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Jassem, Hofmarcher: Treatment of lung cancer must be standardised

We are not facing issues with the availability of drugs or access to treatments like surgery or radiotherapy. The real problem is the insufficient efficiency of the system, say Prof. Jacek Jassem from the Medical University of Gdańsk, President of the Polish League Against Cancer, and Thomas Hofmarcher, Scientific Director of the Swedish Institute of Health Economics (IHE).

Publikacja: 16.09.2024 04:28

Poland’s society and healthcare system are grappling with a rising burden of oncological diseases, with lung cancer remaining the leading cause of cancer-related deaths for both men and women. The incidence of lung cancer is also increasing among women. What is driving this trend?

Prof. Jacek Jassem: This issue extends beyond Poland to other European countries as well. In Poland, smoking rates among men have dropped by 50% over recent decades, whereas rates among women have remained stable or even increased slightly. Tobacco companies have long marketed thin or pink cigarettes to women, emphasiszing their appeal and suggesting they were less harmful. These campaigns contributed to a rise in smoking among women, particularly younger ones, who often viewed smoking as a symbol of independence, equality, or adulthood. Changing this perception will require time and effort. Additionally, while the overall number of smokers is decreasing, the proportion of lung cancers attributable to non-smoking factors, such as air pollution, is rising. Some studies suggest that women may be at a higher risk due to hormonal factors. For instance, oestrogen, a well-known mitogen linked to breast cancer, is also thought to potentially promote lung cancer.

In September, you released the ‘Cancer Dashboard for Poland: Lung Cancer’ report. What topics did it address, and what are its key findings?

Thomas Hofmarcher: In the report, we evaluated the quality of lung cancer care in Poland by examining seven distinct aspects of the disease. We analysed various indicators for each aspect to assess patient care quality and compared it with other Visegrad Group and EU countries. We also looked at regional disparities and evaluated how Poland’s performance aligns with the objectives of the national oncology strategy and other European and global initiatives related to lung cancer. Overall, the findings indicate that Poland has yet to meet many of its targets and often falls below the EU average. Significant improvements are needed across the system. Prof. Jassem highlighted smoking as a persistent problem that must be addressed. Additionally, the report points out that poor air quality in Poland exacerbates the issue, contributing to the incidence of lung cancer.

I would like to highlightspotlight a significant finding from our report, which was made possible through our successful collaboration with the National Cancer Registry and Prof. Joanna Didkowska. For the first time, we are highlighting an encouraging trend: survival rates for lung cancer, historically very low, have begun to improve in recent years. Sadly, this improvement in Poland lags behind that observed in other countries.

Why is it so?

T.H.: Looking at diagnosis and treatment, Poland faces several challenges that complicate patients’ access to appropriate care. Recently, there has been a revolution in lung cancer treatment with the advent of new, more effective methods beyond traditional chemotherapy. Immunotherapy has largely replaced chemotherapy for most patients, and targeted therapies are being used for some. The availability of medications has improved, with the National Health Service now reimbursing new drugs, which is a positive development. However, access to these treatments is still not universal. One significant issue is the limited number of tests conducted to identify patients who could benefit from molecularly targeted therapies.

To administer such a drug effectively, it isss crucial to determine whether the patient is a suitable candidate. This requires a personaliszed approach and, importantly, the completion of specific tests. However, only about 35-40% of medical centres in Poland that treat lung cancer patients have the capability to conduct these tests promptly. Consequently, access to these diagnostics is challenging in some Voivodeships.

The report emphasiszes the necessity for well-structured procedures grounded in clear and actionable recommendations to enhance diagnosis and treatment outcomes. How do these findings align with the advancements of the National Lung Cancer Strategy? What are the critical areas that need to be addressed both urgently and in the long term?

J.J.: We are currently developing national recommendations for diagnosing and treating lung cancer. Despite my over 20 years of involvement in this field, full implementation of these recommendations remains elusive due to the fragmented nature of lung cancer care in Poland. The condition is managed across hundreds of institutions, lacking centraliszed centres of excellence similar to the nearly 60 specialiszed breast units that ensure efficient and guideline-based care for breast cancer. Efforts to establish such centres for lung cancer have been ongoing for years, yet they remain unrealiszed. This fragmentation complicates the adoption of uniform diagnostic and treatment protocols and hampers effective patient monitoring, leading to significant delays. Patients often face months of waiting from the onset of symptoms to the commencement of treatment. Additionally, the underutiliszation of modern therapies is a pressing issue. Without dedicated, competentce centres, many patients miss out on crucial pathomorphological and molecular diagnostics needed for targeted or immunotherapy. There is much room for improvement in the system. We are not facing issues with the availability of drugs or access to treatments like surgery or radiotherapy. The problem lies in the system’s inadequate efficiency.

As Director Hofmarcher highlighted, the advancement in lung cancer treatment began to accelerate following the gradual introduction of new therapies. What does this progress mean in practical terms?

J.J.: Indeed, improved therapy efficacy translates into better treatment outcomes. For lung cancer, innovative therapies are primarily applied at advanced stages, and even at this critical point, we are witnessing remarkable progress. Previously, patients with disseminated non-small cell lung cancer had an average survival of 8 to 12 months with conventional chemotherapy. Today, modern therapies extend survival to two, three, or even more years—an extraordinary advancement. Similarly, other methods have shown significant improvements. For instance, stereotactic radiotherapy has become a highly effective and safer alternative for patients who, despite having early-stage lung cancer, are not eligible for surgery. Investing in new treatment methods is clearly yielding tangible results. However, lung cancer remains one of the most challenging cancers in terms of prognosis, and much work remains to be done.

The report is part of an international initiative aimed at sharing best practices in cancer care across European countries. How does the Polish healthcare system measure up against its European counterparts? Does it encounter similar challenges? Are there solutions implemented in other countries that could be adopted here?

T.H.: We also prepare similar reports for other countries to inspire them with successful solutions from elsewhere. Thankfully, technological advancements are continually emerging, including innovations in lung cancer treatment, new medications, and advanced radiotherapy techniques. However, the key question is whether patients have access to these developments. As Prof. Jassem noted, Poland would benefit from a standardiszed patient care system, a model successfully implemented in other countries. Efforts should focus on reducing waiting times for treatment, as delays from symptom onset to treatment initiation contribute to higher mortality rates. Standardizing treatment nationwide could significantly enhance care quality, as seen in Sweden and Denmark. Prof. Jassem also pointed out the success of specialiszed breast cancer units in Poland. A similar approach could be beneficial for lung cancer, given its high prevalence. Establishing dedicated centres for lung cancer could help standardisze care and improve treatment outcomes.

Partner: MSD Polska

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Poland’s society and healthcare system are grappling with a rising burden of oncological diseases, with lung cancer remaining the leading cause of cancer-related deaths for both men and women. The incidence of lung cancer is also increasing among women. What is driving this trend?

Prof. Jacek Jassem: This issue extends beyond Poland to other European countries as well. In Poland, smoking rates among men have dropped by 50% over recent decades, whereas rates among women have remained stable or even increased slightly. Tobacco companies have long marketed thin or pink cigarettes to women, emphasiszing their appeal and suggesting they were less harmful. These campaigns contributed to a rise in smoking among women, particularly younger ones, who often viewed smoking as a symbol of independence, equality, or adulthood. Changing this perception will require time and effort. Additionally, while the overall number of smokers is decreasing, the proportion of lung cancers attributable to non-smoking factors, such as air pollution, is rising. Some studies suggest that women may be at a higher risk due to hormonal factors. For instance, oestrogen, a well-known mitogen linked to breast cancer, is also thought to potentially promote lung cancer.

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