Look back: cancer care requires a paradigm shift

11 December 2024

Belgium is an internationally recognized leader in oncological research. Yet, the wave of innovations has not fully addressed cancer patients' needs. Advances in medication, digital technologies, and artificial intelligence necessitate a fresh perspective and a significant shift in mindset among policymakers and stakeholders in the healthcare sector.

Prof. Ahmad Awada speaking at the event "Cancer Care; The Future Is Now"

    The rapid evolution of cancer research and its practical implications formed the core of our conference “Cancer Care: The Future is Now,” organized on November 6. Below is an overview of key discussions.

    Clinical research

    The development of oncology drugs is undergoing transformative changes, emphasizing collaboration through a “spider web” network model that integrates academic and non-academic centers, physicians, laboratories, patients, and more. This shift demands a change in legislation, as cancer research now encompasses hundreds of cancer types instead of just a few.

    Reimbursement and recognition

    Complexity is increasing. The advent of new medication and vaccines tailored to smaller, specific patient groups has dramatically improved survival rates and quality of life for cancer patients. While these new cancer drugs are expensive, we need to look at the bigger picture, as they also represent a cost saving, for example because people return to work more quickly.

    Registration and reimbursement procedures also need to be changed: only 66% of cancer drugs are reimbursed and the process takes 640 days. Only governments and the pharmaceutical industry are involved, while a multi-stakeholder model involving patients, doctors, etc. that takes into account the entire ‘patient journey’ starting from diagnosis is recommended.

    ‘Delays in reimbursing cancer drugs lead to higher morbidity and reduced quality of life.’

    Carina Schey, Global Market Access Solutions

    Having just one process is no longer sufficient, as several procedures (three to five) are needed. And taking ‘overall survival rate’ as an endpoint for evaluation is too limited, intermediate endpoints such as delayed progression, tumor shrinkage… should be included.

    Moreover, the potential of existing molecules, like aspirin for colorectal cancer, must be harnessed for new treatment applications. Accelerated approval procedures for such cases would save both time and money.

    Organization

    The rising incidence of cancer, coupled with increasing oncology consultations and day hospital admissions, contrasts with declining traditional hospital stays. Cancer is increasingly becoming a chronic condition, particularly for older patients with multiple health issues. Beyond merely addressing tumors, healthcare must prioritize quality of life and personalized care.

    Healthcare providers should accompany patients throughout their entire disease cycle. However, many of them remain unprepared for this.

    This shift requires transitioning from individual care providers to multidisciplinary teams offering integrated, holistic support. These teams would accompany patients throughout their disease cycle, both within and outside hospital settings, addressing wellness, patient education, palliative care, and end-of-life support. However, many healthcare providers remain unprepared for these changes. Fragmentation of care and inadequate reimbursement structures present additional obstacles.

    Centralizing cancer care could consolidate expertise, optimize investments, and improve outcomes. Nevertheless, logistical, administrative, and financial barriers—such as staff regulations—must be overcome to achieve this.

    Artificial intelligence

    AI plays a pivotal role in processing vast datasets, such as clinical notes, prescriptions, and genomic information, to guide treatment decisions. Efficient data collection, combined with pseudonymization to ensure privacy, is critical for success.

    Standardization and analysis are necessary to make data usable. The OHDSI Belgium consortium, for example, is working toward creating an ecosystem for analyzing datasets using a common model. Regulatory changes are essential to support these innovations.

    Digital technology

    Good follow-up, telemedicine and monitoring, have been shown to improve survival rates, quality of life, and reduce complications and hospital (re)admissions. Despite this, governments and users have been slow to adopt these technologies. Building trust through education and awareness, followed by structured financing and reimbursement frameworks, will be key to driving adoption.

    ‘A pilot study shows older adults can embrace digital tools. Even those without smartphones learned to use a simple app in five minutes.’

    Peter Van Vooren, Remecare

    Challenges such as poor integration into existing IT systems and a lack of interoperability continue to hinder progress. To address this, www.telemonitoring-prescription.com connects hospitals, software providers, and other stakeholders through a standardized prescription system as an intermediate step.

    And what about policymakers?

    The policy debate at the conference highlighted some political awareness of cancer care challenges.

    There was consensus on the need to increase the healthcare prevention budget to 5%. Yannis Bakhouche (MR) advocated for re-federalizing prevention efforts, while Kathleen Depoorter (N-VA) supported de-federalization. Bakhouche also suggested allocating a portion of health insurance growth norms to innovation. Additionally, more interaction and collaboration are needed between stakeholders from the private and public sectors.

    Stéphanie Lange (Les Engagés) argued for a higher growth norm to finance new medicines and wants to reform the reimbursement procedures. Depoorter emphasized the need for centralized care for rare cancers, balanced with local access for treatments like radiotherapy.

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