Every Month Matters report

Patients with advanced prostate cancer face a lottery in the standard of care they receive, with wide discrepancies in access to the latest treatment advances depending on the country they live in, according to a new report published recently.

In addition, European healthcare systems are failing to deliver the latest medical breakthroughs to men with advanced prostate cancer despite prostate cancer being the most common malignancy in men.

Understanding and treatment of advanced prostate cancer is evolving fast, with more progress made in recent years than the previous three decades. It is now possible to tailor care to meet the specific needs and preferences of each patient, delaying cancer progression and improving survival.

However, not all healthcare systems in Europe are keeping pace with scientific and medical advances. For example, UK cancer patients have to wait longer than those in France to access new oncology treatments. In addition, in a study of six western European countries, France had the highest use of oncology drugs, followed respectively by Spain, Germany, ltaly, Sweden and the UK.

This usage did not always reflect differences in the number of cancer cases in these countries.

Access to optimal therapy is one of the most important reasons for international differences in cancer survival, and UK mortality rates for prostate cancer are higher than those in neighbouring countries.

Dr Heather Payne, Consultant Clinical Oncologist, University College London Hospitals NHS Foundation Trust (UCLH) and report contributor, said: "With advanced prostate cancer we are dealing with an incurable disease and every month matters for these men. Placing patients at the heart of the care pathway and ensuring access to the right treatment approaches mean that extra time and a good quality of life is now possible. But this is not happening in every country. There are many reasons for international differences in cancer survival, but swift access to innovative treatments and the availability of best practice care are important in order to deliver the best outcomes in terms of life extension and quality of life."

Every Month Matters: lmproving Advanced Prostate Cancer Care in Europe is the first report of its kind to take an in-depth look at the rapidly changing landscape of advanced prostate cancer treatment, highlighting the changes that need to be implemented to improve care for men with advanced disease.

The report found that prostate cancer research is frequently underfunded compared with other malignancies and there is little focus on advanced disease,  despite the fact that up to 20% of men who receive a prostate cancer diagnosis already have metastatic disease. The report calls for improved resourcing for advanced prostate cancer, whilst acknowledging the continuing efforts put in to treating early disease.

Key recommendations from the report include:

•     Governments must recognise that advanced prostate cancer is a serious, life-threatening disease that must receive the same level of resourcing and focus as other complex diseases

•     Care teams must be multi-disciplinary, including allied health and social care professionals who work alongside healthcare professionals to personalise the goals of treatment for patients

•     Patient organisations across Europe must have a voice in national and local decisions about access to treatments and decisions regarding reimbursement should be evidence-based, transparent and equitable

•     Men must have access to accurate, reliable information which takes into account the individualised needs of the patient.

Dr lan Banks, President of the European Men's Health Forum (EMHF) and report contributor, said:  "The personal, economic and social impact of prostate cancer is huge and is increasing throughout Europe. There is still no cure for advanced prostate cancer, and every month matters for men and their families faced with the physical, emotional, social and financial burdens of living with the disease. Men with prostate cancer have been in the shadows for too long when it comes to research, information and access to the latest treatments and care. It is time that healthcare organisations from across Europe recognise the needs of men and their families who are dealing with this complex disease."

To coincide with the report launch and reveal the impact of advanced prostate cancer on men and their families, a short film has been released, which tells the story of Matt, who is living with advanced prostate cancer.


No awareness of personalised medicine across Europe

Nearly two out of three people in four major European countries  have no awareness of personalised medicine-despite the fact that this evolving discipline has vast implications for Europe's healthcare issues and Europeans' personal health. These statistics were presented recently at the European Alliance for Personalised Medicine (EAPM) conference in Dublin.

The results were part of the PACE Cancer Perception Index that studied knowledge and attitudes about cancer treatment and care, the healthcare system and patient involvement. PACE, a Lilly Oncology initiative, stands for Patient Access to Cancer care Excellence.

The EAPM Conference on Innovation and Patient Access to Personalised Medicine brought together researchers, patients, healthcare professionals, payers, regulators, policymakers and industry to evaluate the potential and the development of personalised medicine in light of the European economic crisis.

Irish Minister of Health Dr. James Reilly stressed the potential of personalised medicine "to provide solutions that are better tailored to the individual patient than traditional 'one size fits all' medicinal products."


Public supports personalised medicine

A work group discussed the importance of informed, engaged and empowered patients where personalised medicine is concerned. Central to the discussion were the results of
the PACE Cancer Perception Index: A Six-Nation, Public Opinion Survey of Cancer Knowledge and Attitudes.

Sue Mahony, President of Lilly Oncology, said: "The PACE Cancer Perception Index devoted a considerable amount of time to the subject of personalised medicine, and what we found was both surprising and promising. While only a third of respondents were aware of personalised medicine, the majority were supportive once the concept was introduced. They not only recognised its benefits for them and society, but they expressed a willingness to help by being tested for personalised medicine, and by sharing their medical information."

Among people in the UK, France, Germany and Italy who were surveyed, there was strong support for personalised medicine, with 91% in the UK and 75% in Italy believing doctors should discuss personalised medicine with their cancer patients. 70% of all survey respondents said they are willing to be tested for personalised treatment even if it would not work for them. More than 50% see it as a cost-saving measure for their healthcare systems.


Interest in sharing medical records and test results

Personalised medicine depends on making better use of patient data and genomic information; detailed profiling of individuals is necessary to take advantage of a molecular understanding of diseases.

Findings from the survey show there is willingness among the general public, patients and caregivers to share medical records and test results with physicians and scientists when it comes to supporting research. Nearly nine in 10 respondents would agree to share medical records for the improvement of cancer research and treatment. Still, sizable minorities report concerns about potential misuse of data, with 53% of Italian respondents expressing the most concern.

The public also expressed a willingness to be part of an improved clinical trial and drug development system. For example, more than 70% of the general public said that patients need more opportunities to participate in clinical trials.

Nearly six in 10 surveyed say that they are satisfied with the progress made in the fight against cancer over the past 20 years, but 72% believe there is not enough information available to patients about new treatment options like personalised medicine. In fact, more than four out of 10 people surveyed believe that cancer is a single disease, when in fact it is more than 200 different diseases with many different biologic, genetic and environmental origins.


Current help inadequate for patients wanting to quit smoking

A new report, published in GP Magazine recently, concluded that  GPs are averse to nicotine delivery devices being introduced to the market without a robust regulatory system in place However, e-cigarettes could be the answer to help reduce health inequalities  and save lives.

The new research, which asked both GPs and smokers for their opinions on current stop-smoking initiatives found that seven in 10 smokers want to quit but find it hard with current help available; 65% of GPs do not currently know enough about e-cigarettes; 68% of GPs would prescribe e-cigarettes if they were regulated and 44% of smokers would try e-cigarettes if prescribed by their GP.

Smoking remains the single biggest preventable cause of early death and illness in the UK, with one in five adults (around 10 million people) being smokers.  Tobacco control measures have led to a decrease in smoking prevalence but the decline in smoking rates has lost momentum in recent years with no significant change in the prevalence of smoking in the last five years.

With an annual cost to the NHS attributable to smoking estimated at around £2.7bn, and recent figures published in Annals of Oncology showing the number of lung cancer cases in the UK- particularly among women-is still rising, in a world first the UK's Department of Health is looking at a radical new approach to the smoking epidemic. 

Currently smokers only receive 12 weeks of a nicotine-containing product, such as gum or patches, on prescription alongside support from a Stop Smoking Advisor. The draft guidance from NICE on harm reduction approaches to smoking, published in October 2012, recommends that health professionals should offer nicotine-containing products on prescription to people who smoke, as part of a harm-reduction strategy to abstain from smoking on a short, medium or longer-term basis.

Nearly 40% of smokers would be more likely to try and quit using a nicotine-containing product if they were available for longer than 12 weeks, a new survey reveals, which is promising given that it also shows 64% of smokers currently want to quit.

GPs also agreed that the NICE guidance offers a pragmatic approach to managing smokers who are unwilling or unable to quit; and a potentially meaningful way of decreasing the current 20% prevalence of smoking in the UK.

Dr Roger Henderson, a GP from Shropshire, said: "Encouraging patients to swap cigarettes for nicotine-containing products would dramatically improve their health and could potentially save millions of lives.  However, although helpful, few smokers find current nicotine replacement therapy (NRT) to be a satisfying alternative to smoking. For some smokers it's not just the nicotine, it is a conditioned habit that is triggered by the sensory cues and rituals so often associated with smoking. The need to address this may in part explain the dramatic rise in the use of e-cigarettes by smokers trying to quit, as they offer smokers a similar experience to their normal habit."

The Royal College of Physicians has been calling for new nicotine products since 2007 stating that: "If nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved." In fact it is estimated that a switch of just 1% of smokers a year from smoking to less harmful nicotine sources could save around 60,000 lives in only 10 years.

E-cigarettes are currently the only products that deliver nicotine with an experience closer to cigarettes, and therefore could be the answer to the country's smoking problem. Despite the draft NICE guidance being published in October 2012 and the final due in spring 2013, 73% of the GPs surveyed were not aware of the new tobacco harm reduction approach.