KOL Idea

The essential role of the medical
oncologist in global cancer control

Dario Trapani

European Institute of Oncology - University of Milan, Milan, Italy; WHO Cancer Consultant

Dario Trapani, a medical oncologist mentored by Giuseppe Curigliano (University of Milan), and Cancer Consultant to the WHO under the supervision of André Ilbawi (WHO Technical Officer for Cancer), talks passionately about the essential role of medical oncologists in the challenging environment of global public policy. He shares his ideas on how medical experts can support the WHO in developing and implementing global cancer policy which can affect the daily practice of health professionals.

The 2017 World Health Organization (WHO) Cancer Resolution, unanimously adopted by 194 countries, represents a landmark achievement for oncology in the context of the global health agenda; the Resolution officially and globally recognises cancer as a public health priority requiring attention, investment and prioritisation by governments and international organisations at both a national and global level. “As I learn about global cancer policies, it is clear to me that medical oncologists have the technical competencies, versatility and comprehensive overview needed to guide cancer control strategies. They are the ones that face, on a daily basis, issues of affordability and accessibility to cancer care in their mission to achieve the best possible outcomes for their patients.”

“Medical oncologists should be involved in addressing questions relating
to global cancer policy at all levels.”

Trapani explains that in lower-resourced countries, where fragmentary information on cancer burden exists, the collection and publication of robust data on cancer-specific patient outcomes is fundamental to support tailored global policy planning. “Some projection models that form the basis for policy decisions have poor reliability because they lack data on specific populations, particularly country-specific data on cost-effectiveness, toxicity and cancer burden, and this is where the medical oncologist can offer their expertise. Their role in global cancer policy may be likened to their role within translational and precision medicine; in the same way that a medical oncologist adapts treatment to a tumour type, they can help to tailor policies to the specific needs of a country, and their in-depth knowledge of cancer is essential to both.”

He continues, “Encouragingly, young medical oncologists seem eager to become more involved with global policy but are currently unclear how to go about it. The ESMO Global Policy Committee, chaired by Alexandru Eniu, provides them with a way to participate in ESMO’s activities with the WHO and other international organisations, on topics such as ensuring an adequate and well-trained workforce, and supporting countries to prioritise cancer interventions in their national cancer control plans.”

“ESMO provides an excellent opportunity for medical oncologists to become more involved in global cancer policy.”

ESMO experts were also responsible for developing the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS). Trapani comments, “This is one of the best tools available to provide unbiased information to help guide clinical and policy decisions relating to the selection of essential cancer medicines for inclusion in the WHO and national cancer medicines lists. Using the scale, each newly approved medicine by the European Medicines Agency is assigned an objective score based on evidence of the magnitude of clinical benefit. It is important to emphasise that the ESMO-MCBS was developed by medical oncologists who are expert in its use and are able to provide valuable input to policies involving cancer medicines.”

“I am proud to see that my society, ESMO, is investing time and resources into issues related to public health. I believe other societies should do the same because I am convinced that future global policies will increasingly require novel ideas from curious and creative scientists who are able to open doors to new ways of thinking about sustainable solutions for oncology.” Global investment in public policy education for medical oncologists would enable specialist courses to be introduced as part of the oncologist’s global core curriculum and encourage participation in cancer policy workshops, meetings and congresses. “I see education on cancer policy as a missing link in the speciality of medical oncology; cancer is a huge global burden, and I strongly support the creation of global networks of medical oncologists who can disseminate knowledge about optimal treatment strategies and public policies to help improve the outcomes of cancer patients throughout the world.”

“I am proud to see that my society, ESMO, is investing time and resources into issues related to public health.”

“My experience of supporting the projects ESMO is working on with the WHO has taught me how much decisions at the national and global policy level can affect daily practice at my institute in Milan. For example, when I prescribe chemotherapy, I will remember that some inexpensive, essential, life-saving cancer medicines are not available in all countries – and that the WHO and ESMO are advocating at the global level for them to be available and affordable for everyone who needs them. As a cancer doctor, I was not aware of the complexity of public policy issues and I now know how important it is for me to follow them and to support ESMO to defend our profession and our patients at European and global levels. The research that I am doing to support ESMO’s projects with the WHO is giving me a wide perspective of how cancer is being dealt with in other countries. I am also being exposed to large global models that the WHO is developing to fulfil its mandate to provide governments with tools to implement the 2017 Cancer Resolution. It is rewarding to attend meetings with expert multi-stakeholder teams that need to come together to develop the framework for such models and determine how they will function in practice. Both ESMO and the WHO have a team of incredible professionals, and I am proud and honoured to work with them. I am deeply grateful to ESMO for this wonderful opportunity to enhance my career and advance my knowledge of global public policy issues.”