After his re-election as president last year, Jacques Chirac announced plans for a reinvigorated fight against the rapid increase in cancer mortality in France. Now Jean-Francois Mattei, the minister of health, has unveiled more details as to how the plan will be implemented.
Cancer today is the second most frequent cause of death in France after cardiovascular disease, and its diagnosis, monitoring and therapy cost the state healthcare system $15 billion in 2002. Each year 150,000 people in France die of cancer with the annual number of new diagnoses increasing by 63% between 1980 and 2000.
Lucien Abenhaim, director general of health services, in his recent report from the Commission on Cancer, pointed out that although part of the increase in cancer incidence is due to the "graying" of the population, an estimated 35% results from increased risk factors which are avoidable, such as smoking, alcohol, bad dietary habits and professional risks. He said that each year 25% of cancer deaths that is 30,000 due to tobacco and 16,000 to alcohol arise from these two factors, and that in this aspect "the French culture is too permissive."
A major step in the fight proposed by the commission is an improvement in the quality and coverage of cancer screening programs, with as an initial target the creation of a regional institute of cancer in each of France's six regions and associated with oncology departments of universities, university hospitals and existing regional cancer testing centers. Improvements in the provision of chemotherapy services at home and the beefing-up of basic cancer treatment training for primary care physicians also are planned.
The commission proposes an acceleration in the placement of imaging systems for diagnosis and monitoring, as well as an easing of limitations on new installation authorizations. To facilitate access to chemotherapy at home, the report proposes specific allocations for this purpose within the general global budgets in public hospitals.
Abenhaim proposed the creation of a National Institute of Cancer (INC), inspired by the National Cancer Institute (Bethesda, Maryland) in the U.S., to define and coordinate nationally oncology research. Six regional cancer institutes under the supervision of the INC will be created.
In announcing the report, Mattei said that it will be the subject of wide consultation and that proposals for the organization and financing of the projects will be put forward to Chirac soon.
In other European cancer news:
Prevention, rather than cancer treatment, is the focus for a new breast cancer research center in Manchester, UK. This will be the first program in Europe to focus its work on prevention rather than oncology therapy. Led by Manchester-based charity Genesis Appeal, the $15 million project will specialize in cancer genetics and diet and lifestyle studies, as well as providing a residency for Britain's first professor of cancer prevention.
A study led by Lars Holmberg at the University Hospital (Uppsala, Sweden) has shown for the first time that prostate cancer surgery can reduce mortality risk. Published in the New England Journal of Medicine, the study reported on 695 men aged between 60 and 70 with prostate cancer. Half the patients were allocated to the "watchful waiting" cohort recommended by many physicians because of a claimed lack of proof that surgery would be better, while the other half had the cancer excised surgically.
On an average 6.2 years of follow-up, 8.9% of the watchful waiting group had died, but only 4.6% of the surgery group. In terms of quality of life, however, 80% of the surgery group experienced impotence and 49% experienced urinary leakage compared to 45% and 21%, respectively, in the watchful waiting cohort.
British devices market today and tomorrow
The UK Department of Health last year decided on a series of strategic changes aimed at improving health and healthcare provision in Britain. A key move of the NHS (National Health Service) Plan is the devolving of power from the Department of Health to Primary Care Trusts (PCTs) that will receive 75% of the NHS budget and become responsible for the management and provision of healthcare services in their community. Under the PCTs will come 28 new Strategic Health Authorities, each responsible for healthcare administration for an area of about 1.5 million people.
The number of people waiting for in-patient treatment in NHS hospitals for more than 12 months has started to move downward, with March this year as the deadline for no one waiting for more than a year. By 2005, the NHS Plan says that no one should wait for more than six months for an operation or more than three months for an outpatient appointment.
Every health authority now has at least one electronic appointment booking program in operation, and by March 2005 it is envisioned that all primary care physicians and patients should be able to book appointments this way.
The procurement scene also is changing rapidly, said Michael Kreuzer, director of the Association of British Health-Care Industries (ABHI; London). The arrival of Strategic Health Authorities is leading to the creation of Supply Management Confederations to provide an intermediate tier between the NHS Purchasing and Supply Agency (PaSA) and the PCTs, Kreuzer told The BBI Newsletter. It is not yet clear what this may mean for suppliers, but he said the ABHI is in close contact with the PaSA and is seeking involvement in the first pilot projects now being started.
Potentially the most significant change coming soon is the introduction of a new system known as Health-Related Groups (HRGs) and foreseen in a recent consultation paper on "Reforming NHS Financial Flows." HRGs appear to be close to Diagnosis-Related Groups (DRGs), already well-known in the U.S., Germany and elsewhere, and in some cases seen as a threat to suppliers of medical technology.
Kreuzer emphasized that the activities of PaSA are restricted to England with separate e-procurement systems already being set up for Scotland and Wales. It is likely that these will differ from those being developed in England, he said.
Galen launches intra-vaginal ring
Galen Holdings (Craigavon, Northern Ireland) said it has received an approvable letter from the FDA for its estradiol acetate intra-vaginal ring marketed in Britain under the Menoring label. The product is administered for the treatment of symptoms of menopause and delivers 50 or 100 micrograms of drug each day over a 90-day period.
"This approval is a great achievement for the Galen team, both in the U.S. and in Northern Ireland. The U.S. is the most significant market for this product and we believe that this innovative form of delivery will be well received by the patient," said Roger Boissoneault, Galen CEO. The Menoring will be marketed in the U.S. by Warner Chilcott (Rockaway, New Jersey), a division of Galen.
Separately the company reported acquiring from Eli Lilly and Co. (Indianapolis, Indiana) for $295 million the marketing rights for Sarafern, a drug used in the treatment of depression caused by menopause. Lilly will continue to manufacture the drug for Galen for the initial three years of the agreement.
'Dropped foot' implant improves mobility
Each year in Britain around 30,000 people are left with a mobility deficit following stroke. Typically this shows as a dropped foot where the individual is unable to lift the foot on the affected side, leading to it being dragged forward or swung out to the side.
Finetech Medical (Welwyn Garden City, UK) has developed an implanted dropped-foot stimulator in conjunction with the University of Twente (Twente, the Netherlands) and Roessingh Research and Development (Utrecht, the Netherlands). It consists of a small two-channel nerve stimulator implanted in the calf, an external controller and a sensor placed in the shoe under the patient's heel.
Ten successful trial implantations have been carried out, five at Salisbury District Hospital in the UK and another five in the Netherlands, with excellent patient acceptance. Full clinical trials are under way in Britain and the Netherlands and are due to be completed this year.
Siemens Infinity monitors
The Infinity Patient Monitoring System from Siemens Medical Solutions (Solna, Sweden) was first launched in 1995 but has undergone significant changes since that date. "At Siemens , we believe that if you take the same approach, you get the same results. We wanted to create a uniquely different patient monitoring system, so we started anew," said Wilhelm Isenberg, group vice president of the Electromedical Systems division.
Siemens claims that the system is unique, providing hospitalwide monitor standardization without compromising the needs of individual clinical departments. Jim Elliott, principal engineer of the coronary care unit at Royal Hospitals (Belfast, Northern Ireland), said, "In the past, we moved patients around to match the monitors available. Now, we don't have to prioritize patients' needs in this way. Everyone can have the same high-quality monitoring."
Colonoscopy by robotic caterpillar
A robotic coloscope has been developed by Italian and Korean scientists that moves like a caterpillar. The device is under 2 cm wide, 20 cm long at full stretch and retracts to 10cm. Its head end attaches first, then its rear end, grasping the colon wall by means of a special clamping element devised by Dr. Arianna Menciassi of the Center for Applied Research in Microengineering (Pisa, Italy).
Intestinal tissue is sucked into a small gap by creating a vacuum at the head end. When the robotic device wishes to release the tissue, it widens the gap. The device, which is fitted with a camera and LED illumination to detect cancer cells, has already been successfully tested in animal trials.
The next stage in development will be to enable the device to navigate its way round the colon unaided. Menciassi and colleagues at the Intelligent Microsystem Center (Seoul, Korea) are seeking to cooperate with a company to develop the robot for human applications.
Philips launches EnVisor ultrasound
The new flexible EnVisor ultrasound system from Philips Medical Systems (Best, the Netherlands) can be configured for general imaging, vascular, cardiac or obstetrics/gynecology tasks, and is claimed by the company to provide performance and features previously unavailable for less than $100,000.
"Until now, ultrasound labs have needed to compromise on imaging quality or ease of use if they wanted a lower priced system," said Dick Tabbutt, director of marketing, specialty ultrasound systems. "In developing EnVisor, our objective was to deliver the imaging performance, usability and data management capabilities that were previously unavailable in this price range."
The new system was shown for the first time in December at the Journ es Francaises de Radiologie conference in Paris.
Teraklin's artificial liver trials to widen
After a successful Phase I trial of the MARS (molecular adsorbent recirculating system) made by Teraklin (Rostock, Germany) carried out at the University of Michigan (U-M; Ann Arbor, Michigan), a multicenter randomized trial is scheduled to start soon comparing MARS albumin dialysis with standard medical treatment in chronic liver failure patients in hepatic coma. "We must also explore whether the system can help patients regain function in their own livers, as two of our patients did," said Robert Bartlett, professor of surgery and lead investigator at U-M.
Resorbable suture anchor system
Bionx Implants (Tampere, Finland) has released for marketing in Europe the Duet Suture Anchor, which is a bioresorbable suture-anchor system, made from a proprietary polymer for reattaching soft tissue to bone. The primary application for the product is in the treatment of rotator cuff injuries in the shoulder, a worldwide market valued at $55 million to $60 million.
Beria develops emergency infusion device
Beria (Liege, Belgium) has developed the Droper infusion device, which utilizes mechanical compression of infusion bags to provide continuous vascular infusion in emergency situations where IV poles are not available. An integrated Drop2Drop flowmeter measures the infusion speed and allows simple adjustments to be made on site.