Is The EU’s Cancer “Master Plan” at Risk?
It was encouraging to see that tackling cancer was high on the agenda of the European elections in 2019 in comparison to previous years. Tackling inequalities in access to treatment across the EU will be paramount going forward as cancer will soon become the biggest cause of disease burden in Europe. The so-called “cancer master plan”, coined by Manfred Weber but now widely accepted as a pan-European concept, calls for researchers and policymakers to work closely together and outlines some initial ways to improve cancer care in Europe. However, with the results of the recent EU elections leading to the departure of several vocal supporters in the cancer policy caucus, is the cancer master plan at risk.
Prominent MEP departures
Post-election, several experienced MEPs will not return to Brussels due to lack of support for reelection or due to retirement. For the cancer policies caucus, the list of departing MEPs includes Slovenian MEP Alojz Peterle1 who was president of the MEPs Against Cancer Group, Belgian MEP Lieve Wierinck and Portuguese MEP José Inácio Faria.
Despite some prominent departures, the number of individuals and organizations who participated in the cancer dialog was high, meaning that the topic looks to remain a top policy priority. At Bayer, we are in strong favor of keeping the master plan alive and support several changes in Europe so that cancer patients are ensured access to the latest innovative medicines.
Keeping cancer care on the EU agenda
The topic of how to fight cancer started off in a moonshot style and the subsequent debate in Brussels focused on pan-European improvements and leveling inequalities in access and care for cancer patients across the continent.2 Some of the ideas captured in the campaign talks were commonplace calls such as doubling the budget for cancer research and focusing on prevention3 through public awareness campaigns. Other ideas reflect long-needed policies. For example, there are proposals for the Commission to build a framework for the interoperability of European cancer registers, calls for the European Council to review its 2003 recommendations on cancer screening, and discussions regarding better cooperation between the European Medicines Agency (EMA) and national Health Technology Assessment (HTA) authorities. Due to the limited competencies of European institutions, there is also a need to improve cancer care at the European national level, particularly regarding funding.
Pan-European initiatives needed to tackle the cancer disease burden
The current EU legal framework for cancer policies is outdated and needs a refresh. We strongly support the proposal to update the 2003 cancer screening recommendations4 that call on all EU countries to take common action to implement national, population-based screening programs and should also comprise an effort to enable access to genomic testing for cancer patients. For European patients, doctors and healthcare systems, high-quality and broad genomic testing, such as Next Generation Sequencing (NGS), should become part of routine clinical practice.
Health data could be a treasure chest in the fight against cancer as it can help doctors and scientists understand when therapies can deliver the most value for patients. There is huge fragmentation in Europe, illustrated by the sheer number of cancer data registries, all of which vary in quality and storage methods – from handwritten notes to gigabyte files of genomic datasets. Cancer data can be found in more than 1,100 different sources in Europe.
At Bayer, we believe that Europe needs a harmonized approach to how data is collected and stored. EFPIA has addressed this through the Oncology Data Landscape in Europe project, which identifies a range of initiatives designed to improve access to existing datasets, improve collection, standardize data, and collect new data. If long-standing issues like interoperability and the need for standardized data coding structures are addressed, as well as an improvement to the health data infrastructure, the potential of hundreds of isolated sources across Europe could be unlocked.5
As previously discussed, different European Member States have different procedures to assess the benefit or value of drugs, which is called Health Technology Assessment (HTA). EU-level discussions envision better cooperation between the EMA and national HTA authorities in order to focus investment on drugs that have a real benefit for patients across the EU. Better alignment between EU-level regulatory bodies and national HTA reimbursement can facilitate smoother value assessment procedures and we support any measures that enhance such cooperation. Such streamlining will also improve evidence development and enable value assessment processes.
There was also strong support for HTA initiatives that include the patient perspective. The “MEPs Against Cancer (MAC)” group called for patient participation in HTA with greater relevance on patient reported outcomes as well as elevating quality of life indicators as primary endpoints together with overall survival. At Bayer we support such initiatives, as we believe that patients are, of course, the true experts in living with disease and we want to ensure their needs are met in the treatments we provide.
Improving access to cancer care on the national level
Beyond the pan-European initiatives, European governments remain responsible for national health priorities.6 Many EU countries could improve access to cancer care if they increased cancer funds so that spending matches the disease burden. We notice that healthcare budgets in many countries are at full stretch and budget sustainability remains a high priority for policymakers. However, governments need to recognize the value of cancer drugs for sustainable healthcare systems, taking into consideration that spending for cancer drugs – generic and innovative - accounts for only 1.5 percent of the yearly health expenditure and about 20 percent of total cancer care spending in Europe.
As we laid out already in the Bayer Pharmaceuticals EU manifesto, our vision explores fostering a pro-innovation environment in order to contribute to a healthier future for Europe. We strongly support the inclusion of cancer on the European policy agenda and see the current conversation as a promising development. More alignment is needed to tackle the cancer disease burden and we believe Brussels can play a major role to increase cancer care outcomes with pan-European initiatives.
 The latest EFPIA Patient W.A.I.T. Indicator 2018 found that the average delay between market authorisation and patient access for oncology products is between 2 months to over 2.5 years in Europe. https://www.efpia.eu/media/412747/efpia-patient-wait-indicator-study-2018-results-030419.pdf, p. 29.
 The WHO International Agency for Cancer Research (IARC) estimates that 50% of cancer deaths in Europe can be prevented “if current knowledge about cancer prevention was put into practice”.
 Article 152 of the European Community Treaty states that Community action in the field of public health shall complement national policies – EU recommends (and harmonizes) policies which is then implemented by EU states according to national laws, responsibilities of health service delivery and “national epidemiological specificities”.