BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPEL
ung cancer has the highest incidence and mortality of all cancers worldwide. While 200 different
types of cancer are the cause of one in six deaths, one in five of these cancer deaths are caused
by lung cancer, in spite of it being a largely preventable disease. Although there has been important
progress in recent years, lung cancer remains amongst the deadliest types of cancer, with a high disease
burden and variability in medical need. And incidence continues to rise remorselessly: between 2012
and 2018 the number of new lung cancer diagnoses increased from 1.8 million to 2 million worldwide.
Yet, historically, lung cancer has not had the attention it deserves. In Europe, the spend to burden ratio
remains much lower for lung cancer than for other major cancers such as breast, colorectal or prostate
cancer.
Poor outcomes for lung cancer patients have stemmed from several factors, including late diagnosis,
poor access to treatment, and a mixture of fatalism and stigma. With new treatment options arriving
on the scene it is an appropriate time to review the current picture of disease burden, investigate
unmet needs and recommend improvements to how health systems currently manage lung cancer.
Following an evidence-based approach, incorporating an evidence review and advisory board, we
designed a policy scorecard to assess current policy and systems performance across five domains:l Lung cancer is a strategic priority: focusing on control plans and guidelines
l Lung cancer is a public health issue: covering tobacco control and screening
l Lung cancer is a race against time: rapid diagnosis and fast-track referral
l Lung cancer is at a crossroads: on effective treatment and quality care
l Lung cancer is a focus for research: investing in registries and R&D
Indicators within each domain were selected based on evidence of their association with improved
outcomes. After drafting scores for indicators within these five domains from the published and grey
literature, we then attended national workshops to validate our scores and flesh out opportunities for
improvement in each country. In addition to this report each country has a country profile detailing
national data on epidemiology and spend, scores for each indicator and a list of recommendations.
There are two phases of our study in Europe: this first phase includes 11 countries. The second phase
will cover a further 16 countries.
Our findings show that while good practice exists, there is room for improvement across all
countries and all domains. This includes ensuring that there are fast-track referral pathways,
effective psychological support services, strong public health regulations and access to high-quality
treatment. Comprehensive and up to date national cancer control plans can be used to guide these
improvements, and registries with clinical data—such as stage and pathology at diagnosis, treatment
received, and patient reported outcome measures—will help to evaluate implementation.
Health outcomes are influenced by a range of factors, only some of which can be impacted by
policy. There is often a time lag between policy implementation and impact. We should not, therefore,