Cancer represents the second most important cause of death and morbidity in Europe, with more than 3.7 million new cases and 1.9 million deaths each year. Although Europe comprises only one-eighth of the total world population, it has approximately one-quarter of the total global cancer cases with approximately 3.7 million new patients per year (1).
In the last years, there has been a positive increment in the number of cancer survivors (2). Unfortunately, most of these patients may suffer from cancer-related complications and comorbidities, which often result in very severe or fatal outcomes (3,4).
A comorbidity is defined as the co-existence of disorders in addition to a primary disease of interest. It is calculated that most cancer patients report at least one comorbid condition (5). A cancer complication is an adverse event resulting from the underlying malignancy or its treatment. Some of the main cancer-related complications are:
- Cancer-associated thrombosis (deep venous thrombosis and pulmonary embolism)
- Chemotherapy and radiotherapy toxicity
- Respiratory failure from tumor
- Central neurological complications
- Gastrointestinal tract complications (6,7)
Patients with comorbidities and complications may not tolerate cancer treatments and this may impact on their survival. On the other hand, cancer therapies can worsen pre-existing comorbidities (8). The result is a deterioration of patients’ quality of life, the need of extensive supplemental healthcare and treatments, and an increased burden for the health system.
To overcome this situation, in December 2019, the European Thrombosis and Haemostasis Alliance (ETHA) signed a joint statement to make cancer-related complications and comorbidities a priority for the European Union (EU) policy (9). ETHA specifically highlights the higher risk of developing thrombosis for cancer patient, that is currently not addressed with effective screening in cancer care.
The timing for this proposal is appropriate as the EU policy context is strongly driven toward the establishment of a New European Cancer plan, closely linked with the research mission on cancer in the future Horizon Europe program for 2021–2027 (10).
The joint statement is aimed to focus EU policy makers towards a constant discussion about cancer-related complications, and pinpoints actions to be taken:
- Identification of multidisciplinary teams to improve screening and integrated care approach
- Use of the real-world data to improve patient information database that can be available and shared among the EU countries
- A better cooperation of the different branches of medicine
- Finding appropriate funding and resources
- Coordination of prevention strategies and definition of future steps through an efficient communication involving all the healthcare professionals and stakeholders around the EU members
ETHA is committed to prepare EU Member States for the challenge of aging populations, suggesting that the EU re-focus on new cancer aspects, such as cancer-associated thrombosis, and to make use of an integrated multidisciplinary approach to ensure better health for all European patients.
References
- WHO Regional office for Europe. http://www.euro.who.int/en/health-topics/noncommunicable-diseases/cancer/data-and-statistics
- Rowland JH, Kent EE, Forsythe LP, et al. Cancer survivorship research in Europe and the United States: where have we been, where are we going, and what can we learn from each other? Cancer. 2013;119 Suppl 11(0 11):2094–2108. doi:10.1002/cncr.28060
- Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M. The impact of comorbidity on cancer survival: a review. Clin Epidemiol 2013;5(Suppl 1):3–29. doi:10.2147/CLEP.S47150.
- Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768-2801. doi: 10.1093/eurheartj/ehw211.
- Koroukian SM, Murray P, Madigan E. Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care. J Clin Oncol. 2006;24(15):2304-10. doi: 10.1200/JCO.2005.03.1567.
- ECPC & LEO Pharma. Cancer-Associated Thrombosis (CAT), A neglected cause of cancer death: actions needed to increase health outcomes and reduce mortality https://ecpc.org/wp-content/uploads/2019/08/ECPC-White-Paper-Cancer-Associated-Thrombosis-1.pdf
- Torres VB, Vassalo J, Silva UV, et al. Outcomes in critically ill patients with cancer-related complications. PLoS One. 2016;11(10):e0164537. doi:10.1371/journal.pone.0164537
- Sarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatments. CA Cancer J Clin. 2016;66(4):337-50. doi: 10.3322/caac.21342.
- Making cancer-related complications and comorbidities an EU health priority. Joint statement https://etha.eu/news-and-events/etha-signs-a-joint-statement-on-cancer-comorbidities/
- Mission letter to Stella Kyriakides, Commissioner-designate for Health. 10 September 2019. https://ec.europa.eu/commission/sites/beta-political/files/mission-letter-stella-kyriakides_en.pdf