Multiple actions into a single goal: sustainability

There is no one-size-fits-all solution to overcome current challenges, and the work of the ESMO Cancer Medicines Committee guides the way to sustainable cancer care by running different strategies in parallel.

Achieving sustainable cancer care is integral to enabling all patients to have equal access to quality treatment and cancer prevention. At a time when the term 'sustainability' is on everyone’s lips in the field, what does sustainable cancer care really stand for? Perceptions and the given value of what is sustainable today in oncology can vary depending on different factors including demographics, geographical area, professional specialisation and expertise, and this can affect the search for potential solutions. That sustainability is a multifaceted and complex topic emerged also from a survey conducted at ESMO 2018 when 341 participants at the annual event provided their feedback on the congress’ tagline ‘Securing access to optimal cancer care’ and potential strategies to tackle the issue. The availability of the latest diagnostic and treatment opportunities and the need for a change in healthcare models were equally reported by respondents, reflecting the idea that multiple actions must be undertaken in order to achieve sustainability and equal access to cancer care.

Professor Elisabeth de Vries, Chair of the ESMO Cancer Medicines Committee, highlights what are the current challenges to sustainability and provides her perspectives on the directions that should be taken in order to achieve this goal.

Elisabeth de Vries

University Medical Center Groningen, Groningen, The Netherlands; Chair ESMO-MCBS Working Group

What are the current challenges/barriers facing European countries in terms of access to medical treatments?

The challenges to achieving sustainability are multifaced and complex.They include the increasing prevalence of cancer, the increasing armamentarium of novel drugs, increasing costs of established and new treatments, lack of resources in poorer countries and financial restrictions on healthcare budgets in others, and the need to balance treatment costs with clinical benefits for reimbursement policies.

In 2016, the ESMO European Consortium Study on the Availability of Anti-Neoplastic Medicines demonstrated substantial differences in the formulary availability, out-of-pocket costs and actual availability of anti-cancer medicines across Europe, particularly in lower-income countries. Differences were largely related to the costs of new agents developed and licensed in the past 10 years. Disparities were most commonly seen for new expensive agents for incurable diseases and were less pronounced in curative situations where treatments were sometimes subsidised and available in most countries. But there are problems with inexpensive, essential medicines as many European countries currently face shortages which are disastrous for patient care, causing delays and suboptimal treatment. That medicine shortages are a major issue was highlighted by a survey from the European Association for Hospital Pharmacists in 2018, in which oncology was the third most frequent therapy area reported as having shortage problems.

What can be done to improve sustainability and accessibility?

"Given the complexity of the challenges, a one-size-fits-all approach is not appropriate to find a solution. Instead, multiple synergic efforts are needed."

Reflecting this, the ESMO Cancer Medicines Committee (formerly the ESMO Cancer Medicines Working Group, which was established in 2015) formed two separate working groups: one dedicated to examining challenges surrounding inexpensive, essential cancer medicines and the other considering issues related to expensive, innovative cancer medicines.

The Working Group on Expensive, Innovative Cancer Medicines is addressing a range of issues related to the reimbursement of new medicines, with the hope that recommendations can be translated into models that can facilitate interactions between national and regional stakeholders. As part of this work, the ESMO-Magnitude of Clinical Benefit Scale (MCBS) has been developed to derive a relative ranking of the magnitude of clinically meaningful benefit that can be expected from anti-cancer treatments. The ESMO-MCBS has already been incorporated into current ESMO Clinical Practice Guidelines and is being used as part of Health Technology Assessment (HTA) processes.

Biosimilars may create new opportunities for sustainable cancer care, and ESMO’s work is reflected in a position paper published in 2017 exploring the issues surrounding biosimilars that are relevant in oncology. In the same year, a report by an ESMO-Economist Intelligence Unit partnership addressed the issue of shortages of inexpensive, essential cancer medicines. Policy recommendations were proposed, including introducing legislation, establishing strategic plans, introducing incentives and improving procurement practices.

These strategies are all part of a collaborative effort to better understand the challenges and deliver cost-effective and more affordable cancer care in the face of limited resources, ultimately ensuring access to optimal cancer care for all patients.