ESMO COLLABORATION WITH WHO

ESMO COLLABORATION WITH WHO

Josep Tabernero

ESMO President

ACCESS TO CANCER CARE FORMS AN

INTEGRAL PART OF THE ESMO 2020 VISION

The ESMO 2020 Vision statement recognises that progress in the management of cancer care can and will only occur when high quality care is

both available and affordable to everyone everywhere

The ESMO 2020 Vision supports the WHO one to reduce mortality from cancer and promote universal health coverage for everyone at all ages

ESMO GLOBAL POLICY COMMITTEE

The Global Policy Committee represents

the global arm of ESMO’s public policy

initiatives

The Committee is the main partner within

ESMO for joint projects with the WHO

The Committee has experience leading large

international multi-stakeholder projects

The Committee has the expertise to provide the WHO with medical oncology input from around the world

Members

Chair: Alexandru Eniu, Romania Deputy Chair: Eduardo Cazap, Argentina

Sana Al Sukhun, Jordan Soe Aung, Myanmar

James Cleary, USA Giuseppe Curigliano, Italy

André Ilbawi, Switzerland David Kerr, United Kingdom

Sumitra Thongprasert, Thailand Staff coordinator: Gracemarie Bricalli

Adamos Adamou, Cyprus Gouri Shankar Bhattacharyya, India

Ahmed Elzawawy, Egypt Nagi El Saghir, Lebanon

ESMO GLOBAL CANCER TASK FORCE

Co-Chairs:

Alexandru Eniu, Romania

and Eduardo Cazap, Argentina

The Global Cancer Task Force is the ESMO Global Policy Committee’s

international platform for ESMO partner societies to meet and agree how to

support ESMO’s activities with the WHO

The Task Force has face-to-face meetings twice a year with specific action items for the participants to accomplish in their own

countries

• Letters to Ministry of Health

• Raise awareness about policy issues

• Organise policy sessions at congresses

• Collect data and provide feedback

Cancer Resolution: ESMO will work with ASCO, UICC, US-NCI the Global Cancer

Task Force, to provide guidance and resources to national oncology societies

on how they can support work in their country to implement the WHO Cancer

Resolution

ESMO PROJECTS WITH THE WHO

ESMO EUROPEAN AND GLOBAL OPIOID

POLICY INITIATIVES

First-of-its-kind perception survey that provided recommendations to overcome barriers to

access to opioids, including those on the

WHO Model List of Essential Medicines

ESMO survey supported the 2014 WHO Resolution on Palliative Care and the

2016 UN Outcome Statement on Controlled

Substances – both promoting increased access of opioids for

legitimate medical use

The ESMO Designated Centres Programme

has13 criteria for accreditation, based on

WHO guidelines for palliative care. This ESMO

programme has 200 accredited centres from

around the world

0% 20% 40% 60% 80% 100%

Eligibility Restriction

Prescriber Restriction

Emergency Prescriptions

Limited Prescription Duration <29days

Pharmacist Authority

Burden of Prescriptions

Restricted Dispensing Sites

Negative languages in Laws

Middle East

India

Asia

• The international initiative had 17 partner societies and surveyed

population of 5.76 billion people

• There is still a lot of work to be done. A WHO report of 2010 shows that

7.5% of people live in countries with adequate opioid consumption levels

ESMO EUROPEAN AND INTERNATIONAL CONSORTIUM STUDIES

ON THE AVAILABILITY OF ANTI-NEOPLASTIC MEDICINES

Perception survey of a snapshot in time to

determine if a patient can obtain a cancer medicine

when prescribed

Surveyed cancer medicines for adult solid tumours, including those on the WHO Model List of Essential Medicines

Over 20 national and regional societies

collaborated

Results showed that in low- and middle-income countries inexpensive

essential medicines are not always available or

affordable

Reasons for lack of availability were multiple, including lack of supply, manufacturing problems,

parallel exports, and budget capitation

Survey results led to the creation of the ESMO

Cancer Medicines Committee

Paediatric Oncologists are now conducting a

similar survey in Europe for children’s cancer

medicines

AVAILABILITY OF MULTI-USE ESSENTIAL

MEDICINES

Free

<25% cost

25-50% cost

Discount >50% and <100%

Full cost

Not available

Missing data

Country Bleo CarboP CisP

Cyclo

(IV) Cyclo (tab) DTIC Dox. Epir. Etop (IV) 5FU Ifos.

MTX

(IV)

MTX

(tab) VBL VCR

Argentina

Australia

Canada

Chile

Cyprus

Israel

Japan

Korea, South

Oman

Qatar

Saudi Arabia

Singapore

United Arab Emirates

USA

Algeria

Brazil

China

Colombia

Iran

Kazakhstan

Lebanon

Malaysia

Mexico

Peru

South Africa

Thailand

Tunisia

Turkey

Bangladesh

Egypt

Ghana

India

Kenya

Morocco

Pakistan

Palestine

Sudan

Vietnam

Zambia

Afghanistan

Burkina Faso

Tanzania

Uganda

Zimbabwe

COST AND AVAILABILITY

High-Income

Upper Middle-Income

Low-income

Lower Middle-Income

PROMOTING SUSTAINABLE CANCER CARE

ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS)

A

B

C

5

4

3

2

1

Curative Non-curative

Since 2016 new cancer medicines or indications approved by the European Medicines Agency have been scored and presented either in the ESMO Guidelines where relevant or as an e-Update

Medicines which obtain the highest scores A and B (curative setting) 5 and 4 (non-curative setting) represent the highest priority for rapid endorsement by national bodies across Europe

USING THE ESMO-MCBS TO SUPPORT

SUSTAINABLE CANCER CARE

• The rising costs of medicines was threatening the ability of a

country to maintain its universal healthcare coverage plan

• The Ministry of Health of that country asked WHO to evaluate

their cancer medicine protocols to find a sustainable solution,

and proposed use of the ESMO-MCBS

• For this project, ESMO:

Provided expert review of the country’s cancer medicines

and protocols

Prepared a detailed report for the WHO Country Office,

which exceeded their expectations

Established a methodology that can be used in the future

for countries seeking similar assistance from the WHO

and ESMO

ANTICANCER MEDICINES: AVAILABILITY

VERSUS BENEFITEXAMPLE OF USING ESMO-MCBS: BREAST CANCER: ROMANIA IN 2014

Medication SettingPrimary

outcome

ESMO-

MCBSReimbursed

Chemotherapy +/-

trastuzumab

(Neo)adjuvant HER-2

positive tumoursDFS A Yes

T-DM1 vs lapatinib +

capecitabine

2nd line metastatic after

trastuzumab failure

PFS and

OS5 No

Trastuzumab + chemotherapy

+/- pertuzumab1st line metastatic PFS 4 No

Lapatinib +/- trastuzumab 3rd line metastatic PFS 4 No

Capecitabine +/-lapatinib2nd line metastatic after

trastuzumab failurePFS 3 No

Eribulin vs other

chemotherapy

3rd line metastatic after

anthracycline and taxaneOS 2 No

Paclitaxel +/- bevacizumab 1st line metastatic PFS 2 Yes

Exemestane +/- everolimus

Metastatic after failure of

aromatase inhibitor (with

PFS > 6 m)

PFS 2 No

Cherny et al. Ann Oncol 2015 and Alex Eniu for Romania

ESMO participation in

UICC-led initiative to

update the WHO Model of EML

ESMO audience aware through an article on WHO

EML published in ESMO Open in

March 2016

ESMO survey showed WHO

essential cancer medicines are

not available or affordable in

many countries

ESMO-MCBS scores for cancer medicines on the WHO EML are

high

About 20 inexpensive

essential cancer medicines are

used in the treatment of 80%

of cancers

WHO MODEL OF ESSENTIAL

MEDICINES LIST (EML)

The WHO made a list of priority medical devices

especially for cancer

ESMO contributed to the sections on systemic therapy

and palliative care

The list of interventions serves as the basis for the

survey questionnaire for the WHO oncology workforce study done in partnership

with ESMO

WHO PRIORITY LIST OF MEDICAL DEVICES

FOR CANCER MANAGEMENT

We are pleased the WHO is working to optimise the cancer workforce and predict future needs

Securing the future of the medical oncology workforce is paramount to ESMO and ESMO members

In 2018, ESMO will co-lead with WHO and Ministries of Health 2 pilot projects in Europe before the tool is launched worldwide by WHO

WHO ONCOLOGY WORKFORCE SURVEY IN

PARTNERSHIP WITH ESMO

Module 1: The Cancer Workforce

Module 2: Education and early career

Module 3: Regulation of professional practice

Module 4: Professional associations

Module 5: Policies, national plans and legislation

Module 6: Cancer workforce planning models and infrastructure

Module 7: Country progress

WHO ONCOLOGY WORKFORCE SURVEY

MODULES

ESMO has collaborated with the WHO on projects from essential cancer medicines,

to priority medical devices for cancer, to an oncology workforce that will estimate

future needs for an optimal oncology workforce.

WHO Essential Medicines

WHO Priority Medical Devices for

Cancer Management

WHO Oncology Workforce Survey

ESMO-WHO COLLABORATIONS

2017 WORLD HEALTH ASSEMBLY

CANCER RESOLUTION

The 194 WHO Member States unanimously adopted a Cancer Resolution at the World Health

Assembly in May 2017.

The Resolution represents a landmark for cancer on the global health agenda. It demonstrates the

importance the WHO and the United Nations are giving to cancer at the highest political levels.

The Resolution addresses all aspects of cancer care from prevention to survivorship.

ESMO is a main partner of WHO for four key deliverables mandated by the Cancer Resolution:

A 2018 Oncology Workforce Study, which will provide recommendations on how to optimize a

country’s current workforce and future needs

A 2019 Global Report on Cancer to provide countries with policy recommendations to improve

cancer services

A 2019 Access to Cancer Medicines Report, which will provide guidance on how to improve

access and affordability of cancer medicines

A 2020 National Cancer Control Plan Prioritization and Costing Tool, an interactive online tool,

that contains a menu of cancer services that governments can implement, showing them the

impact the services provide to the country’s population, and the cost to implement them

CELEBRATING ESMO-WHO RELATIONS

Successful

collaboration on 2

major ESMO projects

on the availability of

pain and cancer

medicines

15 years of

collaboration and 5

years of official

relations status

Invite by WHO to

ESMO to partner on

projects to

implement the 2017

Cancer Resolution

Global visibility of the

WHO at the ESMO

Congresses and

Summits

Promotion of the

WHO Model List of

Essential Medicines

ESMO-WHO COLLABORATIONS

• In 2017 there was a paradigm shift from

WHO working with ESMO on ESMO

projects, to WHO inviting ESMO to

work with WHO on WHO projects

• We are extremely proud to be entrusted

by WHO with such an important role in

global public policy

• ESMO looks forward to collaborating

with WHO to provide Africa and the

entire oncology community with tools

and resources necessary to improve

cancer control and the lives of patients

worldwide

THANK YOU