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Cancon_PolicyPaper5_Inequalities

Cancon_PolicyPaper5_Inequalities

Cancer Control Joint

Cancer Control Joint Action – Policy Papers Figure 2 Figure 2 : Number of radiation professionals per million inhabitants Denmark Norway Czech Republic The Netherlands Slovenia Spain Belgium Switzerland Belarus Poland Lithuania Austria United Kingdom Estonia France Montenegro Luxembourg Malta Iceland Hungary Portugal Bulgaria Ireland Albania 0 10 20 30 Iceland United Kingdom Denmark Belgium Ireland Luxembourg France Lithuania Switzerland Spain Portugal Slovenia Norway Belarus Estonia Malta The Netherlands Hungary Czech Republic Austria Bulgaria Poland Albania Montenegro The Netherlands Ireland Denmark Norway Switzerland United Kingdom Belgium Slovenia Austria Iceland Portugal Luxembourg Belarus France Bulgaria Lithuania Montenegro Malta Czech Republic Poland Hungary Estonia Albania Spain 0 5 10 15 20 25 0 20 40 60 80 a. ROS per million inhabitants b. MPs and DOs per million inhabitants MP: dark green – DO: light green c. RTTs and RNs per million inhabitants RTT: yellow – RN: orange ROs: radiation oncologists; MPs: medical physicist; DOs: dosimetrists: RTTs: radiation therapists RNs: radiation nurses Recommendation 12: Ensure that all patients have timely access to appropriate systemic therapy. While many cytotoxic medicines have been shown to be effective treatments for cancer patients, there are significant social inequalities in access to these treatments across Europe. A recent survey indicated that over 50% of European hospital pharmacists have experienced significant shortages in access to life-preserving and life-sustaining cytotoxic regimens (ranging from 33% in Northern Europe to 59% in Western and Southern Europe and 65% in Eastern Europe) (147). Unfortunately, information on the causes of medicine shortages is not currently consistently collected and reported across Europe, thus it is difficult to develop potential solutions. Increased understanding of disease biology is fuelling a “personalised cancer medicine” revolution (148). However, providing innovative treatments in a timely fashion to European cancer patients is hampered by a pricing/reimbursement approach that differs markedly between individual European countries, thus accentuating inequalities between countries in access to optimal cancer care (33). In many EU countries cancer patients have experienced extended delays in access to innovative treatments due to the lengthy decision-making process for pricing and reimbursement. Such decisions are normally due within 180 days from the European Medicine Agency (EMA) decision on market authorisation, in line with the relevant EU binding regulation. In certain cases (149), this has led to significant discrepancies in access, which may have a detrimental effect on survival, although more research is required in this area (150). S.R. 12.1: Promote access to innovative therapies that deliver value-based, effective care, by harmonising Health Technology Assessment in all Member States. Examples: For some essential cancer drugs, there are marked differences in time to approval/reimbursement in all EU Member States, which vary from few days from the EMA market authorisation to more than 12 years from EMA approval (149). In 10 out of 28 EU countries, it has taken 2 years or more to provide some drugs to patients in the metastatic setting, further demonstrating the unacceptable 26

Tackling Social Inequalities in Cancer Prevention and Control delays in accessing this essential cancer drug. One of the reasons for such delays relates to the heterogeneity of procedures and methodologies used by Member States to assess relative effectiveness (REA) and cost-effectiveness of new medicines. More than 5,000 patients annually with metastatic melanoma in Europe do not have access to new life-saving drugs. A recent study presented at the European Society of Medical Oncology (2016) reported unacceptable differences in access to lifesaving innovative melanoma medicines across Europe. At least 70% of patients with metastatic melanoma in Western Europe were treated with innovative medicines. In Central Europe only 41% of patients had access to these innovative drugs, while only 10% of patients had access to these medicines in Southern and Eastern European countries (150). Recommendation 13: Develop national cancer rehabilitation and survivorship policies, underpinned by an equity perspective. The end of cancer treatment does not signal the end of cancer care. It is important to raise awareness of potential late effects of cancer treatment and of early detection of cancer recurrence and secondary tumours. Key elements in the prevention of cancer recurrence include the maintenance of a healthy body weight, healthy diet and physical exercise. Avoidance of the use of tobacco, excess sun exposure, and alcohol are also important elements, just as they are for primary prevention. Rehabilitation is a key component to ensure that cancer survivors have the best chance of returning to a normal life. Rehabilitation must be understood to include not only physical rehabilitation, but also psychological, cognitive, sexual, spiritual and professional rehabilitation. These principles must be enshrined in every National Cancer Control Plan in the form of Survivorship Care Plans to ensure the fullest possible recovery of all cancer survivors. This is especially important for those in situations of social vulnerability, because they face greater challenges in terms of access to care and health behaviours. Many cancer survivors are at risk for loss of employment, which can lead to significant financial and social burdens, and reduction in quality of life. Surviving cancer patients may suffer unacceptable discrimination in relation to employment and other areas of society, including access to insurance, mortgage approval and social re-integration (151). Geographical and social isolation may make it more difficult for rural or otherwise socially vulnerable patients to access social and practical support. European and national authorities have a role to play, by allocating adequate financial resources to support services and in implementing adequate survivorship and rehabilitation services for all social groups, as well as in informing the public and raising awareness. It has been shown that cancer survivors with a low socio-economic position are more often unemployed (25) or take early retirement, which can act as a substitute for disability leave or unemployment (153). Emerging research also suggests the existence of social inequalities in the ability of cancer survivors to return to work (154). Working conditions and psychosocial conditions of a manual job can act as additional barriers (155). Furthermore, women often become informal caregivers to family members with cancer and are more at risk of unemployment and early exit from the labour market. 27

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