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5 questions for the future of cancer treatment

This policy brainstorm white paper is part of Global Policy Lab: Decoding Cancer.

A transformation..

This policy brainstorm white paper is part of Global Policy Lab: Decoding Cancer.

A transformation is underway in cancer care, with both drugs and treatment strategies increasingly personalized for individual patients. The genetic profile of a tumor can tell us which medicines are most likely to work. Teams of specialists will collaborate to work out the best course of treatment for a specific tumor. Therapies like CAR-T even promise to re-engineer patients own cells to fight their specific cancer.

Health systems are not transforming at the same rate. High costs and novel approaches to treatment are confounding old systems that werent designed to pay for them.

The transformation also means operating with a higher degree of uncertainty: Its urgent to give patients a fighting chance, but sometimes drugs are so new, or tested in such small populations, that we dont really know what were getting — or if the results were measuring are actually those most important to patients and their families.

POLITICO Global Policy Lab has been looking at how to move the cancer care system ahead of the science, including ways to make sure advances dont leave some patients behind. In this brainstorm white paper, we lay out the key questions facing policymakers, industry leaders and society as the fight against tumors gets increasingly personal.

The problem: Breakthrough cancer drugs are expensive: They cost a lot to discover, and in many cases, theyre designed for just a small sliver of patients, driving developers to seek high prices. Health systems are struggling to adapt — and cost isnt the only factor. Cancer experts increasingly look to fight tumors together in teams, and new therapies like CAR-T can only be provided in specialized centers. Insurance systems arent necessarily set up to pay for these approaches.
The question: How can health systems provide access to innovative new therapies? What can we learn from the current experience with the newly approved CAR-T treatments Kymriah and Yescarta?

The problem: Regulators are changing their approach to approving cancer drugs for patients with no other options, allowing treatments to enter the market based on smaller studies, though often with more dramatic initial results. The idea is that “real world data” will help us reassess those drugs in the future. For the health systems and insurance funds that have to pay for these drugs, however, determining a fair price amid so much uncertainty is a challenge.
The question: How does the drug price negotiation process need to change to accommodate experimental drugs?

The problem: Some view artificial intelligence as an increasingly important tool for diagnosis and treatment of cancer. But winning the trust of patients, and perhaps more crucially, the doctors whose livelihoods could be transformed by AI, could be a barrier. Likewise, concerns about data protection and confusion about ownership of patient information stand as barriers to personalized medicine that relies on genetic data.
The question: How do we find the right balance of embracing data and AIs potential without undermining trust, privacy and quality of care?

The problem: Theres a growing consensus that specialized cancer centers — where doctors have a lot of experience and can collaborate with experts across different fields of medicine — are key to improving outcomes. But studies also show that living far away from a cancer hospital can lead to later diagnosis and lower-quality care. This tension is especially acute for treating rare and childhood cancers, where there may only be a few experts in Europe.
The question: What are the unique sources of disparities in cancer research, treatment and long-term care, and how do we address them? What are the key barriers to treating rare and childhood cancers, and how can we overcome them?

The problem: “Patient-centered care” has become a buzzword, but its definition is fuzzy. While many clinical studies focus on improving survival, the effect of new drugs on quality of life is often an afterthought in the development process. As new treatments lead to longer lives, many cancer survivors find they face discrimination and long-term health effects.
The question: How can patients priorities be measured and incorporated throughout the treatment process, and beyond?

POLITICO Global Policy Lab is a collaborative journalism project seeking solutions to pressing policy problems. Join the community.

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NHS told to ditch ‘absurd’ fax machines

The NHS will be banned from buying fax machines from next month – and has been told by the governmen..

The NHS will be banned from buying fax machines from next month – and has been told by the government to phase out the machines entirely by 31 March 2020.

In July, the Royal College of Surgeons revealed nearly 9,000 fax machines were in use across the NHS in England.

The Department of Health said a change to more modern communication methods was needed to improve patient safety and cyber security.

An RCS spokesman said they supported the government's decision.

In place of fax machines, the Department of Health said secure email should be used.

Richard Kerr, who is the chair of the RCS's commission on the future of surgery, said the continued use of the outdated technology by the NHS was "absurd".

He added it was "crucial" that the health service invested in "better ways of communicating the vast amount of patient information that is going to be generated" in the future.

The group's report from earlier this year found the use of fax machines was most common at the Newcastle upon Tyne NHS Trust, which still relied on 603 machines.

Three-quarters of the trusts in England replied to the survey – 95 in total. Ten trusts said that they did not own any fax machines, but four in ten reported more than 100 in use.

Fax facts

  • The first "facsimile" machine was invented in 1842 by Scotsman Alexander Bain
  • Bain's invention worked by scanning a message written with special ink on a metallic surface. This picked up the electrical impression of the original and a telegraph circuit could be used to transmit it
  • By the beginning of the 20th Century, fax machines were being used commercially by organisations such as newspapers
  • After technological improvements by Japanese companies, fax machines became widespread in the 1970s and 1980s
  • The technology reached its peak around the end of the 20th Century, and was then gradually replaced by more modern methods of communication

Do you still use a fax machine? Get in touch by emailing (more…)

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The athletes starving themselves for success

Anna Boniface seemed to have the world at her feet when finishing as the 2017 London Marathon's..

Anna Boniface seemed to have the world at her feet when finishing as the 2017 London Marathon's fastest amateur female runner.

Her performance earned her an England team place in that autumn's Toronto Marathon. The then 25-year-old finished the London race in two hours, 37 minutes and travelled to Canada six months later.

But 10 miles into her international debut, Anna's ankle fractured.

"It was the breakthrough that broke me," she tells BBC 5 live Investigates.

"It was horrible, I'd never not finished a race in my life. I thought I could just struggle to the end somehow, but I realised I would not be able to go on, I just had to sit on the kerb and wait."

But worse was to come for the Reading runner. In addition to the stress fracture of her ankle, tests found poor bone density, including osteoporosis in her spine, which made fractures a real risk.

These symptoms were all hallmarks of a condition called Relative Energy Deficiency in Sport (Red-S).

This occurs when sports people restrict their diet in the belief that constant weight loss will keep improving performance, to such an extent that some of the body's functions begin to shut down.

The condition can cause a range of health problems in men and women including a drop in hormone levels, a deterioration in bone density, a drop in metabolic rate and mental health problems.

Anna, who works as a physiotherapist, admits she was aware of the condition but was so desperate to keep improving that she ignored the warning signs, which included not having a period for eight years. (more…)

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Asian longhorned tick is a growing threat in the US, but it’s not the main threat

The Centers for Disease Control and Prevention is alerting the public about the Asian longhorned tic..

The Centers for Disease Control and Prevention is alerting the public about the Asian longhorned tick, a species of tick not normally found in the United States that is known for its ability to mass-reproduce. Since its discovery in 2017, it has been spotted in several states, according to this weeks Morbidity and Mortality Weekly Report.

“The full public health and agricultural impact of this tick discovery and spread is unknown,” said Ben Beard, Ph.D., deputy director of the CDCs Division of Vector-Borne Diseases in a press release. “In other parts of the world, the Asian longhorned tick can transmit many types of pathogens common in the United States. We are concerned that this tick, which can cause massive infestations on animals, on people and in the environment, is spreading in the United States.”

There is a lot of mystery surrounding the Asian longhorned tick, so heres what you should know.

The Asian longhorned tick can produce offspring at 1,000 to 2,000 eggs at a time, just like the more than 850 species of other ticks. However, the Asian longhorned tick is unique for the fact that it doesnt need to mate to reproduce — it can do so all by itself. As a result, when an infestation occurs, hundreds to thousands of ticks can end up on an animal or person from a single tick.

New Jersey was the first state to report the tick after finding an infestation on a sheep. But since then, eight other states — Arkansas, Connecticut, Maryland, North Carolina, New York, Pennsylvania, Virginia and West Virginia — have reported finding the tick on a variety of hosts, including people, wildlife, domestic animals and in the environmental.

To better understand the full potential impact of this tick discovery in the United States, the CDC says it is working with a network of federal, state, and local experts who specialize in veterinary and agricultural science and public health. Their goals include determining where the ticks are located, the kinds of pathogens they might carry that could infect people and how often they bite humans and animals. They also plan to develop prevention and control plans.

“In other countries, bites from these ticks can make people and animals seriously ill,” said Dr. Sloan Manning, medical director of Novant Health Urgent Care and Occupational Medicine in Winston-Salem, North Carolina, told ABC News. “As of October 2018, no harmful germs have been found in the ticks collected in the United States”

Ticks are already very common in the U.S., living in areas with tall grass or around animals. They cant survive without feeding on blood, so when they find a host, they latch on and stay on.

Though ticks are often associated with Lyme disease Rocky Mountain spotted fever and Ehrlichiosis, Manning said that most of them wont be carrying these illnesses. Still, its important to remove them as the longer they stay on, the more likely they are to transmit a disease — if they are carrying one.

“It takes several hours for a tick to transmit bacteria into the skin,” Manning said. “If you think it has been attached for more than 24 hours or if youve developed a fever, rash or other typical symptoms, you should seek medical attention.” (more…)

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