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The Lancet Commission on Oncology also identifies gaps in the European cancer research landscape and calls for a doubling of the European cancer research budget, as well as prioritization of neglected areas of cancer research, including prevention and early diagnosis , radiotherapy and surgery, implementation science, action on gender equality and a deeper focus on survivorship.
The COVID-19 pandemic has highlighted weaknesses in cancer health systems and the cancer research landscape across Europe that, if not urgently addressed, will set back cancer outcomes by almost a decade. In a new report, the authors emphasize that prioritizing cancer research is crucial for European countries to provide more affordable, higher quality and more equitable cancer care, and for patients treated in research-active hospitals to have better outcomes than those that are not.
The new report, European Groundshot: Addressing the challenges of cancer research in Europe: a Lancet Commission on Oncology, brings together a wide range of patient, scientific and healthcare experts with detailed knowledge of cancer research activity in All Europe. Using accurate, timely and granular data, the report sheds a penetrating light on cancer research in Europe, highlighting current and future challenges and identifying gaps in the research landscape.
The Lancet Commission on Oncology echoes the US Cancer Moonshot by setting out ambitious recommendations to develop a successful and resilient cancer research roadmap. However, the Lancet Commission on Oncology argues that cancer research in Europe should take a more patient-centred, rather than techno-centric, approach, and therefore a ’Cancer Groundshot’ is a more appropriate target.
“Against the backdrop of the COVID-19 pandemic, Brexit and the Russian invasion of Ukraine, it is more important than ever for Europe to develop a resilient cancer research landscape to play a transformative role in improving prevention, diagnosis, treatment and quality of life for current and future patients and those living beyond cancer,” says Professor Mark Lawler, Queen’s University Belfast, UK and Chair and Lead Author of the Commission.
It continues: “We estimate that approximately one million cancer diagnoses were missed across Europe during the COVID-19 pandemic. [1] We are in a race against time to find those missing cancers. Additionally, we saw a chilling effect on cancer research with laboratory closures and clinical trials delayed or canceled in the first pandemic wave. We are concerned that Europe will be heading towards a cancer epidemic in the next decade if health systems and cancer research are not urgently prioritized. Our European Commission Groundshot provides crucial findings on the current cancer research landscape, exposes key gaps and calls for the prioritization of European cancer research agendas over the next decade.”
European cancer research faces a triple threat
The European Groundshot Commission analyzed data on the impact of the COVID-19 pandemic across Europe and found that doctors saw 1.5 million fewer cancer patients in the first year of the pandemic, and one in two cancer patients he did not receive surgery or chemotherapy in a timely manner. Furthermore, 100 million cancer screening tests were missed and it is estimated that up to one million European citizens could have undiagnosed cancer due to cancer accumulation.
Given these findings, one of the key recommendations of the European Commission Groundshot is that the European cancer research community accelerate the research response to the indirect impacts of the COVID-19 pandemic on cancer and that, now more than ever, there is a crucial need to ensure that cancer is adequately protected and prioritized in current and future European research agendas.
The Russian invasion of Ukraine represents another major challenge for cancer research in Europe. Russia and Ukraine are two of the largest contributors to clinical cancer research in the world, especially industry-sponsored clinical research. Many cancer clinical trials in Ukraine include cancer centers in Central and Eastern European countries, and the conflict will likely result in many of these major trials being delayed or not recruiting. An additional danger is that the industry could consider conducting clinical cancer research in countries bordering Ukraine too high a risk: the loss of private sector investment would be very detrimental to cancer research in Central and Eastern Europe. The European Groundshot Commission recommends that, as a matter of extreme urgency, the European oncology community collect data on the impact of the conflict on patients, oncology services, drug and other shortages, and gaps in the workforce, in Ukraine and in neighboring countries, as well as developing a plan to mitigate the impact of war on cancer research.
“While there has been much news coverage of the Russian invasion of Ukraine, what has been relatively unreported is its profound and ongoing impact on clinical cancer research. We hope that our European Commission Groundshot will help direct necessary attention to the significant and worrying impact the conflict will have on cancer research, including but not limited to clinical trials in Europe. There is already a growing east-west gap in European cancer research and it is crucial that the war between Russia and Ukraine does not cause this gap to grow,” says Dr Andreas Charalambous, President of the European Cancer Organisation.”
The European Commission Groundshot also predicts that Brexit will continue to have a negative impact on European cancer research. The Commission analyzed data comparing EU28 research activity (including the UK) with EU27 research activity (not including the UK) and found a significant gap, a gap which the Commission suggests, it is very unlikely to be resolved by further research activity from the remaining EU27. Another key recommendation from the European Commission Groundshot is that European cancer research funders and the European cancer research community mitigate the impact of Brexit and other political challenges by ensuring that the UK can continue to collaborate with European partners and contribute to cancer research and innovation in Europe.
"UK cancer research in the post-Brexit world is at a crossroads where strategic decisions will determine whether we continue to prosper and partner internationally or whether isolationism will reduce our global standing," says Professor Richard Sullivan, co-director. of the Commission and Professor of Cancer and Global Health at the Cancer Policy Institute, King’s College London.
Professor Lawler adds: “If the UK does not participate in EU collaborative cancer research and is not part of the Horizon Europe research community, this will have an extremely detrimental effect on European cancer research activity. “Ultimately, cancer patients will pay the price for this decision in terms of healthcare outcomes.”
Gaps in European cancer research and its funding
The European Commission’s Groundshot analysis of investment in cancer research in Europe in 2010-19 found that the total amount of investment, excluding the private sector, was around €20 to €22 billion, around €26 per capita. The equivalent minimum figure for the US during the same period was 80.5 billion US dollars (around 76 billion euros and 234 euros per capita). Taking into account this dramatic gap in per capita spending, the European Groundshot Commission calls for doubling the European cancer research budget to €50 per capita by 2030.
The European Commission Groundshot argues that cancer prevention research in particular has not received the funding it deserves. A greater focus on cancer prevention would reduce the number of people who develop cancer and therefore allow more resources to be available for those who require treatment. The report calls for a significant change in the priorities of cancer prevention, cancer screening and early cancer detection research to reduce the burden of cancer on European citizens and allow those who develop cancer to access more resources and best treatments available.
“It is estimated that 40% of cancers in Europe could be prevented if primary prevention strategies made better use of our current understanding of cancer risk factors. There are already cost-effective, evidence-based cancer preventive interventions available, and we want to see more effective implementation and communication of these across Europe. Furthermore, up to a third of cancer cases in Europe are more likely to have a better outcome if caught early, but unfortunately we find that screening rates vary widely between different European countries. More research is needed to understand why people do not participate in cancer screening programs across Europe,” says Anna Schmutz, International Agency for Cancer Research, France.
Gender equity in cancer research is another crucial gap identified in the European Groundshot Commission, with senior female authors representing less than a third of all authors from European countries contributing the majority of the research results. cancer research. The gender of principal investigators in Europe was also determined for 22,291 cancer research projects: the majority of principal investigators were men with less than 33% women, reflecting the gender inequality that exists.
“Our data on female authors clearly illustrates the significant gender gap that exists in the European cancer research community. More research is needed into the reasons why some European countries or regions have greater gender inequality in cancer research than others. Strategies based on these data are expected to improve the gender balance in cancer research in Europe,” says Professor Yolande Lievens, Ghent University Hospital, Ghent.
Commissioners hope that the conclusions and recommendations of this report will help the European cancer research community in its work towards a more equitable agenda in which all citizens and patients, no matter where they live, benefit equally from advances in cancer research.
“This European Groundshot has an important focus on the patient, which is very welcome,” said Teodora Kolarova, Bulgarian patient advocate and executive director of the International Alliance Against Neuroendocrine Cancer, “Too often the patient’s point of view is ignored. patient, but it is front and center in this Commission. . Patients should be active participants in research, co-creating with their scientific and clinical colleagues. Another welcome focus is on central and eastern Europe: it is crucial that we see a critical increase in research in this region, so that the east-west gap is narrowed, not widened.”
Professor Lawler adds: “Collecting data and turning it into cancer intelligence has been our north star on this Commission. Too often, opinion, even expert opinion, has trumped data in the genesis and implementation of cancer research policies. Simply continuing to devote resources and efforts to a narrow research agenda is no longer desirable or feasible: we must follow the data and act on what it reveals. “We have an unrivaled opportunity to reimagine cancer research and its implementation to achieve our ambitious Vision 70:35, an average of 70% 10-year survival for patients treated for cancer in Europe by 2035. Let us seize this opportunity.”
Writing in a linked commentary, Márcia Costa and David Collingridge, editors of The Lancet Oncology , say: “European leaders must break down the political barriers dividing the continent, overcoming popularism, to work together in the common quest to harmonize the missions of cancer research. and national cancer plans, strengthening health systems and supporting all cancer patients, including those from neighboring countries in need of international help. The research, data, recommendations and actions outlined in the European Groundshot Commission could be powerful drivers of change if all actors are willing to listen and put aside artificial divisions. After all, we are all Europeans, regardless of politics, and we deserve better.”
