European and US politicians are bidding to invigorate efforts to prevent and treat cancers. Bette Browne reports
“We can end cancer as we know it,” declared US President Joe Biden at the re-launch in February of his ‘cancer moonshot’, which aims to halve the US death rate from cancer over the next quarter of a century.
The US programme’s goals, which are similar to those approved by the European Parliament, involve earlier diagnosis, prevention, addressing inequities in treatment and targeting the right treatments to the right patients.
When President Biden first announced the initiative in 2016, he was former President Barack Obama’s Vice-President. But now as President he promised to “supercharge” the cancer moonshot and has announced the establishment of a ‘cancer cabinet’ to focus on implementing his goals.
“I committed to this fight when I was Vice-President. It’s one of the reasons why, quite frankly, I ran for President. Let there be no doubt: Now that I am President, this is a presidential White House priority – period,” he said during the re-launch at the White House in early February. “Let’s end cancer as we know it. I refuse to believe this is beyond our capacity. I refuse to believe it.”
“Let’s show the world what’s possible. Let’s show the world that we’re committed. Let’s show we can do big things,” he declared. “The goal is to cut the cancer death rate in half in the next 25 years – at least by 50 per cent – and to turn more cancers from death sentences into chronic diseases that people can live with; to create a more supportive experience for patients and their families; and by doing these things and more, to end cancer as we know it.”
In 2021, the European Commission presented a new strategy in relation to the disease titled Europe’s Beating Cancer Plan. In December the European Parliament’s special committee on beating cancer (BECA) adopted final proposals on how to strengthen the EU’s role in the fight against cancer.
MEPs said that the implementation of Europe’s Beating Cancer Plan was a first step towards “a real European Health Union”. The comprehensive strategy addressing cancer at EU level should “serve as a model for other non-communicable diseases”, MEPs add.
Ireland was represented on BECA by Ms Deirdre Clune MEP. The committee was created in June 2020 and ended its mandate in December 2021. The adoption of the committee’s report by the Parliament was hailed by MEPs as a major step in addressing “the biggest killer of our times”.
They said implementing Europe’s Beating Cancer Plan would advance the struggle against the disease on several fronts by laying out a co-ordinated EU strategy. BECA’s Chair Mr Bartosz Arlukowicz MEP commented: “If we can co-finance building bridges, roads, and museums together, as a Union, then we can surely start fighting the biggest killer of our times, cancer. If we work together, if we pool our resources, we can really beat cancer.”
Prevention
In 2020, cancer killed almost 10 million people worldwide, according to World Health Organisation figures.
In the EU, 2.7 million people were diagnosed with cancer and 1.3 million people lost their lives to the disease. The American Cancer Society projects about 1.9 million new cancer cases and 609,360 deaths in 2022.
With an estimated 40 per cent of all cancers now preventable, MEPs called for effective prevention measures at national and EU level, based on independent scientific expertise.
Europe’s Beating Cancer Plan includes funding programmes that encourage people to stop smoking and measures to promote actions to reduce and prevent alcohol-related harm as part of a revised EU alcohol strategy. MEPs were also concerned that patients still faced problems when accessing healthcare services and participating in clinical trials in other EU countries.
The Covid-19 health crisis affected cancer research considerably, leaving facilities with financial and logistical challenges
They called for the existing legislative framework to be reformed to allow for mobility and access to highly specialised equipment and care. There should be a single set of rules to authorise and reimburse cross-border healthcare, including a right to a second opinion.
Multi-national cooperation and the way cross-border clinical trials are run also needed to be more effective, they said. “We cannot allow the unequal access to diagnosis and treatment to persist,” Mr Arlukowicz stressed. “A woman with breast cancer in one country should not have 25 per cent less chance of surviving cancer than a woman with the same cancer in another country.”
To counter shortages and make cancer treatments more accessible and affordable at EU level, MEPs strongly advocated extending joint procurement procedures, especially for rare, paediatric, and novel cancer medicines and treatments. They also want to diversify the cancer drugs supply chain, monitor shortages more closely and create a strategic stockpile of critical cancer medicines.
A key recommendation in the BECA report, which the parliamentarians approved, was to guarantee to all EU patients the ‘right to be forgotten’. Under this right, insurers and banks would not be allowed to consider the medical history of people affected by cancer 10 years after the end of their treatment and up to five years for patients who were diagnosed before the age of 18.
The Parliament heard that people affected by cancer were over three times more likely to have difficulty purchasing insurance than the general population, and over twice as likely to experience problems in getting a mortgage.
France, Portugal, Belgium, Luxembourg, and the Netherlands have already ensured that cancer survivors can use their right to be forgotten when, for instance, applying for a mortgage 10 years after the end of their treatment, if there has been no relapse.
But no such right exists in Ireland. Nearly a quarter of people affected by cancer in Ireland said they could not get a quote for a range of financial products and services due to a diagnosis at some point in their lives, according to a survey published in February by the Irish Cancer Society.
Screening
Other significant recommendations, approved by the EU Parliament, included adding other cancers, besides breast, cervical and colorectal cancer, to the updated EU cancer screening scheme. At present, this scheme aims to help EU countries ensure that 90 per cent of the EU population who qualify for breast, cervical, and colorectal cancer screenings are offered screening by 2025.
“Twelve years after the last European strategy to beat cancer, the one we are now presenting is historic, both in terms of its ambition and its objectives, and in terms of the resources we will provide,” said BECA Rapporteur, Ms Veronique Trillet-Lenoir (MEP).
“We will finally be able to fight effectively, together, against the health inequalities that persist within the European Union and respond to the needs of millions of Europeans affected by this disease.”
Lessons learnt by the committee on the impact of the Covid-19 pandemic on cancer care have also been incorporated. “Healthcare services face multiple challenges in providing essential care to their patients in the midst of Covid-19 restrictions across the EU,” the BECA report emphasised.
“Cancer care services have endured significant delays or cancellations leading to backlogs of patients furthering the already existing strains on healthcare systems and healthcare professionals. The Covid-19 health crisis affected cancer research considerably, leaving facilities with financial and logistical challenges.”
Nonetheless, it said “the pandemic sparked the use of innovative health technologies, for example telemedicine, in the mitigation of the detrimental effects on all cancer-related services and research and fuelled the drive to restructure existing health systems and make them more resilient for future health crises.”
US expenditure
For Americans, Biden’s moonshot initiative recalls President John F Kennedy’s pledge in 1961 to conquer space by sending a man to the moon and safely returning to Earth – a goal that took almost a decade to achieve.
In 2016, the US Congress authorised $1.8 billion (€1.6 billion) in funding for the cancer moonshot over seven years. The National Cancer Institute, which oversees the initiative, says it has already spent $1 billion on more than 240 research projects. There is an estimated $410 million (369 million) left for the next two fiscal years.
The financial support was facilitated by the 21st Century Cures Act, which has provided new funding for cancer research in several areas including cancer disparities, new clinical trial networks to drive drug discovery, and childhood cancer.
The Act, signed into law in December 2016, streamlined cancer-related decision-making at the US Food and Drug Administration through the formation of an Oncology Center of Excellence so that treatments could be approved faster and patients could have more direct access to information about the regulatory process.
In many ways, fighting cancer has been a personal mission for President Biden and his wife Dr Jill Biden. Her advocacy for cancer education and prevention began back in 1993, when four of her friends were diagnosed with breast cancer. She subsequently launched the Biden Breast Health Initiative to inform high school girls about the importance of cancer prevention.
As First Lady she has continued her work, which has emphasised early detection efforts. She stressed the importance of cancer screenings, especially those delayed due to the Covid-19 pandemic, and has urged government partners, the business community, and non-profit sectors to help make screenings more accessible and available.
As Vice-President, Biden brought together a taskforce and urged the public and private sectors to unite to progress measures against the disease.
Companies, patient groups, universities and foundations, worked together to forge new partnerships and programmes.
At the time, the cancer moonshot initiative was ambitious and it achieved progress on a number of fronts. Its three overarching goals were to accelerate progress in cancer research, encourage greater collaboration, and improve the sharing of data.
Under the initiative, the National Cancer Institute funded two groups of research teams focused on immunotherapeutic approaches in adults and children. The Immuno-Oncology Translational Network, which included 31 principal investigators at 19 different institutions, investigated the mechanisms by which tumours in adults interact with the immune system, developed new immune-based therapies and created approaches aimed at minimising the risk of side-effects.
Because most paediatric cancers are biologically different from adult cancers, a separate network of research teams was established to focus on identifying immune targets and treatments specific to paediatric cancers and developing laboratory models for testing immunotherapies against these cancers. A data management centre was also built into the immunotherapy component, which allowed researchers to share their work and facilitate collaboration.
Detection
Another area in which significant progress is being made is in cancer prevention and early detection. Some of the research being funded in this area is making extensive use of implementation science – taking evidence-based interventions and testing ways to apply them in real-world settings. For example, several research teams tested methods to improve efforts to encourage people to stop smoking. Similarly, there were initiatives to improve the uptake of colorectal cancer screening.
However, just a year after Vice-President Biden launched the initiative, a new US administration took over under President Donald Trump in January 2017 and there was far less focus on the moonshot. Funding cuts to the National Institutes of Health followed and inevitably impacted cancer research within the agency.
Old practices created data silos, minimised the role of patients, fostered the wrong kind of competition instead of the right kind of collaboration
Propelled by concerns about the fate of the cancer moonshot, the President and his wife, Dr Biden, decided to launch a private sector Biden Cancer Initiative in June 2017, under the auspices of the Biden Foundation. The goal was to give momentum to the cancer moonshot and push for faster progress in new treatments, prevention, and detection.
But in 2019, when President Biden announced a presidential run, it meant the foundation had to close for political reasons, although the work of the Biden Cancer Initiative continued independently. The Vice-President of the Biden Cancer Initiative was Dr Danielle Carnival.
Dr Carnival, who spoke with the Medical Independent (MI) in a lengthy interview in 2019, has now been tapped to oversee the “supercharged” version of the moonshot announced by President Biden. Dr Carnival told MI in 2019 that she believed the moonshot was bringing a greater sense of urgency to cancer prevention and treatment, both nationally and internationally.
President Biden also spoke about that same sense of urgency in his re-launch of the initiative in February. “The cancer moonshot brought the country and the world closer together on this issue. Our goal was to bring a new sense of urgency to the system of prevention, research, and patient care to take advantage of the 21st Century science and technology.
“And that’s why I’m proud to announce our plan to supercharge the cancer moonshot as a central effort of the Biden-Harris administration. It’s bold, it’s ambitious, but it’s completely doable.”
To help make it “doable”, President Biden is calling on scientists to explore the lessons learned from the development of the Covid vaccines to see if mRNA vaccine technology could also be used to stop cancer cells when they first emerge.
“To target the right treatments to the right patients, we’re learning more about how to use genetics, immune response, and other factors to tell which combinations of treatments are likely to work best for a particular individual,” the President said.
“To address inequities, we can target prevention, detection, and treatment efforts so that all Americans – whether they’re urban, rural, or Tribal communities – have equal access to cancer diagnostics, therapeutics, and clinical trials.
President Biden announced the formation of a new ‘cancer cabinet’. The cabinet will coordinate the work of multiple government agencies. It has representatives from the Departments of Health and Human Services, Veterans Affairs, Defence, Energy, and Agriculture, as well as the Environmental Protection Agency, the National Institutes of Health, the National Cancer Institute, and other agencies across the executive branch.
The President has also called on Congress to fund his proposed Advanced Research Projects Agency for Health (ARPA-H), which will be a new entity within the National Institutes of Health to drive what he described as “unprecedented progress” in biomedicine. “ARPA-H will have a singular purpose – to drive breakthroughs to prevent, detect, and treat diseases, including cancer, Alzheimer’s, and diabetes, and other diseases. I’m also calling on the scientific and medical communities to bring the boldest thinking to this fight.”
He said harnessing the private sector will be key to progress. “I’m calling on the private sector to develop and test new treatments, make drugs more affordable, and share more data and knowledge that can inform the public and benefit every company’s research.”
Cancer screening should also be stepped up: “Americans have missed more than nine million cancer screenings in the last two years because of Covid. We have to get cancer screenings back on track and make sure that they are accessible to all.”
But a major obstacle to improving access to preventive measures, like early detection and treatment, is the continued lack of health insurance for millions of Americans. Despite gains in health insurance coverage following the implementation of President Obama’s 2010 Affordable Care Act, some 30 million Americans aged between 18 and 64 are still uninsured, according to the US National Health Interview Survey by the Centres for Disease Control and Prevention (CDC).
The President has also called on the medical profession and scientists to examine the efficacy of their practices. “Take a hard look at your practice. Ask yourself, am I practising perfectly or am I practising to make the old way permanent? Old practices created data silos, minimised the role of patients, fostered the wrong kind of competition instead of the right kind of collaboration. My plea to you scientists is (to) share data as best you can.”
He said too little was known about why treatments worked for some patients, but not others. He added that patients often wanted to share their data to help more people.
The President called on companies to develop mobile units and pop-up clinics to make screening more accessible and he urged members of Congress to “fund this particular programme and focus on it until we beat cancer”.
President Biden’s launch of the moonshot initiative came just a year after his son Beau had died at age 46 of glioblastoma. Beau’s doctor was at the moonshot re-launch event. The President pointed to him and spoke emotionally about how cancer patients often asked their doctors for two more weeks to see their daughter’s wedding or six more months to see their baby born.
He added: “For survivors and caregivers, who carry the physical and mental scars of treatments and recovery, and for those who have lost, and for the ones we can save: Let’s end cancer as we know it.”
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