Digital transformation: Health systems’ investment priorities

Health systems around the world are facing a host of challenges, including rising costs, clinical-workforce shortages, aging populations requiring more care (for example, to treat chronic conditions), and increasing competition from nontraditional players.1 At the same time, consumers are expecting new capabilities (such as digital scheduling and telemedicine) and better experiences from health systems across their end-to-end care journeys.2 In response, health systems are increasing their focus on digital and AI transformation to meet consumer demands, address workforce challenges, reduce costs, and enhance the overall quality of care.3 However, despite acknowledging the importance of these efforts to future sustainability, many health system executives say their organizations are still not investing enough.

AI, traditional machine learning, and deep learning are projected to result in net savings of up to $360 billion in healthcare spending.

AI, traditional machine learning, and deep learning are projected to result in net savings of $200 billion to $360 billion in healthcare spending.4 But are health systems investing to capture these opportunities? We recently surveyed 200 global health system executives about their digital investment priorities and progress.5 Seventy-five percent of respondents reported their organizations place a high priority on digital and analytics transformation but lack sufficient resources or planning in this area.

Increasing prioritization

In line with other industries, the majority (nearly 90 percent) of health system executives surveyed, in both technical roles (such as chief information officer or chief technology officer) and nontechnical roles (for example, CEO or CFO), reported that a digital and AI transformation is a high or top priority for their organization. At the same time, 75 percent of respondents reported their organizations are not yet able to deliver on that priority because they have not sufficiently planned or allocated the necessary resources.


Health system digital investment priority areas and anticipated impact

For health system executives, current investment priorities do not always align with areas they believe could have the most impact. There is alignment in some areas, including virtual health and digital front doors, where about 70 percent of respondents expect the highest impact.1 In other areas, such as AI, 88 percent of respondents reported a high potential impact,2 yet about 20 percent of respondents do not plan to invest in the next two years. The absence of investment in a robust, modern data and analytics platform could delay value creation in areas that depend on these capabilities—such as efforts to close gaps in care, improve timely access for referrals, and optimize operating room throughput.

Major headwinds and slow progress

Given the current macroeconomic climate and increasing cost pressures on health systems, most respondents identified budget constraints as a key obstacle to investing at scale across all digital and AI categories of interest (51 percent of respondents ranked this obstacle among the top three). For example, a health system that is building a digital front door may lack the resources to simultaneously invest in the latest generative AI (gen AI) capabilities.

Respondents called out challenges with legacy systems as the second-greatest concern (after budget constraints). Core tech modernization is key to delivering on the digital promise,1 but health systems have typically relied on a smaller set of monolithic systems that have become a challenge to untangle.

Additional highly ranked challenges include data quality (33 percent), tech talent and recruiting (30 percent), and readiness to adopt and scale new technology (34 percent).

Satisfaction with digital investment

Most executives of health systems that have invested in digital priorities (72 percent) reported satisfaction across all investment areas. Among the comparatively fewer respondents who reported investing in robotics and advanced analytics, satisfaction was even higher, at 82 percent and 81 percent, respectively. Given that investments result in a high level of satisfaction and that 75 percent of executives reported they are not yet able to deliver on their digital transformation ambitions (as noted above), health systems may be facing a failure to scale their digital programs.

What health systems can do and how they can learn from other industries

The goal of digital and AI transformation is to fundamentally rewire how an organization operates, building capabilities to drive tangible business value (such as patient acquisition and experience, clinical outcomes, operational efficiency, and workforce experience and retention) through continuous innovation. Delivering digital value for health systems requires investment and new ways of working.

Building partnerships. Scale is crucial to value creation. But the definition of at-scale systems has changed in the past few years; today, it takes more than $13 billion to be a top 20 system by revenue, and many have reached their current position through inorganic growth.6 Partnerships (joint ventures and alliances) may offer a promising avenue to access new capabilities, increase speed to market, and achieve capital, scale, and operational efficiencies.7

Moving beyond off-the-shelf solutions. History shows that deploying technology—such as electronic health records (EHRs)—on top of broken processes and clinical workflows does not lead to value. Realizing value from healthcare technology will require a reimagination (and standardization) of clinical workflows and care models across organizations. For example, optimizing workflows to enable more appropriate delegation, with technical enablement, could yield a potential 15 to 30 percent net time savings over a 12-hour shift. This could help close the nursing workforce gap by up to 300,000 inpatient nurses.8

Using the cloud for modernization. Health systems are increasingly building cloud-based data environments with defined data products to increase data availability and quality. Health systems can also use cloud-hosted, end-user-focused platforms (such as patient or clinician apps) that integrate multiple other applications and experiences to simplify stakeholders’ interactions with the system.

Operating differently. Operating differently entails fundamental changes in structure (flatter, empowered, cross-functional teams), talent (new skill sets and fully dedicated teams), ways of working (outcome orientation, agile funding, and managing products, not projects), and technology (modular architecture, cloud-based data systems, and reduced reliance on the monolithic EHR). With these changes, some health systems have begun to see real value within six months. Building a digital culture helps the transformation succeed over time.9

Cautiously embracing gen AI. Gen AI has the potential to affect everything from continuity of care and clinical operations to contracting and corporate functions. Health system executives and patients have concerns about the risks of AI, particularly in relation to patient care and privacy. Managing these risks entails placing business-minded legal and risk-management teams alongside AI and data science teams.10 Organizations could also implement a well-informed risk-prioritization strategy.

Digital and AI investments provide health systems with opportunities to address the many challenges they face. Successful health systems will invest in areas with the greatest potential impact while removing barriers—for example, by upgrading legacy infrastructure. Health systems that make successful investments in digital and analytics capabilities could see substantial benefits and position themselves to benefit from the $200 billion to $360 billion opportunity.11

ABOUT THE AUTHOR(S)
Jack Eastburn is a partner in McKinsey’s Southern California office; Jen Fowkes is a partner in the Washington, DC, office; and Karl Kellner is a senior partner in the New York office. Brad Swanson is a consultant in the Denver office.

The authors wish to thank David Bueno, Camilo Gutierrez, Dae-Hee Lee, Audrey Manicor, Lois Schonberger, and Tim Zoph for their contributions to this article.

Πηγή: mckinsey.com
find more :https://eefam.gr/digital-transformation-health-systems-investment-priorities/

A Different Chemotherapy Approach for Ovarian Cancer

OVARIAN CANCER that spreads to the lining of the abdominal cavity, called the peritoneum, is difficult to treat. Patients with this advanced cancer typically undergo debulking, also called cytoreductive surgery, a lengthy procedure in which surgeons aim to remove all cancer from the abdominal cavity and affected organs, including the ovaries and fallopian tubes as well as the bladder, colon and other parts of the gastrointestinal tract. In recent years, researchers have looked at the efficacy of using hyperthermic intraperitoneal chemotherapy (HIPEC), which is heated chemotherapy delivered directly to the peritoneum, to destroy remaining cancer cells immediately after debulking surgery.

Scientists in Belgium and the Netherlands published long-term data from OVHIPEC-1, a randomized phase III trial to evaluate adding HIPEC to interval cytoreductive surgery for ovarian cancer, in the October 2023 Lancet Oncology. (In interval surgery, chemotherapy is given to shrink the cancer prior to surgery.) The study enrolled 245 women with stage III epithelial ovarian cancer whose cancer showed no signs of progression after upfront chemotherapy. Researchers randomly assigned women to have debulking surgery alone, or surgery plus HIPEC using the chemotherapy drug cisplatin. After 10 years, median overall survival for the surgery-plus-HIPEC group was 44.9 months versus 33.3 months for the surgery group. Median progression-free survival was 14.3 months and 10.7 months, respectively. The rates of adverse events were similar—25% with surgery alone versus 27% with surgery plus HIPEC—and the most common events were abdominal pain, infection and slowed bowel function.

These results are in line with the researchers’ five-year analysis, published in the New England Journal of Medicine in 2018. In that analysis, 6.6% of patients in the surgery group had survived without progression at five years, compared with 12.3% in the surgery-plus-HIPEC group. At 10 years, 6.6% of the people who received surgery were alive with no progression versus 10.1% in the surgery-plus-HIPEC group. While surgery plus HIPEC did not result in better cure rates, the authors note that it significantly prolonged the time cancer was controlled. “The most important finding is that the benefit for patients with stage III ovarian carcinoma when interval cytoreductive surgery is combined with HIPEC remains present after a 10-year follow up,” says Willemien van Driel, lead author and a gynecologic oncologist at the Netherlands Cancer Institute in Amsterdam, who notes that patients in both arms of the study received similar treatment after subsequent recurrences.

Van Driel says that there is still variation in the use of HIPEC along with cytoreductive surgery. European guidelines published in October 2023 note that HIPEC with cytoreductive surgery should not be considered a standard of care. In the U.S., National Comprehensive Cancer Network guidelines state that HIPEC can be considered for patients with stage III epithelial ovarian cancer.

Van Driel and her colleagues are now enrolling patients in the OVHIPEC-2 trial, which will study the effect of adding HIPEC in women with stage III ovarian cancer undergoing primary surgery, which is surgery done upfront prior to chemotherapy. Other trials are evaluating HIPEC use for recurrent ovarian cancer. She notes there are several unanswered questions, including optimal dosing and temperature for HIPEC and the impact of including other drugs, such as PARP inhibitors, with this approach, since many of these drugs were not standard of care at the time of the trial.

HIPEC may be a valid choice for patients who are generally healthy and open to a longer procedure and hospital stay. Although the length of surgery plus HIPEC varies, HIPEC generally adds 90 minutes or more to debulking surgery, which itself takes several hours. Also, patients typically require a longer hospital stay for recovery, possibly with intravenous or tube feedings while the digestive system recovers. 

Find more :

A Different Chemotherapy Approach for Ovarian Cancer

How to Find the Right Oncologist for You

After a cancer diagnosis, it’s one of the most important decisions you’ll make.

After a career as a golf professional in southeastern New Mexico, Doug Lyle, 76, decided he had somewhere better to be than on the course: spending time with his new grandchild. Then this summer, just as he was settling into retirement, he learned he had prostate cancer.

“When you’re first diagnosed, you immediately go to the internet, and you can be overwhelmed in short order,” he said. “The more you read about it, the more complicated it gets.”

One of the first and most important choices he had to make was who his oncologist would be. Many of the two million patients diagnosed with cancer in the United States each year get the news from a primary care doctor. Those patients might accept a referral to an oncologist without question. But research suggests that it’s worth considering the choice closely: It can shape the care you receive, your satisfaction with the treatment and your chances of survival.

Not everyone has a choice of oncologists. There are fewer providers in rural areas, and patients must travel farther to reach them. Insurers may only cover certain clinicians and hospitals. And patients from certain populations have less access to oncologists for a range of reasons, which may affect the care they receive. For example, research suggests that Black and Hispanic women with breast cancer are more likely than white women to experience delays in starting radiotherapy. And Black men with prostate cancer are less likely than white men to receive treatment that’s intended to cure their condition, even when they’re at similar stages of disease.

No matter your circumstances, you should feel empowered to have a say in who treats your cancer.

Ideally, experts said, you’d be able to easily compare doctors’ levels of experience and the outcomes of patients they’ve treated with your same diagnosis. But such apples-to-apples comparisons are not always easy to make. But “right now, there are no publicly available data to help a patient with cancer say, ‘Oh, this is where I want to go,’” said Dr. Nancy Keating, a physician and professor of health care policy and medicine at Harvard Medical School. (And even if there were, apples-to-apples comparisons are not always easy to make, since patient populations vary from one doctor to the next).

Still, there are some accreditations to look for. The National Cancer Institute has given a special designation to 72 cancer centers, which must show they treat patients in accordance with the latest evidence and also conduct research into new therapies. The American College of Surgeons Commission on Cancer has accredited over 1,500 programs that meet certain standards. And the American Society of Clinical Oncology has several certification programs, including a list of 300 practices recognized for their quality and safety.

There are resources to help you search for oncologists, too, including a U.S. News & World Report directory that lets you sort by location, patient reviews and accepted forms of insurance. The consumer research firm Castle Connolly also has a database of doctors who are nominated by their peers and then evaluated for their qualifications, interpersonal skills and more.

Look for an oncologist who frequently treats patients with diagnoses similar to yours. Research has long shown that when doctors perform certain procedures more often, their patients have better outcomes. One study found that patients of surgeons who removed more than 25 lung cancers a year spent less time in the hospital, had a lower risk of infection and were more likely to survive three years without recurrence of disease.

Dr. Timothy Pawlik, the chair of the surgery department at Ohio State University Wexner Medical Center, said he only treats a handful of cancers. “You want someone with depth, not breadth,” Dr. Pawlik said. That way, he explained, “the patient may have a rare cancer, but it’s not rare to that doctor.”

Additionally, everyone else on the care team including the anesthesiologists and nurses, will also be familiar with your particular cancer and treatment.

Your primary care provider may be able to find someone specializing in your diagnosis. Some physicians’ websites will identify sub-specialties, and you can also ask for guidance from patient advocacy groups focused on your type of cancer. When you reach out to a doctor, don’t be shy about asking how many patients with similar cancers they treat per year.

Mr. Lyle hesitated to get a second opinion for fear of offending the first doctor he’d seen. But he ultimately chose to do so, a step many experts recommend. “Medicine is an art, and there are sometimes differences of opinion,” said Karen Knudsen, the chief executive of the American Cancer Society. Weighing those differences can help you make a more informed choice.

If a second physician agrees with your original treatment plan, it can give you more confidence in the approach. Research suggests a second opinion can also lead to clinically meaningful changes in treatment. One 2023 study of 120 cancer patients found that a for a third of patients, a second opinion led to treatment changes that yielded better outcomes. Many had received evidence-based care from their first doctor but decided after a second opinion to scale back treatments that might have been unnecessary and had harmful side effects.

Mr. Lyle said that during his first conversation with a physician, he didn’t know enough to ask the right questions about his diagnosis and newer treatment options. “The fine points, you’re not aware of yet. So you almost need a rehearsal,” he said. (For help with what to ask during an appointment, the National Comprehensive Cancer Network has detailed information about care for many cancers.)

When it is clinically appropriate, some cancer centers now offer second opinions through telehealth. You can call to see if it’s possible to submit your medical records and get a remote consultation.

Find more:

What to Know About the HPV Vaccine and Cancer Prevention

New research shows many eligible people are not getting the shots.

Nearly 20 years after the first vaccine against human papillomavirus became available, many eligible Americans still are not getting the shot — even though it provides powerful protection against the leading cause of cervical cancer and a strong risk factor for anal cancer.
HPV is the most common sexually transmitted infection in the United States, and while most infections are asymptomatic and clear up on their own within two years, a small number persist and can cause cancer. HPV causes nearly all cases of cervical cancer, and can also lead to penile, anal, oral, vulvar and vaginal cancers.

The HPV vaccine, delivered as two or three doses, can significantly cut the risk of infection. It “is really one of the most effective vaccines we have,” said Dr. Lauri Markowitz, the HPV team lead in the Centers for Disease Control and Prevention’s division of viral diseases. But uptake remains stubbornly low: A report released by the C.D.C. this month showed that in 2022, only 38.6 percent of children ages 9 to 17 had received at least one dose of the HPV vaccine. Other new research suggests that HPV vaccination rates stalled in the wake of the coronavirus pandemic.

A study published this week laid out some of the primary reasons cited by parents in the United States who don’t plan to vaccinate their children against HPV, including safety concerns, a lack of knowledge about the vaccine and a belief that it isn’t necessary.
“We are still facing an uphill battle from what I would call inappropriate messaging or incomplete messaging when the vaccine rolled out about why this is so important,” said Karen Knudsen, chief executive of the American Cancer Society.

The HPV vaccine fools the body into thinking it has come into contact with the virus, marshaling antibodies in defense. Those antibodies can help clear the virus and prevent infection if someone is later exposed, which can happen through oral, anal and vaginal sex.

The vaccine offers protection from the types most likely to cause cervical and anal cancers and genital warts. Since the vaccine was introduced in 2006, infections with the types of HPV that cause most HPV-related cancers and genital warts have fallen by 88 percent among teen girls and by 81 percent among young adult women, according to the C.D.C.
One reason doctors are so enthusiastic about the vaccine is that it is one of very few tools to combat HPV: Condoms do not entirely prevent transmission, and there is no treatment for the virus itself. Researchers believe HPV is responsible for more than 90 percent of cervical and anal cancers and a majority of vaginal, vulvar, and penile cancers.

Children can be vaccinated starting at age nine. The C.D.C. recommends the vaccine for all preteens from the age of 11 or 12 and anyone up to age 26. It’s most effective before people are exposed to the virus, and “the assumption is that most people have started having sexual intercourse by age 26,” said Dr. Ban Mishu Allos, an associate professor of medicine at Vanderbilt University Medical Center.

The vaccine may still provide some benefit for people over age 26, and is approved up until age 45. The C.D.C. says that people between the ages of 27 and 45 might get the vaccine after talking to their doctors about their risk for new HPV infections.

You can ask your primary care doctor or local health centers for the vaccine. Most insurance plans fully cover it through age 26. Children and adolescents who are uninsured or underinsured can get the shots for free through the Vaccines for Children program. After age 26, insurance may not fully cover the shot, which can cost hundreds of dollars per dose. Merck, which makes the HPV vaccine Gardasil 9, has a patient assistance program for eligible people.

Researchers believe much of the hesitation stems from a key misunderstanding: “More people perceive it as a sexually transmitted infection prevention vaccine, as opposed to a cancer prevention vaccine,” said Kalyani Sonawane, an associate professor of public health sciences at the M.U.S.C. Hollings Cancer Center and an author of the new paper on parental attitudes toward HPV vaccination.

Dr. Sonawane’s research has also found that many parents are concerned about side effects. But doctors say many people do not experience side effects, and for those that do, the issues are generally mild and can include arm soreness, nausea, dizziness or, in some cases, fainting.

Doctors urge parents to vaccinate their children before they’re likely to become sexually active, which gives some parents pause, said Dr. Monica Woll Rosen, an obstetrician-gynecologist at the University of Michigan Medical School.

You’re doing something to prevent them from getting cancer in 30 years,” she said, “and the disconnect might be too large for some people to really wrap their heads around.”

 

Find more : https://www.nytimes.com/2024/02/22/well/live/hpv-vaccine-cancer.html

Telehealth Palliative Care Provides the Same Benefits as In-person Care

A recent study found that video-based telehealth palliative care produced results similar to in-person palliative care for patients with advanced non-small cell lung cancer and their caregivers. The study, presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting in June, found that quality-of-life scores were virtually the same for telehealth and in-person palliative care.

Barriers Impacting Access to Palliative Care

According to Lindsey Ulin, a palliative care fellow at Massachusetts General Hospital and Dana-Farber Cancer Institute in Boston, who was not involved in the study, palliative care is focused on providing supportive care to people living with cancer and other serious illnesses. Palliative care physicians help manage symptoms and side effects like pain, fatigue and nausea.

According to a 2019 analysis in Quality of Life Research, patients with advanced non-small cell lung cancer and family members or friends who care for them often face physical, emotional and financial challenges that may impact their mental health and overall quality of life. And a 2024 article in American Society of Clinical Oncology Educational Book argued that early integration of palliative care alongside cancer treatment can improve patients’ quality of life.

However, both Greer and Ulin say many barriers limit access to this care for advanced-stage patients and their caregivers. Common roadblocks include hospitals and clinics not offering palliative care, the misconception that palliative care is only for people at the end of life, transportation issues and the cost of care.

“The hope is that telehealth palliative care reduces these burdens for the patient and the caregiver,” Greer says.

Telehealth Palliative Care Study Shows Promising Results

Greer’s study involved 1,250 patients with advanced non-small cell lung cancer and their caregivers. His research team randomly assigned participants to telehealth or in-person early palliative care across 22 cancer centers in the United States.

Participants attended palliative care appointments every four weeks throughout their cancer treatment. At the week 24 assessments, quality-of-life scores were similar for telehealth (99.67) and in-person palliative care (97.67) based on the Functional Assessment of Cancer Therapy-Lung (FACT-L).

Researchers found there wasn’t a significant difference in patient-reported symptoms, such as anxiety and depression, between the groups. “These are fairly standard measures when looking at the effects of palliative care,” Greer says. “We look at these because we’ve found that palliative care clinicians can help patients improve their quality of life, as well as their symptoms of anxiety.”

One difference that study data revealed was less caregiver involvement (36.6%) in virtual palliative care than in-person care (49.7%). “We had hypothesized that, given how convenient telehealth is, it would be easier for caregivers to participate,” Greer says. “We realized that telehealth gives patients more autonomy to decide when to have a caregiver present. But with in-person care, the patient often needs a loved one to help them get to the clinic.”

“In palliative care, we think about the person living with cancer and their caregiver together as a unit,” Ulin says. “Palliative care is an extra layer of support, helping caregivers cope, communicate with other providers, understand a cancer diagnosis and treatment options, and provide resources.”

See more
https://www.cancertodaymag.org/cancer-talk/telehealth-palliative-care-provides-the-same-benefits-as-in-person-care/

Ending financial discrimination for cancer survivors: embedding the Right to be Forgotten in legislation across Europe

A new study published today in The Lancet Oncology highlights that many of the current 20 million cancer survivors across Europe are being discriminated against in accessing financial services, including loans, mortgages, health and travel insurance.

The work indicated that on average, up to 25% of those living beyond their cancer may be having more difficulty accessing appropriate financial services.

A European-wide effort is currently attempting to fight this discrimination, by supporting the introduction of legislation that will permit successfully treated cancer patients to not declare a previously diagnosed cancer, so that their diagnosis is essentially “forgotten”.
In January 2016, France became the first country in the world to introduce the “Right To Be Forgotten”, specifying that long-term cancer survivors do not have to share medical information with a financial institution about their cancer diagnosis after a delay of five years without recurrence. Seven other European countries have since taken similar legal measures to counter financial discrimination against cancer survivors. Other European Member States have chosen to implement self-regulatory codes of conduct (Denmark, Finland, Greece, Ireland, Luxembourg), but these are not legally binding.

With over eight years of experience, evidence from France indicates no significant negative impact on insurance companies operating in the French jurisdiction.

Those who are living beyond their disease should not be penalised for a previous cancer diagnosis. Cancer patients across Europe who have been successfully treated should, by law, be able to avoid disclosing a previous diagnosis of cancer, so that they can access the financial services that they need.

Professor Lawler added: “This is not about compassion; this is about evidence and acting on that evidence. When a cancer professional says that you are cured and international benchmarking agrees, then why do the financial institutions say that you are not? Don’t make cancer patients pay twice. Ensure the Right To Be Forgotten is enshrined in law throughout Europe.”

Read the full study here: https://lnkd.in/e_PZHn_j

It’s never been more important to focus on cancer prevention

With an ageing population, cancer cases predicted to increase from 17 million to 30 million by 2040 and rising levels of overweight and obesity, it’s never been more important to focus on cancer prevention. Over 40% of cancers could be prevented if we all lived healthy lifestyles, including maintaining a healthy weight, being physically active and eating a healthy diet.

But what does this mean in practice? Every day we’re bombarded with information about what’s healthy and what isn’t. It can be confusing and seem contradictory: what’s missing is the context – how do all the disparate pieces fit together to make a coherent picture?

That’s where our Global Cancer Update Programme, formerly known as the Continuous Update Project, comes in. This huge undertaking pulls the puzzle pieces together to show how what we eat, what we weigh and how active we are all affect our risk of cancer. The Expert Paneloverseeing the process then use that information to develop Recommendations for Cancer Prevention.

A while back I wrote about how this work was moving into a new and exciting phase of development. This new phase has now started and the programme has changed in a number of ways. It’s more:

  • targeted – looking at specific research questions such as early life exposures and their impact on cancer risk later in life.
  • collaborative – to increase the reach and scope of the work a number of collaborations with leading international research groups will take place that focus on specific areas such as dietary patterns and the life course.
  • efficient – we are shifting from reviewing all risk factors for every cancer to systematically scanning the evidence to identify which topics are likely to be the most fruitful areas of detailed study. Integrating more automation into the review process will be central to this.
  • inclusive – in addition to looking at cancer prevention, the work will expand to encompass cancer survivors. With improved diagnosis and treatment the good news is that there is a growing population of people living with and beyond cancer. The Global Cancer Update Programme will help us to understand how diet, nutrition and physical activity can improve long-term health and prolong survival after a cancer diagnosis.

There are four major themes to the work:

1. Cancer incidence

Looking at how a wide range of factors relating to diet, nutrition and physical activity as well as patterns of diet and lifestyle can affect cancer risk – either through decreasing risk or increasing it.

2. Cancer survivors

Focusing on the impact of diet, nutrition and physical activity on long-term health (cancer and non-cancer related morbidity, mortality and quality of life) after a cancer diagnosis. As part of this, we will look to determine for the first time the impact of diet, nutrition and physical activity on childhood cancer survivors.

3. Cancer mechanisms

Understanding the biological processes that underpin the links between diet, nutrition and physical activity and cancer.

4. Obesity

Ensuring previous work in relation to overweight and obesity remains up to date, given its critical role in increasing the risk of many cancer types. In addition, we will explore whether more specific guidance can be made for preventing obesity in adulthood and early life.

This comprehensive programme of work will allow us to look more deeply at how diet, nutrition and physical activity affect cancer risk and survival. In the next few years, the Global Cancer Update Programme will enable a more sophisticated understanding, with a more personalised approach to cancer prevention and survival than ever before.

Find out more about our Global Cancer Update Programme

Commercial determinants of health: how they are driving up rates of cancer and other NCDs

A new report from the WHO Regional Office for Europe looks at the impacts of the commercial determinants of health

Tobacco, alcohol, highly processed foods and fossil fuel industries cause 19 million deaths per year globally. These shocking statistics, reported in Commercial Determinants of noncommunicable diseases in the WHO European Region, show how commercial activities are harming our health and increasing the global burden of non-communicable diseases (NCDs), including cancer (WCRF International contributed to two case studies to this report, one on civil society engagement and one on alcohol warning labels).

The commercial determinants of health (CDOH) assess how commercial industries and their products can influence and impact the overall health and health equity of people, and whole societies.

Impacts of CDOH are felt across society, from the individual consumer, their health behaviours and choices, extending to global levels of consumption, and the politics and economics of increasing globalisation.

Health-harming industries

Commercial determinants that negatively impact health involve products from unhealthy commodity industries, which produce and sell health-harming products such as:

  • tobacco
  • alcohol
  • highly processed foods
  • and fossil fuels

The recent WHO/Europe report shows how exposure to these health-harming products is driving up already exceptionally high rates of cancer and other NCDs globally.

In the European Region alone, almost two thirds (61.3%) of deaths caused by NCDs can be attributed directly to risk factors linked to unhealthy diets, physical inactivity, alcohol and tobacco consumption.

This equates to an estimated 2.7m deaths annually, or more than 7,400 deaths every day. Many of these deaths could be prevented with reduced exposure to these commercial products.

Corporate channels of influence

You will certainly have experienced commercial forces at play in the world in both visible and invisible ways. Industries influence and impact health, and undermine policymaking through the following corporate channels:

  • marketing and advertising
  • engaging in corporate social responsibility strategies and activities
  • lobbying governments and policymakers; and
  • deflecting attention away from their role and responsibilities in causing health harms

Marketing and advertising enhance the acceptability and desirability of health-harming products. Often selling a certain lifestyle, aesthetic or experience, it normalises these products as part of everyday life, as well as more aspirational ways of living.

Marketing and promotions have been found to disproportionately target low socioeconomic status or minority populations, with industry tactics ranging from timing marketing campaigns to coincide with the distribution of benefits from food assistance programmes, to aiming advertisements directly at children.

Corporate social responsibility activities serve to improve corporate brands and reputations. Coca-Cola or PepsiCo’s frequent sponsorship of sports teams, events, and funding children’s physical activity programmes seeks to shift focus away from how their own products contribute to the obesity epidemic, and instead reflect favourably on their support for physical activity promotion.

DrinkAware, an alcohol-industry funded health information organisation, promotes “responsible drinking” campaigns (despite alcohol being classified as a Group 1 carcinogen that is causally linked to 7 types of cancer), and engages in partnerships with government and public health agencies.

Lobbying governments and policymakers works to avoid or circumvent regulation. Examples include the food and beverage industry’s opposition to sugar-sweetened beverage taxes, or the alcohol industry’s use of legal threats to stop the implementation of health warning labels.

Public health experts are also targeted through less obvious channels, such as Coca-Cola’s emails to the US Centre for Disease Control (obtained through Freedom of Information Act requests) to advance corporate objectives over health, including trying to influence the WHO.

Other tactics include funding research and political parties to sway the evidence base and policymakers in their favour—influencing all levels of policy, from scientific evidence through to policy development and implementation.

Where does the buck stop?

Perhaps the most significant and insidious tactic used by health-harming industries is their deflection of responsibility. Industry uses the rhetoric of ‘personal responsibility’, ‘individual’ or ‘freedom of choice’ around the consumption of their products.

These messages shift the blame away from health-harming industries, and onto their customers. This argument is used not only to shape societal views around consuming tobacco, alcohol and unhealthy foods, but also in legal arguments to deny or downplay their responsibility and liability for the costs they impose on society.

Do not be mistaken: these efforts are intentionally well-crafted and funded. Health-harming industries seek to protect their own interests and offload their responsibility at the expense of public health. These narratives serve to manufacture doubt and increase uncertainty in the public, while simultaneously undermining trust in government agencies and scientific evidence to normalise the prevalence and use of their products.

Is addressing commercial determinants of health anti-business?

It’s also important to recognise what addressing CDOH is not. Addressing CDOH is not anti-business; but rather, it challenges the existing status quo and power imbalances. It also does not assume a solely negative impact: it accounts for industry actors to drive health and equity in either direction.

Profitable business and health promotion do not need to be mutually exclusive. For example, a coalition of Nestlé shareholders (co-ordinated by Share Action) has filed a resolution to challenge the company to increase their proportion of sales from healthier products.

Work to address CDOH is also not an attack on the free market, or personal liberties. It is about a consumer’s right to know about the risks involved with consuming a harmful product.

Say for instance you had a higher risk of developing breast cancer. Would knowing that drinking alcohol increases your risk of developing it, or 6 other types of cancer, impact whether you decide to consume alcohol? When buying products, would you want to be thoroughly informed about the risks you take?

Interestingly, critics of responses aimed to address CDOH often (knowingly or unknowingly) follow the same script taken straight from health-harming industries’ playbook.

This upholds the narrative that responsibility solely rests with the individual and does not hold corporations accountable for the health impacts of their products, or their influence through the four corporate channels.

Getting rid of the industry playbook; reframing the issues

But this criticism is misplaced: rather than effecting a ‘nanny-state’ or ‘prohibition’, addressing CDOH is an act to abolish and break free from the false-narratives and manipulation that industries employ for their own profit and gains.

Given the scale and size of transnational corporations, some with incomes higher than GDPs of whole countries, putting a focus on the CDOH and their impacts will have a global effect.

This is a movement to shift the focus and alignment of political will in a direction that better serves public health and health outcomes, including the reduction of health inequities, and incidence of cancer and other NCDs.

For more information on CDOH
> WHO Europe Report Commercial Determinants of noncommunicable diseases in the WHO European Region – the report also contains a number of case studies, which WCRF International has contributed to.

Nearly half of adult cancer deaths in the US could be prevented by making lifestyle changes, study finds

About 40% of new cancer cases among adults ages 30 and older in the United States — and nearly half of deaths — could be attributed to preventable risk factors, according to a new study from the American Cancer Society.

“These are things that people can practically change how they live every single day to reduce their risk of cancer,” said Dr. Arif Kamal, chief patient officer with the American Cancer Society.

Smoking was the leading risk factor by far, the study found, contributing to nearly 1 in 5 cancer cases and nearly a third of cancer deaths. Other key risk factors included excess body weight, alcohol consumption, physical inactivity, diet and infections such as HPV.

Overall, researchers analyzed 18 modifiable risk factors across 30 types of cancer. In 2019, these lifestyle factors were linked to more than 700,000 new cancer cases and more than 262,000 deaths, the study found.

Cancer grows because of DNA damage or because it has a fuel source, Kamal said. Other things — such as genetics or environmental factors — can also create these biological conditions, but modifiable risks explain a significantly larger share of cancer cases and deaths than any other known factors. Exposure to sunlight can damage DNA and lead to skin cancer, for example, while fat cells produce hormones that can feed certain cancers.

“With cancer, it oftentimes feels like you have no control,” Kamal said. “People think about bad luck or bad genetics, but people need to feel a sense of control and agency.”

Certain cancers are more preventable than others, the new study suggests. But modifiable risk factors contributed to more than half of new cases for 19 of the 30 types of cancer evaluated.

There were 10 types of cancer where modifiable risk factors could be attributed to at least 80% of new cases, including more than 90% of melanoma cases linked to ultraviolet radiation and nearly all cases of cervical cancer linked to HPV infection, which can be prevented with a vaccine.

Lung cancer had the largest number of cases attributable to modifiable risk factors — more than 104,000 cases among men and 97,000 among women — and the vast majority were linked to smoking.

After smoking, excess body weight was the second largest contributor to cancer cases, linked to about 5% of new cases in men and nearly 11% of cases in women. It was associated with more than a third of deaths from cancer of the endometrium, gallbladder, esophagus, liver and kidney, the new study found.

Another recent study found that the risk for certain cancers was significantly reduced for people taking popular weight-loss and diabetes medications such as Ozempic and Wegovy.

“Obesity is emerging, in some ways, as just as potent of a risk for people as smoking is,” said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. He was not involved in the new study, but has prior experience working on cancer prevention initiatives.

Intervening on a set of “core behavioral risk factors” — quitting smoking, eating well and exercising, for example — can make a “dramatic difference in the rates and outcomes of chronic diseases,” Plescia said. And cancer is one of those chronic diseases, just like heart disease or diabetes.

Policymakers and health officials should work to “create environments where it’s easier for people, where the healthy choice is the easy choice,” he said. And it’s particularly important for people who are living in historically disadvantaged neighborhoods, where it might not be safe to exercise or easy to get to a store with healthy food.

As rates of early-onset cancer rise in the US, it’s especially important to create healthy habits early, experts say. It’s harder to quit smoking once you’ve started or lose weight that you’ve gained.

But “it’s never too late to make these changes,” Plescia said. “Turning (health behaviors) around later in life can make a profound difference.”

And making lifestyle changes to minimize exposure to certain factors can reduce cancer risk relatively quickly, experts say.

Cancer is something your body fights every single day as your cells divide,” Kamal said. “It’s a risk that you face every day, and that also means that the reduction of the risks can benefit you every day as well.”

READ MORE :

https://edition.cnn.com/2024/07/11/health/cancer-cases-deaths-preventable-factors-wellness/index.html?utm_source=salesforce-marketing-cloud&utm_medium=email&utm_campaign=July+23%2c+2024+Cancer+Today+eNewsletter&utm_term=Read+More+in+Cancer+Today

What Is a Cancer Vaccine?

When you hear the word “vaccine,” you might think of your annual flu shot or COVID booster, but did you know that some vaccines can treat—or even prevent—cancer?

But before we get there, let’s start with the basics—what is a vaccine? How does it protect you from disease?

A vaccine at its core delivers something associated with disease, such as a protein, into your body, which trains your immune system to recognize and react to the disease later on.

Think of it as training a dog on a specific scent.

Flu vaccines, for example, deliver pieces of a protein from the flu virus. Your immune system sees the protein, recognizes that it doesn’t belong in your body, mounts an immune response against it, and stores this information in its “memory.”

Now that your immune system has been trained to respond to this flu protein, it will be ready to attack if you later are infected with the flu, allowing it to rapidly get rid of the virus before it has a chance to make you sick.

CAN VACCINES PREVENT CANCER?

Yes! Several vaccines protect against human papillomavirus (HPV), the most common cause of cervical cancer and a major cause of anal, oral, throat, and genital cancers. By preventing HPV infection, these vaccines also prevent the cancer-causing changes induced by HPV.

The first HPV vaccine was approved by the U.S. Food and Drug Administration (FDA) in 2006, and since that time, the rate of cervical cancers has dropped significantly among people who were vaccinated as adolescents.

The Center for Disease Control (CDC) recommends HPV vaccines for all adolescents (boys and girls) beginning at age 11 or 12 and up to age 26 for those who didn’t receive them earlier. Some people might be eligible for the vaccine after age 26 as well.

HOW DO VACCINES TREAT CANCER?

The vaccines we’ve discussed so far are preventive vaccines—they help people avoid a particular disease. Other vaccines, known as therapeutic vaccines, are instead used to treat patients already diagnosed.

Therapeutic vaccines for cancer work in the same way as preventive vaccines: biological material is injected into the patient, where it trains the immune system to find and attack disease, cancer in this case.

To date, only one targeted therapeutic cancer vaccine has been approved by the FDA, but researchers have continued to develop and test different types of cancer vaccines, with many of these showing recent promise against hard-to-treat cancers.

Unlike vaccines that target viruses, therapeutic vaccines for cancer train the immune system to attack the patient’s own cells, rather than an invading virus. Researchers, therefore, have to find ways to direct the immune response to cancer cells to avoid damaging healthy tissue.

To minimize effects on normal, noncancerous cells, therapeutic cancer vaccines train the immune system to recognize proteins that are either absent from normal cells or found at significantly lower levels on normal cells. Vaccines expose immune cells to these proteins in various ways, based on the type of vaccine.

PROTEIN-BASED VACCINES

Sipuleucel-T (Provenge), the sole FDA-approved therapeutic vaccine for cancer, was greenlit in 2010 for prostate cancer. It works by delivering small pieces of a protein found at high levels in prostate cancers. When the patient’s immune cells encounter the delivered protein, they become more likely to attack prostate cancer cells.

Multiple protein-based vaccines delivering other target proteins are under investigation for a variety of cancer types, including head and neck, lung, pancreatic, brain, and colorectal cancers, among others.

While protein-based cancer vaccines can be highly effective and well tolerated, they are expensive, time-consuming, and oftentimes difficult to develop.

RNA-BASED VACCINES

Another category of cancer vaccines uses messenger RNA (mRNA)—the same design used to develop the first COVID-19 vaccines. Instead of delivering the target protein, these vaccines provide cells with the genetic instructions (in the form of mRNA) to make the protein, which, in turn, stimulates the immune system to seek out and attack cancer.

mRNA-based vaccines can be produced much more rapidly than protein-based vaccines, but delivering the mRNA and preventing bothersome side effects can be a challenge.

mRNA-based vaccines are being tested to treat a myriad of cancer types, with recent success against advanced skin and pancreatic cancers. Many of these vaccines are custom-made for each patient—a level of personalization made possible by the mRNA platform, which allows custom vaccines to be produced quickly and without major delays in treatment.

DNA-BASED VACCINES

Like RNA-based vaccines, DNA-based vaccines deliver instructions to make the target protein, but they provide the instructions as DNA rather than mRNA.

DNA-based vaccines have many of the same benefits as RNA-based vaccines, including the inexpensive and rapid production. DNA-based vaccines, however, may cause autoimmune reactions or impact the patient’s own DNA. Further, administering DNA-based vaccines requires unconventional methods, and once administered, DNA still has to make its way into a specific compartment of the cell to function.

Despite these challenges, DNA-based vaccines have shown clinical promise against various solid tumors, such as cervical cancer, breast cancer, glioblastoma, and others.

VIRAL- AND BACTERIAL-BASED IMMUNE STIMULANTS

While not quite cancer vaccines, a related category of cancer therapy exploits the innate ability of viruses and bacteria to stimulate the immune response. The bacterial strain Bacillus Calmette-Guérin (BCG), for example, was originally developed as a preventive vaccine for tuberculosis but is now also used to treat bladder cancer. When BCG is administered into a patient’s bladder, it triggers an immune response within the organ that helps kill cancer cells.

Researchers are also using modified viruses that preferentially infect and kill cancer cells to release immune-stimulating molecules from cancer cells, with one such therapy approved to treat certain melanomas.

NEW DIRECTIONS IN VACCINE RESEARCH

Researchers continue to explore innovative strategies to improve therapeutic cancer vaccines, combining them with other immunotherapy drugs, using new technologies to identify and test novel designs, and developing faster ways to produce vaccines.

To learn about anticipated progress in the field of cancer vaccines, check out our interview with cancer vaccine expert Catherine J. Wu, MD, FAACR.

Read more

What Is a Cancer Vaccine?