Synergy, new technologies, prevention, and information: EU watchwords against cancer

Brussels – Like the population of the city of Rome: 2.7 million. These are the people who, according to European Union estimates,  were diagnosed with cancer in 2022,  while there were 1.3 million cancer-related deaths in the same year. These are the numbers, but behind every diagnosis or figure are people’s lives, with their unique stories of fear, pain, and tenacity. All of this was the focus of  “Promoting synergies to beat cancer: the impact of EU-funded projects“, the event by HaDEA (European Health and Digital Executive Agency) on the occasion of World Cancer Day (last February 4). An initiative that was attended by 220 people—including representatives of EU institutions, NGOs, health organisations, decision-makers, and stakeholders—and about 500 others connected online and that demonstrated the impact of various grants and tenders managed by HaDEA in relation to the European Plan to Beat Cancer and the EU’s mission on cancer.

“Our projects contribute massively to the EU effort in defeating cancer,” explained in her remarks Marina Zanchi, director of the HaDEA Agency. Many are the projects, such as RadioVal, which is the first international clinical validation study of radiomics-based prediction of response to neoadjuvant chemotherapy treatment from breast MRI and develops a comprehensive and standardised methodological framework; or THRIVE, which aims to improve outcomes of pediatric and adult patients with liver cancer by improving understanding of the disease; identifying biomarkers for current therapies and developing new treatments to overcome resistance; the RESOLVE project that aims to validate Measurable Residual Disease (MRD) as a treatment-guiding biomarker for acute myeloid leukaemia (AML) and chronic lymphatic leukaemia (CLL). Moreover, SAGITTARIUS which optimizes the treatment for high-risk stage II and stage III colon cancer because it tailors treatment with immunotherapy or targeted therapies for those at risk, sparing others chemotherapy, improving survival and quality of life; JANE-2, which is an ambitious joint EU action that aims to create seven new cross-cutting networks of expertise (NoEs) on cancer and change the way cancer care and, consequently, health care will be delivered across Europe, and the joint eCAN action aimed to support member states in introducing telemonitoring and teleconsultation into national health systems to reduce inequalities in cancer care in the EU.

However, the essential point, the red thread of the cancer pathway, is the unity and synergy of all stakeholders involved. Not surprisingly, the panel discussions highlighted the critical importance of collaboration, data use and sharing, equity, and innovation in addressing cancer care and research, including new technologies and Artificial Intelligence. Not only that. The event focused on cross-sectoral synergies and a multistakeholder approach, essential to advancing cancer care and improving patient outcomes.

Talking about the work that is being done is essential because, beyond the numbers, there is the humanity of the matter that “is extremely personal,” Zanchi recalled, “and goes beyond the mere medical/health aspect. Behind every diagnosis there are unique human stories, stories of pain, grief, illness, resilience but also love and beyond,” she recalled. Therefore, for Zanchi, “showing cases is very important for HaDEA because we run a very large number of cancer projects.” For example, putting together the two main programs, Eu4Health and Horizon Europe in the health part, HaDEA managed from 2021—the year the agency was established and became operational—to 2024, cancer programs with a total of €1.2 billion of EU contribution. “This is tangible evidence of the huge investment by the Union on cancer and HaDEA,” she pointed out.

Teaming up and synergy also means expanding technology’s horizon and its possibilities. For Zanchi, therefore, addressing the complexity of cancer also involves accelerating digital transformation. “Nowadays, we cannot have the new systems if you don’t have the correct modern digital systems,” she noted. “In this regard, the implementation of digital technologies and Artificial Intelligence is becoming increasingly important in cancer treatment and cancer care, and that is why, in line with the name of our agency, we are promoting synergies between health and digital components,” she reminded. The watchword, therefore, is synergy. “Making synergy is the key,” Zanchi continued. “We need to leverage EU investments and ensure the right connection between the different parts of our programs by joining the dots between different projects and stakeholder communities,” she added. “In today’s event, we address this need for cross-sectoral collaboration, and we plan to include projects from other funding programs, also managed by Hadea but in addition to Horizon and Eu4Health. In particular, I am referring to the Connecting Europe facility in the part on digitisation, which through the telecommunications infrastructure is contributing significantly to the transformation of welfare systems,” she stressed, as through high-capacity 5G networks in the personalised diagnosis of breast cancer already at a very early stage. Another key program is the Digital Europe program that supports testing and deployment of artificial intelligence solutions for cancer and training programs to improve the digital skills of health workers. “Someone a few decades ago said that a policy without money is a policy without legs, and this was none other than Jacques Delors,” recalled Health Director General Sandra Gallina. “So, money is key to achieving our fundamental goal in Europe: to try to defeat cancer. Because yes, we want to defeat cancer,” she pointed out.

The 2025 Revision of the European Plan to Fight Cancer

“Cancer is a significant public health challenge in the EU,” writes the European executive’s Directorate-General for Health and Food Safety in the Review of the European Plan to Combat Cancer released on World Cancer Day. “It is the second leading cause of death in the EU and the leading cause of death for men and women under the age of 65. Both incidence and mortality from cancer are increasing. Due to an ageing population, cancer cases are projected to increase by 18.3 per cent from 2022 to 2040 in the EU and cancer deaths by 26.3 per cent over the same period,” the report says. The paper points out that “large disparities in incidence, detection, treatment, and survival persist both between and within member states.” And, besides “the stress” to which millions of people, their families and loved ones are subjected in their daily lives, cancer entails “notable economic consequences, estimated at €100 billion per year in Europe.” In addition, “as the population ages and the burden of cancer increases, so does the health care spending required to treat cancer. Per capita healthcare spending on cancer treatment is projected to grow by an average of 59 per cent in the EU between 2023 and 2050. On average, it is estimated that healthcare spending in the EU will be 4.7 per cent higher in 2050 in real terms than in 2023 due to the fight against cancer. Due to the impact of cancer on productivity and labour force participation, member states are estimated to lose the equivalent of 1.1 million full-time workers per year due to cancer,” the paper continues.

There are four main pillars of EU action with the projects and the Plan: prevention, early detection, diagnosis and treatment, quality of life and survival.

Prevention is not just a slogan because, as Health DG Director-General Sandra Gallina pointed out, “40 per cent of cancers are preventable,” for example, through vaccination, as the case of papillomavirus shows. In this context, as the DG Health Review document highlights, “the Cancer Plan aims to improve health literacy by providing tools for healthier choices, promoting education on healthy behaviours, and promoting post-cancer care.” For example, data from an evaluation of the impact of the European Code Against Cancer on cancer prevention awareness and attitudes, adopted in 1987 and most recently updated in 2014, showed that 70 per cent of respondents in 2017 were aware of cancer prevention guidelines in general, but only between 2 and 21 per cent in the eight countries studied were aware of the Code. “By updating the European Code Against Cancer and promoting its messages, the Cancer Plan aims to achieve 80 per cent awareness of the Code and its new evidence-based recommendations by 2025 and thus help more people reduce their risk of contracting cancer,” writes the DG document.

Among the behaviours and causes, there are elements more or less already known: “tobacco consumption is the leading cause of preventable cancer”; “alcohol-related harm is another major public health problem in the EU”; obesity and physical inactivity; “air pollution is also a major cause of mortality: it is linked to 0.5-1 per cent of all cancer cases (2020) and 7 per cent of lung cancers in Europe (2018), causing 2 per cent of cancer deaths in the EU (2020)”; “regarding hazardous substances and radiation, occupational carcinogens caused 8.9 deaths per 100.000 people in the EU in 2019″; while “some cancers are caused by infections and can be prevented by vaccination.”

On the early detection front, the document from the EU Commission’s DG Health highlights that “screening significantly improves cancer outcomes, but participation rates vary widely across the EU.” In 2019, for example, 11.4 per cent, 13.7 per cent and 48.7 per cent of eligible individuals had never been screened for breast, cervical and colorectal cancers, respectively. Therefore, “the Cancer Plan aims to ensure that 90 per cent of eligible EU residents are offered screening for breast, cervical, and colorectal cancers by 2025 through the new Cancer Screening Scheme.”

After detection comes diagnosis and treatment. According to Brussels, “all EU residents should have access to affordable, high-quality cancer care, relying on skilled multidisciplinary teams, timely services, and access to essential medicines and innovation.” According to the data, in 2020, the EU had an average of 0.78 radiation therapy machines per 100,000 people, “highlighting the need for more investment in under-resourced member states.” This is the context for the “Diagnosis and Treatment of Cancer for All” initiative, which aims to expand access to innovative treatments, supported by the Samira Action Plan (Strategic Agenda for Ionizing Radiation Applications in Medicine) to improve radiation safety and ensure the availability of radiopharmaceuticals.

Finally, with respect to quality of life, the EU document recalls that “cancer survivors often face challenges such as unmanaged treatment effects, poor care coordination, and psychosocial needs. Disability-adjusted life expectancy (DALY) related to cancer is used as a measure of the overall burden of the disease and expressed as the number of years lost due to premature mortality and years of healthy life lost due to the disease. In 2019, in old age, a person with cancer in Europe lost 3.3 DALYs.” Therefore, actions such as the “A Better Life for Cancer Patients” initiative and the SmartCARE 2023 project (which aims to launch a “Smart Card for Cancer Survivors”) have been launched to address unmet medical and psychosocial needs.

The people

The HaDEA event was also given space for some testimonials. “We want to find cancer when it is curable: today, less than 20 per cent of the chances are at this stage, and that is a tragedy,” said Erik Briers of Europe Men, a European rights movement representing 27 prostate cancer patient groups in countries across Europe. “I myself am a prostate cancer patient who was diagnosed by chance when I was 50 years old,” he recounted. “I didn’t have any symptoms or signs, I had no pain, no blood in my urine, I didn’t wake up at night: at 50 you don’t usually have these things,” he continued. “But I did have it. I was successfully treated, my doctor is here in the room. So, 20 years later, I’m sitting here and talking to you because I’m not a patient who doesn’t want to remember his disease. I want, rather, that other patients have the same chance in life to discover cancer early and not by accident.” “We want the real screening we need,” “but the problem is how will we implement it in the member states? This is not Europe’s responsibility,” he said. “That’s why we as patients will have to work with doctors and politicians in our countries and regions: we want there to be screening,” he stressed.

“Cancer affects all of us in one way or another,” Zanchi said in conclusion. “If we are not affected directly, we may have a person in our family, friends, or loved ones who have had cancer. And when cancer comes, we don’t give up on life, but we live it step by step and day by day. And I believe that by combining our passion, commitment, and the positive energy that comes from you, from the testimonies, from the project representatives and my colleagues, from the Commission services, we are really showing today that we are all united to beat cancer,” he noted.

The European Cancer Plan.

Adopted in February 2021 in the midst of the COVID-19 pandemic and rising cancer prevalence and mortality in the EU, the European Plan to Combat Cancer seeks to be a practical effort to address the entire disease pathway. The review by the EU Commission’s Directorate-General for Health explains that four years after the Plan’s inception, over 90 per cent of the actions have been completed or are ongoing. By far, the largest number of sub-actions included in the Cancer Plan belongs to the prevention pillar (45 per cent), reflecting a strong commitment to cancer prevention. Major achievements in this area include the adoption of the Council Recommendations on Vaccine Preventable Cancers and Smoke-Free Environments in 2024, actions that reflect the fact that 40 per cent of all cancers are preventable and that prioritising prevention not only addresses immediate risk factors but is also the most effective and cost-effective long-term cancer control strategy.

In terms of funding distribution, prevention is the pillar receiving the largest share of cancer funding through the EU4Health program (49.3 per cent) as of April 2024. Flagship initiatives such as the European Cancer Imaging Initiative, the European Cancer Inequalities Registry, and the EU Network of Youth Cancer Survivors have been established and are now operational. “These three initiatives are already having an impact: making large amounts of cancer imaging and related clinical data accessible to European clinicians, researchers and innovators; providing robust and reliable data on cancer prevention and treatment to identify trends, disparities and inequalities across member states and regions; and providing young cancer survivors with a platform to amplify their voices and ensure that their needs are taken into account,” the report outlines. In addition, preparatory work has been completed to launch an EU network of comprehensive cancer centres and seven new networks of expertise. Another joint action concerns cancer screening to make it more accessible and better aligned with the latest scientific evidence and the highest quality standards.

“Implementation of the Cancer Plan continues to be a concerted effort across policies and sectors, and this collaborative approach has positioned the plan as a successful example of a health-based initiative across all policies,” the EU writes. “Two key factors that contribute to the success of the Cancer Plan are rooted in this teamwork approach: first, there is a joint governance mechanism for the Cancer Plan and the EU Cancer Mission, which ensures coherence between cancer research, innovation and policy; and regular interactions of all actors along the entire cancer pathway. Second, a wide range of actors are involved in implementation, which has led to high levels of involvement from member states and stakeholders.”

The problems identified in the report relate to the successful adoption of Cancer Plan actions at the national, regional, or local level and their long-term sustainability. “The most obvious problems are: concerns about financial barriers, such as increased health care costs; a lack of resources to support strategic goals in national cancer plans; and imbalances in the availability of health professionals and infrastructures between and within member states.” While at the health care level, they found “a lack of alignment of policy and clinical practice; a lack of national implementation, or uneven national application, of international guidelines for specific types of cancer; and the need for stronger interprofessional and multidisciplinary approaches in cancer care.” In addition, regional disparities and a lack of coordination among stakeholders and relevant services were reported. Issues further compounded by a lack of data, potential barriers to data sharing, and behavioural and cultural barriers.