Ambitious Plan to Improve Childhood Cancer Care in Europe

Liam Davenport

October 05, 2015

VIENNA — There are number of disparities in the provision of care and access to treatment across Europe for children and adolescents with cancer that can be tackled through coordinated action, according to a major report.

The SIOPE Strategic Plan: A European Cancer Plan for Children and Adolescents was launched here at the European Cancer Congress (ECC) 2015, and published on the SIOPE website on September 26.

It sets out a series of ambitious goals and objectives that could help the reduce the 6000 childhood deaths from cancer in Europe each year, and benefit the more than 300,000 pediatric cancer survivors.

"We are proud to have achieved consensus on the important steps that need to be taken to tackle the issue of childhood cancer in Europe," said Gilles Vassal, MD, PhD, head of clinical and translational research at the Institut Gustave Roussy, Villejuif, France, and president of SIOPE.

"Through setting specific and obtainable objectives, strengthening collaborations, and establishing funding partnerships, we believe that we will be able to make a real difference to the lives of pediatric cancer survivors," Dr Vassal commented in a statement.

"We would like to see our report form the basis of a European Cancer Plan for children and adolescents, and we urge all those involved to work together with us in order to see this come about," he added.

Need for Practical Plan

The SIOPE report is a response to statistics indicating that there are 35,000 new cancer cases in young people every year, most commonly leukemia, brain tumors, lymphoma, and neuroblastoma. One in 600 newborns develop cancer before they are 20 years of age.

In addition, more than 60 cancers that occur in children and adolescents are different from those seen in adults, making it essential that treatments and management strategies are tailored to young people.

There are currently 300,000 childhood cancer survivors in Europe; this is set to rise to almost 500,000 by 2020. Crucially, the mortality risk among cancer survivors remains higher than the general population 5 years after diagnosis.

"This is a serious problem for patients, their families, and for health services, with major inequalities existing across Europe," commented Dr Vassal.

These encouraging successes have had a counterproductive effect.

"Add to this the facts that 35% of such cancers normally occur before the child is 5 years old and that many pediatric cancers are difficult to treat, and you will understand why we thought it essential to try to tackle this problem in a practical way," he added.

The report, which forms part of the European Network for Cancer Research in Children and Adolescents 7th Framework Programme, was developed after widespread consultation with parents, patients, survivors, and oncology healthcare professionals.

The authors identified a series of problems with the current provision of pediatric oncology in Europe, including a lack of access to new drugs, a lack of funding, disparities in treatment access across the continent and, as a result, disparities in survival.

Approximately 6000 children and adolescents die of cancer each year in Europe, which equates to around 20 deaths per day. However, recent progresses in pediatric hemato-oncology mean that 80% of young people with cancer are disease-free at 5 years.

"These encouraging successes have had a counterproductive effect," the report says, as there is a tendency for politicians to see the 80% cure rate as evidence that pediatric oncology does not required concentrated efforts on prevention and cure.

Seven Key Objectives to Tackle the Current Issues
Provide safe, effective, and innovative treatments
Develop precision cancer medicine to help guide therapeutic decision-making
Improve understanding of tumor biology and speed up translation into new treatments
Ensure equal access across Europe to standard care, expertise, and clinical research
Address the specific needs of teenagers and young adults
Improve quality of life for survivors of childhood cancers
Understanding the causes of pediatric cancers and set up prevention strategies wherever possible


Improving Understanding of the Biology of Pediatric Tumors

Focusing on the issue of developing precision cancer medicine "may not be possible because of limitations in regulatory affairs," Martin Schrappe, MD, PhD, director of the Department of General Pediatrics at the Christian–Albrechts University of Kiel in Germany, and SIOPE president-elect, said during a press briefing. "It is one of our concerns."

"Technically, it is absolutely feasible," he explained. "We have achieved this already in some areas, and we utilize this information for clinical treatment, but we are concerned that the health systems that are available in the various countries do not provide the adequate support needed because it's still an expensive approach."

For example, said Dr Schrappe, "20 years ago, we introduced molecularly guided treatment of acute lymphoblastic leukemia, the more common cancer in children. It took us about 15 years to get it into the health system, to be reimbursed by social security."

"You a need a long run to achieve this, but we remain optimistic," he noted.

Another objective is to improve understanding of the biology of pediatric tumors. "Cancers in adults result from a multistep process, usually after exposure to external carcinogens such as tobacco, alcohol, and diet, and often progress over many years," Dr Schrappe explained.

"Pediatric malignancies develop early in life and over a much shorter time period. This suggests that fewer and stronger events are required for them to progress. Compared with adult cancers, most of them show fewer genetic defects and have a lower genetic complexity," he said.

"Major progress has been made in understanding pediatric tumor biology, and this has led to the discovery of some unique cancer hallmarks. Now we need to use modern, innovative technologies to further decipher the mechanisms of pediatric tumor development, progression, and relapse, and speed up its translation to the clinic," he added.

Ethical Issues: Palliation and Funding

One area in which there are large disparities in provision across Europe is that of palliative care. Dr Vassal said during the briefing that it is important to try to understand the differences between countries and to determine the best way to provide patients with palliative care.

Dr Schrappe added that palliative care, in essence, relates to the ethics of care. "It's not only end of life, it's also several points before the potential end of life. But I think [it's] extremely important; it's an issue we have to address very carefully," he said.

"I think one should not only focus on palliative care, although I think it's important," he explained. But "all the way through the disease, we really need to look after [ethics of care]."

One aspect of the report that touches on ethical issues is that of funding. It calls for an innovative approach to financing both access to novel drugs and pediatric oncology research in Europe.

Dr Vassal said: "We are not naive. Our vision is that we need got diversity the sources of funding."

"We need to first to have a real support at the European level, because we need funding for infrastructure; otherwise, we will not be able to develop this plan in the next years," he pointed out.

In the past 30 years, pediatric oncologists have developed their protocols without interacting with industry.

"We need support from industry and what we call an intelligent and transparent partnership. [It's] a new way to work together with industry, because they don't know how to address children with cancer," he explained. "In the past 30 years, pediatric oncologists have developed their protocols without interacting with industry."

He continued: "The point is we need to develop this funding in such a way that patients have access to the new drugs."

Another key area of funding is the challenges faced by parents, patients, charities, and nonprofit organizations. Dr Vassal pointed to Unite2Cure, a network of groups and individuals from across Europe working to speed access to novel drugs for pediatric oncology patients.

He emphasized that changes to the legal environment and the way in which innovative treatments are developed will also be needed. "It's only through funding — European and national grants, strong support from the EU, but also from charities, from people willing to support this initiative, and from industry — that we will find the money to run this plan for the care of patients," Dr Vassal said.

The authors have disclosed no relevant financial relationships.


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