Cancer Prevention and Treatment in Europe vs. the U.S.

John Whyte, MD; Fabrice Barlesi, MD, PhD


November 23, 2022

JOHN WHYTE: Welcome, everyone. I'm Dr. John Whyte, the Chief Medical Officer of WebMD. And you're watching our video series, Cancer in Context, where we explore some of the latest innovations in cancer care.

Have you ever wondered about cancer rates around the world? Here in the United States, we have higher cancer rates than Europe. But also higher survival rates. Does treatment vary based on where you live?

While Europeans make up only 1/10 of the world's population, about 25% of all annual cancer cases occur in Europe. What progress is being made in Europe? And what can we learn?

Well, joining me to discuss these issues is Professor Fabrice Barlesi. He's a lung cancer specialist, and he's also the general director of Gustave Roussy, one of the world's leading cancer centers. Dr. Barlesi, thanks for joining me today from Paris, France.

FABRICE BARLESI: It's my pleasure.

JOHN WHYTE: Dr. Barlesi, I want to start with cancer rates in Europe. Cancer is the number one cause of death in Europeans under the age of 65. Why do you think that might be? Is it an issue of higher smoking rates? Is it diet?

Is it -- some people will say it's socialized medicine. But what do you see as some of the factors that might be causing that?

FABRICE BARLESI: We consider this in France that 40% of the cancer cases are evitable. And we believe that there are four different causes that are responsible of those cancer -- tobacco exposure, of course, is the first one, with alcohol consumption. But we also know that the overweight and the lack of sports, or at least physical activity, are associated with -- the foods are, in fact, responsible of the vast majority of this cancer that may be evitable for our subjects.

JOHN WHYTE: Well, I want to talk about prevention as well as screening. So I had the opportunity to attend ESMO, the European Society of Medical Oncology in Paris. And there actually was a whole booth and a whole discussion around prevention. One doesn't normally see that at scientific conferences.

Are we finally putting more focus on prevention of cancer?

FABRICE BARLESI: We have precision programs regarding how we consider the risk for every subject, and how we can be more and more precise. And being more precise, we can adapt our strategy regarding what you should do, what is the follow-up or the type of screening procedures you should follow, in order to decrease the risk of being sick of cancer.

JOHN WHYTE: Does Europe do a better job focusing on prevention than the rest of the world?

FABRICE BARLESI: I don't know. I think the situation is clearly heterogeneous across the different countries in Europe. But when we look at the huge effort the European community is putting on cancer fighting, and you know that Europe has set up a large, I believe that the prevention took much importance compared to the past.

And just as an example, I can tell you that the Ministry of Health in France that was called Ministry of Health for, I don't know, thousands of years, is in fact now the Ministry of Health and Prevention. And it highlights the fact that our view about prevention is clearly changing, and we put more and more importance on that.

JOHN WHYTE: That's a big deal -- certainly not just name. Now, what about screening in terms of mammograms, in terms of colorectal screening.  How is Europe doing in screening rates?

FABRICE BARLESI: There are some European recommendations, I would say, regarding the screening, but all of the countries have not implemented the screening in the same way. I'm talking especially about lung cancer screening right now. For the other types of screening, of course, it's more in the [INAUDIBLE].

Then one of the issue is the fact that the rate of subjects that are eligible for the screening compared to the rate of subjects that are doing the screening is, in fact, quite low. If we look at the rate, it's clearly very low in some parts of Europe. And it could be as low as 30% of the eligible subjects for the screening procedure -- when we look at breast cancer screening, or even colorectal cancer screening.

Then, I believe once again, we should educate people. But we should educate people probably even the very young people. Because I believe they could convince their parents, their friends, to go to do a screening procedures, even if they are not concerned by themselves because they are [INAUDIBLE].

JOHN WHYTE: That's a good point, to encourage our friends to undergo screening. We often don't do that in the United States. I want to talk about when people ultimately are diagnosed with cancer, does cancer care vary in Europe versus the rest of the world? And you're based in France, so let's talk about France.

Is there a difference in terms of access to drugs, in terms of tumor histology? What are you seeing, if anything, in terms of perhaps it may differ, say, in France, versus the United States?

FABRICE BARLESI: We are quite lucky in France regarding the program we have. And as you know, I think like 20 years ago, there was a decision by the French president to create the French NCI, and there were large programs. But on the organization and the accessibility and the equity of care, for the cancer care, for the French population.

Then I would say regarding the multidisciplinary management of the patients, regarding the access to all the imaging techniques, the modern imaging techniques, the access to high level surgery, but also to specialist, etc. And also to the genotyping. And then, I believe that right now, there is quite good access to all these procedures -- maybe one of the huge difference regarding, I would say, at least French but it's probably true across Europe, is the access to the new drugs.

JOHN WHYTE: I want to go back to this issue of education, and how we need to educate patients, the public, about prevention measures, about screening measures. But you're at Gustave Roussy, the leading oncology center in France, one of the leading cancer centers around the world. We also have to educate our colleagues.

So how do you educate physicians in your community about those latest innovations that you were just referring to? Sometimes there seems to be information overload. What strategies do you utilize at your center?

FABRICE BARLESI: In fact, we use a lot of different strategies, and we try to provide our physicians, but also our nurses, and all the health care workers inside Gustave Roussy, but also outside Gustave Roussy, with different way to be informed about innovations in the field of cancer care.

Then, we use a podcast within the institution. We use small videos. We ask all of our key opinion leaders to communicate about their research, about the work they are presenting during international meetings. We have also summaries of those meetings that are open to a larger public, even outside Gustave Roussy.

I believe that we should try to use the modern tools that we have. And especially, we know the role right now of the social networks.

JOHN WHYTE: Now, you referenced precision medicine. There are a lot of high-tech aspects of cancer care. But on your site, you talk about the need, particularly in cancer care, of being hands on. So how do you reconcile that, Dr. Barlesi?

These high-tech strategies that we have in imaging, and biopsy, and different types of immunomodulators, yet, at the end of the day, patients also need to be touched. We need to have the laying on of hands, as we often talk about in medicine. How are those reconciled at Gustave Roussy?

FABRICE BARLESI: In fact, one of the answer we provided in this field is we created a department that is dedicated to the patient journey. It's called the DIOPP. In fact, it's the interdisciplinary department for the organization of the patient journey.

The idea is that we try to better understand what are the patient characteristics at the time he's entering in our programs, in order to understand if there are some comorbidities, if there are some medications, some specific fragility regarding these patients.

And if there are some, then we try to monitor and to provide them with an adapted support during all of his or her care. And also this department is in charge of all of our digital programs regarding the follow-up of the patient. And we have digital tools, and the patients complete some data on the digital tools that is informing us if the patient is doing well, or if we need to call in or ask him or her to come back to the institution.

Then it's one of the things where we are providing regarding this balance, really high intensity, and I would say, humanity.

JOHN WHYTE: What does cancer care in Europe look like 5 years from now? Will it be very different than it is today? Or just a few tweaks?

FABRICE BARLESI: I believe it will be quite different. If we look at the speed of the innovations in cancer care, 5 years in the past, we can't believe that there will be probably large changes. Especially, I believe, in the field of prevention, screening, and, and how we manage on the multidisciplinary way the early stage of the older cancers. Probably with more oncological treatment, especially immunotherapy, in this stage.

And I believe that the progresses regarding cellular therapy will probably deeply change how we manage the patient. Probably in 5 years from now, it will be mainly through clinical trials. But we may imagine that all the types of new drugs we have that are modulating the immune environment, or that are manipulating the immune system, will take a large place and probably a larger place than it is right now.

JOHN WHYTE: Well, Dr. Barlesi, I want to thank you for taking the time today for breaking down what some of those differences are between cancer care in Europe and France and the rest of the world, as well as what you see of what the future looks like. So thank you.

FABRICE BARLESI: It's a pleasure. Thanks to you.

This interview originally appeared on WebMD on November, 17, 2022

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