CANCER PREVENTION AND ACCESS TO MEDICINES. Gracemarie Bricalli ESMO Head of International Affairs

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1 CANCER PREVENTION AND ACCESS TO MEDICINES Gracemarie Bricalli ESMO Head of International Affairs

both available and affordable to everyone everywhere!

2 ESMO s 2020 Vision: Access to cancer care ESMO s 2020 vision statement recognises that progress in the management of cancer care can and will only occur when high quality care is both available and affordable to everyone everywhere! ESMO s vision supports that of World Health Organization and the United Nations of universal health coverage for everyone at all ages

United Nations High-Level Meetings on Health To date, health has only been addressed 2 times at the United Nations level 2000 for HIV/AIDS 2011 for

3 United Nations High-Level Meetings on Health To date, health has only been addressed 2 times at the United Nations level 2000 for HIV/AIDS 2011 for Non-communicable diseases (abbreviated NCDs and mainly focusing on cancer, cardiovascular, diabetes, and chronic respiratory disease) with follow-up meetings in 2014 and 2018

4 From the United Nations to the World Health Organization 2011 UN High-Level Meeting on NCDs WHO Global NCD Action Plan Primary focus on prevention

5 Cancer Prevention Definition of Cancer Prevention Primary prevention to reduce the incidence of cancer by controlling (avoiding) exposure to risk factors or by increasing an individual s resistance to these risk factors (by immunization or chemoprevention); Secondary prevention to detect cancer at an early stage (by screening) when treatment is more effective, leading to a higher rate of cure and a reduced frequency of the more serious consequences of disease; and Tertiary prevention defined as prevention of locoregional relapse and/or metastatic disease after primary treatment by surgery or radiotherapy.

Cancer Prevention European Chronic Disease Alliance ESMO is a Founding Member of the European Chronic Disease Alliance (ECDA) (2010) http://www.alliancechronicdiseases.

6 Cancer Prevention European Chronic Disease Alliance ESMO is a Founding Member of the European Chronic Disease Alliance (ECDA) (2010) The ECDA members represent over 100,000 health professionals and address cancers, heart disease, stroke, hypertension, diabetes, kidney, respiratory and liver diseases.

7 Cancer Prevention European Chronic Disease Alliance Mission: To reverse the alarming rise in chronic diseases by providing leadership and policy recommendations based on contemporary evidence. Chronic non-communicable diseases affect more than one-third of the population of Europe over 100 million citizens - and account for 86% of deaths in the WHO European Region. The ECDA has produced a number of position papers Priority areas: Invest in prevention measures to tackle chronic diseases

8 Cancer Prevention Role of Medical Oncologist in Cancer Prevention The perspective and role of the medical oncologist in cancer prevention: A position paper by the European Society for Medical Oncology (2008)

9 Cancer Prevention Role of Medical Oncologist in Cancer Prevention Medical oncologists should take part in the development of cancer screening programs, providing the scientific insights necessary to guarantee that such programs have a positive impact and that drawbacks are kept to a minimum (false positive, false negative, etc.). Medical oncologists should contribute to, and participate in, awareness campaigns to inform the population about the importance of screening programs and disseminate information about how to prevent cancer. Medical oncologists can, during the treatment, inform their patients on the lifestyle and environmental factors having an impact on health and their recovery.

10 ESMO advocacy for both prevention and treatment ESMO s official relations status with the WHO allows ESMO to attend WHO meetings and to make official statements ESMO advocated within WHO that prevention is not enough and that in order to treat patients according to the ESMO evidence-based clinical practice guidelines, timely access to medicines and medical devices is essential. ESMO projects with WHO focused on gathering data to show barriers to access to medicines and where efforts need to be focused

11 ESMO projects with WHO on access to medicines Access to Medicines Access to Opioids Access to Cancer Medicines Access to WHO Essential Medicines List

12 ESMO: VALUABLE DATA & TOOLS ESMO Members ESMO Guidelines ESMO Guidelines Magnitude of Clinical Benefit Scale Access to EMAapproved cancer medicines

13 ESMO GUIDELINES, E-UPDATES, AND APP: OVER 70 CLINICAL PRACTICE GUIDELINES

14 ESMO PATIENT GUIDES Patients should be treated according to evidence-based clinical practice guidelines ESMO translates them into Patient Guides using language they can understand. Some of the Patient Guides are translated into Italian Membership

15 ESMO SURVEYS ON AVAILABILITY OF CANCER MEDICINES ESMO Global Policy Committee conducted European and International studies: Opioid use for legitimate medical use. Study resulted in 10 recommendations to decease barriers Supported 2014 World Pallative Care Resolution Supported 2016 UN Outcome Document on Controlled Substances Availability of licensed anti-cancer medicines to a patient when prescribed Survey results show barriers and unavailability in many countries, with largest discrepancies in lower income countries Even some of the essential medicines on the WHO Essential Medicines List are not routinely available or only at full cost to patients Membership

16 COMMUNICATING ABOUT ESMO SURVEYS ON THE AVAILABILITY OF CANCER MEDICINES ESMO Global Policy Committee conducted European and International studies: on the availability of opioids for cancer pain management and the availability of anticancer (anti-neoplastic) medicines for the treatment of cancer patients ESMO members treat patients with cancer medicines Members inform about issues with cancer medicines availability ESMO leads surveys and gathers data with partner societies Data is the first of its kind Data collected from clinicians (ESMO members and partner societies) and oncology pharmacists, not government sources Survey is a perception survey at a snapshot I time Reasons for lack of availability not conclusive Membership

17 COMMUNICATING ABOUT ESMO SURVEYS ON THE AVAILABILITY OF CANCER MEDICINES 1. Deciding what to report 2. Reporting in a fair and balanced manner 3. Framing the issue within a broader context 4. Choosing credible and reliable sources of information Challenges This is a complex multi-faceted issue Sensitive issue to communicate about Need more information Established a Cancer Medicines working Group to address some of the issues Membership

ESMO CANCER MEDICINES WORKING GROUP Surveys ESMO Cancer Medicines Working Group Inexpensve but essential Medicines Innovative more expensive medicines Economist

18 ESMO CANCER MEDICINES WORKING GROUP Surveys ESMO Cancer Medicines Working Group Inexpensve but essential Medicines Innovative more expensive medicines Economist Intelligence Unit report supported by ESMO 6 policy recommendations on how to avoid and manage shortages of inexpensive but essential medicines in Europe Membership

19 EXPENSIVE MEDICINES ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) When a new anticancer medicine is EMA-approved, its benefit will be «scaled» by the Guidelines Committee and reviewed by the ESMO-MCBS Working Group Curative A B C Non-curative All new anticancer EMA approved medicines will be highlighted in the ESMO Guidelines where relevant or as an eupdate 2. Medicines which obtain the highest scores (A&B or 5&4), represent the highest priority for rapid endorsement by national bodies across Europe

20 WHO Model List of Essential Medicines 2015 update led by UICC with ESMO participation 16 new cancer medicines added to bring the list to 46 Each medicine is listed together with the disease area for which it is effective List serves as a model for national essential medicines lists

21 2015 WHO ESSENTIAL MEDICINES LIST: Solid Tumors UICC Task Force on EML: UICC, Dana Farber Cancer Institute, ESMO, ASCO, SIOPE, US NCI, NCCN International & others New drugs, tumor-specific indications Cytotoxics Cytotoxics Cytotoxics Hormones bleomycin docetaxel irinotecan anastrozole calcium folinate doxorubicin methotrexate bicalutamide capecitabine etoposide oxaliplatin dexamethasone carboplatin fluorouracil paclitaxel leuprorelin cisplatin filgrastim rituximab tamoxifen cyclophosphamide gemcitabine trastuzumab dacarbazine Ifosfamide+mesna vinblastine dactinomycin imatinib vincristine vinorelbine

22 2017 Cancer Resolution: From global commitment to national action communications package

23 THANK YOU!

THE ESMO INTERNATIONAL ANTINEOPLASTIC MEDICINES SURVEY: HOW AVAILABLE ARE THE WHO ESSENTIAL CANCER MEDICINES?

THE ESMO INTERNATIONAL ANTINEOPLASTIC MEDICINES SURVEY: HOW AVAILABLE ARE THE WHO ESSENTIAL CANCER MEDICINES? Alexandru ENIU, MD, PhD Chair, ESMO Global Policy Committee Department of Breast Tumors Cancer