5.3.7 Future developments

In Europe the incidence rates for most cancer types are increasing. The number of new cases is also increasing, because European increase of life expectancy makes cancer a disease of the elderly, and because people are still exposed to cancer risk factors. Moreover, cancer patients survival in Europe has strongly increased in recent years (Coleman et al, 2003). Cancer prevalence, the measure of living people with a past cancer diagnosis, grows with incidence and with the percentage of survival. In Europe we can estimate nearly 14 million of all cancer prevalent cases in 2002. With cancer prevalence, the demand for resources to follow-up cancer patients and identify and treat cancer recurrences increases. At the same time, new knowledge is being acquired thorugh genetic research and this is changing the reality of cancer.

The implication is that the demand for resources to follow-up cancer patients and identify and treat cancer recurrences is increasing. While this is happening, new knowledge is being acquired via genetic research which is changing the understanding of cancer: from a limited number of major killer diseases to a long list of distinct rare diseases, each requiring a different treatment.

These are the problems that an integrated and effective cancer control policy for Europe should address. We included all aspects in a two dimension single strategy including time and organisation. Short, medium and long term objectives have been stated, while also the political structures required to attain them have been outlined (Micheli et al, 2007). Moreover, the successful implementation of these objectives requires sustained collaboration between health authorities, research organizations, patients and stakeholders.

Short-term objectives (responsibility of Member States under the European recommendations)

The two major short-term problems in the field of cancer are:

·          Take into consideration the cancer patient needs: achieve full knowledge of the variation in demand for health services as a function of cancer type, patient age and rehabilitation requirements to address with adequate investments the problem of the increase in prevalent cancer cases (i.e. increased needs of the elderly in richer countries)

·          Focus on early diagnosis: implementing organized cancer screening programmes and investing in modern diagnostic and treatment technologies to eliminate inequalities in the access to cancer diagnosis and treatment facilities in Europe (especially in Eastern European countries)

Medium and long term objectives (responsibility of Member States. Needs of European directives)

·          Reduce incidence: address primary prevention as a main priority, sustain the collaboration between national health authorities, private sectors, research organisations, and stakeholders to put into effect policies that can achieve a substantial reduction in cancer incidence over the next 10-20 years (i.e.: European implementation of the “Gaining Health” policy and outline for action for preventing non-communicable diseases published by the WHO in 2006)

·          Diffusion of best practice: support the spread of best practice and pressure to raise consistently poor standards. Give the best possible treatment and care to cancer patients, exchange information on best practices regarding diagnosis, treatment, rehabilitation and palliative care.

Long-term objectives (responsibility of European Union)

European guidelines for cancer research: research on the molecular bases of cancer offer new therapeutic possibilities every day and have transformed cancer from being one disease into many rare diseases, requiring each a different treatment. The long term objective of the European Union should be to address the escalation of costs of cancer control, that even rich countries may soon be unable to meet. Only the European Union can promote a wide-range debate to find ways of reducing the Health Systems expenditures in Europe while improving cancer services.