Cancer care in Italy
Italy’s healthcare system will face several challenges in the coming years to guarantee the overall sustainability of the system, while pharmaceutical innovations increasingly turn acute diseases into chronic ones.
In 2018, Italy recorded 3.3 million people surviving after a cancer diagnosis, with an overall 5-year survival rate of 63% for women and 54% for men. It was estimated that diagnoses of new cancers in 2018 would amount at 373,000, as stated by the most recent report of AIOM, the association of medical oncologists. Thanks to the development of both prevention campaigns and innovative therapies, prevalence increased by just 3% a year in the last 15 years. However, cancer still represents the second biggest cause of mortality in Italy, after cardiovascular diseases.1
While the financing of healthcare system as a share of GDP is experiencing a downward trend (from 6.6% in 2018 to 6.4% in 2021), expenditure for oncology drugs reached €5 billion in 2017, some 22% of public expenditure for drugs.2
Therefore, the overall system of cancer care must address a dual target of broad access and sustainability of therapies, technologies and assistance services. This goal can be reached by both increasing financial resources – as happened in 2017 with the creation of a €500 million fund for the purchase of innovative oncology drugs – and looking at streamlining the patient journey and properly allocating resources where they can create the greatest benefit for cancer patients.
All.Can Italy initiative
All.Can Italy looks at coalescing a multi-stakeholder platform – including patient associations, scientific societies, and both pharma and non-pharma companies – able to tackle these goals:
- Introducing discussion of the impact of innovation on the patient journey, from diagnosis to follow-up, into the policy agenda
- Identifying critical issues for patient access in the healthcare system
- Improving efficiency and sustainability of cancer therapies, favouring high-value care and assistance services.
All.Can Italy will work primarily on the collection of data and evidence about inefficiencies in care pathways for cancer patients, outlining whether heterogeneous organisation of regional healthcare systems is directly reflected in health outcomes.
Key milestones and activities
- Establishment of the platform and set-up of the first ad interim steering committee: Bristol-Myers Squibb as main sponsor, AbbVie as contributing partner, FAVO as first knowledge partner
- Appointment of Emilia Grazia De Biasi, former Head of the Health Committee of Italy’s Senate, as the platform spokeperson
- Official approval at the European CanCer Organisation (ECCO) summit in September 2018
- Set-up of the first working package: evidence collection about the organisation of cancer care and regional cancer networks
- Official launch of the platform and a multi-channel communication campaign on 19 February 2019.
References
- Rapporto Aiom – Airtum “I numeri del cancro in Italia – 2018 Available here: https://www.fondazioneaiom.it/wp-content/uploads/2018/10/2018_NumeriCancro-pazienti.pdf [accessed: January 2019]
- Rapporto OsMed 2017 Available here: http://www.aifa.gov.it/sites/default/files/Rapporto_OsMed_2017_AIFA.pdf [accessed: January 2019]
The start-up of the Italian platform involved a wide range of stakeholders from scientific societies and patient associations. All.Can Italy’s membership now encompasses leading patient associations such as FAVO and ACTO, a research foundation (Fondazione Melanoma) and specialised consultancies like IQVIA.
Steering group
Valerio Biglione
Bristol-Myers Squibb
Federico Fucetola
AbbVie
Luca Pinto
IQVIA
Francesco De Lorenzo
FAVO
Silvia Gregory
ACTO Onlus
Nicoletta Cerana
ACTO Onlus
Claudio Cartoni
AIL
Barbara Rizzi
VIDAS
Raffaella Gay
VIDAS
Adele Patrini
Scuola di Senologia
A successful best practice: continuity of care in hematology
All.Can Italy has been working for years to build initiatives that could raise awareness among institutions on how to better manage oncology patients and improve their treatment. These efforts include finding and collecting best practices from the territory that deserve attention, and the program carried out by hospital Policlinico Umberto I in Rome totally fits this description. Led by Claudio Cartoni and Maurizio Martelli of the hematology department, and supported by the Italian Alliance against Leukemia, Lymphoma and Myeloma (AIL Rome), the program aimed at facilitating access to home therapies for hematology patients, securing pharmacological treatment to pain and improving the wellbeing of people. The project presents one main difference from many other home care programs: it triggers a cultural change because specialists are asked to move out from the hospital and take their expertise at someone’s home.
The initiative consisted of patients being inserted in an integrated and simultaneous hospital-to-home care program, which allowed for a more appropriate use of the beds in hospital and incentivized the treatment in the best setting possible. In the years 2020-2021, during the COVID-19 pandemic, 243 patients were cared for at home by the Palliative Care Unit of the Policlinico Umberto I. Then, a non-randomized, real-life comparative study, published in the Journal of Palliative Medicine, was designed to evaluate the costs, resource use, and clinical outcomes comparing a home-based early palliative care program vis-à-vis a standard hospital care. The outcome of the study was revealing: at home, the average weekly number of transfusions (1.45) was lower than in hospital (2.77) and a higher rate of infections occurred in the hospital (54%) than at home (21%; <0.001).
The program turned out to be successful in financial terms as well. As a matter of fact, compared to the hospital, home care produced weekly savings of €2,314.9 for the healthcare system, with an additional burden of €85.9 for the family, thus making home care more appealing also for the sustainability of the system as a whole. Moving the hospital closer to patients is therefore beneficial in terms of both clinical and financial outcomes.
This successful practice was also awarded with a deliberation that officialized the AIL-Policlinico Umberto I partnership and extended the project with new funds to use. Aware of the potential of the initiative, All.Can Italy organized a press conference at the Senate, moderated by its spokesperson Paolo Bonaretti, to showcase and give visibility to the practice. Promoted by Senator Elisa Pirro, member of the Health Committee of the Senate, the press conference featured the presence of representatives of the Policlinico Umberto I, Claudio Cartoni, Maurizio Martelli and Alberto Deales, Health Director of the structure. Maria Luisa Viganò, President of AIL Rome, Massimo Annicchiarico, Director general of Healthcare in the Lazio region, and Rodolfo Lena, President of the Health Committee in the Lazio region, completed the panel.
“The great difference between this program and the traditional integrated home assistance” spcecified Claudio Cartoni “is that we moved specialist services towards the patients and we avoided patients to remain too much time in hospital”.
The press conference tried to shed light on a best practice which is reproducible elsewhere and to which every hospital can look up. Now that All.Can Italy has contributed to draw attention on the project, it is time for institutions to do their part. “My duty is to turn these local initiatives into a reality that every Italian citizen can enjoy everywhere they reside” claimed Senator Pirro during the press conference.
Hoping that politics will live up to expectations, All.Can Italy and all oncology patients will not step aside and will play their active part every day, working side by side with decision makers.
All.Can Italy’s analyses Europe’s Beating Cancer Plan from an Italian perspective
All.Can Italy – Updates
Report on regional disparities presented in Rome along with MPs and top cancer stakeholders
On December 9 All.Can Italy held its last event of 2019 where it presented the report ‘Regional disparities in cancer care: evidences and actions’.
All.Can Italy: poster on regional disparities presented at ISPOR
Outcomes of the All.Can analysis on regional disparities in cancer care across Italy have been presented at ISPOR.
All.Can Italy holds first public seminar on cancer networks
All.Can Italy held its first public seminar in Rome, bringing together patients, key opinion leaders and policymakers
All.Can Italy officially launches at event in Rome
All.Can Italy has officially launched, unveiling its aims and ambitions at a press conference in Rome on 19 February 2019.
A successful best practice: continuity of care in hematology
All.Can Italy has been working for years to build initiatives that could raise awareness among institutions on how to better manage oncology patients and improve their treatment. These efforts include finding and collecting best practices from the territory that deserve attention, and the program carried out by hospital Policlinico Umberto I in Rome totally fits this description. Led by Claudio Cartoni and Maurizio Martelli of the hematology department, and supported by the Italian Alliance against Leukemia, Lymphoma and Myeloma (AIL Rome), the program aimed at facilitating access to home therapies for hematology patients, securing pharmacological treatment to pain and improving the wellbeing of people. The project presents one main difference from many other home care programs: it triggers a cultural change because specialists are asked to move out from the hospital and take their expertise at someone’s home.
The initiative consisted of patients being inserted in an integrated and simultaneous hospital-to-home care program, which allowed for a more appropriate use of the beds in hospital and incentivized the treatment in the best setting possible. In the years 2020-2021, during the COVID-19 pandemic, 243 patients were cared for at home by the Palliative Care Unit of the Policlinico Umberto I. Then, a non-randomized, real-life comparative study, published in the Journal of Palliative Medicine, was designed to evaluate the costs, resource use, and clinical outcomes comparing a home-based early palliative care program vis-à-vis a standard hospital care. The outcome of the study was revealing: at home, the average weekly number of transfusions (1.45) was lower than in hospital (2.77) and a higher rate of infections occurred in the hospital (54%) than at home (21%; <0.001).
The program turned out to be successful in financial terms as well. As a matter of fact, compared to the hospital, home care produced weekly savings of €2,314.9 for the healthcare system, with an additional burden of €85.9 for the family, thus making home care more appealing also for the sustainability of the system as a whole. Moving the hospital closer to patients is therefore beneficial in terms of both clinical and financial outcomes.
This successful practice was also awarded with a deliberation that officialized the AIL-Policlinico Umberto I partnership and extended the project with new funds to use. Aware of the potential of the initiative, All.Can Italy organized a press conference at the Senate, moderated by its spokesperson Paolo Bonaretti, to showcase and give visibility to the practice. Promoted by Senator Elisa Pirro, member of the Health Committee of the Senate, the press conference featured the presence of representatives of the Policlinico Umberto I, Claudio Cartoni, Maurizio Martelli and Alberto Deales, Health Director of the structure. Maria Luisa Viganò, President of AIL Rome, Massimo Annicchiarico, Director general of Healthcare in the Lazio region, and Rodolfo Lena, President of the Health Committee in the Lazio region, completed the panel.
“The great difference between this program and the traditional integrated home assistance” spcecified Claudio Cartoni “is that we moved specialist services towards the patients and we avoided patients to remain too much time in hospital”.
The press conference tried to shed light on a best practice which is reproducible elsewhere and to which every hospital can look up. Now that All.Can Italy has contributed to draw attention on the project, it is time for institutions to do their part. “My duty is to turn these local initiatives into a reality that every Italian citizen can enjoy everywhere they reside” claimed Senator Pirro during the press conference.
Hoping that politics will live up to expectations, All.Can Italy and all oncology patients will not step aside and will play their active part every day, working side by side with decision makers.
Disclaimer:
The All.Can initiative is made up of leading representatives of patient organisations, policymakers, healthcare professionals, science and industry. All the publications produced under the initiative reflect the consensus of All.Can members who have full editorial control. The All.Can initiative in Italy is financially supported by Bristol Myers Squibb and AbbVie. None of the content developed in discussions and activities of the All.Can initiative contains direct or indirect references to specific medicinal products or therapies. The All.Can Italy platform currently includes patient associations such as FAVO, AIL, ACTO, Fondazione Melanoma, Vidas and Scuola di Senologia. Use of content from this website is permitted provided that the source of information is clearly mentioned.