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C a n c e r W o r l d 2 5 Education & knowledge through people & facts J U L Y Number 25, July-August 2008 - A U G U S T 2 0 0 8 MIke Richards § Mike Richards: the man with the plan § World Cancer Declaration puts cancer control on the global human rights agenda § Poor health literacy prompts warnings of an underclass § Careers in cancer: the next generation voices its frustration Contents 3 Editorial A question of human dignity 4 Cover Story Mike Richards: the man with the plan 14 Grand Round The hopes and frustrations of a career in cancer: the next generation speaks out Editor Kathy Redmond [email protected] 22 Drug Watch Assistant Editor Personalised medicine: the dream and the reality Anna Wagstaff Editorial Assistant 28 Masterpiece Corinne Hall A scientist without borders Editorial Board Franco Cavalli (chair), Alberto Costa Jacques Bernier, Vincent T. DeVita 36 Spotlight on... Lex Eggermont, Jan Foubert Lynn Faulds Wood , Mike Richards Tackling cancer in the Middle East: Euro-Arab School of Oncology Umberto Veronesi contributes a mix of international and local expertise Contributing Writers Ghassan Abou-Alfa, Marc Beishon Jim Boumelha, Noah Choi 40 Impact Factor Janet Fricker, Lia Halasz Peter McIntyre, Eileen O’Reilly Does prophylactic cranial irradiation reduce the incidence of Anna Wagstaff brain metastases in extensive small-cell lung cancer? Publishing Advisors Comparison of gemcitabine plus platinum analogue with Gillian Griffith, Fedele Gubitosi gemcitabine alone in advanced pancreatic cancer Website Liaison Chatrina Melcher Newsround Art Editor Jason Harris 52 Patient Voice Layout Designer Europe must tackle health illiteracy to avoid a health ‘underclass’ Max Fuller Production 58 Systems & Services HarrisDPI www.harrisdpi.co.uk We’re back! How an alliance of patients and politicians put cancer Printed by back on the EU agenda Arti Grafiche Amilcare Pizzi Cover photograph Jason Harris Published by European School of Oncology Direttore responsabile Alberto Costa Registrazione Tribunale di Roma Decreto n. 436 del 8.11.2004 All enquiries about Cancer World should be made to: ESO Editorial Office Via del Bollo 4 20123 Milan, Italy e-mail: [email protected] Fax: +39 02 8546 4545 All correspondence should be sent to the Editor at [email protected] Cancer World is published six times per year by the European School of Oncology with an average print run of 10,000 copies. It is distributed at major conferences, Copyright ©2008 European School of Oncology. mailed to subscribers and to European opinion leaders, and is available online at All rights reserved www.cancerworld.org CANCER WORLD I JULY/AUGUST 2008 I 1 Editorial A question of human dignity § Mary Robinson I GUEST EDITOR ocial and economic progress over life-saving tools such as HPV vaccines avail - the course of the last century has able to those who need them most and to helped people in many countries ensure that robust health systems are in place Senjoy longer, healthier lives. Public health, by to support their delivery. and large, has improved and health inter - The World Cancer Declaration, which ventions are now available to prevent or treat will be launched at the UICC World Cancer most conditions, including cancer. Congress in Geneva this August, outlines Yet cancer continues to kill millions of the critical steps needed to build the basis for people worldwide every year and the death toll sustainable delivery of effective cancer pre - is projected to rise dramatically.A full 70% of vention, early detection, treatment and pal - these deaths occur in low- and middle- liative care worldwide. The Congress provides income countries. a critical forum for health professionals, pol - According to the WHO, up to one third of icy makers and advocates to galvanise the the cancer burden could be cured if detected global health community behind the goals of early and treated adequately, and another the Declaration. third could be reduced through cancer pre - These and other steps to advance global vention strategies aimed at reducing the expo - health are not just matters of moral concern: sure to cancer risk. These include changes they are issues of fundamental human rights. in tobacco use, immunisation against HPV Article 25 of the Universal Declaration of infection and control of occupational hazards. Human Rights declares that “everyone has Cervical cancer is just one example. the right to a standard of living adequate for Although we have the tools to prevent this ter - the health and well-being of himself and his rible disease, it affects an estimated 500,000 family, including medical care.” women each year and leads to more than As members of The Elders, we have 250,000 deaths – the vast majority in devel - highlighted the right to health as part of oping countries. Most women affected do not the Every Human Has Rights Campaign have access to local health systems or routine (www.everyhumanhasrights.org) to mark the gynaecological care, including regular screen - 60 th anniversary of the Universal Declaration. ing, which plays a critical role in preventing The message that health is a fundamen - cancer in industrialised countries. tal human right must be heard again Much more must be done to encourage today. We all have a role to play in moving the the international support necessary to make cancer control agenda forward. Mary Robinson, former UN High Commissioner for Human Rights, is the President of Realizing Rights (www.realizingrights.org) and a member of The Elders – a group of public figures noted as elder statesmen, peace activists, and human rights advocates CANCER WORLD I JULY/AUGUST 2008 I 3 Cover Story Mike Richards: the man with the plan § Marc Beishon “Congratulations, you are now in charge of sorting out England’s failing cancer services, what are your plans and can you start on Monday?” The job offer took Mike Richards by surprise but, mindful of the fickle nature of political support, he accepted the post, got straight down to work, and within six months he not only had a plan, but was ready to put it into action. here are two ways of looking at the job of other countries in the UK, to which responsibility for a country’s cancer ‘czar’ – the person health has now been devolved). The NHS Cancer charged with masterminding a national Plan for England as drawn up in 2000 was, as cancer control plan. Many will see it as Richards says, a long overdue necessity. an impossible task, trying to keep every - “No country has a perfect system, but ours was far Tone from politicians to doctors and patient groups in behind many,” he says. “When I became national can - line with a programme that could never be compre - cer director I visited Sweden and talked to people in hensive and chasing targets that are constantly out of charge of service delivery – they told me we were reach, thanks to an ageing population, unhealthy beginning to do the right things but they’d started 20 lifestyles and lack of treatment progress, not to men - years earlier, with systems such as regional care net - tion continual changes in healthcare bureaucracy. works and service guidelines. The UK had great Others, however, will point to countries where a fragmentation in its cancer workforce and too few cancer plan and its leader have made clear progress people and facilities – we were not looking at cancer despite these odds, and on the international stage in the round, from prevention to screening, diagno - arguably the most prominent example is England and sis, treatment and care. It was a system failure.” its national cancer director, Mike Richards. The plan in 2000 set out to address these short - England stands out because, when it embarked comings. It has now been revised as a new reform on its cancer plan in 2000, it was the first large strategy, targeting in more sophisticated ways areas country in recent years to take this step. Denmark that are proving most problematic, such as early started its plan around the same time, but it was not diagnosis. After several years of spending a lot more until 2003, with the launch of the French cancer on cancer – although still less per head than Germany plan, that another large country followed suit. Eng - or France – the emphasis is shifting to effectiveness, land also stands out as a country that was in desper - and Richards is now looking to establish England’s ate need of playing ‘catch up’ with comparable cancer care among the world’s best. countries in the West (and this also applied to the For his own part, Richards – who was a professor 4 I CANCER WORLD I JULY/AUGUST 2008 Cover Story S I R R A H N O S A J CANCER WORLD I JULY/AUGUST 2008 I 5 Cover Story of palliative medicine in his last clinical post – does “I come from a medical family – my father was a GP, not preside over an expensive bricks-and-mortar and both my sister and brother had gone into medi - institute to direct the strategy. He has kept his office cine – but I hadn’t seriously considered it myself until at St Thomas’ hospital, London, with a view over the I switched from a natural science degree at the end River Thames to the Houses of Parliament, and has of my first year at university. I found it combined sci - a small team to call on. Networks, and networking, ence with humanity and I’ve never regretted making he feels, are far more effective than central diktat. the change,” he says. A snapshot of just a few days in Richards’ diary Richards did the usual training in general medi - reveals just how varied his own networking is – and cine, and found his way into medical oncology.