Overview of major cancer policy research at ECC 2013
Prof Richard Sullivan - King's College London, UK
Today at ECCO we’ve had a really exciting launch of a new piece of work, a book actually, a new book on global cancer by Peter Boyle and colleagues looking at the state of oncology in 2013 across the globe. It’s really quite a remarkable textbook, we’ve now got almost 3,000 major textbooks in cancer and most of them belong to three categories: one is textbooks on cancer care, big, big tomes; others are around fundamental aspects of cancer research and then finally there are the more popular books like The Emperor of All Maladies. But, amazingly, to date we’ve not had a textbook on global cancer and The State of Oncology 2013 by the International Prevention Research Institute, so Peter Boyle, myself and a number of other editors, and over 120 collaborators, is really the first of its kind.
We’ve had another paper that has just come out in the Annals of Oncology let out by Dr Morris and colleagues looking at the relationship between outcomes in breast cancer specifically and overall healthcare expenditure. An interesting piece of work because although we’ve known for many years that there’s a relationship between the amount of money you spend on your healthcare system and longevity, that’s life expectancy, no-one has ever looked at the disease specific level. So this is the first piece of work that has really come out to look at the disease specific level and it’s found across Europe that broadly speaking the more you spend on your healthcare system the better your outcomes broadly are. But there’s a big division between old Europe and new Europe in terms of the amount of money spent on their healthcare system and then mortality in breast cancer. The divisions, as we know, are actually starting to grow. So the first major public policy issue is that Europe is very heterogeneous, that the outcomes for breast cancer patients in many parts of Central and Eastern Europe are very poor compared to what we’re seeing in the top EU five and critically something needs to be done about this. The relationship with the economics of the health system is also critical, we know that it’s not just a matter of money though, that there are many other issues that lead to good outcomes that need to be taken into account when developing your cancer care system. For instance, the culture of the way you deliver your care; the question of whether there’s stigma in that particular society so people are presenting later; issues around the organisation and structure of the pathways that deliver the care. So the message really is it’s not just a matter of throwing money into a system, it’s also making sure there’s alignment, structurally, organisationally and culturally to ensure that that money actually produces really excellent outcomes.
The issue has really been with overall healthcare expenditure is it’s a surrogate, really, for the strength of the system, the country as a whole. When you strip healthcare expenditure down to disease specific areas, then you have major issues of disparities in terms of that relationship breaking down. That’s a piece of work that ourselves and other people are starting to do which is to understand the money that goes into what we consider to be disease-specific areas in healthcare, like cancer, like cardiovascular, Alzheimer’s and the relationship then is much more fragile because the system’s outcomes are much more dependent on cultures, organisations and structures than they are about the money going in at the front end.