‘Efficiency in oncology care is something we should embrace!’

Earlier this year, All.Can Belgium published its memorandum on oncology care in Belgium. This listed a series of well-reasoned recommendations for the next government, divided into four key topics: prevention & screening, quality of care, new therapies, and research.

Our Chair, Professor Dr. Ahmad Awada  is eager to add a fifth topic: efficiency. This is a common thread underlying the entire memorandum and sums up what All.Can Belgium represents.

Professor Awada, efficiency may well be All.Can Belgium’s flagship. Why do you place such great emphasis on efficiency in oncology care?

“There are tremendous needs in oncology, but resources are limited. This obviously has consequences. While every need may be relevant, we know that we cannot possibly address all of them at the same time, and so we have to make choices.”

‘Efficiency is not an end in itself for All.Can Belgium, but rather a means to get the most out of the resources available for oncology care.’

“We have to properly understand the needs before setting priorities: what should we focus on first? For us, this is at the heart of an effective oncology policy. So efficiency for All.Can Belgium is not an end in itself, but rather a means to get the most out of the resources available for oncology care.”

You can draw a parallel with oncology care itself. Being diagnosed with cancer is not only a terrible blow, but for many people it’s also a sudden wake-up call that they are mortals. And so people will start to look at what really matters to them. Is that because they consider efficiency important in itself? No, it’s because they want to make the most of their time left on earth.”

Let’s look at how we can implement this in practice. How can oncology care in Belgium become more efficient?

“Ideally, you should start from a detailed picture of the current situation regarding oncology care in Belgium. In 2008, I help lay the groundwork for the National Cancer Plan. Together with a whole load of specialists, we mapped the situation of oncology care at that time. We looked at the state of play of the various facets of oncology care in Belgium: what was going well, what certainly had to be improved, and so on.”

“This analysis helped guide us to create an effective oncology policy. Policymakers built on our efforts to launch the first-ever National Cancer Plan that same year, based on clear priorities and with concrete actions.”

So do we need a new cancer plan now?

“A cancer plan would certainly be welcome, but the sector feels that there is no political support to develop a new plan at the moment. And let me be clear: while having such a plan is a very valuable asset, it’s not the only way to drive efficiency.”

‘While having a cancer plan is a very valuable asset, it’s not the only way to drive efficiency in oncology care.’

“Rehashing the exercise from 2008 would take months and months of work and require lots of people and resources. That’s the main reason why a new plan is currently not a political priority. But that doesn’t mean we shouldn’t take action. We could, or rather we should, review the existing cancer plan and update its priorities. That is the bare minimum if we want to maintain and preferably improve the quality of oncology care in the years to come.”

“Together with all our stakeholders – from patients and healthcare providers to academia and industry – we have defined four areas that we believe should be prioritised. Our key message to policymakers? Focus on those priorities in the next parliament.”

What are these four priority domains according to All.Can Belgium?

“Prevention and early detection, quality of oncology care, innovation, and research. If you want to read our recommendations in detail, please see our memorandum. For now, I’d like to highlight a few key elements of each priority.

The importance of prevention and early detection speaks for itself: prevention is always better than cure. But if prevention fails, early detection is key – for patients, but also for society as a whole. The WHO identifies early detection as one of the most effective measures for reducing the impact of cancer on healthcare systems.

We also need to look at which types of cancers we can have the biggest impact on. For example, last year All.Can Belgium launched Get Checked Early. This campaign was aimed at young people and focused on three types of cancer, which we found to be relatively common in this population but detected late: breast cancer, testicular cancer, and sarcoma.

Our memorandum calls on policymakers in the next parliament to develop targeted prevention and early detection measures for specific cancers.”

The second domain you highlight is quality of oncology care. What are the key takeaways for policymakers?

“Our main message here is that quality in oncology care should never be taken for granted – you have to keep working on it. We’ve identified a number of quality-related issues that we believe should be high on the political agenda. These range from paying more attention to the patients’ perspectives and providing psychosocial support to further concentrating complex oncology care and focusing more on the effects of cancer on other organ systems.”

The last two domains are closely linked: innovation and research. How is Belgium performing in these domains and what could and should be improved? 

“If we look at the availability of innovative cancer therapies in Belgium, we should be honest: our performance is mediocre. It’s not terrible, but it’s not great either. At All.Can Belgium, we believe we can and should do better.”

‘In terms of innovation in oncology care, Belgium’s performance today is mediocre. We can and should do better.’

“Thanks to advances in technology, IT, bioinformatics and so on, our understanding of cancer has come on leaps and bounds. Whereas in the past we simply talked about ‘breast cancer’, today we know there’s at least 11 different molecular profiles of breast cancer. This segmentation is also visible in other types of cancer, and it allows us to develop better and more personalized treatments. This leads to a virtuous cycle of innovations.”

“When I started my career thirty years ago, you had one or two new cancer therapies emerging every 2 to 3 years. Today, we are seeing two to three new innovative therapies a month! That’s eight to twelve a year, compared to less than one a year in the past…”

“Governments today are struggling to keep up with all these new therapies, and that’s understandable. Our reimbursement model is simply not designed to handle this. That’s why we believe it’s necessary to update this model, to allow valuable innovations to find their way to patients efficiently.”

“The growing segmentation of cancer into subtypes also has implications for translational and clinical research. Belgium does perform well in this area, but its position is increasingly coming under pressure. As cancers become more and more segmented, target groups are getting smaller, whereas research requires sufficient patients. That raises additional challenges for a small country such as Belgium.”

“If we want to maintain our lead in clinical trials, our country will have to make bold choices. Our memorandum puts forward some concrete recommendations in that respect. For example, authorities should actively help academia to attract research, but they should also modernize the methodology that applies to studies in our country, for example. If we can do this, we can become leaders in Europe.”