Research Ideas and Outcomes :
Workshop Report
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Corresponding author: Luca Cassetta (luca.cassetta@ed.ac.uk), Pedro M. Rodrigues (pedro.rodrigues@biodonostia.org)
Received: 04 Dec 2020 | Published: 10 Dec 2020
© 2020 Luca Cassetta, Pedro Rodrigues, Toni Andreu, Bruno Botta, Sven Brandau, Chrissie Brierley, Clive Wilson, Inga Dadeshidze, Lucia Forzi, Federica Ortelli, Mafalda Quintas
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Cassetta L, Rodrigues PM, Andreu T, Botta B, Brandau S, Brierley C, Wilson C, Dadeshidze I, Forzi L, Ortelli F, Quintas MA.C (2020) Beating Cancer by 2030: Mission Impossible? Research Ideas and Outcomes 6: e61662. https://doi.org/10.3897/rio.6.e61662
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Cancer has been for many years the second leading cause of mortality right after cardiovascular diseases, representing 25% of all the deaths reported yearly and this tendency is expected to increase. Although the recent public health emergency caused by COVID-19 pandemic diverted much of the attention of policy makers, the public opinion and even researchers from other important, economical relevant and deadly diseases, cancer still remains as one of the major healthcare issues. Moreover, recent studies revealed the negative effects of COVID-19 pandemic on the increase of avoidable cancer-related deaths. It is then the perfect time to bring back the spotlight onto the topic of cancer.
The aim of this paper is to share the outcomes of the workshop organized by the COST (European Cooperation in Science and Technology) Association, bringing together sixty participants representing a broad variety of stakeholders, to discuss a holistic approach on how to beat cancer by 2030.
The conclusions of this workshop are highly relevant for the community and are supporting the work being undertaken by the EU Mission Board on Cancer. This report lays down the main conclusions and recommendations agreed by the workshop participants, focusing on different aspects such as better stakeholder collaboration, citizen education, innovative therapies, and patient-centric care.
Cancer Prevention and Treatment, Science Policy, Research Roadmap
21st to 22nd May 2019, COST Association, Av. Louise 149, 1050 Brussels, Belgium
The conclusions and recomendations of this paper are the result of the discussions and ideas from all the workshop participants (full list in supp material 1: Booklet of the Workshop - Beating cancer by 2030: mission impossible?).
Disclaimer: Dr Wolfgang Burtscher, Deputy Director General at DG Research and Innovation (EC) and Dr Sanja Damjanovic, Minister for Science in Montenegro, attended the workshop as invited guests and gave presentations for the benefit of the participants. They were not active participants and therefore, the conclusions and recommendations reported in this paper shall not be associated with their opinion nor the position of the institutions they represented.
See Suppl. material
The recent COVID-19 pandemic overshadowed the importance of other major health issues such as cancer (
The COST Association organised a COST Connect event entitled “Beating cancer by 2030: mission impossible?”. This paper shares the conclusions and recommendations of this event to help refocus attention to this important issue.
In 2015, cancer caused around 1.320.000 deaths in the European Union (EU), constituting the second leading cause of mortality second only to cardiovascular diseases, representing 25% of all the deaths reported (
Considering the worldwide, exponential population increase and the average life expectancy, cancer is now identified as one of the major causes of death (first or second leading cause of death before 70 years of age in 91 countries). Noteworthy, cancer currently accounts for 20% of all deaths occurring in Europe every year (3.9 million new cases and 1.9 million deaths yearly), and is expected to stand out as the major leading cause of death worldwide during this century (
The main preventable causes of cancer in Europe reside in unhealthy lifestyles, which include excessive alcohol consumption, tobacco use, inappropriate diet, obesity, and lack of physical activity. In fact, as a result of the westernization of the lifestyle, changes in the profile of the most common cancer types are more striking in emerging economies, where a displacement of infection-related and poverty-related cancers by those cancers more frequently reported in developed countries is taking place (
The economical sustainability of cancer management in national health systems remains a major concern. Paralleling the epidemiological cancer data, the costs of cancer care are increasing, likely as a result of the development of new diagnostic imaging techniques and new innovative therapies. Importantly, in European countries, up to 30% of total hospital expenditure arises directly from oncology-related expenses and the costs spent on new drugs which is exponentially rising is expected to continue increase (
All this data reinforces the need for strong efforts in European cancer research to invest money, create infrastructures, and distribute knowledge with the final goal to beat cancer by 2030. In this regard, the European Cooperation in Science and Technology (COST - www.cost.eu), an EU-funded programme, enables researchers and innovators to set up COST Actions, interdisciplinary research networks in Europe and beyond to timely address scientific and societal challenges. COST also organises highly interactive COST Connect events aiming at bringing together representatives of the funded networks with the wider scientific communities, stakeholders and policymakers working together. Such events aim at creating synergies and reducing research fragmentation in the field, initiating future research cooperation. They actively promote the COST Actions strategic research roadmaps, identify new funding opportunities and priorities for Horizon Europe.
The aim of this paper is to share the outcomes of the workshop organized under the COST Connect series on cancer research: “Beating cancer by 2030”. This workshop provided a multidisciplinary platform where researchers, policy-makers, cancer patient organisations and industry discussed the challenges in cancer research, aiming at an improved coordination at European level. The event and this report come at a crucial time, providing pan-European input into the ongoing Horizon Europe discussions, as cancer has been identified as one of the future missions in the next Framework Programme for Research and Innovation.
The methodology of the workshop is based on the concept of the Pro-Action Café, which is an interactive yet simple facilitation methodology for creative, inspirational, and relevant conversations.
The event has no set agenda and starts with short “setting-the-scene” presentations aiming at providing a general overview of the challenges and activities of the different actors in the field. In a Pro-Action Café, discussion topics are proposed by the participants themselves and selected by the audience, ensuring a maximum engagement and relevant outcomes.
After agreement of the discussion topics, participants invite the audience to define strategies to overcome a specific identified challenge. This is achieved by three rounds of conversation in café style, each guided by a few generic questions to help deepen and focus the conversations. In each round, a new set of participants join the tables, benefiting from the collective intelligence present during the event.
The detailed program of the workshop is given in Suppl. material
The workshop focused on possible strategies to beat cancer. The discussions were supported by presentations from policy makers who presented the current state of affairs in the policy arena (Fig.
Dr Wolfgang Burtscher, Deputy Director General at DG Research and Innovation (EC) (L) opened the event presenting an overview of the state of play of current Horizon Europe negotiations and the planned Mission in the field of Cancer. Dr Sanja Damjanovic, Minister for Science in Montenegro (R), presented the roadmap for establishing The South East European International Institute for Sustainable Technologies (SEEIIST), which aims developing Hadron Cancer Therapy and Biomedical Research with Protons and Heavy Ions.
From the Stakeholder side presentations focused on their activities in the field: Dr Manola Bettio presented ECIS - European Cancer Information System from the Joint Research Centre (EC); Dr Chrissie Brierley presented the view of the JPI Healthy Diet for a Healthy Life. Industry initiatives were presented by Dr Alexandre Ceccaldi (European Technology Platform on Nanomedicine). The views of the patients were presented by Ms Antonella Cardone (European Cancer Patient Coalition). The need and potential for data sharing services was presented by Dr Ashley Woolmore (IQVIA - CODE).
Representatives of selected COST Actions presented the achievements of the different networks in different aspects of cancer research: Dr Christof Krafft on Raman-based applications for clinical diagnostics (Raman4clinics; BM1401); Dr Daniel Ortega: on Multifunctional Nanoparticles for Magnetic Hyperthermia and Indirect Radiation Therapy (RADIOMAG; TD1402); Prof. Sven Brandau on European Network of Investigators Triggering Exploratory Research on Myeloid Regulatory Cells (Mye-EUNITER; BM1404); Prof. Stefano Alcaro on Multi-target paradigm for innovative ligand identification in the drug discovery process (MuTaLig; CA15135); Dr Georgia Pennarossa on In vitro 3-D total cell guidance and fitness (CellFit; CA16119); Dr Puri Fortes on Delivery of Antisense RNA Therapeutics (DARTER, CA17103); Dr Richarda De Voer on Identifying Biomarkers Through Translational Research for Prevention and Stratification of Colorectal Cancer (TRANSCOLONCAN; CA17118).
The workshop participants agreed to focus on some important topics which were discussed among them following a Pro-Action Café methodology (Fig.
The conclusions and recommendations presented in this paper are the result of such discussions on the following topics:
I. Translational research and precision medicine: How to improve translational cancer research? How to make precision medicine real in diagnosis and treatment?
II. Cancer prevention: How to achieve widespread healthy lifestyle choices for cancer prevention and survival?
III. Patients: How to evaluate the quality of cancer care that patients and their carers are receiving across Europe?
IV. Low-hanging fruits: How to improve cancer treatment approaches in cancers with the most urgent needs by 2030?
V. Strategy: How can we build a process to crosstalk and coordinate between the different stakeholders (academia, patients, industry, healthcare providers) in the field of cancer to get the most value for maximising efficacy and beating cancer?
I. Translational research and precision medicine: How to improve translational cancer research? How to make precision medicine real in diagnosis and treatment?
Moving novel cancer targets from bench to bedside is always a priority but also a big challenge; the translation efficiency and speed depends on multiple factors such as the ability to prioritize targets and accelerate their validation, the presence of solid infrastructures to link basic and clinical science, the ability to create academic spin-offs and a solid collaboration pipeline with pharmaceutical companies. So, what is missing to improve research translation in Europe? The working group identified several potential action points, summarized here below:
II. Cancer prevention: How to achieve widespread healthy lifestyle choices for cancer prevention and survival?
As stated in the introduction most cancers in Europe are caused by tobacco, alcohol consumption and general unhealthy lifestyles; therefore, it is easy to hypothesize how many cancers could be avoided if a healthier lifestyle would be adopted. The quest behind this mission is not easy to solve however, because making European citizens aware of the risk associated with certain behaviours and enabling them to live healthier lifestyles is not so straightforward. This working group discussed widely why people choose unhealthy lifestyles over healthier alternatives; several discussion points emerged, including the easy access to cheap unhealthy options compared to good ones, the confusion that arises from the available amount of, sometimes misguiding and contradictory, information, socio-economic disparities in different European countries. What is missing to improve cancer prevention in Europe? The working group identified several potential action points, summarized here below:
III. Patients: How to evaluate the quality of cancer care that patients and their carers are receiving across Europe?
One major issue that is of extreme importance and should be taken into consideration is patient’s welfare and quality of life from the perspective of the patient. Somehow, it is imperative not only to focus on cure by itself but also drive our efforts into patient’s care. Noteworthy, cancer patients are stigmatized in society and for instance, once cured, they do not get any insurance and/or help to get a job. Therefore, is it enough to focus only on cancer treatment? One major question that was raised is: how can we evaluate the quality of cancer care that patients are receiving across Europe?
Health benefits are usually measured in quality-adjusted life years saved. Cost-usefulness analysis is widely used to assess the efficacy of different clinical regimens by quantifying the changes in prognosis (survival rates, time to recurrence, etc.) and corrected by the quality of life. As such, quality of life is also a mean to address inequalities between patient’s treatment and welfare worldwide. Currently, the existing data systems are challenging and EU initiatives, such as European Cancer Information System (European Commission/JRC. European Network of Cancer Registries: European Cancer Information System (ECIS)), which is included in the European Network of Cancer Registries (ENCR) and constitutes a web-based tool that aims to promote awareness on cancer burden and to report/disseminate cancer burden indicators (incidence, mortality and survival), have a lot of space for improvement. Furthermore, considering that this topic is somehow complicated to evaluate and there is a lot of diversity, it is not totally clear which sources have the most trustful information. Consequently, getting the “right” indicators is key. Quality of life consists of a very complex and broad issues, including:
An important question that was raised by the working group to understand what is currently missing is: what is patient’s perspective on quality of life? All the parameters related with quality of life are differently measured across Europe and unfortunately, there are some issues that are not well-discussed and measured. Therefore, there is as urgent lack of agreements/agreed measures/consensus across EU on baseline requirements on quality of life and data discussion is imperative. Parameters, prioritisation is also pivotal. When facing cases where it is impossible to address all the parameters, which ones are the most important? Data sources are very heterogenous across Europe and between different sectors (e.g. hospital vs community) and public availability should be revised.
Taking all these into account, the working group proposed several actions that might be implemented to improve the cancer patients care (Fig.
IV. Low-hanging fruits: How to improve cancer treatment approaches in cancers with the most urgent needs by 2030?
Although there are several therapeutic approaches currently available for cancer patients, an important question was raised: how can we improve cancer treatment approaches in cancers with the most urgent needs by 2030? To efficiently address this point, some questions were discussed.
Taking these questions into consideration, the working group proposed some concerted actions that might be applied in the future to advance these topics:
V. Strategy: How can we build a process to crosstalk and coordinate between the different stakeholders (academia, patients, industry, healthcare providers) in the field of cancer to get the most value for maximising efficacy and beating cancer?
A coordinated and efficient collaboration between the different stakeholders is one of the most important and determinant factors that might contribute to beat cancer. However, it is well-known that these relationships are not easy and should be extensively improved. Therefore, an important question was raised and discussed: how can we build a process to cross-talk and coordinate between the different stakeholders (academia, patients, industry, healthcare providers) in the field of cancer to get the most value and for maximizing efficacy and, therefore, beating cancer? This question has been under debate for many years and has not a simple question. Still, the working group identified potential and important missing facts that should be considered in the future.
Firstly, the lack of trust between the different stakeholders comprises an important drawback in this process. For instance, basic researchers usually do not fully trust pharmaceutical industries. A problem-solving approach in the development of the research agenda as well as creating specific and efficient cooperation tools might also help in ending this gap and create some cohesion between all the involved entities.
Considering all the bureaucratic paperwork and process in this cross-talk, the development of a simplifying administrative process for projects under development is urgently needed. Furthermore, it will be important to include experts and stakeholders in process design with strategic knowledge that will make this process easier for all involved parties.
Cross-sectional calls should be envisioned that might involve all the stakeholders and be inter- and trans-disciplinary as much as possible. This may imply that some funding calls might need to be revised and adapted, which calls also for a change of mindset within the research and innovation funding agencies.
Last but not the least, academic and research institutions need to adopt a mission-oriented research. This will facilitate the collaboration and joint efforts with other stakeholders.
The working group highlighted what should be done in the next years to overcome this problem:
The COST Connect workshop raised important aspects which have to be considered if we really want to achieve the important goal of beating cancer by 2030. In summary these below are the main conclusions and recommendations:
Strategy. We need to connect all the stakeholders (academia, patients, industry, healthcare providers) and policy makers to build a strong relationship based on trust and productive cooperation. The main recommendation would be:
Education. We should invest our time and resources to prevent cancer by creating European science media centres and public engagement programs to reduce the gap between science and society and to improve people knowledge on cancer prevention. We also need to produce more data on the potential positive impact of prevention measures on the European budgets and better understand the reasons behind unhealthy lifestyles. The main recommendation would be:
Therapy. The translation process of novel cancer targets into the clinic is too inefficient and expensive, too many clinical trials fail due to poor pre-clinical validation of targets. The main recommendation would be:
Patients. We should not only focus on treatment but also on the quality of life of patients under cancer treatment and patients who, once cured, are stigmatized in society. The main recommendation would be:
Lucas Cassetta and Pedro Rodrigues coordinated and led the writing of this paper and share first authorship. The remaining authors of this paper were involved either in coordinating the workshop, leading the discussions, or summarising the conclusions.