Rob O'Connor, Irish Cancer Society Research
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We can't treat ourselves out of the emerging cancer and healthcare crises
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Rob O'Connor, Irish Cancer Society Research
- 1. Robert O’Connor, Ph.D. Head of Research & Head of Communications, Irish Cancer Society “We can’t treat ourselves out of the emerging cancer and healthcare crisis”- www.cancer.ie/research@drrobertoconnor /@irishcancersoc 1
- 2. The Irish Cancer Challenge -Currently • > 40,000 cancers newly diagnosed 2016 – >20,000 invasive cancers • ~9,000 die annually • Communicating this? – 40,000/365 = 110 per day 1/~13 mins – a death every hour of the week. • In reality – working week – A diagnosis every 3 mins, – A life changing diagnosis every 6 mins of working week • 1/3 will have cancer diagnosis in lifetime • numbers Doubling in 25 years!! 3
- 3. The Irish Cancer Challenge –future • NCRI cancer projections from 2010 to 2040 http://www.ncri.ie/sites/ncri/files/pubs/Cancer%20projections%20for%20Ireland %202015%20-%202040.pdf4
- 4. Why is this happening? 5
- 5. Older = more cancer 0 1000 2000 3000 4000 5000 6000 0~4 5~9 10~14 15~19 20~24 25~29 30~34 35~39 40~44 45~49 50~54 55~59 60~64 65~69 70~74 75~79 80~84 85+ Incidenceper100,000population Age group Cancer Incidence by age in Ireland 2004-2011 Female Male Strong mutation UV Chance Previous & current environment Mutational “load” Summary genetics Chance http://www.ncri.ie/data/incidence-statistics (all invasive cancers)6
- 6. Our population is aging = more disease Health in Ireland – Key trends 2015, Dept of Health http://health.gov.ie/wp- content/uploads/2015/12/Health_in_Ireland_KeyTrends2015.pdf8
- 8. So the numbers of people getting cancer are increasing • Age • Lifestyle • Awareness & diagnosis • More public openness about cancer 10
- 9. The cost of treatment • 2009 cancer cost Ireland €1.5billion or 0.9% of GDP 11
- 10. Cancer drug costs exploding 12
- 11. Numbers of new drugs increasing 15 for cancer indications 13
- 12. Summary • Numbers getting cancer will continue to rise • Treatments can be effective but • Costs per patient are shooting up ⇒On an ECONOMIC BASIS • WE WILL NOT TREAT OURSELVES OUT of this “EPIDEMIC” of CANCER 14
- 13. Research is saving lives – right here in Ireland 54% of adults cured (alive 10 years after diagnosis) Children - >90% of children leukemias cured ~70% of them involved in research by being on a trial 15
- 14. The reality of that current cancer “cure” 16
- 15. A cure – at what cost…. • Disability • Fatigue • Sexual issues • Mental health • Chronic pain • Medical issues 17
- 16. The Real Cost of Cancer in Ireland 18
- 17. Cancer survivors • >1/4 are disabled in some way following their treatment • But they are LIVING LONGER too • Economics – The personal costs are significant – Treatment and after treatment mount up – Ability to make economic contribution evaporates • THE COST OF SUSTAINING SURVIVORS IS ALSO MOUNTING 19
- 18. What do we do? 20
- 19. RESEARCHWE’RE 21
- 20. Research & ACTING ON research findings is the key 22
- 21. Action research – Applying same investment and rigour as employed in medicine research (clinical trials) to rest of the cancer “problem” • Test hypotheses about improving healthcare – Prevention – Early detection – Treatment Efficacy – Post treatment and End of life care 23
- 22. Prevention 24
- 23. Smoking prevention • Smoking kills ~5,500 Irish people each year • Annual Irish Health care costs alone > €500m (2009) • Typical cessation success rates – Drugs/cold turkey etc. ~5% 25
- 24. We can quit • Evidence-based 12 week supported programme in women from poorer communities • 46% Quit rate 26
- 26. Early bowel cancer detection • Bowel cancer kills ~1000 Irish people annually • But only 40% of women and 36% of men take free FIT test for bowel cancer 28
- 27. UK early detection figures From Early Detection – saves lives & money 29
- 28. Post treatment exercise – 46% lower mortality! 30
- 29. MedEx • Exercise improves outcome after serious disease 31
- 30. Summary • Cancer numbers are inexorably climbing • Much we can do to reduce disease & increase quality longevity • Modern, personalised cancer treatment is becoming economically unsustainable – WE WILL NO TREAT OURSELVES OUT OF THIS • No single solution • Need to attack problem at each point of intervention • Research is our only tool to guide evolution of a sustainable “wealthy” health future 32
Hinweis der Redaktion
- Hoping to persuade you that our current direction in research is no longer fit for societal or financial needs
- A brief note on the role of research in the Irish Cancer Society
- We have a big and growing cancer problems This has an enormous human cost
- Based on the anticipated aging profile, The national cancer registry projected the increase in cancer numbers in the coming decades Already it is apparent these estimates are low
- The challenge of cancer is not spread evenly among our community and the older we get, the more likely we will get cancer
- We are also living much longer This UK data slide shows the enormous improvements in lifespan 175 years ago half of the population died by the age of about 20. Today nearly 65 years has been added to lifespan
- Also our population is aging By that I mean the numbers of people living into older age Post retirement is growing substantially
- We know the major contributors to increased cancer risk And this means that roughly 40% of cancers could be prevented with some simple steps in childhood
- So cancer numbers are increasing Because we are living longer And because of poor lifestyle choice
- Although Ireland is on the lower level of expenditure in health in general, including cancer, this is still a lot of money. 7 years ago we spent 1% of GDP just on cancer treatment
- But costs of diagnosis and treatment of cancer are rocketing This is one of a range of new high cost treatments for very specific forms of cancer
- The numbers of such new drugs is also increasing This graph shows that 45 new drugs were approved by the FDS last year 1/3 of all of these were for cancer indications
- The take home points Cancer numbers will increase greatly in the coming years Treatment can be effective with up to 50% of patients cured but Per person Cost of that treatment is also growing Clearly this is not economically sustainable and We simply won’t treat our way out of this epidemic
- Notwithstanding the increased numbers of cancers Application of research knowledge means that survival rates have increased substantially This means now that 170,000 people are alive and living with cancer
- So what is the reality of those 170,000 people
- Treatment for cancer often leaves a life long legacy Macmillan data in the UK shows that 1.4 of treated patients have a disability
- We in the Irish cancer society have also researched the financial impact during treatment Extra costs associated with treatment leave cost the average patient nearly €900 Not including loss of earnings
- So ¼ people treated for cancer are rendered disabled People are living with cancer but there are major HR issues among employers about how best to deal with such challenges So many cancer patients can’t work but are living They have significant personal costs Treatment costs (borne by the insurance or state systems are getting bigger Can’t contribute to these costs So not alone are treatment costs rising but cost of sustaining survivors also high
- What can we do about this?
- Some of you might have seen the recent Matt Damon martian film I’m modifying it a little We are going to have to research the shit out of this.
- Undertaking action research and employing the proven outputs of that research
- Identify, test and prove hypotheses about how to improve things Focus on 4 areas Prevention stop cancer happening Early detection – pick up when it can more readily be cured Improve treatment And better management after treatment Let me give some examples
- Just to illustrate one aspect of cancer prevention Smoking has an unbelievable cost Most smokers want to quit but Traditional cessation rates succeed in 1 in 20 attempts
- By developing a targeted intervention Focussed on women called we can quite we have been able to bring the success rate to 46%
- If we take the example of Bowel cancer WE have a great free screening test for 60-69 yr olds But only 36% of men take up the offer We are researching how to bring that up
- Research from CRUK shows that early detection of bowel cancer Saves lives And costs much less
- There is increasing evidence that patients can greatly improve their own outcome after treatment Exercise has proven to greatly reduce death rate after treatment
- WE are supporting research in the DCU MEDEX programme Aimed at working out how best to bring exercise treatment to patients all across the country
- So, to summarise WE simply won’t treat our way of this cancer epidemic WE need to invest in research to guide improvements to give us a sustainable economically viable and wealthy health future