The pope periodically offers an urbi et orbi prayer to the city and the world. Wishes for peace, health, spirituality addressed to all. A call to action to help our condition as sentient and mortal humans.
Religion continues to shape history, but that is not our point. This papal prayer finds reference in a scientific and social initiative. The Harvard Business Review1 recently referred to the Orbis project. This public initiative, focused on excellence in oncology care, aims to level the differences between jurisdictions in access to innovative cancer diagnostics and treatments.
The estimates presented in this article are damning: delays in the gene characterization of tumors and the approval of new cancer therapies are costing hundreds of thousands of years of life.
Notably, immunotherapy for lung cancer reduces the risk of death by 38%. A year of delay in the introduction of this avenue resulted in the death of about a third of patients with lung cancer since the median survival without immunotherapy is 12 to 18 months.
Quebec and Canada are part of the sad contingent of countries that cause and suffer these reductions in human experience. Both because of the bureaucratic process for approving diagnostic and therapeutic measures (Health Canada) and because of the slowness of decisions to reimburse and fund them (provincial authorities), citizens are forced to wait. Waiting to analyze genes aimed at identifying tumor characteristics making them potentially susceptible to targeted therapy. Waiting for new therapies proven effective and available in other countries to become available in Quebec and Canada.
What sets us apart so much to explain these delays? More complete and extensive data required by regulatory authorities to ensure patient safety before approving a new therapy? No way. The registration dossier is generally extremely similar to that which leads more quickly to clinical use elsewhere, and in the United States in particular.
So why wait another one to two years? No reason, if not the inertia of a machine that takes pleasure in its power to decide the fate of a vulnerable population.
While in the condition of COVID-19, under political pressure, this same machine proceeded in record time to approve new vaccines and antiviral therapies.
However, each year of delay in therapies or diagnostic options has proportionally the same impact in years of life as COVID-19. But this variation in relation to cancer is not very measurable. For COVID-19, we are trying to stem the loss of years of life. For cancer, we want to increase the survival of people affected. Moreover, the absence of adequate data, of registry, makes it impossible to formally measure the impact of health measures, such as access to a complete diagnosis in a timely manner or to a new treatment.
And if we refer to data from the Canadian Cancer Society2the prevalence of cancer requires the implementation of a concerted plan that generates hope, even empathy, beyond the eagerness to promote medical assistance in dying.
Furthermore, improved care and survival translate not only into new therapies, but also into the identification of individuals who require one treatment rather than another. A Canadian study published in the Journal of the National Comprehensive Cancer Network3 recently demonstrated a significant improvement in survival for women with breast cancer for 30 years, both through the emergence of targeted therapies and the exclusion of non-required therapies analyzing a molecular analysis of the tumor.
The application of scientific data therefore translates into an improvement in survival, but also in the quality of life.
In medical jargon, we speak of treatment morbidity. It is generally less with more adapted, targeted therapies. Hence the even more pressing need to modify models of care to incorporate innovative approaches.
Moreover, the most effective measures are those which make it possible to avoid, prevent cancer or detect it early. In this regard, there is also reason to review the processes in place in Canada and in Quebec more specifically, where systematic screening is only established for breast cancer, forgetting programs for colon or lung cancers to name only those.
There remains the economic aspect. Does the proposal to quickly adopt diagnostic and therapeutic measures conflict with the ability to pay? This requires the initiation of a social debate. Long-term models will have to be projected determining the value of years of life gained in people with cancer and the additional costs associated with improving care. This estimate is difficult to establish, but the net increase in the number of cases expected in the coming decades obliges us to compel ourselves to such an exercise.
In fact, political remarks too often cause inertia, a cognitive alteration that insists on comparing to the past rather than planning for the future.
This is the case in oncology, when the increase in incidence and the amount of care needed to deal with it have not been carefully anticipated.
In Canada, and in Quebec in particular, we want an Orbis vision in oncology, aimed at offering here what is best offered elsewhere. Much has been made about the overall availability of vaccines for COVID-19. We believe that the same is true for oncological care, requiring a globalization of knowledge, its dissemination and its application.
Urbi and orbi. To the city and to the world. To measure and in time for each patient who suffers or will suffer from cancer or its consequences.
1. Daly et al., Harvard Business ReviewOctober 2022
3. Kirkham et al., Journal of the National Comprehensive Cancer NetworkSep 2022