We know about our responsibilities. We have heard the request for patient support. But has anyone else?
Every second man and every third woman is diagnosed with cancer during their lifetime. About one-half of people with cancer are to be cured after five years. Nevertheless, cancer is the second most common cause of death overall, after deaths caused by cardiovascular failure. With few exceptions, the incidence of cancer increases sharply with age, and so ageing is the most important (and unfortunately unchangeable) risk factor for cancer. In addition to epigenetic changes that increase over the life course, other factors play a role. These include weakening of the primary defences against cancer by the immune system and DNA repair machinery.
Improved survival rates can be achieved by improving therapeutic approaches to cancer care. The chronicity of the disease makes the additional support provided by pharmacists indispensable.
Thousands of epidemiological studies, in conjunction with clinical trials and basic research, produce an important overall picture of cancer prevention. We agree that at least 50% of all tumours could be prevented through following a healthy lifestyle. The main risk factors are cigarette smoking, poor nutrition, obesity, and physical inactivity. Preventative interventions include smoking cessation, sun protection, plant food, exercise, aspirin, human papilloma virus vaccination, and screening.
It is important that, for each tumour entity, different risk and preventive factors apply, and therefore the data must be interpreted accurately so that recommendations can be made. ESOP is supporting a call for action titled ‘Stop cancer now!’ This call for action was announced on World Cancer Day by the World Oncology Forum, which was organized by the European School of Oncology in partnership with The Lancet. The ‘Stop cancer now!’ appeal was also advertised in the International Herald Tribune, Le Monde, El País, La Repubblica and Neue Zürcher Zeitung, and also published alongside a commentary in The Lancet and in an article in Cancer World. The goal is to appeal to governments across the world to take action now to turn back the tide of cancer.
This year, the 17th European CanCer Organisation (ECCO) Congress will be held on 26 September–1 October 2013, Amsterdam, The Netherlands. All society members have been working towards the ‘Stop cancer now!’ vision by integrating expertise and insights of the different professions and stakeholders in the oncology community to achieve the best possible outcomes for patients.
Professor Cornelis van der Velde, in his First President’s Page for 2013, stated that ‘I also believe that a sense of renewed focus and vigour is being felt throughout the wider oncology community this year’; ‘We at ECCO believe that we are in a unique position to achieve this, as the only multidisciplinary and multi-professional organisation that connects and responds to all stakeholders in oncology Europe-wide.’
Despite the shared understanding and objectives of all members of local and national healthcare teams, efforts towards good patient care are being thwarted by the shortage of drugs. This is evident in most important drug groups, but especially in cancer treatment. Nearly four months ago, we were faced with a worldwide shortage of one single drug, mostly used in protocols for colon cancer. As this drug could not be delivered for several weeks, pharmacy stock dwindled and, in some cases, ran out. Political pressure had to be brought to bear on pharmaceutical companies. About a year ago, President Obama opened serious discussions in the US about the responsibility of pharmaceutical companies to look after shareholder value, but not at the expense of patients, as exemplified by the plight of 170,000 or so new colon cancer patients in Germany.
The combination of globalization within the pharmaceutical industry, the scaling down of plant operations, the liberalization of drug selling, and the increased demand for quality has driven us to this critical point. As a result of safety concerns, and the cost and availability of life-saving treatments, EMA subsequently published a reflection paper on medicinal product supply shortages caused by manufacturing and the problems in good manufacturing practice compliance .
A survey conducted in 2011 by the Institute for Safe Medication Practices showed that 25% of clinicians indicated that an error had occurred at their site because of drug shortages . Many of these errors were attributed to inexperience with alternative products.
EMA is aware that the crises in public health is caused by shortages of medicinal products, and believe that the following actions are required: centralized assessment by multidisciplinary teams from within the pharmacovigilance network; the engagement of all stakeholders in the network; frequent engagement of experts inter-linked with, but not operating within the network; rapid and sophisticated communication of appropriate risk-management measures; and an implementation that is customized to the national situation.
In this issue of EJOP, we show again how ESOP provides professionals with state-of-the-art educational and scientific information by presenting cutting-edge clinical and pharmaceutical research. ESOP offers a variety of educational programmes to give young oncology pharmacists the opportunities to strengthen their skills, knowledge, and expertise, while providing a platform for networking with other oncology pharmacists and relevant professionals in the field.
Nobody can tell that we have not heard and we are willing to share. Just do it!
European Medicines Agency [homepage on the Internet]. Reflection paper on medicinal product supply shortages caused by manufacturing/Good Manufacturing Practice Compliance problems. 2012 Nov 22. Available from: www.ema.europa.eu/docs/en_GB/document_library/Other/2012/11/WC500135113.pdf
Gatesman ML, Smith TJ. The shortage of essential chemotherapy drugs in the United States. N Engl J Med 2011;365:1653-5. Available from: www.nejm.org/doi/full/10.1056/NEJMp1109772?viewType=Print