1. Assessment of the needs in healthcare

Currently, there is not much known about the condition of Ukrainian healthcare. A medical reform, which started in 2016, impacted the surveillance tools for many diseases. The transition to the new tools for the biggest part of the diseases has not happened yet. Additionally, the COVID-19 pandemic dragged away the focus from the completion of the reform and disrupted the proper functioning of multiple levels of healthcare. Therefore, it is difficult to assess the dynamics of the pre-invasion morbidity structure and what has changed afterward. Attempts to evaluate the current situation are being performed, but they are not as numerous as they could be in a peaceful time. Despite the ongoing war leading to the prioritization of more urgent needs, planning for the further development of the system should remain in focus.

2. Healthcare services coverage

As of 24th July 2022, more than 900 healthcare facilities in Ukraine were damaged, and 127 hospitals were destroyed. As of April 2023, large territories of Ukraine were de-occupied. But, nevertheless, continuous shelling and rocket strikes continue to damage Ukrainian infrastructure, including healthcare facilities. Inner migration of the population and increased demand for medical care of wounded in combat militaries and civilians cause a strong strain on the preserved part of the healthcare system. In rural areas, especially in regions that have spent some time under Russian occupation, there is a severe lack of healthcare personnel and medical goods supply. Multiple non-governmental organizations with their humanitarian missions make a huge difference. However, a systematic approach and careful planning are needed to address the current situation.

3. Cancer care

Pre-invasion cancer epidemiology in Ukraine was quite comparable to the world’s data. Despite the comparison with the data from European Region revealing the need for improvement in cancer care (Semenov et al.), implementation of nationwide programs would be likely to improve the situation. However, the priority of cancer care was pushed back during the COVID-19 pandemic, as well as during the war. It is natural to expect a surge of cancer cases, especially in advanced stages, given that the information about these cases will be accumulated.

4. Mental health

Mental health problems were under-recognized in Ukraine before the full-scale invasion. The comprehensive epidemiological data about mental health problems in the Ukrainian population was quite scarce. On the one hand, the stigma of mental health and the cultural perception that mental health issues are not serious problems (unlike somatic pathologies) could be an important cause of neglecting mental health by people. On the other hand, treatment of mental health conditions is usually prolonged and costly (like antidepressants, which are not reimbursed in Ukraine, or psychotherapy). It is quite natural to expect a drastic surge in the number of people who require psychological support during the war.

It is expected that around 15 million Ukrainians will require psychological support, among them around 3-4 million will require pharmacological treatment due to mental health problems. Importantly, mental disorders often aggravate pre-existing pathology or could be a risk factor for the development of new diseases, which for sure will influence the population’s health.

5. Rehabilitation

Last but not least, are the consequences of the direct influence of combat and artillery/rocket strikes. It is expected that the number of people who need rehabilitation and prosthetics will increase in the nearest time because of the war. The official information about the number of wounded and killed in combat (both military and civilians) is scarce, and contradictory, and usually comes with a delay. However, given the intensity of combat, the area involved, and the numbers that appear in the media, it can be assumed that the genuine number of wounded people is huge.

It is very likely that Ukrainian rehabilitation centers will face a need for restructuring and an increase in their capabilities. A lot of Ukrainian soldiers and civilians receive medical help in other countries and it makes a huge difference. But the increase of resources in Ukrainian own rehabilitation centers might become a pressing question in Ukrainian healthcare.

The presented list is not exhaustive. There are other aspects of Ukrainian healthcare that require attention, such as the shift from emergency care to planned healthcare programs, dealing with an energy shortage due to Russian attacks on the Ukrainian energy systems, training of medical staff to face the challenges related to the war, and many others.

The text was prepared by Viktor V. Semenov and Lilia V. Kriachkova in cooperation with the Centre for Innovation in Medicine.

Over four years, 4P-CAN (www.4p-can.eu) will identify barriers to cancer primary prevention measures adoption by studying risk factors for cancer such as smoking, alcohol consumption, physical inactivity, excess body weight, HPV and HBV infections (preventable through vaccination) and environmental pollution. The project will gather evidence around individual adherence to healthy behaviours in countries from Eastern Europe such as Romania, Bulgaria, the Republic of Moldova, North Macedonia, Montenegro, and Ukraine.

“4P-CAN is a very timely project because it’s addressing the primary prevention of cancer in the context of the Cancer Mission recommendations, with the primary aim to develop a new model of personalised primary prevention, based on innovative approaches from the social sciences and humanities. It benefits from the expertise of 17 beneficiaries, from 11 countries. We know that cancer primary prevention is neglected and underfunded – only 5% of the research funds were spent on it in the last decade. On the other side, we have high expectations of the citizens to invest and to come up with more efficient solutions for cancer prevention. 4P-CAN answers to this need and aims to find new effective strategies to approach cancer primary prevention. Moreover, our consortium is highly representative at the European level, mixing Eastern and Western partners, and so being able to understand and address the East-West inequalities in cancer.”

Dr Marius Geanta, 4P-CAN Coordinator, President of the Centre for Innovation in Medicine

The 4P-CAN project is built on an innovative vision that seeks to understand the complex system surrounding the citizen and how it increases the risk of cancer on three levels – macro (at the national level), meso (at the community level), and micro (at the individual level). The project will follow the narrative of the European Code Against Cancer, implementing research, social sciences, and humanities with behavioural sciences to create personalized tools for the primary prevention of cancer. Based on project knowledge and implementation methods, 4P-CAN will establish two living labs, one in Romania and one in Bulgaria, targeting the adoption of preventive behaviours based on the 12 recommendations of the Code.

The 4P-CAN project is a collaboration among 17 organizations from 11 different countries, including the Balkan countries, which are European Union (EU) Member States and non-EU Member States, and Western EU Member States such as Portugal, Italy, France, Ireland, and Belgium.

For more information on the 4P-CAN project, please visit our social media platforms on LinkedIn and Twitter.

Contact: office@ino-med.ro

The #ECHoS consortium has the potential to bring the #CancerMission spirit, vision, and ambition to the Member States and at the societal level, very close to citizens. But only by understanding people’s needs and involving them in research and the immediate implementation of research results can we achieve better results than before.

We need to work together to generate and maintain a new mindset regarding cancer research, as well as the way prevention, screening, diagnosis, and treatment services are delivered to citizens and patients. Research should no longer be viewed as a luxury but as a critical part of cancer control in the 21st century.

The national hub structures must take into account the specificities of each country (or even the local or regional specificities), and cultural and social factors. Still, there will always be a common thread connecting them all, ensuring coordination, multi-directional dissemination of good practices, and continuous feedback mechanisms aimed at continuously improving quality.

We have the opportunity to generate unique, disruptive, and adaptive impact models, as they have never existed before, based on mapping, activating, and involving traditional and non-traditional stakeholders, in an approach to cancer as a societal problem.

An essential role will be played by specialists from non-traditional areas as well: social sciences and humanities, science communication, social innovators, digital media analysts, and so on.

In the complex picture of cancer, oncology research, and European and national initiatives (dozens of research projects approved by the EU in less than 2 years), we need a new type of leadership (distributed leadership; leadership as a process) to respond effectively.

Trust is a key word when considering new possible leadership models and when thinking about effective models for involving citizens in #CancerMission. It is essential to understand the mechanisms by which people’s trust is formed (in doctors, healthcare systems, decision-makers, or trust at the societal level), as well as their attitudes and perceptions of cancer, in order to create new, personalized models of communication, education, and engagement.

Cancer represents a global health challenge. It affects everyone regardless of gender, or even social status and is a tremendous burden for patients, families, friends, and societies. According to the European Cancer Information System, the incidence of cancer in Europe by 2040 is expected to increase by 20.96% and mortality by 31.76%. This means that if no further actions are taken, around 3.24 million people will be diagnosed, and 1.66 million people will die in Europe. In Romania, the mortality will increase by 13.6%.

Driving the Horizon Europe Mission on Cancer initiative is the ambitious goal to improve “the lives of more than 3 million people by 2030 through prevention, cure and for those affected by cancer including their families, to live longer and better”. This is also the driving force behind the project ECHoS, Establishing of Cancer Mission Hubs: Networks and Synergies.

ECHoS, a new, three-year European consortium supported by Mission on Cancer, will play a vital role in supporting the bold and inspirational goals defined by this European initiative. Bringing together the expertise of 58 leading organizations, from governmental, healthcare, research, academic, and non-profit sectors, this key consortium will ultimately provide member states and associated countries (MS/AC) with the capacity to create National Cancer Mission Hubs (NCMHs) gradually. These NCMHs, operating at national, regional, and local levels, will have a vital role in involving all relevant stakeholders, including citizens, in cancer-related policy dialogues.

“The fight against cancer can no longer be an isolated endeavor. Currently, research, innovation, and healthcare initiatives are largely siloed within specific communities and the engagement of citizens is either poor or non-existent,” said Dr. Anabela Isidro, member of the AICIB (Agency for Clinical Research and Biomedical Innovation in Portugal) board. “Supported by the European Beating Cancer Plan and the EU Mission on Cancer, cancer occupies a central place within the European political agenda. At the conclusion of the Conference on the Future of Europe, political leaders championed pan-European cooperation towards a Health in All Policies approach, and a data-informed, citizen-focused, research-driven agenda. The time to act is now.” She concluded.

Romania is represented by the Centre for Innovation in Medicine, which will collaborate closely with the consortium coordinators (AICIB) and leading experts across Europe, to establish a NCMH in our country. This combined effort will coordinate R&I and Healthcare actions on cancer with policy-making processes toward people-centric healthcare and research systems in ways that cannot be achieved through individual efforts and fragmented initiatives.

“The creation of national hubs of the Cancer Mission and their interconnection is a fundamental step for the Europe’s Beating Cancer Plan and the Mission’s action plan. The ECHoS project will generate in the next 3 years both models of governance and impact, as well as models of interaction with traditional and non-traditional stakeholders, but especially with citizens. Cancer Mission hubs must have real citizens at the center, start from their needs, and involve them in research, innovation, and implementation from the beginning and continuously. For this reason, the Cancer Mission is more than a mission that promotes cancer research, just as ECHoS is more than a European project – it is the beginning of a movement that involves 58 organizations from 28 countries, including the Centre for Innovation in Medicine”, said Dr. Marius Geanta, President of the Centre for Innovation in Medicine, and national coordinator of the ECHoS project. “Creating a National Cancer Mission Hub in Romania represents a key step towards strengthening the voice of national stakeholders in cancer policies in Europe.”

The recent COVID-19 emergency exposed the fragilities in health systems, halting research, arresting clinical trials, and forcing limited resource allocation to tackle these emerging needs. Still, it highlighted countries’ capacity to create functional synergies in health, policy, and research, successfully impacting the health scenario. With the Kick-Off Meeting occurring today, ECHoS will set the foundations for a strong and cohesive network of NCMHs among MS/AC aligned with the Mission on Cancer. ECHoS will break new frontiers, beyond established research and health systems, reaching from individual citizens to European Institutions, Civil Society, Social Sector, Academia, and Public and Private Sectors, improving the current landscape and setting a brighter future in cancer.

The Centre for Innovation in Medicine (INOMED) is an Associated Partner of the Project.

“We have many medicines at our disposal, but unfortunately, we still know too little about the categories of patients who can truly benefit from them. Personalized medicine has the potential to breathe new life into existing drugs that are not being used to their full potential, for the benefit of both patients and healthcare systems. We are honored to be part of the PRIME-ROSE project because it gives us the opportunity to learn from the best about personalized medicine in oncological practice, while at the same time preparing for the implementation of these approaches in the Balkan states to reduce East-West inequalities through innovation.”

Dr. Marius Geantă, President of INOMED

Sustainable and affordable precision cancer medicine across Europe

The PRIME-ROSE vision is access to affordable Precision Cancer Medicine (PCM) that prolongs life at the best quality possible for all cancer patients. PCM is an approach that depends on access to adequate molecular diagnostics and drugs to have an impact and move towards implementation in the national healthcare systems. Today there is inequality in access to PCM between and within EU countries, and while the promise of PCM is clear, implementation remains a challenge. This, in particular, affects cancer patients with the poorest prognosis who have exhausted all lines of standard-of-care treatment, those with tumors carrying rare mutations, and patients with carcinoma of unknown primary.

The PRIME-ROSE project builds on a bottom-up, clinician-initiated family of PCM clinical trials which have been particularly successful in bringing up inclusion rates to offer additional lines of treatment and in providing patient benefit. These trials share the pragmatic clinical trial design of the original Dutch DRUP trial, with broad inclusion criteria and a limited set of endpoints. However, the trials are still anchored into a national context and are funded independently. The result is a distributed DRUP-like clinical trial network that addresses local priorities while collaborating internationally for scale and impact.

Work to be done in PRIME-ROSE moving PCM forward in Europe

The consortium will use these existing adaptive and pragmatic clinical trial platforms to answer key questions regarding clinical effectiveness, provide health-economic evaluations, and contribute to scientific progress across cancers. In particular, the cross-country collaboration provided by PRIME-ROSE will build capacity as well as enable cross-trial data aggregation and analysis, initiate shared cohorts across borders, and provide health-economic evaluations. To ensure successful implementation, the consortium will work together with regulators, policymakers, payers, healthcare providers, and patient advocacy groups to implement evidence-based PCM in routine practice and address inequalities in access.

Altogether, this Europe-wide precision cancer medicine deployment will address key scientific and methodological questions to accelerate broad and equitable access to new and effective cancer treatments. The ongoing effort is already leading to harmonization, standardization, and pragmatic consensus.

Pan-European precision cancer medicine community: PRIME-ROSE project is led by Professor Kjetil Taskén, Head of the Institute for Cancer Research at Oslo University Hospital Comprehensive Cancer Centre in Norway.

PRIME-ROSE Consortium Partners:

1. Oslo University Hospital, Oslo, Norway
2. Leiden University Medical Center, Leiden, The Netherlands
3. Stockholm School of Economics, Stockholm, Sweden
4. Capital Region, Copenhagen, Denmark
5. Helsinki University Hospital, Helsinki, Finland
6. Centre Leon Berard, Lyon, France
7. IPOPORTO, Porto, Portugal
8. Region Uppsala, Uppsala, Sweden
9. The Swedish Institute for Health Economics, Lund, Sweden
10. Karolinska Institutet, Stockholm, Sweden
11. Region Skåne, Sweden
12. Heidelberg University Hospital, Heidelberg, Germany
13. Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland
14. University Hospital of Split (KBC Split), Split, Croatia
15. Tartu University Hospital, Tartu, Estonia
16. National Institute of Oncology, Budapest, Hungary
17. Vall D’Hebron Institute of Oncology, Barcelona, Spain
18. Center for Personalized Cancer Treatment (CPCT, DRUP trial consortium), hosted by Radboud University Medical Center, Nijmegen, The Netherlands
19. National Cancer Institute, Vilnius, Lithuania
20. Cancer Research UK, London, UK
21. University of Manchester, Manchester, UK
22. Trinity College Dublin, Dublin, Ireland
23. Masaryk Memorial Cancer Institute (MOU), Brno, Czech Republic
24. Center for Innovation in Medicine (CIM), Bucharest, Romania

The atmosphere at the Grand Hotel Stockholm lobby during the Nobel Week Dialogue was nothing short of magical. As I entered the hall, I was immediately struck by the sense of history and intellectual prowess that enveloped the room.

Under the glow of elegant chandeliers, the air buzzed with anticipation, excitement, and the electric energy of intellectual exchange. The lobby was filled with an extraordinary gathering of some of the brightest minds in the world – Nobel Prize laureates, casually sipping coffee, engaged in animated conversations that spanned the realms of science, literature, and peace. The hum of passionate discussions resonated throughout the space, filling the air with the amazing scent of discovery and innovation.

As I stood there, taking in the awe-inspiring scene, I couldn’t help but feel a deep sense of gratitude and humility. To be in the presence of such remarkable individuals, including the legendary Dr. James Watson, was an experience I will never forget. Surrounded by the spirits of past and present Nobel laureates, I was reminded of the power of curiosity, the importance of perseverance, and the boundless potential of the human spirit.

That unforgettable encounter with Jim Watson amidst the grandeur of the Grand Hotel Stockholm lobby will forever remain etched in my memory.

On this 70th anniversary of the DNA double helix discovery, I am grateful for the opportunity to have shared a moment in time with one of the greatest scientific minds of our age and to have firsthand experienced the enchanting atmosphere that unites those who have shaped our understanding of the world.

On a cold 2012 December day, I had the honor of attending the Nobel Week Dialogue in Stockholm. Never in my wildest dreams did I expect to have a personal interaction with one of the most legendary scientists of all time, Dr. James Watson. As we sat down for a one-hour discussion, I was humbled and awestruck by his passion, wisdom, and humility.

That day Jim recounted the incredible journey he and Francis Crick embarked on 60 years prior culminating with the discovery of the double helix structure of DNA.

As we are celebrating the 70th anniversary of this groundbreaking discovery, on this day, April 25th, I am filled with emotion and gratitude. Their perseverance and dedication unlocked the secrets of life, paving the way for countless innovations in medicine, agriculture, forensics, and more.

Jim explained to me the implications of his and his colleagues discovery, which has since transformed our understanding of life and its intricacies.

As I reflect on that extraordinary encounter with Jim Watson back in 2012, I am struck by the profound impact that one discovery has had on our lives. The double helix has woven its way into the fabric of our existence, shaping our understanding of the world and ourselves.

One of James Watson’s most famous quotes, reflecting his curiosity and passion for scientific discovery, is: “The important thing is to never stop questioning.” This quote encapsulates Watson’s approach to science and his relentless pursuit of knowledge.

On this 70th anniversary, we honor the legacy of James Watson, Francis Crick, Rosalind Franklin, and Maurice Wilkins, whose relentless pursuit of knowledge illuminated the secrets of life and inspired generations to come.

The DNA double helix discovery laid the foundation for one of the most ambitious and transformative scientific endeavors in history: the Human Genome Project. This international collaboration, launched in 1990, aimed to map the entire human genome by identifying and sequencing the 3 billion nucleotide base pairs that constitute our DNA. The project sought to unravel the complexity of our genetic blueprint with the ultimate goal of improving our understanding of human biology, health, and disease.

Completed in 2003, the Human Genome Project stands as a testament to the power of international cooperation and the relentless pursuit of knowledge. This monumental achievement has opened up new frontiers in genomics, personalized medicine, and our understanding of the intricate interplay between genes and the environment. The project has accelerated the discovery of disease-causing genes, paved the way for novel diagnostic tools, and informed the development of targeted therapies tailored to an individual’s unique genetic makeup.

Dr. James Watson’s impact on the field of genetics extends beyond the discovery of the DNA double helix structure and his involvement in the Human Genome Project.

In 2007, Watson became the first person to receive his fully sequenced genome as part of the Personal Genome Project, led by Dr. George Church at Harvard Medical School. The project aimed to advance personalized medicine by sequencing the complete genomes of volunteers and making the data publicly available for research purposes.

Receiving his sequenced genome was a poignant moment for Watson, marking yet another milestone in his storied scientific career. The sequencing of his genome demonstrated the remarkable progress made since the discovery of the double helix, as well as the increasing accessibility of genomic information.

Watson’s willingness to share his genetic data emphasized the potential of genomics to transform medicine and our understanding of human biology.

The sequencing of Jim Watson’s genome has also raised important ethical questions about privacy, consent, and the potential consequences of widespread genomic data sharing. These discussions have contributed to the ongoing conversation about responsible genomics research and the development of appropriate regulations to protect individuals and communities.

As we celebrate the 70th anniversary of the double helix discovery, we must acknowledge Dr. James Watson’s enduring influence on genetics and genomics, from the foundational discovery of DNA’s structure to the ongoing pursuit of personalized medicine. His lifelong commitment to advancing our understanding of the human genome continues to inspire researchers and pave the way for a future where genomic knowledge benefits us all. The double helix has forever changed our world and it is our duty to ensure that the progress.

… I am Marius Geanta, MD, President and Co-Founder of the Centre for Innovation in Medicine, and Medical Director of McCann Health Brain & Heart.

Dnipro region is the area that is located near the frontline and Dnipro itself has become an eastern fortress of Ukraine. Despite no active military actions taking place in the region, its southern parts suffer from constant shelling from the occupied part of Ukraine – from the other side of the river Dnipro. The additional danger always in the minds of locals is Zaporizhia Nuclear Power Plant, which is currently occupied by Russian troops. Only mentioned problems would be enough to paralyze an average Ukrainian in spring 2022. But not in spring 2023.

Science keeps developing in Ukraine, despite being usually associated with a quiet university environment. And problems that were bothering scientists in peaceful times are being considered again. One of the latest studies, conducted by a team composed of scientists from Dnipro State Medical University (including myself) and the Cancer Registry of Dnipropetrovsk region investigates the epidemiology of gastric cancer in the region.

Significant efforts have been made to decrease the prevalence of risk factors of gastric cancer. But even despite a gradual decrease in incidence and prevalence, gastric cancer remains one of the top killers in oncology worldwide. Especially for the male population. The study I coordinated (Semenov et. al) represents an extended version of the routine cancer surveillance performed by the National Cancer Registry of Ukraine. The study presents the data of isolated gastric cancer cases collected in the Dnipro region from 2009 to 2019.

Investigation of isolated gastric cancer is important and in this study, we attempted to eliminate the influence of coexisting cancers that could impact the prognosis of patients. Standardized incidence and prevalence allow comparing the results of the study to European and World data. On top of that, we provide the anonymized research data, making possible additional insights from other researchers.

The results of the study show that the epidemiological situation with gastric cancer (incidence, prevalence, mortality rate, and survival of patients) in Ukraine is comparable to the situation in the World. However, the incidence and mortality of gastric cancer in Ukraine are around 1.5 times higher than in the European Region. Generally, gastric cancer in Ukraine follows the same pattern as in other countries – males and older persons suffer more often and have a greater risk of death. Sub-analysis by the area of residence has revealed some differences between the parts of the Dnipro region, but the underlying basis for such differences is to be investigated.

The study demonstrates trends in gastric cancer epidemiology in the Dnipro region over 11 years of observation. The results of the study indicate the need for the development and implementation of a nationwide program targeted at the systematic prevention of gastric cancer in Ukraine. The experience from the neighboring countries might be of use during the development and implementation of the program.

It seems very optimistic that in this anxious time, such very fine things as science keep existing. Thanks to the bravery of Ukrainian soldiers supported by the Allies, the whole of Europe, together with a large part of Ukraine can lead a relatively peaceful life. But let’s not forget what the price of our quiet lives is…

The link to the full-text version of the study:
Viktor V. Semenov, Lilia V. Kriachkova, Natalia Shestakova, Viktor Khanov, Halyna Donchenko, Olga Balashova, Yulia I. Viklienko. Gastric cancer epidemiology from 2009 to 2019 in Dnipro Region, Ukraine. Cancer Epidemiology, 2023, Volume 82, 102315, https://doi.org/10.1016/j.canep.2022.102315.

I discussed the vision behind ECHoS Project with Hugo Soares, Agency for Clinical Research and Biomedical Innovation AICIB – National Cancer HUB, Portugal, during an event organized in Bucharest by the Executive Agency for Higher Education, Research, Development and Innovation funding (UEFISCDI), ”Working together for a quick and diagnosis and better treatments for cancer EEA & Norway Grants contributions to the EU Mission Cancer”.

• How does the ECHoS project align with the objectives of the Cancer Mission and how will it contribute to reducing inequalities in access to cancer care?

ECHoS is not a research project, it is a project aiming to put together groups of stakeholders, who are not considered conventional when you think about cancer care. This will enable interactions beyond those involving researchers, medical doctors, and the health system, who are traditionally our main players. But when you think about citizens and patients, their needs go beyond what healthcare providers and researchers can do. Employees, municipalities, and regional administration members are also stakeholders. If you think about prevention, in a city there is a lot of space for intervention by local authorities or by the educational sector. Such stakeholders can raise awareness of risk factors such as smoking and promote healthy habits. There is also an opportunity to involve the sports community (e.g., ministry of sports, professional regional teams) who can work with citizens, as well as the spiritual leaders who also can have an influence on how people react and adhere to the national campaigns towards less smoking habits and healthier diets.

When you think about cancer there is much more than just health and research. ECHoS aims to get close to communities, involve them in cancer research and then go to researchers, health professionals, and the EU Commission and share the real needs, involve them, and reach back to the community. By creating this positive feedback loop we will be able to identify needs beyond classical ones. The authorities will create the conditions to answer these needs and implement them. Then again, patients and citizens should be involved in assessing how these solutions and technologies work, revise them, and reconnect again with the initiative, reaching to the European authorities to the local organizations.

• How will the project ensure the sustainability of such multi-stakeholder collaboration?

In Portugal, the sustainability goals might differ from Romania’s or Germany’s. In the EChoS, we will work on developing a set of criteria and guidelines on how to make these sustainable. It is important that structures created in different countries maintain contact and interaction between national goals, otherwise it will evolve differently and create silos that we want to avoid.

What is important is that we have this common framework. (…) You can’t go in all directions at full speed. You have to prioritize according to the needs of citizens, have the right frameworks for implementation with awareness related to what is happening, and evaluate the positives and negatives of the implementation. The good thing about ECHoS is the opportunity to put all the learnings together.

• How do we engage citizens to become actively involved in prevention and ensure they do not become patients?

It doesn’t work just to provide information and expect people to follow and voluntarily adhere to what they are told to do. We need the population to understand, not just to provide directions, but to educate on the benefits of these directions and the risks. It is important that we are open to listening to what the community is saying.

In Portugal, we have very different rates of people adhering to screening programs in the north versus the south. It is important to highlight that we have national education and health care systems thus, virtually, equal access to both education and care. It might be because of public transportation, costs of commuting, it might be related to local beliefs, local groups influencing them, or maybe traditions. And all this should be addressed.

When you think about patient engagement, it is not about more campaigns on television, it’s about asking why people don’t go to screening programs. And you don’t just ask this in expert groups. You also ask people about this.

It is all about enabling people to participate in the process of developing solutions. Imagine the low adherence is related to public transportation. We might think that a solution could be, for example, cheaper bus tickets – or related. But the actual problem might be there is no actual transport at the right time because people work 9h-to-17h with just 1h for lunch, and they need to spend 1h or 2h just on public transportation to get to the doctor and return. It is really important that we involve them in co-designing and assessing the solutions that are put forward.

• How do we ensure citizens’ trust in disruptive technologies such as genomics, which are transforming cancer care?

We cannot make the technology fully available for everyone at the same time and at the same pace, so it is important to prioritize. Thinking about genomic data and the impact on cancer treatment and risk stratification, people should know that the genomic data belongs to them. This is not part of the research community, not even the healthcare community. It’s their data, they should be able to retrieve it if they want to. It is important that people are aware of their rights and responsibilities because genomic data is very personal. If we think about young people with cancer, who might want to access jobs later in life or get health insurance, people should be informed when they are providing this data to the health system for diagnosis and treatment, that their data will be protected and that they have the right to. It is important for people to break the fear of data sharing. We go back to education and literacy and involve people in all steps of the process.

• Are there any examples of good practices from your country that could be implemented in Central and Eastern European countries? How has Portugal progressed when it comes to the implementation of the objectives of the Cancer Mission?

In Portugal we have the National Cancer Hub which works in synergy with the EU Beating Cancer Plan, coordinated by the Agency for Clinical Research and Biomedical Innovation and the Directorate General for Health, gathering representatives from both research and health ministries. The Hub’s actions are implemented by different groups. A policy group that unites key decision-makers, and a stakeholder group with 400 representatives from healthcare, research, and communities. A plan for this year is to create and moderate a new group called the Citizens and Patient Forum. In the first phase, the goal was to engage the community already involved in cancer care and break silos with the classical agency, create awareness among the policymakers regarding the opportunities in Europe and how could this Portugal benefit from this. Now that we have decision-makers engaged with the Mission on Cancer, we are ready to move to the next phase. Now we go to the individual level and involve patients in activities that emerge from the EU Commission and those organized by the National Cancer Hub.

• What does future cancer control look like 5 years from now, in your opinion?

I would like to appeal to a motto of A cancer-free society, but it is quite ambitious to think of this. However, we know that more than 50% of cancers are preventable, most of those are determined by external factors such as smoke, UV lights, work-related conditions, mining, chemicals exposure, and so on. At least for these ones, I would like to see a dramatic decrease in the level of exposure. If we reach 25%, this will have a huge impact on the lives of everyone, as well as on the economic and healthcare system. If we think that side by side with the cancer revolution, we see the revolution in genomics, you can also think about the 10% of cases that are caused by genomic mutations.

If we can screen for those genetic conditions and become aware that they exist, monitor the evolution of cases, and control the external factors, then we would see Europe as a much better place when it comes to cancer control. We cannot control cancer from developing but screening for genetic conditions and controlling of external factors could make a difference. We know a lot of things in the field of cancer, and with all the knowledge implemented we can do a lot of things in the years to come.

We are witnessing a revolution in oncology. I remember more than 30 years ago when we gave up the previous political regime and started thinking of unthinkable things. Then we had a momentum, we lived a historical moment that changed our lives forever. Probably this is the perfect place to say this, as we are standing in the University Square in Bucharest, where the revolution started. And we are also living a similar momentum in oncology because we have a chance to think beyond the death penalty which cancer was in the past, we have a chance to cure several of our patients and give promises to those who at this point cannot be cured.

We are living through many societal changes, many of which are highlighting the importance of reforming the healthcare systems and more importantly redefining what we understand by health and disease. In the European Union, there is a commitment for the years to come under the ambitious Horizon programme, aiming to address the major challenges citizens face in their daily lives. More than €600 million will be invested in the five EU Missions in 2023, as part of the Horizon Europe framework programme.

Cancer is the first disease that changed the EU’s involvement in healthcare. From a Moonshot approach to a Plan dedicated to cancer, now we live the momentum when all this can become reality in all member states. The Mission on Cancer launched on 29 September 2021 aims at improving the lives of more than 3 million people by 2030 through prevention, and innovative treatments, and for those affected by cancer including their families, to live longer and better.

I had the honor to meet Prof. Jeliazko Arabadjiev, the first Balkan in the EU Mission on Cancer Board, Ambassador for Bulgaria, Romania, and Lithuania, during an event organized in Bucharest by the Executive Agency for Higher Education, Research, Development and Innovation funding (UEFISCDI), ”Working together for a quick and diagnosis and better treatments for cancer EEA & Norway Grants contributions to the EU Mission Cancer”.

An oncologist by profession, Prof. Arabadjiev explained how the Cancer Mission implementation should look in the Central and Eastern European countries (CEE region), discussed his priorities, and shared his motivation to make the voice of the Balkans heard at the highest level to transform the lives of citizens and cancer patients.

• Transformation of culture and communication are key objectives in the Mission implementation Plan. As Balkans, we share a cultural background that influences the way we relate to cancer. How do you see the objectives of the Mission being implemented in the region and maybe the perspective of building a CEE Cancer Mission Network?

Bulgaria and Romania joined the European Union more recently, and we made huge efforts to make sure we fulfill the criteria for joining the EU. I believe that citizens in both countries are happy we are part of the EU. Unfortunately, we might not have been prepared for this because being part of the EU requires a specific behavior that is different from the cultural heritage, we Balkans share.

When it comes to cancer, we need to overcome the stigma we lived with for decades. I remember a time when cancer was a disease nobody wanted to speak about and was considered a death penalty.

My grandmother died of colorectal cancer 42 years ago. I remember she was diagnosed in November and died in January. At that time. once we heard the diagnosis, the whole family went to tears. The only option was chemotherapy and there was no support from society, no psychological support, no program to help the patient, no innovative treatment, and no personalized medicine.

I became an oncologist because oncology reflects the best innovation society expects from science. I speak as a board member of Cancer Mission but also as an Oncologist. I can use my knowledge of cancer and the opportunity to be the first Balkan Oncologist elected to the Board of the EU Mission on Cancer. I have great plans on how to synchronize our efforts and create the types of synergies that the EU Commission expects.

All recommendations from the first Board Mission on Cancer and all efforts of the current board are towards changing the perception of cancer in countries like ours. We need to battle the inequity not only to ensure access to personalized treatment but to all aspects of the disease, from the perspective of cancer patients as well as the perspectives of the family. The EU Beating Cancer Plan and Mission on Cancer will tackle the inequities between member states. This will be very beneficial for Balkan countries because we will get access more quickly to cancer care. But we need to speak up about this, to encourage transborder collaboration.

• Citizen empowerment in the CEE can be a challenging task because the patient-doctor relationship is a traditional one with many inequalities specific to the area. How to change the mindsets of citizens to engage actively when it comes to their own health?

We need to provide citizens with a proper roadmap of their disease and a proper outline of progress, and also for relatives and family. Cancer is more than the relationship between oncologist and patient. We need to ensure the continuum of cancer care, which doesn’t include only treatment. We need to make sure patients and citizens get the full benefits out of cancer care, the way it often happens in Western Europe. The Implementation Plan outlines every aspect needed to achieve this.

We need to establish structures and involve stakeholders in this process of synchronizing cancer care in our countries so we can manage to implement all that. The first board tackled all the problems with cancer patients and outlined the measures we need to take in our countries. The mission of this Board is not only to show things but to propel the action, to achieve all that we put in the implementation plan.

Cancer will be best treated in a multidisciplinary team, and in a diverse way, which will attract stakeholders who were not visible before. I am talking about insurance companies, social care providers, and such stakeholders. We need to encourage cooperation between institutions, this will make things happen. Unfortunately, we need to consider our cultural background and understand the differences from the Western countries, but we have a chance to learn from best practices implemented in other countries and recognized at the EU level. It is a very beneficial time for us. We don’t have to recreate the wheel or find hot water.

• How can we ensure that disruptive technologies such as genomics and data science make full impact in the regions since there are major gaps to be covered?

We are lagging behind other countries because we do not have proper cancer registries. We need to create a proper organization to restore or implement cancer registries and digitalize them. There is no wonder there are so many topics dedicated to digitalization in Horizon Europe.

At this point, we have the technology to get the full genomic profile of a tumor. Once we find the mutation, we can find a truly effective treatment, which should be available for all those who need it. So far, genetic testing has been left in the hands of the health authorities, ministries, and national health funds. Both are not prepared for such an extent of knowledge, because so far genetic testing has been expensive, and are not ready for the cost of the treatment informed by genetic profiling.

We need to start discussing this with the health authorities, educate them, we need to show them in a very professional way the benefit for patients and for citizens, who are not patients yet, and for society. And also, from an economical point of view. Let’s say we have a patient in his 40s and if he is put on a personalized treatment he can live many years, with a proper quality of life, and the capacity to work and be an active part of society. We need to start explaining this to the institutions and brainstorm with them. We cannot afford to miss genomic profiling just because there is no money for this.

We don’t have just oncology anymore, we are not <<chemotherapists>> – how they used to call my profession 20 years ago. Genetic testing is crucial. We are oncologists who can offer a precision approach to our patients.

• the fight against a pathogen not yet fully known, the fight in which unprecedented financial, human, and scientific resources were thrown into the game
• the challenge of dealing with a large number of patients with chronic diseases that no longer had access to the hospital (the healthcare systems in Eastern Europe are centered on in-hospital care) and for which solutions had to be found, especially in 2020

The introduction of telemedicine overnight (after years of procrastination) represented a step forward, but an incomplete one, in the absence of integration with other data sources: electronic files, wearable devices, or other mini devices used at home by chronic patients, to monitor the evolution of the disease.

It’s very important that the investments and prioritization for Covid-19 offered important results – vaccines, diagnostic tests, oral treatments, etc., but one effect was the deprioritization of patients with chronic diseases – cancer, cardiovascular, diabetes patients, and the list can go on and on.

The data are eloquent: hundreds of thousands of excess deaths in Eastern Europe in 2020-2021, two-thirds of which represented excess mortality as a result of uncontrolled chronic diseases.

It is clear that the solutions identified in the pandemic crisis, such as telemedicine, have not reached their potential. There are multiple reasons for this.

(1) Probably the most important reason is the inertia and reduced adaptation to change of medical doctors, but also of patients, even in a crisis situation.

(2) During the pandemic, there was no standardization of the use of digital solutions such as telemedicine. For example, a law was promoted during this time, but the application rules were published only last week in Romania.

The next step is the professional’s opinion, for each therapeutic area, regarding when, and how telemedicine should be used. For this, we probably need pilot projects, implementation research, and real-life use of various digital tools, with the aim of increasing the quality of life of patients.

Creating models based on real life is essential for increasing trust (of people in technology, but also of patients in doctors and the health system) because it takes into account cultural, social, and environmental factors that influence attitudes, perceptions, and individual behavior.

The pandemic has shown us how important individual behavior is in relation not only to classic public health measures but also in relation to innovations – mRNA vaccines, genomic surveillance of virus circulation, the use of the Covid-19 digital certificate or the use of applications that signal proximity to an infected person.

I think there are lessons from the pandemic that we are still learning – and one of them is that innovation and the digital component of innovation must start from our needs, but also take into account individual behavioral elements. Without these elements, digitization and innovation will remain at the stage of buzzwords.

The version in Romanian: Telemedicina, una dintre lecțiile pandemiei Covid-19 pe care încă nu am învățat-o în România