TOMORROW is the 4th of February. An important date for those who have a tumor and all the doctors and researchers working in the field of oncology, because it is the day symbol of global efforts against cancer. the I am I will (I am I do) it is not by chance that the slogan chosen for the World Cancer Day organized around the world by the Union for International Cancer Control (UICC). An appointment is also an opportunity to take stock of the situation in Italy, the Country that shows the most survival of all the european countries. Data are very positive, but also some of the shadows that relate to the access to screening tests and to the most innovative treatments.
survival in Italy is among the highest. But you can improve The today recalls the Italian Association of medical Oncology (Aiom): in ten years the number of patients alive after diagnosis of cancer have increased 53%. They were 2 million and 250 thousand in 2010, today there are 3 million and 460mila. A very important result that demonstrates the progress made in cancer care. But it is a result which can be improved, because there are still too many differences in our territory: from the adhesion and coverage of screening is still too low in the South, the creation of networks of oncological regional patchy, the availability only in some Regions, the most virtuous of effective therapies and tests that can analyze the molecular profile of the tumor. It is a real risk of dangerous discrepancies to the detriment of patients. The Aiom launches an appeal to the Institutions to be following the example of the most virtuous, to the benefit of patients.
“The quality of our Health care System is evidenced by the survival at 5 years from diagnosis, which has higher rates than the european average in the tumors more frequent: 86 per cent, in the breast (83% for the EU), 64% in the colon (60% EU), 16% lung (15% EU), and 90% of the prostate (87% EU),” explains Giordano Beretta , the President of the National Italian Association of Medical Oncology (AIOM) and Head of Medical Oncology at the Humanitas Gavazzeni in Bergamo. “And we achieve these results with lower investment: the public health spending-to-GDP ratio in our Country has registered a decrease, passing from 7% in 2010 to 6.5% in 2017, compared to 9.8% of the eu average. There are, however, still regional differences that must be overcome, because no one is left behind and everyone can have access to more effective treatments regardless of the place in which they live”.
Melanoma, only the Campania reimburse the double immunotherapy Some Regions, such as Campania have marked the road. “In October 2019, was the first in Italy to provide free of charge to all patients suffering from melanoma, a skin cancer, the combination of two molecules immunoterapiche, nivolumab and ipilimumab,” says Paolo Ascierto , Director of the Oncology Unit of Melanoma, Immunotherapy of Cancer and Innovative Therapies of the National Cancer Institute, IRCCS-Fondazione ‘G. Pascale’, Naples: “A year ago, the therapy was approved by the Italian Drug Agency (AIFA), but left in band C, thus preventing the reimbursement by the National Health Service. It is created in this way a serious damage to the patients affected by melanoma, especially for people with brain metastases asymptomatic, approximately 40% of the total, for which this combination has highlighted important results: 70% of the people is recurrence-free survival at 2 years, which is why this treatment is recognized as the first option from the main international guidelines in these patients. In other Regions the therapy is not yet reimbursed, we ask that the local Institutions function as before because the sick can’t wait”.
breast Cancer, only Lombardy reimburses the tests that predict the benefits of chemo Lombardy has been a forerunner on the genomic testing, determining, in September 2019, the eligibility for women with breast cancer in early stage. “It was the first Region to adopt a measure of this kind”, emphasises Nicla La Verde , member of the Board of the national AIOM and Director of Oncology at the Sacco Hospital in Milan: “genomics provides extraordinary information about the nature of some tumors, particularly in breast cancer and adds to the data that the clinical parameters, such as the diameter of the tumor mass or its staging, are not able to offer. The genomic tests are able to predict the aggressiveness of the disease at an early stage and to better estimate the risk that a patient, operated for breast cancer, has the development of metastases; therefore they can help you decide whether to add chemotherapy to hormonal therapy after surgery. Thanks to genomic testing, some patients at intermediate risk of recurrence can avoid chemotherapy. This can result, on the one hand, in a clinical benefit for the patients that are not exposed to an excess of the treatment and the relative risk of toxicity, immediate and late, from one another in a favorable impact on health care expenditure, which represents an element of fundamental importance with which clinicians are confronted”.
If the medication is dependent on the hospital for the treatment of breast cancer there is another disparity that is related to the access to the neoadjuvant therapy (that is, before the intervention, to reduce the size of the tumor and increase the possibility of healing). “In particular, In the forms that express excessive amounts of the HER2 protein and who represent about 15-20% of the cases, the entity regulatory committee (EMA) in 2015, has approved pertuzumab, molecular targeted therapy before surgery,” explains Lucia Del Mastro , member of the Board of the national AIOM and Responsible for the Breast Unit IRCCS Hospital San Martino of Genoa: “it Is shown that the drug, given together with chemotherapy before surgery, increases the probability of obtaining the pathologic complete response, i.e. disappearance of invasive tumor both in the breast and in the lymph nodes, thereby reducing the probability of recurrence of the disease. AIFA has received the indication european, but in 2017 has decided not to reimburse the molecule. In this way, you are creating inequalities both compared to other european Countries instead (except for France, ndr.) they refunded the molecule is within the national territory. We see disparities are unacceptable in the access to treatment, even within the same Region, why some hospitals have taken the decision to buy the drug, and other, considerations of budget, I have adopted it. When the EMA approves a drug with a specific indication, AIFA should not only implement the decision, but also compensate for the therapy. The current situation creates problems for both the patients and the doctors that may not follow international guidelines which recommend the neoadjuvant treatment with pertuzumab”. Screening is still not widespread in the South of Italy In 2019, the new diagnosis of cancer have been 371mila. “With respect to 2018, it is registered – for the first time – a decrease of about 2 thousand cases, contributed to the effectiveness of screening for colorectal cancer, which allows to identify lesions at risk prior to their transformation into neoplasia,” recalls Beretta: “adherence to mammography, in 2017, has reached 55% and in the screening of colorectal 41%. There are considerable differences between the North and the South that are to be traced also to the different coverage. With regard to mammography, is almost complete in northern and central Italy, to the South, on the contrary, only 6 out of 10 women receive the invitation. In screening colorectal, the North and the Centre, we are close to full coverage (92% North, 95% Center, ed.), the South is still under 50%”.
A course for patients To increase the awareness of patients on the treatment of cancer, the 4th and 5th of February in Milan, Aiom and Fondazione Aiom organizes a training course on the Guidelines. “The Guidelines are one of the main tools of evidence-based medicine,” explains Maximum Height , the National Secretary of the AIOM and Director of the Oncology of the Ospedale Mauriziano of Turin: “Through a process of systematic and transparent and make it possible to transfer in clinical practice of all of the new knowledge produced by the medical-scientific research. In the elaboration of different Guidelines Aiom also took part in the patients, which in addition to medical specialists, are the ‘end users’ of these documents. Must be included in their writing, for this we organize training courses for patients. But the Guidelines are not enough. To extend the good practices to the whole territory”, concludes Di Maio – must be implemented in the networks of oncological regional, the activation of which as of today is heterogeneous. Networks to represent the model to ensure in our Country the access to diagnosis and appropriate care and quality, in order to rationalise resources, expertise and technologies, and to curb the disturbing phenomenon of migration health”.
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