Cancer is now being targeted through a novel integration of genomics in clinical care and public health, known as CAN.HEAL. As the name suggests, this is bringing unprecedented power to bear in tackling and solving the challenges that cancer poses to patients, their relatives, and the population at large.
A Europe-wide consortium is set-up? to exploit unexplored synergies in public health and cancer genomics. This deployment of innovation has won backing from the European Commission for its role in meeting the ambitions of the Europe Beating Cancer plan and the Mission on Cancer, and. helping national cancer plans across Europe.
The project aims at aligning clinical and population-based interventions. By exploiting the increasing wealth of data on genomes it will allow better and earlier diagnosis. And by taking account of regulatory, scientific, economic, research and gender perspectives, it will increasingly make it possible to give the right treatment to the right patient at the right time. This is not only better for patients: it can also bring benefits to health care systems. Improved diagnoses and more effectively targeted treatments can help to reduce lost time for patients and doctors, and avoid waste of resources. The two strands of the project – care and protection – are reflected in the title CAN.HEAL.
A quarterly newsletter (sign up here) will provide regular information on progress and highlight the work of the partners as they drive the initiative forward. This inaugural issue provides an overview of the project and an outline of the objectives and work packages. As the project evolves, further information will appear on the project’s twitter account (@CAN.HEAL) and project website (URL), and can be obtained directly from the project coordinator (firstname.lastname@example.org).
Profiling of genomic modifications with new technology has become a major asset in tackling cancer, and CAN.HEAL springs from the recognition that both patients and citizens can benefit from a concerted approach that embraces both the clinical and public health aspects of personalised care.
The clinical arm of this dual approach focuses on applying next-generation sequencing technology to detect different types of alterations with a potential clinical utility. And in the public health arm, bringing new precision can help provide the right intervention to the right population at the right time, with the goal of improving health for all.
The beneficiaries range from cancer healthcare professionals and researchers to cancer patients, citizens and cancer healthcare policy makers. Patients and citizens will receive more effective clinical support, healthcare professionals will gain a broader view on the cancer of their patient or the risk of the citizen, and healthcare policy makers will be offered recommendations for integrated systems to lower the cancer burden of the population and increase quality of life. As the initiative develops, the target population will expand to include the health community at large as well as policy makers beyond the healthcare sphere.
The potential is enormous. It is now well-established that 40% of cancers are preventable. But in addition, there is increasing clarity over the hitherto unappreciated and underestimated burden of genetic susceptibility that gives rise to cancer risks. Making better use of large population-based studies and biorepositories, coupled with appropriate cancer genomics studies on health and sick people, can deliver invaluable new information on prevention.
The clinical aspect of CAN.HEAL will allow EU cancer centres to
· take advantage of national initiatives to structure omics use in patient care, with harmonized data interpretation and facilitated treatment decisions
· improve equity by sharing data on similar diagnostic and therapeutic approaches for patients with comparable cancer profiles across the EU
· exploit molecular tumour profiling biomarkers of cancer predisposition to allow better counselling of family members regarding cancer risk.
The public health aspect of CAN.HEAL will generate
· novel insights in estimating cancer risks in healthy populations, by using polygenic risk score analysis within population-wide interventions
· identification of people at risk in health systems through testing relatives of affected individuals
· strategies for remote genetic counselling and telegenetics, based on incidental findings on cancer status from genetic screening interventions
The initiative brings together two specific strands of current EU health planning: ‘Cancer Diagnostic and Treatment for All’, and ‘Genomics for Public Health’, and aims at creating a continuum of prevention, diagnosis, prognosis and treatment.
CAN.HEAL has synergies with a wide range of projects launched within the Europe Beating Cancer Plan, the Mission for Cancer and the Digital Europe strategy. It is complementary to numerous European programmes in genomics in cancer, and to multiple national and international initiatives integrating genomics into healthcare systems at clinical or public health level. It will link to recent EU initiatives in the fourth health programme (EU4H), to the JRC Knowledge Centre on Cancer, ICPerMed, the 1+Million genomes initiative and others. Its outcomes will contribute to the goals of the updated EU pharmaceutical legislation, the European Health Data Space, the implementation of the In Vitro Devices Regulation as well as other future projects.
Ongoing EU activities are engaged as use cases for the initiative, so as to provide evidence or tools for developing a platform that can pave the way for implementation at a broader scale.
Coordinating policies and innovation programmes in personalised medicine is an urgent need. CAN.HEAL is the response to the evident lack of international multi-centric collaboration necessary to advance large-scale high quality, viable prevention, diagnosis and treatment of cancer.
EU and member state policy makers require the best possible information and advice in minimising barriers to the uptake of personalised medicine at the political level, and the continuous technical dialogue offered by CAN.HEAL is capable of feeding into that. Patients can benefit in unprecedented ways – and so too can healthcare systems.
The process can improve value for money in cash-strapped healthcare systems that are struggling with ageing populations, increased co-morbidities and chronic diseases, and health workforce shortages at the same time as dealing with a new clinical trial paradigm in the wake of the discovery of ever more rare diseases, A restructuring care delivery has to be envisaged, with new care models, strategies and investments in a combination of novel bottom-up and top-down approaches.
Four clear challenges present themselves.
Key objectives to the initiative are:
Specific focuses of the work will include implementing NGS-based and liquid biopsy assays in clinical practice, establishing a quality management system for NGS-based clinical assays, standardizing assay-reporting outcomes, developing ethical and legal data governance for re-use of genomic data , and developing recommendations, guidelines, and best practices.
The work will be conducted in 14 work packages, covering Coordination, Communication, dissemination and outreach, Evaluation, Genome of Europe, Prevention/early detection, Polygenic risk scores and decision support tools, Diagnosis and treatment decision via Molecular Tumour Boards, Building clinical utility, Treatment and follow-up, Oncology decision support tools, NGS including liquid biopsy, Law, ethics and citizen engagement, Education & training, and Health care system implementation.
The CAN.HEAL agenda is under finalisation and will be published in early 2023.
Plenary meetings of CAN.HEAL are tentatively scheduled for Rome in late spring 2023 (27-28 April), Berlin in autumn 2023 and Paris in early spring 2024.
February 7 ‘Propelling early diagnosis into the twenties for cancer patients’. The importance of CAN.HEAL will be flagged up with MEPs and the European Commission at a meeting in the European Parliament on February 7 (shortly after World Cancer Day) hosted by EAPM, a co-lead of CAN.HEAL for communications.
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