Here's a breakdown of some of the highlights from the second day of the 2021 European Society for Medical Oncology (ESMO) Congress.
Catch up on some of the latest updates to come from the second day of the 2021 ESMO Congress.
Do We Need Full Molecular Profile Upfront in All CRC Patients in Daily Practice?
The use of molecular profiling in colorectal cancer (CRC) continues to be controversial, which is why day 2 of the ESMO Congress featured the “Do we need full molecular profile upfront in all CRC patients in daily practice?” session, which was led by Dr. Clara Montagut Viladot from Barcelona, Spain.
Dr. Sara Lonardi from Padova, Italy was up first to argue that yes, molecular profiling should be completed upfront in all CRC patients, and to support her stance, Dr. Lonardi looked at it from both a clinical and convenience perspective.
From a clinical perspective, she noted that other genomic biomarkers besides RAS, BRAF, and MSI have predictive value and by doing a full molecular profile, clinicians are able to spare ineffective treatments, identify potential strategies, and save money for healthcare systems. Additionally, the guidelines state that next-generation sequencing can be an alternative to PCR testing if it does not generate extra cost.
And from a convenience perspective, Dr. Lonardi provided the following reasons to support the use of full molecular profile upfront in CRC patients:
- Less risk of tissue sample exhaustion
- Less risk of test failure
- Better analysis planning
- Higher trial inclusion
- Lower total cost
Dr. Lonardi concluded by saying that while full molecular profiling is still experimental, it’s important to remember that the sooner we test, the sooner we’re able to treat, and that means better outcomes for patients.
On the flip side, Dr. Rodrigo Dienstmann from Sao Paulo, Brazil presented an argument as to why full molecular profiling should not be done upfront in all CRC patients. Instead, he believes in taking a sequential approach and quoted the ESMO CRC treatment guidelines, which state that a patient’s RAS, BRAF, and MSI status along with clinical conditions can be enough to guide treatment decisions in the first-line setting.
Based on those guidelines, Dr. Dienstmann argues that there’s room to postpone full molecular profiling and that taking a more conservative approach to molecular testing is acceptable.
After both Drs. Lonardi and Dienstmann presented their arguments, Dr. Viladot concluded the session by polling the attending oncologists on the following three questions:
- Should biomarkers RAS/BRAF/MSI be tested for upfront?
- Should full next-generation sequencing (NGS) be done?
- Is liquid biopsy acceptable to be used in daily practice?
While most responded ‘yes’ to the first question, the second and third questions received mixed results, pointing to the fact that this is still a controversial topic that deserves more exploration beyond the ESMO Congress.
The Burden of Cancer: Cancer’s Financial Toxicity & The Right to Be Forgotten
Day 2 of the ESMO Congress also featured a session titled, “The Burden of Cancer: Cancer’s Financial Toxicity & The Right to Be Forgotten.” Led by patient advocate Agata Polinska from Poland, this session featured legal expert Grazia Scocca from Belgium, patient advocate Isabelle Lebrocquy from the Netherlands, and econometrics expert Martijn Ludwig from the Netherlands, who all discussed different aspects of the progress that’s been made to better understand and combat the financial toxicity associated with cancer.
Here are some of the highlights from this session.
The Cost of Cancer Care Is Increasing, Making Action to Combat Financial Toxicity Essential
Advancements in cancer treatment have resulted in more patients than ever living after diagnosis…but they’ve also caused treatments to become more and more expensive. According to Ms. Polinska, cancer drugs are 10 times more expensive now than they were in 2012. But it’s also important to consider the indirect costs of cancer care, which is where financial toxicity comes into play.
Financial toxicity refers to the impact of direct and indirect healthcare costs that lead to a significant financial burden for patients and caregivers. Direct healthcare costs include those relating to the diagnosis and treatment of cancer, such as consultations, tests, drugs, and medical equipment, while indirect healthcare costs include loss of productivity and impaired quality of life.
While financial toxicity is dependent on a variety of factors, such as age, location, and cancer types and stages, direct and indirect healthcare costs can both result in increased psychosocial distress and poor quality of life. This may lead to the discontinuation of treatment, which in turn deprives patients of a longer lifespan. This is why the need to decrease this financial toxicity has become a priority among patients and policymakers.
4 EU Member States Have Adopted “Right to Be Forgotten”
Due to generalized fears and doubts regarding life expectancy, cancer survivors often face financial discrimination in the form of difficulty getting insurance, jobs, and bank loans—just to name a few. In fact, Ms. Lebrocquy was one such patient who lost her job and couldn’t buy a house because of her cancer diagnosis.
According to Ms. Lebrocquy, stigma is a major contributor to this problem. Cancer is still considered fatal, which is why Ms. Lebrocquy believes it’s important to change the way cancer is perceived and the way cancer is talked about. One such initiative that aims to achieve that goal is Right to Be Forgotten.
Right to Be Forgotten is a policy built upon the idea that a past cancer experience cannot be taken into consideration to assess a request to get access to financial instruments. And thanks to the work of individuals like legal expert Grazia Scocca and Ms. Lebrocquy, this policy is now enacted in Belgium, Netherlands, Luxemburg, and France.
In fact, Netherlands is now one of first countries in the world that makes it possible for cancer survivors to get life insurance and buy a house, which is a tremendous improvement in the battle against financial toxicity.
Multiple Programs Have Been Developed to Help Cancer Survivors
Patient advocates Ms. Polinska and Ms. Lebrocquy were motivated by their own struggles with financial toxicity to develop programs aimed at helping others cope with those same struggles.
After losing her job because of her cancer diagnosis, Ms. Lebrocquy founded oPuce. With this business network, cancer survivors can directly contact members of the network to find a job and return to work. This is especially important since 1 in 4 cancer patients lose their job in the Netherlands, which is where Ms. Lebrocquy lives.
In Poland, Ms. Polinska’s older brother founded Piggy Bank Programme, a crowdfunding project that collects money for patients and helps them manage the financial burden caused by the diagnostic, treatment, and recovery processes. It was started after Ms. Polinska and her family nearly went bankrupt paying for her cancer treatment, which can unfortunately be a common scenario among patients and their families.
Since its founding in 2010, Piggy Bank Programme has supported more than 1,000 patients, and many beneficiaries can now afford essential therapies and services with the support of this organization.
From policies to programs, much progress has been made to help decrease the financial toxicity associated with cancer, but there’s still more to be done, which is why it’s important to retain constant dialogue between researchers, private sectors, patients, and oncologists so that the developments made by science can be brought into society.