The Lancet Commission on Oncology estimates that one million cases of cancer have gone undiagnosed in Europe in the last two years due to the impact of covid-19. It, therefore, calls for a doubling of the research budget in this area and for public health to be strengthened.

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The report says that patients treated in research-active hospitals have better outcomes than those who are not.

The covid-19 pandemic has highlighted the weaknesses of healthcare systems in cancer treatment, as well as the shortcomings of cancer research across Europe. “Improvements in these areas are urgently needed, otherwise progress against the disease will be delayed by almost a decade. This is the warning of a report by a group of experts from the Lancet Commission on Oncology.

The authors stress that “prioritising research is crucial for European countries to provide more affordable, higher quality and more equitable cancer care, as patients treated in research-active hospitals have better outcomes than those who are not.

“Against the backdrop of the coronavirus pandemic, Brexit and the Russian invasion of Ukraine, it is more important than ever that Europe develops a cancer research environment capable of playing a transformative role in improving prevention, diagnosis, treatment and quality of life for patients,” says Professor Mark Lawler, of Queen’s University Belfast, UK, and chair and lead author of the report.

According to Lawler, “it is estimated that during the covid-19 pandemic around one million cases of cancer went undiagnosed in Europe. In addition, we have seen a chilling effect on cancer research, with laboratory closures and delayed or cancelled clinical trials in the first wave of the pandemic.

Pandemic effects, the invasion of Ukraine and Brexit
The Lancet Commission on Oncology has analysed data on the impact of covid-19 across Europe and found that doctors saw between one and five million fewer cancer patients in the first year of the pandemic and that one in two patients did not receive surgery or chemotherapy in time.

In addition, 100 million screening tests were missed, and it is estimated that up to one million European citizens may have undiagnosed cancer due to delayed diagnosis.

The report, therefore, recommends accelerating the response to the indirect impact the pandemic has had on the diagnosis and treatment of this disease. “Now more than ever, it is crucial to ensure that this area of research is adequately protected and prioritised within current and future European agendas,” the expert’s stress.

Doctors treated between one and five million fewer cancer patients in the first year of the pandemic, and one in two patients did not receive surgery or chemotherapy in time, according to the report.

The authors explain that the Russian invasion of Ukraine represents another huge challenge for cancer research in Europe, as these two countries “are two of the largest contributors to clinical cancer research in the world, especially industry-sponsored research”.

They also stress that “many clinical trials in Ukraine involve cancer centres in central and eastern European countries, and the conflict is likely to result in many of these large trials being delayed or failing to recruit volunteers”.

An additional danger “is that industry may consider it too risky to conduct clinical oncology research in countries bordering Ukraine. The loss of private investment would be hugely detrimental to disease research in Central and Eastern Europe”.

The report calls for, as a matter of extreme urgency, “the collection of data on the impact of the conflict on patients, cancer services, drug and other shortages, and staffing shortages, in Ukraine and neighbouring countries, and the development of a plan to mitigate the impact of the war on cancer research”.

The group calls for data on the impact of the conflict on patients, cancer services, drug shortages and staff shortages in Ukraine and neighbouring countries, as well as a plan to mitigate the impact of the war on research.

The authors also predict that Brexit will continue to negatively affect European cancer research. They stress the need for funders and the European research community to mitigate the impact of Brexit and other policy challenges so that the UK can continue to collaborate with European partners and contribute to progress against the disease.

Gaps in research and research funding
The commission’s analysis found that the total amount of investment, excluding the private sector, was about €20-22 billion, about €26 per head. The equivalent minimum figure for the US in the same period was about 76 billion euros (234 euros per head). Given this dramatic difference in per capita spending, the experts call for a doubling of the European cancer research budget to €50 per capita by 2030.

The group argues that research into prevention has not received the funding it deserves. A greater focus on prevention would reduce the number of people who develop cancer and therefore make more resources available for those who do require treatment.

The report calls for a new priority to be given to research into prevention, screening and early detection of cancer to reduce the burden on European citizens and allow those who develop cancer to have access to more resources and the best treatments available.

Anna Schmutz of the International Agency for Research on Cancer (France) points out that “it is estimated that 40% of tumours in Europe could be avoided if primary prevention strategies made better use of current knowledge about risk factors. Evidence-based and cost-effective preventive interventions already exist, and we want to see more effective implementation and communication of these across Europe,” she says.

Gender gap in research
Gender equity in cancer research is another crucial gap identified in the report. It states that female lead authors account for less than a third of research studies in this field in Europe.

“More research is needed to investigate further the reasons why some European countries or regions have a greater gender gap in cancer research than others. We hope that strategies based on this data will improve the balance,” says Professor Yolande Lievens of Ghent University Hospital.

The Commissioners hope that the findings and recommendations of this report will help the oncology research community in Europe to work towards a more equitable agenda in which all citizens and patients, regardless of where they live, benefit equally from advances in this field.