New cases on the rise, funding always at stake or almost. Italy, which is preparing to celebrate World Cancer Day on 4 February, records the rebound effect of new cancer diagnoses after the two-year period of blackout due to the pandemic: 390,700 diagnoses in 2022 against 370,600 in 2020, an increase of 14,100 cases. And if the new year started with the double good news of fundamental weapons for the fight against tumors such as the unblocking in the State-Regions Conference of the Understanding on the 2023-2027 National Oncology Plan and the transposition (after eight years of ) of the 2014 EU Regulation on clinical trials, the necessary funds are still lacking.
The resource node: Oncology plan in search of funds
The promise aired in the Budget law of 10 million – in any case crumbs – to be allocated to oncology in 2023 and 2024 (20 million in all) has never been translated into reality as far as the Minister of Health Horace Schillaci, researcher and oncologist, is particularly careful. “The prevention and treatment of cancer are at the top of the ministry’s priorities,” Schillaci said ahead of World Cancer Day. And for resources, after the flop recorded in the manoeuvre, we are looking at the arrival of an amendment included in the Milleproroghe decree now being examined by Parliament “aimed at establishing – the minister recalled – a special Fund for the implementation of the Oncology Plan national, which would start with an initial endowment of 10 million for each year”.
Investments in prevention are crucial
Cancer remains the second leading cause of death in the world, with 10 million deaths in 2020, over a third of which could be avoided with adequate prevention strategies, early intervention and timely, quality treatments. In Italy the music does not change: the picture is dramatic but a lot could be done and Minister Schillaci himself reminds us: “40% of cancer cases and 50% of cancer deaths can be avoided by intervening on preventable risk factors”. Hence the announcement of new campaigns on healthy and correct lifestyles starting from elementary school. Investments in prevention are essential, of course, but here too resources and strategies are needed, not limited to the health sector alone and to the Ministry of Health alone, which for its part has just programmed a 76 million plan (including ERDF funds and co-financing) to improve screening in the South as part of the first 625 million PON Equity in health.
Priorities: from screening to lifestyles
After the collapse due to Covid, screening programs have returned to pre-pandemic levels, but the bar is still low and shaky, as certified by the “Cancer numbers” report at the end of 2022: for mammography we are at 46% coverage , 30% for the colon and rectum and 35% for the uterine cervix. With large gaps between the various areas of the country and to bridge the gap under the slogan of February 4 “Close the care gap”, once again, adequate funding is needed. Ditto for the promotion of lifestyles where Italy, traditionally protected by the Mediterranean diet, shows the side with 33% of overweight adults and 10% obese, 24% smokers and 31% sedentary from 23% of the 2008. “Investing in prevention also by leveraging individual and collective behavior means fewer sick people in the future, an advantage in terms of health and sustainability of the NHS” – still warns the Minister of Health Schillaci – but in a health system with the resources after the inebriation of the appropriations to deal with Covid, the National Oncology Plan, promoted in terms of content, also risks remaining on paper.
The other challenges still to be faced
The challenges to be faced, in addition to prevention which is the first guiding star, are many: recovering the gap from the EU driving countries on clinical trials, adequately taking care of patients in whom, thanks to new therapies, the disease is becoming increasingly chronic, complete the regional oncological networks, approve a law that finally recognizes the right to oncological oblivion for that 27% (over a quarter) of people recovered after a cancer diagnosis, support research, innovation and digitization, make fully available the latest generation tests that with genomics allow personalized interventions. Just think of breast cancer, the most widespread: here, at the end of 2020, Parliament inaugurated a 20 million fund for the purchase of genomic tests intended for 10,000 breast operated patients, so as to be able to identify those at high risk of recurrence of disease at 10 years and intervene accordingly. But after two years, only half of the eligible patients were actually prescribed that test.