BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPESmoking is not the only cause
Although most cases of lung cancer result from tobacco use, it is not the sole cause. For example, long-
term exposure to radon is a risk factor for lung cancer; it may in fact be the second leading cause, and
have a synergistic effect with smoking.^45 This stems from domestic exposure arising from the diffusion
of radon from the soil; as radon gas decays, tiny radioactive elements can lodge in the lung and emit
radiation.^46 In order to help minimise exposure to radon, radon control policies exist in nine of our
countries. Poland and Spain are the exceptions.
Lung cancer can also be the result of air pollution from both the general and work environment.
As air quality deteriorates, rates of non-communicable diseases, including lung cancer, increase: air
pollution is the fourth-leading fatal health risk, responsible for one in ten deaths.^47 WHO reports
that 90% of people worldwide breathe polluted air.^48 In 2013, air pollution cost the global economy
approximately US$225 billion owing to lost labour income and about US$5.1 trillion in welfare losses
due to premature death. This translates to amounts comparable to the combined gross domestic
product (GDP) of Canada, India and Mexico.^47 Most of the countries in our research have policies or
programmes in place for control of exposure to environmental hazards, and air quality programmes
may exist as distinct policies or be encompassed within climate and energy strategies. A specific air
quality strategy exists in all our countries except Norway, which has an environmental strategy but not
one specifically focused on air quality.
The patient is speaking, but is anyone listening?
The involvement of patient organisations in policy development can help to build consensus on many
levels; they ensure the inclusion of patient needs and improve decision-making.^49 However, lung cancer
specific patient organisations only exist in some of the countries covered in this report, and where they
do exist there is significant variation in the roles they play in policy development.^49 In some cases they
are nascent organisations that are not yet fully established, thus their role is minimal. In others, patient
organisations are well networked and active participants that engage with government stakeholders to
increase awareness and contribute to policy development.
Seven out of 11 countries have lung cancer specific patient organisations: France, the Netherlands,
Norway, Poland, Spain, Sweden and the UK. Five countries have included patient organisations in
the development of clinical guidelines: Belgium, France, the Netherlands, Sweden and the UK. Six
countries include patient organisations in their health technology assessments (HTAs): Finland,
France, the Netherlands, Poland, Romania and the UK. Including the patient voice provides insights
into care and treatment from a perspective that is unique and impactful. We found that where patient
organisations exist and play an active role, such as in Norway and Spain, participants valued their
contributions; when they are missing, as in Austria, participants noted their absence.