The impact of the Covid-19 pandemic could result in a European cancer epidemic in the next decade, if the weakness in cancer health systems and cancer research are not urgently addressed, according to a Lancet Oncology Commission. The weaknesses exposed by the Covid-19 pandemic must be addressed as a matter of urgency, else European cancer outcomes will be set back by almost a decade. The report titled European Groundshot—addressing Europe’s cancer research challenges: a Lancet Oncology Commission was published on November 15.
The Commission authors note in the report that it is important for European countries to prioritise cancer research to develop more affordable, higher quality and more equitable cancer care. The report highlights several findings collected by communicating with patients, and scientific and healthcare experts with detailed knowledge of cancer research activity across Europe.
Europe cancer research should have a more grounded patient-focused, rather than techno-centric approach, the Lancet Oncology Commission argues.
In a Lancet statement, Professor Mark Lawler, lead author of the Commission, said that with the backdrop of the Covid-19 pandemic, Brexit and the Russian invasion of Ukraine, it is more important than ever that Europe develops 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.
He added that during the Covid-19 pandemic, approximately one million cancer diagnoses were missed across Europe, the authors estimate. In the first wave of the Covid-19 pandemic, there was a “chilling effect” on cancer research because laboratories were shut down and clinical trials were delayed or cancelled.
What is the triple threat which European cancer research faces?
European cancer research has been deeply impacted by the Covid-19 pandemic, Russia’s invasion of Ukraine, and Brexit.
Impact of Covid-19 pandemic
After analysing data on the impact of the Covid-19 pandemic across Europe, the European Groundshot Commission found that clinicians saw 1.5 million fewer patients with cancer in the first year of the pandemic. One in two patients with cancer did not receive surgery or chemotherapy in a timely manner, the report says.
About 100 million cancer screening tests were missed. Also, up to one million European citizens are estimated to have undiagnosed cancer due to cancer backlog. Based on these findings, the European Groundshot Commission recommends that the European cancer research community should accelerate the research response to the indirect impacts of the Covid-19 pandemic on cancer. Also, now is the fine to ensure that cancer is appropriately predicted and prioritised within current and future European research agendas.
Impact of Russia-Ukraine conflict
Russia’s invasion of Ukraine is another huge challenge to cancer research in Europe, the report says. Since Russia and Ukraine are two of the largest contributors to clinical cancer research in the world, especially industry-sponsored clinical research, and many Ukrainian cancer clinical trials include cancer centres in central and eastern European countries, Russia’s invasion of Ukraine will likely result in many of these major trials being delayed or failing to recruit.
The report states that industry might consider it too high risk to run cancer clinical research in countries bordering Ukraine. This will result in loss of private sector investment, which is hugely damaging to cancer research in central and eastern Europe.
As a matter of extreme urgency, the European cancer community must gather data on the impact of the conflict on patients, and workforce gaps, in Ukraine and in neighbouring countries, the European Groundshot Commission recommends. The community should also develop a plan to mitigate the impact of the Russia-Ukraine conflict on cancer research, the report suggests.
Dr Andreas Charalambous, President of the European Cancer Organisation, said while there has been a lot of news coverage on the Russian invasion of Ukraine, the continuing impact of the war on clinical cancer research has gone relatively unreported.
He added that he hopes the Commission will help to direct the necessary attention to the impact the conflict will have on cancer research, including but not limited to clinical trials in Europe.
Impact of Brexit
Brexit will continue to negatively impact European cancer research, the European Groundshot Commission predicts.
After analysing data comparing EU28 (United Kingdom included) versus EU27 (UK not included) research activity, the Commission found a significant gap. The Commission suggests that the gap is extremely unlikely to be bridged by increased research activity from the remaining EU27.
The European Groundshot Commission also recommends European cancer research funders and the European cancer research community to mitigate the impact of Brexit and other political challenges by ensuring that the UK can continue to collaborate with European partners and contribute to European cancer research and innovation activities.
Professor Lawler said that if the UK is not involved in EU collaborative cancer research and not part of Horizon Europe’s research community, this will have an extremely detrimental effect on European cancer research activity. He added that ultimately, patients with cancer will pay the price for this decision in terms of health-care outcomes.
What are the gaps in European cancer research and its funding?
The European Groundshot Commission analysed investment in cancer research in Europe in 2010-19, and found that the total amount of investment, excluding the private sector, was about 20 to 22 billion euros. The investment was about 26 euros per head.
Over the same period, the minimum equivalent figure for the United States was $80.5 billion. This is equivalent to around 76 billion euros, and 234 euros per head.
Commission calls for doubling of European cancer research budget
After identifying this dramatic gap in investment per head, the European Groundshot Commission calls for a doubling of the European cancer research budget to 50 euros per capita by 2030.
Cancer prevention research in particular has not had the funding it deserves, the European Groundshot Commission argues. If there is a greater focus on preventing cancer, it would reduce the number of people who develop cancer. This would allow more resources to be available for those who need treatment. The European Groundshot Commission calls for a significant re-prioritisation of cancer prevention, cancer screening and early cancer detection research to reduce the burden of cancer for European citizens. These strategies will enable those who do develop cancer access to more resources and the best treatments available.
Anna Schmutz from the International Agency for Research on Cancer, France, said it is estimated that 40 per cent of cancers in Europe could be prevented if primary prevention strategies made better use of the current understanding of cancer risk factors. She added that there are already evidence-based and cost-effective cancer preventive interventions available, and the Commission wants to see more effective implementation and communication of these across Europe. Up to one-third of cancer cases in Europe are more likely to have a better outcome if they are detected early but, disappointingly, the rates of screening tests have been found to vary widely between different European countries. Therefore, more research is needed to understand why people do not participate in cancer screening programmes across Europe, she further said.
Gender equity in cancer research
The European Groundshot Commission found that gender equity in cancer research is another crucial gap. Less than a third of all authors for the European countries contributing the most cancer research outputs are senior female authors.
The European Groundshot Commission determined the gender of principal investigators for 22,291 cancer research projects, and found that the majority of principal investigators were men with less than 33 per cent women. This reflects the gender inequality that exists in European cancer research.
Professor Yolande Lievens of Ghent University Hospital, Ghent said the Commission’s data on female authors clearly illustrate the significant gender gap that exists in the European cancer research community. She added that greater research is needed into the reasons why some European countries or regions have greater gender inequality in cancer research than others.
The findings and recommendations in the report can help the European cancer research community as they work toward a more equitable agenda where all citizens and patients, no matter where they live, will benefit from advances in cancer research, the Commissioners believe.
Teodora Kolarova, Bulgarian patient advocate and Executive Director of the International Neuroendocrine Cancer Alliance, said the European Groundshot Commission has a significant patient focus, and that patients need to be active participants in research, co-creating with their scientific and clinical colleagues. She added that another welcome focus is on central and eastern Europe, and a critical upsurge in research in this region is important, so that the east-west divide is narrowed.
What is 70:35 Vision?
Professor Lawler said the world has an unrivalled opportunity to reimagine cancer research and its implementation so as to achieve the ambitious 70:35 Vision. The vision is to ensure an average of 70 per cent 10-year survival for patients treated for cancer in Europe by 2035.