XXVI National Congress

Cancers, 200 deaths a day avoidable with correct lifestyles and a healthier environment

Demand and supply of oncology care go at different speeds: 1,103 public beds in medical oncology cut in 10 years

by Barbara Gobbi

8 November 2024

Tumore al seno: sindaci sentinelle della prevenzione

6' min read

Key points

Inadequate spending in Italy
Schillaci: enhance screening and expand it to lung and prostate
Thousands new cancer diagnoses but not enough resources
In ten years, 1,103 public medical oncology beds cut
Financial toxicity: 5 billion costs borne by patients every year
Involved Patients: Treasuring Empowerment
Psycho-oncology still in few centres and home care in 7 out of ten cases
Aifa's promise: more affordable drugs

6' min read

More than 200 deaths per day from cancer, equal to about 80 thousand of the 180 thousand estimated annual deaths from cancer in Italy, could be avoided by intervening on lifestyle and environmental risk factors. In other words: prevention alone would be capable of saving more than 45% of the lives that are lost in our country due to oncological diseases attributable to modifiable risk factors. The experts from Aiom, the Italian Association of Medical Oncology, who at the XXVI National Congress in Rome turned the spotlight on prevention in particular.

Inadequate spending in Italy

Pointing the finger at a percentage of expenditure that is still inadequate: Italy in fact invests only 6.8% of total healthcare spending in this item - amounting to €7.19 billion in 2021 - below the EU+UK average of 7.1%, and placing only eighth after the UK itself (12.5%), Austria (10.3%), the Netherlands (9.6%), Denmark (8.9%), Estonia (8.3%), the Czech Republic (8.1%) and Hungary (7.6%). "It is important that Italy recovers this negative gap as soon as possible, in order to continue to guarantee the quality of care and sustainability of the health service," explains Aiom president Francesco Perrone.

Schillaci: enhance screening and expand it to lung and prostate

Agreeing that prevention is the lever in which to invest is Health Minister Orazio Schillaci himself, who in the meantime claims to have brought home the new National Cancer Plan 2023-2027 centred on innovation, prevention, and regional oncology networks right from the start of his mandate. "Right from the start we have focused on the promotion of healthy lifestyles and secondary prevention," he said in his speech at the Aiom congress. "We know that about 50% of cancer deaths and 40% of new diagnoses can be avoided, since they are linked to modifiable risk factors that are believed to be the cause of 65,000 deaths a year. Targeted action is aimed at the territorial gaps, "at the southern regions of Basilicata, Campania, Molise, Apulia, Sardinia, and Sicily," the minister emphasises, and at the expansion of screening 'passed on' by the National Health Service. "The supply of those available," says Schillaci, "must be adequate throughout Italy, and we are working to expand the offer with the emerging lung and prostate screenings.

Thousands of new cancer diagnoses but not enough resources

Not only prevention: medical oncologists denounce an imbalance between demand and supply of assistance: 'Italian oncology,' Perrone continues, 'is also asking the institutions for more resources to meet the ever-increasing demand for assistance. In Italy, it is estimated that there are around 1,000 new cancer diagnoses every day and that this number tends to increase year on year by around 1 per cent. Added to this is the increasingly widespread ability to make the disease chronic, thanks to therapeutic advances. Investment to date has not been proportionate to the increase in demand for treatment. Demand and supply of care are going at different speeds. A change of pace is needed, with the allocation of funds to create more space and hire staff'.

1,103 public medical oncology beds cut in ten years

But it is not only more money that is needed: Oncology is also suffering from the bed cuts of recent years and the gap in personnel, both specialists and nurses. "In 10 years," Perrone warns, "1,103 public medical oncology beds have been cut: in 2012 there were 5,262, reduced to 4,159 in 2022. The ability of the public health service to cut down waiting lists, a huge problem that is also at the root of healthcare migration, depends on the optimisation of booking systems and the availability of space and personnel. In addition to more modern beds and facilities, there is a shortage of doctors and nurses, and the differences between the regions are too wide. The shortage of specialists has become a real emergency and is also affecting our medical area. In fact, places in oncology specialisation schools are beginning to remain vacant'. These are issues on which the Minister of Health said he was working: 'We have made great strides in prevention, diagnostics, and treatment,' he said in his speech, 'but there is certainly still a lot of work to be done in order to take full advantage of innovation and new knowledge, as well as to strengthen our National Health Service, which is what we are aiming at with the major reorganisation measures financed by the NRP. We have one of the best SSNs in the world, but we must ensure its future sustainability. There is no doubt that we must start with the personnel, with our professionals. In this regard, I would also like to mention here that in the Manoeuvre we have provided for increases in specificity allowances for medical and non-medical health personnel'.

Financial toxicity: 5 billion costs borne by patients every year

Meanwhile, the real risk of the imbalance between demand and supply of treatment is that the costs borne by cancer patients will increase, 'with an increasing number of citizens having to cope not only with cancer,' Perrone notes, 'but also with the so-called financial toxicity, i.e. the economic losses caused by the disease. Cancer costs in Italy are around 20 billion every year, of which at least five billion are borne directly by patients. A study, published in 'The European Journal of Health Economics', focused on 'out of pocket' costs, i.e. costs paid out of their own pockets by cancer patients and their families, which amount to more than EUR 1,800 per patient per year in Italy. This is spent on transport (359.34 euros on average) due to the problem of health commuting, diagnostic examinations (259.82 euros) and specialist visits (126.12 euros). Services that the SSN, still grappling with the problem of waiting lists, is unable to ensure to everyone in adequate time,' Perrone notes.

Involved Patients: Building on Empowerment

"In often complex organisational contexts," says Massimo Di Maio, president-elect of Aiom, "the resilience of Italian oncology should be highlighted, which manages to do an excellent job both in terms of assistance and research, as demonstrated by structured collaborations with international scientific societies, such as the American (Asco) and European (Esmo) ones". Aiom has played a leading role in defining the Esmo Guidelines on so-called 'Pro' patient-reported outcomes, i.e. the set of symptoms that measure the quality of life of patients during a treatment, to assess its impact. 'They do not replace the doctor's information,' Di Maio explains, 'but they are very important because they add data reported directly by patients, without any filter, expanding knowledge about the value of therapy. The 'Pros' can foster 'patient empowerment', because they allow the patient to express himself independently, bringing out even side effects characterised by a strong subjective component. Moreover,' continues Di Maio, 'in a care system like the Italian one, characterised by a strong imbalance between the forces in the field and the demand for care, Pro can become a tool for 'doctor empowerment' because, if we manage to use them systematically, we will improve the quality of our work, thanks to a more careful assessment of patients' needs, for example by resorting to support interventions that, in a perspective of simultaneous care, are flanked by specific cancer therapies. To date, however, few hospitals take measures to systematically monitor patients' symptoms. It is important to invest in Pro-monitoring, which does not result in increased workloads, but improves patient management'.

Psycho-oncology still in few centres and home care in 7 out of 10 cases

"It is also necessary to act on other tools, which can improve the quality of life of people affected by cancer," says Aiom Foundation President Saverio Cinieri. "The critical issues relate in particular to psycho-oncological care, because too few centres still have a psychologist dedicated to oncology, and oncological home care, which is only available in 69% of facilities. These problems can be addressed by the actual establishment of regional oncology networks, which are only active in a few regions, and which will improve levels of appropriateness and save resources, which can also be used to speed up access to innovative drugs. Oncology patients in our country still have to wait almost 14 months to access innovative anti-cancer treatments, compared to, for example, three months in Germany'.

Aifa's promise: more accessible medicines

'We have worked and are continuing to work to shorten timeframes, to make reimbursement criteria more transparent, and to ensure that our health professionals have access to the most effective and innovative oncology drugs,' promises Italian Medicines Agency (Aifa) president Robert Nisticò. Who reported how Aifa has dedicated a call for independent research precisely to sequencing in oncology, in the areas of hepatocarcinoma, lung cancer and renal carcinoma. 'Finally, we are trying to work,' he concluded, 'to ensure that every patient, regardless of his or her geographical or socio-economic situation, has access to high-quality oncology therapies, and this is why a closer dialogue has been initiated with the regions.