20% of deaths from Covid-19 concerned cancer patients and this is not surprising if we consider that they are fragile patients and that in 2020 99% of breast cancer interventions were postponed, 99.5 % of those in the prostate, 74.4% in the colorectal. Not only. Screenings for breast, cervical and colorectal cancer recorded a reduction of two and a half million examinations in 2020 compared to 2019 and, on average, for the three secondary prevention programs, the delay is between 4 and 5 months. The urgent need to launch a control room as soon as possible to define and launch the National Cancer Plan as requested in the 13th Report on the welfare conditions of cancer patients, presented today in the context of the XVI National Day of the Cancer Patient promoted by Favo (Italian Federation of Voluntary Associations in Oncology).
From Europe to Italy
The starting point is the European Plan for the Fight against Cancer and the Mission on Cancer which aim to cope with the entire course of the disease and thus save 3 million human lives by 2030. The Plan is structured around to four fundamental areas of intervention: prevention, early detection of the disease, diagnosis and treatment, quality of life of cancer patients and people cured of cancer. Ten ‘flagship initiatives’ and their implementation period are also indicated. A real working method to which the National Oncological Plan must also be inspired by providing for actions, timing, funding and regulatory and legislative changes to overcome the oncological emergency. According to the experts, among the priority objectives of the Plan, included in the Favo Report, there must be the financing of the Regional Oncological Networks, the strengthening of home and territorial oncological assistance, the technology for diagnostic screening, the uniform development of telemedicine, CAR-T therapy, the provision of forms of psychological support for cancer patients, the immediate activation of the Rare Tumors Network, the delivery of medicines at home and the implementation of the standard that recognizes the role of the family nurse.
A five-year delay
At the moment Italy, where 377 thousand new cases of cancer were estimated in 2020, does not have a national oncological plan: “The last draft dates back to 2013 and is it? expired in 2016, ”he points out Giordano Beretta, president of Aiom (Italian Association of Medical Oncology). “Has the difficult management of Covid-19 contributed to raising awareness of the need? of a profound technological and process renewal of cancer care. The lesson of Covid-19 should not be wasted. The pandemic produced collateral damage and cancer patients were primarily affected. The reprogramming of health care activities must take into account tumors in the same way as time-dependent diseases where, unlike the cardiovascular specialty, time is not counted in minutes or hours, but in weeks or months that can impact on overall survival, disease free and quality of life “.
The necessary funds
At the institutional level, the Undersecretary of Health, Pierpaolo Sileri has undertaken to present the New National Plan for Oncology at the State Regions Conference by September. What is missing now is funding for its implementation. According to Favo, this can only be partially covered by the 4 billion euros destined for the Member States that will implement the principles of the Plan and carry out the various planned projects. The remaining coverage can only make use of the Recovery Plan (National Recovery and Resilience Plan – PNRR), the investment program that Italy is required to submit to the European Commission to access the extraordinary resources of the NextGenerationEU. One of the six missions of the PNRR is, in fact, dedicated to Health and, in particular, to the strengthening of prevention and health services in the area, to the modernization and digitization of the health system. Precisely for this reason, Favo is asking for the launch of a control room that also involves patient associations, monitoring orchestrated by the bodies in charge and a time schedule defined so as to be harmonized with the European Plan for the Fight against Cancer.
The damage of the delays caused by Covid-19
While waiting for the oncological plan to start, the damage accumulated during the pandemic is counted and in particular the negative impact on survival, documented for example in breast, colorectal, cervical and liver cancer – he says -. “It is estimated that in 2020, during the first 12 weeks of the pandemic, due to the occupation and reorganization of hospital routes due to Covid, about 28 million surgeries were canceled globally in 190 countries”, he explains Alessandro Gronchi, president of Sico (Italian Society of Oncological Surgery).
Regional differences and delay in interventions
Not only that: in Italy the pandemic has seriously accentuated the differences between Regions regarding the availability of services and access to assistance. Numerous surgical departments have been closed and converted into medical departments dedicated to Covid-19 patients and, for many weeks, it has been possible to treat only oncological procedures, both emergency and elective, with evident limitations in terms of the volume of cases treated. “Overall – continues Gronchi – in 2020, over a million surgeries were postponed, as highlighted by a study by the Catholic University. By comparing the data of this research with those of the hospital discharge forms of 2019, it emerges that 99% of the operations for breast cancer, 99.5% of those for prostate cancer, 74.4% for the colon have been postponed. straight. The repercussions did not concern only the volumes, but also the multidisciplinary and organizational path. The time interval between the multidisciplinary discussion on the tumor boards and the surgery and? more than doubled in 2010 compared to 2019: 7 weeks against 3 “.
The delays for those who have to undergo radiotherapy
The role of radiotherapy is also central. “More than half of cancer patients require radiotherapy. In a scenario where systemic and surgical treatments are postponed, it is even more necessary to guarantee access to radiotherapy without significant interruptions – he concludes Vittorio Donato, president of Airo (Italian Association of Radiotherapy and Clinical Oncology). Since the beginning of the pandemic, the Italian Departments of Oncological Radiotherapy have adopted various solutions to minimize the omissions and interruptions of radiotherapy treatments. In the first phase of the pandemic, no center closed, not even among the 85 facilities (68% of the centers) that became Covid-19 centers, and the impact of the emergency on the overall volumes of clinical activity was limited: 38 centers (30 , 4%) reduced the workload by 10-30% and 11 (8.8%) by 30-50%. During the second phase, thanks to all the measures adopted to limit the contagion between staff and patients, most of the centers (61.8%) reported no reduction or a decrease in clinical activity of less than 10%, therefore much less marked than in the rest of Europe and the United States. An exceptional result, considering how much our country has been hit by the pandemic since its inception ”.
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