Athina Kasini, 89 Belgium
The information and views presented in this article are those of the authors only, and do not reflect the positions and opinions of their former or current employers, or of any organisation they were or are affiliated with.
Executive summary
A year after Stella Kyriakides took over as the new Commissioner for the Health and Food Safety Cabinet, she introduced Europe’s Beating Cancer Plan. In February 2021, a joint EU approach on cancer was introduced with a generous budget aiming to support Member States in the fight against the disease. In this paper, I will analyze the content of the Plan, recent developments, potential criticisms, and what this means for the future of healthcare in the EU. The Commission’s interest in coming up with a plan that specifically targets cancer stems from an unmet need to step-up in terms of Union-wide healthcare. According to the World Health Organization, cancer is the second leading cause of death and morbidity in Europe, with more than 3.7 million new cases and 1.9 million deaths each year [1]. As for Ms Kyriakides, her presidency of the First Breast Cancer Movement in her country of origin, Cyprus, and the fact that she organized the first breast cancer awareness campaign at the Council of Europe in 2013, make her one of the most likely candidates to push for such a plan [2]. Taking into consideration the condition of our already burdened healthcare systems at the time this plan was announced, it is interesting to see whether it addresses existing shortcomings brought to light by the pandemic, and what the challenges are in tackling those issues.
Characteristics of the Plan
With multiple available funding instruments supporting it, including the new EU4Health programme, Horizon Europe, and the Digital Europe programme, the Plan promises new technologies, innovation, and well-funded research [3]. Current guidelines are set to be revised to reflect the latest scientific evidence and cancer screening technologies, such as the Council Recommendation on Cancer Screening, and there will be a particular focus on tackling childhood cancers [4]. The plan addresses multiple stages in the disease pathway, through four main pillars: prevention, detection, treatment, and quality of life of patients and survivors.
The first pillar is based around the premise that “prevention will always be better than cure”. This includes improving awareness on cancer and risk among the public through updates to the European Code against Cancer, and increasing its accessibility via an EU Cancer Prevention mobile app [5].
The prevention pillar also sets out to encourage healthier lifestyles, with ambitions to see a significant reduction in harmful alcohol consumption (e.g., by reducing targeted marketing in young audiences), as well as a ‘tobacco-free generation’, i.e., less than 5% of the EU population using tobacco by 2040 [6].
Beyond improvements in awareness and lifestyle, prevention also entails changes in environmental policy; for example, introducing policies that reduce exposure to carcinogens and radiation (such as those found in consumer products or within the workplace), and aligning the EU air quality standards with those of the World Health Organization to reduce pollution [7].
The ‘detection’ pillar sets out to grant equal access to early diagnosis and treatment. The main factors deterring early diagnosis are the fundamental inequalities that persist between and within Member States, which the Plan addresses and aims to reduce. The main factors deterring early diagnosis are, among others, non-standardized management of cancer control and care, which leads to a higher number of deaths in worst-performing versus best-performing states. The plan outlines the Cancer Inequalities Registry that aims to address such issues, as well as improve access to medicines [8].
The third pillar is about ensuring patients receive adequate treatment. The Plan suggests introducing a multidisciplinary cancer training program to create a high-quality cancer care workforce across the EU. With multidisciplinary care at the forefront, patients receive individualized treatment plans from a collective expertise of specialists. Additionally, grants have been launched to link Member States with national comprehensive cancer centers to help the uptake of high-standard and quality-assured diagnosis and treatment, by enabling cross-country collaboration in the management of patients with complex conditions.
In addressing the last pillar, the ‘Cancer Diagnostic and Treatment for All’ initiative aims to increase availability of innovative cancer diagnostics and treatments throughout the EU, with a recent call for proposals. The ‘Better Life for Cancer Patients Initiative’ aims to provide a ‘Cancer Survivor Smart-Card’ within 2022, as well as a virtual ‘European Cancer Patient Digital Centre’ under the ‘Horizon Europe Mission on Cancer’. All these programs aim to help patients and survivors deal with the long-term effects of the treatment, including socio-economic impacts and psychological burdens [9].
Reactions within the Institutions
The Plan was met with both internal and external scrutiny, including from a lot of instruments and committees established to regulate its implementation.
Margaritis Schinas, Commission Vice-President, noted that ‘In a strong European health union, cancer needs to become a shared political, operational and scientific priority. Cancer care is no longer the responsibility of the health sector alone. The success of Europe’s beating cancer plan requires engagement and buy-in from a wide range of sectors and stakeholders, a whole-of-society effort’ [10].
The European Economic and Social Committee pointed out that there is no guarantee of effective implementation of the Plan, since it is not binding, and calls for the need of different instruments to be designed across nation- and region-specific practices [11].
The European Committee of Regions stresses the importance of cancer screening and early diagnosis, and urges the extension of targeted screening in other types of cancer beyond those mentioned in the Plan. It also highlights the urgency for the launch of the Cancer Inequalities Registry, since a lot of national and regional inequalities in access, costs, reimbursement, treatment, etc. are costing people’s access to diagnosis and care [12]. Other feedback comes straight from the Parliament: In June 2020, the European Parliament set up the Special Committee on Beating Cancer (BECA), which oversees Union policy on combating cancer [13]. More recently, on 9 December 2021, the Parliament’s BECA adopted its final proposals on how to strengthen the EU’s role in the fight against cancer. Key recommendations put forward include facilitating access to cross-border healthcare and clinical trials, as region-specific inequalities persevere [14]. Members of the European Parliament (MEPs) say patients should get reimbursed for cancer treatments received in other EU countries [15]. “Those who want or need to go to another country for therapy, must be able to do so without additional hurdles”, said Peter Liese, a German physician who has been an MEP since 1994 [16]. MEPs also call for extending the use of joint procurement procedures, managing shortages of cancer medicines, guaranteeing the “Right to be Forgotten”, funding more research into new therapies, and ensuring equal access to innovative cancer drugs and treatments [17].
Criticisms and concerns
Despite being highly anticipated, the Plan was met with some resistance.
There are concerns that the ‘prevention’ pillar is insufficiently supported. For example, there are limited suggestions made against harmful alcohol consumption, such as the increase in tax, versus the much more ambitious plans against tobacco use [18]. It has also been implied that the Commission deliberately avoided introducing more stringent measures against alcohol use to support competition within the European agriculture–food sector, which the Greek Commissioner, Mr Schinas has denied [19]. On the other hand, according to Italy’s winegrowers’ association, Federvini, tax and regulatory measures tend to demonize responsible drinking rather than effectively combating alcohol abuse [20].
There is also a call to include an endocrine perspective in the Commission’s fight against cancer. According to new research, there is a complex relationship between hormones and cancer in terms of prevention, treatment, and post-treatment care; for example, aggressive cancer therapy may lead to endocrine comorbidities [21].
The Health and Environment Alliance also calls for the Beating Cancer Plan to go hand in hand with initiatives against environmental pollutants through its four demands [22]:
- Reduce environmental pollution by interacting closely with the Green Deal and the Zero Pollution Strategy, in order to step up actions on contaminants in surface, ground and drinking water, soil and air.
- Align the EU’s air quality standards more closely with the WHO guidelines and promote sustainable and smart mobility.
- Improve workers’ protection and reduce their exposure to carcinogens at the workplace by updating directives and commitments to help reduce work-related cancer.
- Address unhealthy diets, obesity, and physical inactivity.
Furthermore, cuts to the EU4Health program, one of the main sources of funds of the plan, are a cause of concern [23]. Even though the budget of the program currently sits at 5.3 billion euros at the time of writing [24] and not at 9.4 billion as the Member States proposed in 2020, it is still about half of what was originally pledged. Even with Ms Kyriakides’ reassurance that a variety of EU programs will contribute to the funding of the Cancer Plan [25], including Horizon Europe and Digital Health, current funds cannot match the ambitions laid out by those of the initial pledge.
What’s next?
Given the political obstacles to asylum reforms that would make the EU less vulnerable to coercive engineered
It has barely been a year into the announcement of the EU Beating Cancer Plan and the expectations could not be higher. A lot of cogs need to be set in motion to ensure the smooth running of this endeavor. Ways by which Member States will choose to implement the Plan’s strategies will likely impact the Plan’s effectiveness; therefore, close communication and collaboration will be required between Member States and Institutions to align goals and deliverables.
For the cancer plan to work, it must coexist with other programs. From current funding programs (such as those outlined in this report), to future endeavors, like the European Health Data Space (due to launch by 2025, aiming to give patients the ability to share their health data across EU Member States), high levels of coordination are necessary [26].
The fight against cancer is not easy; data show that it is one of the leading causes of death globally. There are great expectations of Europe to ensure equal, affordable, and high-quality access to healthcare. Time will tell whether the measures taken will be sufficient, and whether the criticisms and feedback will be put in good use by the institutions.
Sources
[1] WHO Europe, “Cancer – Data and statistics”. Available at: https://www.euro.who.int/en/health-topics/noncommunicable-diseases/cancer/data-and-statistics#:~:text=Europe%20comprises%20 only%20one%20eighth,most%20cancer%20deaths%20 each%20year
[2] Parliamentary Assembly, http://www.assembly.coe.int/nw/Page-EN.asp?LID=Kyriakides
[3] Communication from the Commission to the European Parliament and the Council; Europe’s Beating Cancer Plan” (2021). Available at: https://ec.europa.eu/health/sites/default/files/non_communicable_diseases/docs/eu_cancer-plan_en.pdf
[4] Kyriakides, “Speech by Commissioner Kyriakides at The European Cancer Summit 2021: From Plans To Action” (2021). Available at: https://ec.europa.eu/commission/commissioners/2019-2024/kyriakides/announcements/speech-commissioner-kyriakides-european-cancer-summit-2021-plans-action_en
[5] Ibidem.
[6] Communication from the Commission to the European Parliament and the Council; Europe’s Beating Cancer Plan” (2021). Available at: https://ec.europa.eu/health/sites/default/files/non_communicable_diseases/docs/eu_cancer-plan_en.pdf
[7] Ibidem.
[8] Ibidem.
[9] Ibidem.
[10] Remarks by Commission VicePresident Margaritis Schinas, (2021). Available at: https://www.europarl.europa.eu/RegData/etudes/BRIE/2021/690526/EPRS_BRI(2021)690526_EN.pdf
[11] European Economic and Social Committee, “Opinion on Europe’s beating cancer plan”, (2021). Available at: https://www.eesc.europa.eu/en/agenda/our-events/events/europes-beating-cancer-plan/opinions
[12] European Committee of the Regions, “Opinion on Europe’s beating cancer plan, 2021”. Available at: https://cor.europa.eu/EN/our-work/Pages/OpinionTimeline.aspx?opId=CDR-2072-2021
[13] European Parliament News, “MEPs call for stronger EU action against cancer” (2021). Available at: https://www.europarl.europa.eu/news/en/press-room/20211205IPR18808/meps-call-for-stronger-eu-action-against-cancer
[14] Ibidem.
[15] European Parliament News, “EP calls for action: strengthening Europe in the fight against cancer”. Available at: https://www.europarl.europa.eu/news/en/press-room/20211209IPR19105/ep-calls-for-action-strengthening-europe-in-the-fight-against-cancer
[16] Zubașcu, “MEPs call for more cross-border cooperation in cancer research”. Available at: https://sciencebusiness.net/news/meps-call-more-cross-border-cooperation-cancer-research
[17] European Parliament News, “MEPs call for stronger EU action against cancer” (2021). Available at: https://www.europarl.europa.eu/news/en/press-room/20211205IPR18808/meps-call-for-stronger-eu-action-against-cancer
[18] Rehm, J., & Shield, K. D.. “Alcohol Use and Cancer in the European Union” European Addiction Research, 1–8 (2020)
[19] Fortuna, “EU goes easy on alcohol in cancer plan” (2021). Available at: https://www.euractiv.com/section/agriculture-food/news/eu-goes-easy-on-alcohol-in-cancer-plan/
[20] Ibidem.
[21] ESE, “Hormones in European Health Policies: How endocrinologists can contribute towards a healthier Europe, European Society of Endocrinology” (2021). Available at: https://www.ese-hormones.org/media/3220/ese-white-paper_04052021-web.pdf.
[22] HEAL, “4 demands for an ambitious Europe’s Beating Cancer Plan” (2021). Available at: https://www.env-health.org/4-demands-for-an-ambitious-europes-beating-cancer-plan/
[23] Gourd, “EU4Health budget cut threatens Europe’s Beating Cancer Plan” The Lancet Oncology, VOLUME 21, ISSUE 12, P1558, (2021) https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30678-1/fulltext
[24] European Commission, “EU4Health 2021-2027 – a vision for a healthier European Union”. Available at: https://ec.europa.eu/health/funding/eu4health_en
[25] Naujokaitytė, “Slashed EU4Health budget will undermine cancer plan, MEPs say” (2020). Available at: https://sciencebusiness.net/framework-programmes/news/slashed-eu4health-budget-will-undermine-cancer-plan-meps-say
[26] Zubașcu, “MEPs call for more cross-border cooperation in cancer research”. . Available at: https://sciencebusiness.net/news/meps-call-more-cross-border-cooperation-cancer-research