There is nothing like first-hand evidence. This statement from Sherlock Holmes takes on a whole new meaning when applied to cancer care. Evidence-based care has a dramatic impact in improving outcomes for patients. For a policymaker or a doctor, much like a detective, following a trail of evidence is paramount to drilling down to finding solutions. Three key steps are to be followed:
- Gathering data
Gathering data to understand the scale and nature of the problem is the first step in understanding how to organise care and how to best allocate resources. Some types of cancer are harder to treat; investing in small advances in these difficult to treat cancers can make a big difference for patients. But we need to better understand the disease we are talking about.
For example, gastric cancer is a rare and heterogeneous cancer where evidence is scarce; this is in large part because it is often diagnosed at advanced stages, with survival rates varying widely between countries in Europe. In Sweden, gastric cancer has a mortality rate of 4.2% for both sexes, whereas it is almost three times higher in Latvia, at 15%. A working group of international experts convened by the International Agency for Research on Cancer ( IARC) called on countries with high gastric cancer burden to include the disease in their national cancer control programmes, and highlighted the need for more resources to be allocated to control the disease.
- Corroborating stories
Gathering the evidence is an important step but not the only one. An essential next step is to understand the story that the data is telling us. To do so we can approach it three ways: ask why, combine sources of knowledge and talk to the patients themselves. Patients’ preferences and outcomes are an essential piece of the puzzle and help us see what matters in real life. Another powerful tool is asking why the data is telling us X and not Y. A report released last week by the Institute of Health Economics looks into variations in cancer care, outcomes and costs across Europe over the last decade. It finds that, out of all European cancer patients diagnosed in 2012, 66,000 more than those diagnosed in 2002 will live for at least five years after diagnosis. And looks into some of the reasons why: earlier diagnosis, improved treatment options and multidisciplinary care.
- Take a decision based on the best evidence available
Finally, the evidence and the stories they tell us are only as good as the use we put them to. Cancer care based on solid evidence and shared decision-making is one of these uses. To use the example of gastric cancer once again and the 2016 World Congress on Gastrointestinal Cancer that is coming up next week: some sessions and a number of satellite symposia are looking at exactly how to put newly acquired knowledge into practice. Lilly oncology is supporting one of these discussions, as we truly believe that evidence-based making is crucial, be it in R&D, medical practice, or policy-making.
So maybe next week, after the congress, we will have more first-hand evidence on gastric cancer – and the challenge of how we use it is up to us. Let’s see if we can be as good with it as Sherlock Holmes.
 The report, entitled ‘comparator report on patient access to cancer medicines in Europe’ was financially supported by five EFPIA member companies. Lilly was not one of the sponsoring companies.