The COVID-19 pandemic has exposed the weaknesses and lack of resilience of European healthcare systems with major consequences for cancer care and cancer patients. Crucial attention is needed, not only to restore cancer services but to build back better and be prepared to face upcoming challenges. The Special Network of the European Cancer Organisation on the Impact of COVID-19 on Cancer brings together healthcare professionals, patients, researchers, academics, Community 365 members and others to:
• precisely delineate the challenges that COVID-19 has posed for cancer care,
• amplify activities undertaken by the European Cancer Organisation’s community to address these challenges, and
• produce recommendations on the most critical and urgent policy needs.
Our Network perceives that both WHO Europe and the European Commission can play a crucial supportive role to national health systems, through provision of timely and targeted advice, guidance and coordination. We propose the following seven urgent recommendations to National Governments, the European Union, WHO Europe and others:
• Ways of remodelling vaccination campaigns (e.g. drive-in vaccination centres);
• Innovative methods for maintaining delivery of screening programmes (e.g. deployment of mobile screening units);
• The best means of prioritising the delivery of elective life-saving cancer treatment;
• The creation of dedicated and safe pathways for cancer patient care, taking account of the COVID-19 pandemic scenario;
• Strategies for reducing the bureaucratic burden associated with clinical trials, which otherwise hamper the conduct of research during, and on, COVID-1925,26.
A “Building Back Better COVID-19 Cancer Response” should be an immediate action of Europe’s Beating Cancer Plan.
It should be constructed in cooperation with cancer patients and all relevant health professionals, drawing together best practices and guidelines already identified by expert groups in the cancer community27,28.
This would create an immediate means for providing official EU guidance to health systems on achieving the promptest normalisation of cancer services, and might also be developed in conjunction with WHO Europe.
Furthermore, there are still clear gaps in our knowledge of COVID-19’s impact on cancer care that need to be addressed, in order to deliver successful cancer service recovery. These gaps include:
• Which cancer treatments are safe to provide during a pandemic?
• What are the outcomes of COVID-19 treatments in patients receiving active treatment for cancer?
• What were the precise impacts of the pandemic on ALL elements of cancer care (including aspects such as the provision of psychosocial care, palliative and supportive care)?
• What are the outcomes of COVID-19 treatments in patients on active anti-cancer treatment?
• providing priority access to COVID-19 testing for all cancer patients identified as at risk of having been infected by the virus; and
• ensuring a safe organisation of cancer care, such as through separating out COVID-19 free cancer care centres and diagnostic centres from ‘COVID-19 hospitals’ or alternatively creating separate and ‘fast track’ pathways for cancer patients within ‘COVID-19 hospitals’.
Additionally, regional, national and pan European communication campaigns should be conducted, in order to adequately inform citizens of the critical need to:
• immediately visit their healthcare professional in case of suspected cancer symptoms; and to
• maintain diagnostic and treatment schedules as advised by their healthcare professional team, complying with most recent recommendations for care and follow-up.
This communication effort should be supported at the highest political levels across the EU and its Member States including from Prime Ministers, Health Ministers, and the European Commission leadership.
• Strengthen the EU legislative and operational framework in respect to prevention, early notification, monitoring and management of shortages;
• Promote an increase of production sites of active pharmaceutical ingredients and manufactured products;
• Strengthen cross-region collaboration to ensure the highest quality standards;
• Enable easy redistribution of medicines across European borders in case of emergency;
• Foster permanent action-oriented dialogue with all relevant actors of the supply chain (including the European Medicines Agency, national regulators, pharmaceutical industry, patients and healthcare professionals); and
• Bring about urgent improvement of early warning systems and information-sharing between European countries with respect to medicines shortages.
Furthermore, the recent proposal of the European Parliament to build a European contingency reserve of medicines of strategic importance35 should be given the most serious and urgent consideration.
Protecting the safety and health of all healthcare providers is an absolute requirement for the delivery of quality cancer care. As COVID-19 respects no borders, and in a time when nations should come together to support one another’s citizens, we recommend other non-EU countries be welcomed to participate in RescEU’s COVID-19 support mechanisms.
European countries should make a joint and public expression of the right of every individual working within Europe’s hospitals to access the best quality PPE.
In the immediate period, health system managers in all countries must give the most urgent consideration to the welfare and wellbeing of healthcare professionals who have conducted their daily work under enormous pressure and strain for more than 7 months, with little sign of immediate easing. In the context of an ongoing second wave of the pandemic, the EU should encourage sharing and uptake of best practices in this respect, such as the reduction of unnecessary bureaucratic workload, the addition of psychologists to healthcare teams working in the frontline and the establishment of ‘peer support systems’.
Any redeployment of staff to meet COVID-19 needs must be accompanied by an appropriate assessment of impact on the delivery of cancer care, with immediate actions following such an assessment to address newly created gaps.
Opportunities to ease and better organise cross-border redistribution of workforce in specifically relevant situations (e.g. border areas), such as through leveraging mutual professional recognition instruments, should also be closely considered.
While the EU RescEU mechanism has demonstrated an important coordinating role by the European Commission in addressing product shortages, COVID-19 has also highlighted lack of resilience in the cancer professional workforce. There is an urgent need to better understand the cancer workforce landscape, and how its distribution can be improved. A RescEU mechanism for workforce shortage (in both the short and long term) should be considered.
In the context of Building Back Better and of the Europe’s Beating Cancer Plan, the role of the EU in assisting pan-European cancer workforce planning should be reemphasised and expanded. This must notably include mapping availability of cancer workforce across the EU and addressing persistent and critical shortages in disciplines such as pathology, hospital pharmacy and cancer nursing.
Furthermore, the readiness of European cancer workforce systems to respond to future crises through redistribution of relevant staff must be elevated. This could be achieved by re-emphasising and refreshing the mandate for EU action to promote harmonisation and mutual recognition of healthcare professional qualifications.
In order to provide care and support to cancer patients while avoiding unnecessary risks of infection, all health systems should set up strategies for the appropriate and proportional use of telemedicine in cancer care both during and after the pandemic period. This should incorporate appropriate training opportunities for relevant healthcare professionals and expertly formed guidance on the best use of telemedicine in the cancer setting. Relevant regulations in the field of telemedicine should also be urgently defined, as it has been reported to us, in some countries, legal and practice uncertainty has hampered the deployment of telemedicine.
At the EU and WHO Europe level, best practice sharing on the deployment of telemedicine in cancer care should be conducted. This, and other coordinating measures, can play a helpful role in mitigating against telemedicine exacerbating existing digital health divides in Europe.
Via instruments such as the Horizon Europe and EU4Health programmes, the EU should support much-needed independent research to generate robust evidence on the appropriate use of telemedicine in cancer care and inform future strategies.
Importantly, specific measures must be in place to ensure that the individual status and preferences of the patient are taken into account. Any telemedicine strategy must be focused on equity and equal access across countries and patient groups. In the post-COVID-19 era, hybrid systems combining the offer of telemedicine in specifically relevant situations with the provision of in-person appointments must be put in place. Any patient must be given the choice to access an in-person appointment, and never be denied his/her/their right to benefit from the latter.
To assist rapid sharing of best practices, the European Commission should urgently publish a report highlighting examplar initiatives by Member States to retain cancer services despite COVID-19 pandemic challenges. We recommend this be included as an early action of Europe’s Beating Cancer Plan. An important audience for this exercise will be regulatory bodies as some examples of best practice may demonstrate the need for amendments in regulatory approach (e.g. telemedicine, clinical decision-making on treatment options).
Through its research funding instruments, the European Commission should also help generate robust scientific evidence to evaluate and advise about innovative approaches to cancer care delivery during the pandemic and/or other health emergencies.
As the reality of living with COVID-19 into 2021 becomes increasingly accepted, every country in Europe must ensure timely access and deployment of real-time (or near real-time) cancer data to underpin improved cancer service delivery and enhanced cancer clinical research.
Energies and efforts must be redoubled to bring about greater harmonisation in the European health data domain. EU Member States should positively reinforce the mandate of the European Commission in strengthening the output and realising the value of Europe’s cancer data environment. The creation of a European Cancer Dashboard via Europe’s Beating Cancer Plan, including an urgent ‘Cancer and COVID- 19’ component, would provide an empowering platform to coordinate and better harmonize cancer data across Europe.
In the context of the forthcoming establishment of the European Health Data Space and of the European Cancer Patient Digital Centre recommended by the EU Cancer Mission, we recommend the creation of a pan-European COVID-19 patient data registry, accelerating better understanding of the impact of COVID-19 on cancer outcomes in patients.
We recommend that the European Centre for Disease Prevention and Control be empowered with an expanded mandate and budget to further fulfil its key role in helping European countries to prevent and manage disease, and to communicate important disease-related data to the general public in an easy-to-understand format.
Furthermore, we support calls for the mandate of the ECDC to be extended to cover non-communicable diseases, including cancer.
We support proposals for a European Health Union42.
In addition to the recommendations above concerning the expanded role of the European Centre for Disease Prevention and Control, the role of the European Medicines Agency in helping address crisis scenarios such as pandemics should be further recognised. Its role in proactively publishing clinical data for COVID-19 medicines has been an important element of that agency’s response and should be embedded more widely as an approach to both transparency and enhancing therapeutic development.
The EMA should also be provided with a stronger mandate to help countries manage pan-national cases of medicines shortages, including in respect to centralising and publishing information on pan- European shortages.
The core role of the EU in helping Member States to combat common health challenges, such as infectious disease and non-communicable disease, should be elevated, and more clearly expressed. This should be foremost in mind at the next opportunity for EU Treaty change. Following COVID-19, the phrase “health is not a legal competence of the EU” should be definitively abandoned.
We request all national governments engage seriously and thoughtfully on enhancing international health cooperation, including, but certainly not limited to, the role, remit, powers, governance and functioning of the World Health Organization. This includes the WHO’s International Agency for Research on Cancer (IARC) and other affiliated agencies of the WHO. 2021 should be a year in which new robust long-term foundations of health cooperation for the post COVID-19 future are created.
An immediate means of exhibiting to the public that, post-COVID-19, the international community is more serious than ever on global health cooperation would be to rapidly implement the recently agreed Global Strategy for the Elimination of Cervical Cancer43.