Cancer remains one of the most devastating diseases of our age, with 2.6 million people diagnosed with the disease across Europe in 1995, rising to 3.4million people in 2012 – a staggering increase of 30%.[1] What’s more, cancer incidence is expected to continue its upward trajectory, rising again by over a third, by 2030.

But, there is hope. Over the same period, fewer people have died of cancer thanks to advances in screening, diagnosis and treatment. In fact, for European patients diagnosed in 2012, over 66,000 more will live for at least five years after diagnosis, compared with if they had been diagnosed a decade earlier. In addition, expenditure for cancer remained stable as a 6% share of total health care expenditure over the past 20 years.[2]

Despite progress – cancer care remains a challenge

But the challenge remains for several reasons: Cancer cases are intertwined with demographic change and the latter is likely to continue.[3] In addition, new treatment options have or will become available which haven’t been available before.[4] Finally, yet not everyone has benefited equally from progress, with one of our main challenges in the oncology sector being the ability, going forward, to increase access to innovative treatments across the board.

Access covers a range of issues, including: availability and affordability. But access goes far beyond medicines: health systems’ readiness to incorporate new, innovative treatments; patients’ capabilities to “access/navigate” the system in the right way at the right time; healthcare professionals skills in terms of understanding new therapies; as well as national or regional health and economic policies. 

Fast, equal and sustainable access

Access to cancer care needs to address three distinctive and sometimes conflicting objectives: early access; equal access; and sustainable access. Much has been done but the challenge remains big.

Here a few initial examples to improve access from the pharmaceutical industry:

• On early access we’ve seen examples where multiple stakeholders develop new pathways, adapted to the evidence available, to make urgently needed treatments accessible for patients. Examples of this include the Early Access to Medicines Scheme (EAMS) launched by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and the Innovative Medicines Initiative’s ADAPT Smart project supported by European Medicines Agency (EMA).

• On equal access, we’ve seen collaboration between Member States and industry, aimed at introducing alternative access models to meet individual countries’ needs, e.g. managed entry or risk sharing agreements. Italy offers a good example of how this might work. For low- and middle-income countries, however, where government reimbursement or insurance coverage does not exist and health systems sometimes lack the capacity to provide appropriate cancer care, we have to examine each situation on a case-by-case basis to find a solution for the patient in accordance with local laws and regulations in that country.

• But inequalities have also to be accompanied by other measures such as health literacy: Patients with higher health literacy levels manage better to navigate and access the health system, understand the importance of cancer prevention, and seek earlier diagnosis or adhere better to treatment.[5] Patient empowerment and education are key to achieve this.

• On sustainable access, we acknowledge the affordability challenges faced by healthcare systems. The industry, under the leadership of EFPIA, has entered into a number of framework agreements with Member State governments, aimed at ensuring budget predictability and balancing support for innovation with access to innovative medicines as well as access models for lower-income countries in Europe.

• In addition, innovation itself can contribute to more sustainable health resource use. Through so-called companion diagnostics which assess the biomarker status of a patient it can be determined whether a patient responds to a specific treatment or not, in short: it ensures that the right treatment reaches the right patient at the right time. Targeted or personalized healthcare may lead not only to better outcomes but also more efficient health resources use.[6]

Collaboration is the way forward

These are just a few examples. But the cancer challenge cannot be tackled by a single stakeholder nor resolved by simple solutions. Dialogue is critical to understanding the priorities and needs of each partner in the access equation, physicians, nurses, patients, payers and governments, in order to support and drive the rapidly advancing science and deliver access to innovative medicines across Europe. This is the purpose of the series of EFPIA Roundtables on access to oncology medicines. It is this collaborative dialogue that improves access and to which industry is committed to.

This blog summarizes the presentation of Deepak Khanna, Senior Vice President and Regional President Oncology for Europe, Middle East, Africa and Canada (EMEAC), MSD Oncology, in the session “Collaborating on solutions to ensure sustainable access to new oncology medicines for patients and governments – A Case Study from Europe” at the World Cancer Congress 2016 in Paris.

[1] Jönsson B et al. (2016), The cost and burden of cancer in the European Union 1995-2014; European Journal of Cancer 66: 162-170

[2] Jönsson B et al. (2016), The cost and burden of cancer in the European Union 1995-2014; European Journal of Cancer 66: 162-170

[3] European Commission (20: “The overall size of the population is projected to not only be larger by 2060, but also much older than it is now. The EU population is expected to increase by almost 4% (from 507 million in 2013 up to 2050) […]. Those aged 65 and over will become a much larger share (rising from 18% to 28% of the population), and those aged 80 and over (rising from 5% to 12%) will almost become as numerous as the young population in 2060.”

[4] Jönsson B (2016), Comparator report on patient access to cancer medicines in Europe revisited; http://www.ihe.se/access-to-cancer-medicines-in-europe.aspx

[5] WHO Europe (2013), Health Literacy. The solid facts; edited by Ilona Kickbusch, Jürgen M. Pelikan, Franklin Apfel and Agis D. Tsouros

[6] Godman B et al. (2014), Personalizing health care: feasibility and future implications; BMC Medicine 11: 179