2023-10-11 12:26:00
Postal code (postal code) also makes a difference on treatment. 40% of people with breast or lung cancer move from their municipality of residence for treatment and 20% of those who do not respond to approved and reimbursed therapies, despite meeting the requirements, are not sent to participate in a clinical trial , with experimental drugs, but to palliative care, due to the distance from the centers and the lack of easy transport. These are some of the results of the survey conducted by Elma Research on a sample of over 400 subjects, including patients and oncologists, as part of the Elma Academy project ‘Your postal code matters’, which aims to investigate and quantify the disparity of access to oncological treatments in relation to the place of residence in terms of accessibility, upon indication of the oncologist, to experimental treatments.
“Italy – states Senator Daniela Sbrollini, vice-president of the is not immune to the problem of inequalities, and finding solutions so that there is equal access for every patient must be a priority.”
In Italy, in 2022 – explains a note – the most diagnosed cancer (55,700 cases) was breast cancer, while lung cancer, with 43,900 new diagnoses, was the second most frequent neoplasm in men (15%) and the third in women (12%). For mortality, lung cancer is in first place (18% of all cancer deaths) and breast cancer occupies fifth place (6.9%). Even though these two neoplasms are responsible for the death of 1 in 4 people with cancer, access to clinical trials – calculated using the incidence of the disease, the distance from the centers and the number of experimental studies in the center as variables – is very different . If in the North-East, in the Center and on the Islands, for example, there are large areas with low or medium accessibility, in the North-West, the situation is reversed, with large areas with high accessibility. This translates into a disparity of possible therapeutic options depending on the place of residence of the patients.
The survey, which involved more than 200 oncologists dedicated to the management and treatment of patients with lung and breast cancers and over 200 patients equally distributed across the two diagnoses, highlighted how the postal code, understood as a place of residence, is accessible to all the effects are a criterion of choice for the oncologist on whether or not to include a patient in a clinical trial. With the same clinical picture, non-enrollment is 16% in high accessibility areas, 23% in low ones. 65% of the doctors interviewed reported that cost and organizational factors are the reasons for not sending, while for 36% it is the distance in terms of km and time from the center that discourages the choice.
“For some patients – explains Luca Mazzarella, Group Leader, Laboratory of Translational Oncology, Department of Experimental Oncology, European Institute of Oncology (Ieo) Milan – clinical trials represent the only therapeutic option and the possibility of improving health conditions and quality of life. But when faced with a diagnostic picture suitable for a specific clinical trial – he adds – the oncologist must also consider a series of elements for possible enrollment, such as the cost of reaching the centre, the support of a caregivers for those who are more fragile, family management and other aspects of the person’s life that may be crucial in being able to support and not interrupt the experimentation, while maintaining a good quality of life”.
Moreover, for 3 out of 10 patients the costs related to transfers and the lack of public transport services are the most difficult factors to deal with, together with the distance from loved ones (24%) and family and professional commitments (17%). However, moving is sometimes not a choice, especially for those who live in areas with low accessibility. 57% do so to reach centers capable of providing the best care and 30% do so due to the lack of centers capable of providing the care and tests they need.
“To improve accessibility to studies – reflects Gabriele Grea, Academic Fellow Department of Social and Political Sciences at Bocconi University in Milan, president of Redmint social enterprise – we must focus on the concepts of ‘impact of travel’ and ‘availability of easy transport’ , working on the quality of services and their responsiveness to the needs of users who, being fragile, have specific needs. On the one hand it could be useful – he continues – to evaluate the possibility of activating flexible and ‘on demand’ services by looking at the experience in the context of the so-called Nemt services, i.e. non-urgent scheduled medical transport and, on the other, to reflect on possible optimizations of the distribution of trials in the territory and, where possible, align them with the location of the demand”.
This “independent and self-financed” investigation – underlines Massimo Massagrande, CEO of Elma – gathers the point of view of specialists and their patients to enrich knowledge of the topic and seek solutions to guarantee fairer access to possible therapeutic options for all. In Elma Academy – he concludes – we carry out various projects in the social and health sector to raise awareness of all the actors involved, starting from the institutions up to public opinion on such delicate issues”.
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