer prevention and care. Other three JA have also got grants to work in cancer prevention. Some others initiatives will focus on crisis preparedness, health systems and healthcare workforce.

These four cancer projects are conceived as individual initiatives that have common objectives and should create synergies. In this regard, the head coordinator of eCAN, Marc Van den Bulcke, believes that synchronisation among initiatives is one of the most important aspects in order to achieve the Europe’s Beating Cancer Plan (EBCP) and the Cancer Mission’s goals.

All these projects are mostly related to digitalisation and eHealth, the backbones of the EBCP and the Cancer Mission. As the past president and chair scientific committee of the European Cancer Patient Coalition (ECPC), Kathi Apostolidis, claimed during the eCAN kick-off meeting, “the digital transformation is expected to bring significant benefit for the health sector because as much of 30% of the world’s storage data is currently produced by health systems”. The EBCP and all the initiatives that have been born around it aim to make the most out of health data and digitalisation.

According to the leader of the EBCP, Matthias Schuppe, creating synergies among projects is a challenge for the organisations involved in the different JA. In order to overcome this issue, different levels of coordination are needed. The European Health and Digital Executive Agency (HaDEA) plays a significant role in this regard. This institution implements the EU4Health Programme by managing calls for proposals and tenders from 2021 to 2027. On their side, Schuppe and his team have been able to gather all actions that are related to the plan implementation roadmap, providing periodical updates.

Disease Prevention Joint Actions

Along with eCAN, there are three other JA that aim to dig into disease prevention. PERCH (PartnERship to Constrat HPV) aims to support Member States’ efforts to extend the roll-out of routine HPV vaccination of girls and boys to eliminate cervical cancer and other cancers caused by HPV in the coming decade. The joint action will support the exchange of validated best practices between the EU countries to ensure a consistent and efficient roll-out of HPV vaccination.

CraNE (EU Network of Comprehensive Cancer Centres) is the third JA on disease prevention of the EU4Health Programme 2021-2027. This initiative will create an EU Network linking recognised National Comprehensive Cancer Centres (CCCs) in every Member State. CraNE will work in preparing the necessary preconditions, administrative, professional, and those related to high-quality performance.

Lastly, JANE (Joint Action on Network Expertise) is a new European knowledge network on cancer and cancer conditions that aim to generate and share knowledge in oncology among the European Member States. The European Commission is committed to the creation of seven Knowledge Networks that will cover crucial areas in cancer care, bringing together the best evidence and knowledge, and resources available in Europe in each specific field, in order to support National Networks and Comprehensive Cancer Centres.

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

WHO publishes a guide for operating effective telemedicine services

WHO publishes a guide for operating effective telemedicine services

The World Health Organization (WHO) has recently published a guide intended for healthcare services that use telemedicine to treat their patients. The report, entitled “Consolidated telemedicine implementation guide”, addresses the key steps and considerations to implement this discipline effectively and optimize its benefits and impact.
Its content will be useful for various eCAN Work Packages, especially those that are developing the pilots and the protocol of the Joint Action, but also the ones in charge of risk mitigation, key performance indicators and stakeholders’ engagement.

“For telemedicine to have the most impact when and where it is needed, the enabling environment is critical. Investments in national policies, governance, and standards are important to have in place,” says Alain Labrique, Director of the WHO Department of Digital Health and Innovation. “This guide is not a stand-alone solution, but rather a complementary tool that works in tandem with user-centered solutions that are accessible by all, towards delivering high-quality remote care that is accountable and suitable to the context in which patients live.”

Towards the implementation of remote medicine

Aiming to be a key reference for Member States, this new resource supplements the WHO Digital Investment Implementation Guide (DIIG), which provides a systematic process for planning and implementing digital health interventions. It outlines practical steps countries can take through a process of planning, implementing, maintaining and budgeting a telemedicine programme to obtain equitable health outcomes.

“Telemedicine is an important tool that expands access to critically needed health services, but we need to be mindful of the inherent inequities where access to the technology is limited or where there is the potential for harm. This guide aims to support countries to deliver telemedicine services, while highlighting approaches to optimize and improve health for all”, comments Pascale Allotey, Director of WHO Department of Sexual and Reproductive Health and Research, whose team has contributed to the development of the guide.

Although the case studies in this guide are not from European countries, telemedicine also brings benefits to patients in the EU. This is the conclusion reached by a study published between the WHO and the Universitat Oberta de Catalunya (UOC) that analyses data from over 20.000 patients during the pandemic started in 2019. “We see better clinical outcomes, better follow-up by healthcare professionals, and an overall benefit for both patients and healthcare workers”, says David Novillo-Ortiz, Regional Adviser on Data and Digital Health and lead author of the research.

An opportunity revealed by the pandemic

The COVID-19 pandemic shone a spotlight on how telemedicine can help to deliver healthcare to all, especially for people living in remote areas and underserved communities. Countries around the world have struggled, however, to ensure routine use and long-term sustainable access to telemedicine services – even in those with the most robust health systems.

In order to ensure the sustainable use of telemedicine beyond the SARS-CoV-2 pandemic and amongst multiple complex global health challenges, from conflict and disease outbreaks to climate change, WHO has released this new resource to help guide policy-makers, decision makers, and implementers in designing and overseeing telemedicine implementations.

 

References:

Bento, P. et. al. “Consolidated telemedicine implementation guide”. World Health Organization (2022).

Saigí-Rubió F, et. al. “The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews”. J Med Internet Res (2022).

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.

Brussels hosts the kick-off meeting of the European cancer project eCAN

Brussels hosts the kick-off meeting of the European cancer project eCAN

The Joint Action “Strengthening eHealth including telemedicine and remote monitoring for health care systems for cancer prevention and care” (eCAN) has been presented at the Pullman Hotel of Brussels between the 20th and the 21st of September. The event paved the way for the eCAN project, framed within the EU4Health Programme and that will be running until the end of 2024.

Coordinated by Sciensano (the Belgian institute for health), eCAN aims to provide a framework of recommendations for the integration of telemedicine and remote monitoring in health care systems. The objective is to reduce cancer care inequalities across the European Union and to help Member States to become pandemic proof, particularly for cross-border health emergencies and crisis, such as COVID-19.

During the kick-off meeting, the head coordinator of the eCAN, Marc Van den Bulcke, has highlighted how the coronavirus epidemic has shown that telemedicine and remote monitoring have the potential to consolidate as regular health care practices, raising new opportunities for patients and health care providers, as well as new questions.

Since March 2020, European institutions have demonstrated that it is possible to develop apps related to health care that work in all EU countries. One example is CovidSafe app, used for saving COVID certificates. Designed for other purposes, technological tools might become ideal for helping cancer survivors to get psychological and emotional support, information about where and how to get resources, and so on and so forth.

eCAN will enrich the EU Health Data Space

A total of 16 EU countries are involved in the eCAN project; besides them, the kick-off meeting brought together a large number of actors interested in the applications of eHealth in a disease that registers, in the EU, 2.7 million new cases every year. Among the attendees, there were European Commission representatives, health ministers, international policymakers, organisations, entities and stakeholders.

The leader of the European Beating Cancer Plan (EBCP), Matthias Schuppe, was one of the keynote speakers that participated at the first eCAN event. He has pointed out that launching this kind of initiatives will help states to better tackle future pandemics and the impact these critical situations have for patients.

Apart from those benefits, eCAN will also contribute to enrich the EU Health Data Space. In this regard, the past president and chair scientific committee of the European Cancer Patient Coalition (ECPC), Kathi Apostolidis, has said that this European data space will enable cancer patients to secure their data in an integrated format, and share it with health providers across EU borders. However, digital health literacy, equipment and facilities must be available for all EU member states in order to achieve an appropriate EU Health Data Space and the drop of cancer care inequalities among countries.

The tasks of eCAN

On the other hand, the leader entities of every work package have introduced the tasks that have been assigned to them as well as the road map to carry them out and the difficulties and challenges that these will entail.

Sciensano will lead the coordination work area. Likewise, the Catalan Institute of Oncology (ICO), located in Spain, will be in charge of the communication of eCAN. Maria Skłodowska-Curie Institute of Oncology (in Poland) will assume the third package tasks (monitoring and evaluation), and the Austrian National Public Health Institute (GÖG) will guarantee the sustainability of the recommendations provided.

The Regina Elena National Cancer Institute (IFO-IRE), in Italy, will lead all the actions related to teleconsultation and the legal, ethical framework and cybersecurity aspects. On the other hand, the National eHealth Authority of Cyprus will be in charge of telemonitoring in cancer care. Lastly, the 3rd Regional Health Authority of Macedonia (3rd RHA) in Greece will be the entity responsible of stakeholder engagement, education and training in Members States.

In addition to the beneficiary entities that lead the eight different working areas, eCAN also counts with the participation of other affiliated entities. There is a total of 35 organisations involved in this Joint Action.

Current projections on cancer

Cancer is the second leading cause of mortality in the EU after cardiovascular disease. The prevention and control of cancer would benefit the majority of citizens since cancer shares common risk factors with other noncommunicable diseases. Across Europe, the possibility of receiving a timely cancer diagnosis and of surviving the disease differs considerably because of inequalities in preventive policies, access to state-of-the art diagnostics, treatments and experienced care.

The current projection is that, without strong action, the number of diagnosed cancer cases will increase by a fourth by 2035. Therefore, there is a need to harmonise telemedicine regulations and to explore the efficiency of teleconsultation programmes and telemonitoring in the cancer field. That is precisely the direction in which eCAN is going.

Besides, this initiative coexists with other concurrent European cancer JA. For example, PERCH intends to contribute to improve the dissemination of the HPV vaccine among European citizens, while CraNE and JANE want to establish and improve the EU Network of Comprehensive Cancer Centres and their national counterparts. All these European projects are set to be finished in 2025 at the latest.

Logo EUCo-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA.                                                                       Neither  the European Union nor the granting authority can be held responsible for them.