If you want Italian cancer patients to be treated well, then you need to have a precise picture of the situation: of the steps forward that have been made and, above all, of what still can – and must – be improved for the 323 Oncologies present in Italy. . Let’s start here. Territorial care does not go: only 68.7% of cancer centers provide home care, for example. And the organization that revolves around clinical trials is wrong: more than half of the structures (52%) do not have trial coordinators. As for psychological support, it is now present in almost 90% of the centers (87.3%), although only half have a psychologist dedicated to cancer patients.
The White Paper of Italian Oncology 2022
The state of the art is reported in the “Charter of Italian Oncology Services – White Book 2022”, presented at the XXIV National Congress AIOM (Italian Association of Medical Oncology), which opens today in Rome. The book shows us exactly where we are. The progress in the definition of diagnostic-therapeutic and assistance pathways (PDTA), essential for guaranteeing multidisciplinary assistance, has been very important: to date, 1,240 documents have been approved by the oncological networks. 95% of the centers have pathological anatomy, 81% a reference clinical nutrition and 70% a reference molecular biology laboratory. 88% have a day hospital, 65% an outpatient clinic, 58% an ordinary hospital ward.
The appeal of oncologists to the government to come
“Oncology is a cornerstone of the National Health Service, but it must be supported with structural measures,” he says Saverio Cinieri, President of AIOM: “We ask the Government that will take office in the coming weeks, and the new Minister of Health, to include among the first objectives to be achieved a real strengthening of oncology, with all-round attention: from home care to clinical research. Without forgetting prevention, given that 40% of cases and 50% of cancer deaths can be avoided by acting on preventable risk factors, in particular on lifestyles ”. The government of health and appropriateness spending are issues that Aiom and oncologists have been discussing for some time: “The use of biosimilar drugs in oncology can lead to savings of about 20% – underlines Cinieri – allowing the reallocation of resources to support the ‘access to innovative therapies’.
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Every year, in Italy, there are 377,000 new cancer diagnoses. Five-year survival averages 65% in women and 59% in men: it has therefore increased compared to 63% and 54% in the 2015 survey. ‘immunoncology, in many cases make it possible to make the disease chronic in an advanced stage or to obtain a cure, with substantial savings in other items of expenditure, health and social. “But the quality and sustainability of the system are guaranteed above all with policies to support research, which allows the development of innovative drugs”, the President of AIOM resumes: “Every year about 35 thousand patients in Italy are enrolled in clinical trials. Half, that is 17,500 citizens, are oncologists. The oncology of our country, if adequately supported by the institutions, can establish itself as an engine of development not only in the scientific field, but also in the economic and social field. We offer these topics for discussion to the next government, because the confrontation can no longer be postponed ”.
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Financial toxicity: we need to invest in territorial oncology
In addition to clinical research, it is necessary to invest in home cancer care: at least 30% of cancer patients – the oncologists recall – could be followed close to home for a significant part of the treatment path, with evident positive effects in terms of quality of life and social, as well as human costs. Bringing treatment closer to people also facilitates accessibility, improves life expectancy and promotes savings for patients, containing the so-called financial toxicity of cancer. “The economic difficulties caused by cancer are an increasingly present phenomenon also in our country – he explains Francesco Perrone, AIOM President-elect. The financial toxicity of cancer has always been a big problem in the United States, where treatment costs a lot and the health system, based on private insurance, only partially reimburses it. “The universalistic system of our health system – continues Perrone – should constitute a barrier against this risk, but in reality this is no longer the case. In an analysis of 16 trials conducted between 1999 and 2015, in which 3,760 patients from our country with lung, breast or ovarian cancer took part, we showed that 22.5% had financial toxicity and a 20% higher risk of death in the following months and years than patients without economic problems. Financial difficulties compromise the quality of life and the benefits that can be obtained with anticancer drugs ”.
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Work after cancer and health migration
The survey shows that the problem is particularly pressing in the South and for younger patients, under the age of 65. “Cancer and treatments reduce professional capacity and income”, continues Perrone: “If these citizens are supported and reintegrated into the world of work, they return to constitute a productive component of the country. This is why it is important to identify the causes of individual financial default: only in this way will we be able to ask the institutions to act to remove them ”.
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One of these causes, we said, is certainly represented by unnecessary travel. Too many patients still travel hundreds of kilometers in search of the best treatment. “The distance between the home and the place where the treatment is received and the transport costs to be incurred have a strong impact not only in the extreme cases of health migration from South to North – says Massimo Di Maio, National Secretary of AIOM – Problems can arise for those who live in the provinces and must reach specialist centers in large cities. There are several determinants on which we want to raise awareness among the institutions, which can implement change policies to invest more in the territory and in home care, also by creating an integration between oncology and family medicine. Simultaneous care groups must also be implemented, because 36% of centers still lack them. An early integration of support interventions into the care pathway, with a view to simultaneous care, has a positive impact on the quality and quantity of the patient’s life and on the expected results with the therapies “.
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Oncology is becoming more and more complex
The pandemic stress test showed the system’s exposed nerves, but also its strengths. “In the two years of Covid, medical oncology has never stopped and neither has research – underlines President Cinieri:” The succession of discoveries, the increasingly pressing data of clinical studies, the approvals by regulatory agencies of new molecules or new indications for drugs already in use have continued their course, making our profession, if possible, even more complex ”. The title chosen for the XXIV AIOM National Congress – “Oncology and Complexity. The new challenges for oncologists ”- wants to communicate exactly this. By complexity we mean the entire network of clinical, biological and molecular information that continues to add to the oncologist’s baggage: “Our professional figure – concludes Cinieri – needs to acquire, understand and make their own all the knowledge that has been embedded, like precious stones, on everything we already knew and that our masters have passed on to us ”.