Anyone who has cancer or lives next to someone who is affected does not need a date to remember how much it impacts on their life. But to all the others – citizens, doctors and institutions – World Cancer Day which is celebrated today serves as a warning to listen to the still unmet needs, the progress made and the immense work that still needs to be done before being able to claim victory against a pathology that has become less ‘bad’ over the years but which still reaps victims with an unacceptable social and territorial disparity. Precisely for this reason, the slogan chosen for World Cancer Day, the world day against cancer organized by the Union for International Cancer Control (UICC) like every year on February 4, it is «Close the care gap», that is, closing the care gap. Today the Italian Association of Medical Oncology (AIOM) also recalls it in the national conference “Close the Care Gap” which takes place in the Senate, with speeches by the Minister of Health, Prof. Orazio Schillaci, and by the President of the Higher Institute of Healthcare (ISS), Prof. Silvio Brusaferro, with the aim of making citizens aware of the differences in access to care.
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How important is education and income?
In Europe, 32% of cancer deaths in men (almost half in Eastern Europe) and 16% in women (one in four in Eastern Europe) are associated with socioeconomic inequalities, particularly at low levels of education and income. Moreover, it is well known that the less educated and poorer people adopt incorrect lifestyles, perform screenings infrequently, do not have access to health systems and too often arrive at the diagnosis of cancer in an already advanced stage. These disparities are less evident in countries with universal healthcare systems such as ours, capable of guaranteeing treatment for all. “Across the planet, every year, there are an estimated 18 million new cases of cancer and almost 10 million deaths – he says Saverio Cinieri, president Aiom. In a recently published study, it was highlighted that, in Europe, the risk of dying from cancer progressively increases with decreasing socioeconomic level”.
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Lung, stomach and uterine cervix more ‘sensitive’ to the social gradient
The neoplasms most affected by the social gradient are those of the lung, stomach and uterine cervix. “The more we understand the biological processes, risk factors and health determinants that favor the onset of tumors – continues Cinieri – the more effective prevention, diagnosis and treatment become. Key risk factors should be addressed, taking into account all determinants of health, including education and socioeconomic status. We need a 360-degree vision, which also includes the uncomfortable conditions of citizens, so as not to leave anyone behind”.
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Adherence to screenings
In Italy, social inequalities are added to territorial inequalities because there has always been a gap in adherence to screening programs between North and South. On the occasion of World Day, Aiom relaunches the urgency of strengthening screening programs. “In 2021 – he explains Francesco Perrone, president-elect Aiom – a return to pre-pandemic data has been observed regarding the coverage of secondary prevention programs. But that is not enough, because there are still too many regional differences. In particular, in 2021, mammography coverage values in the North reached 63% compared to 23% in the South. For colorectal screening (search for occult blood in the stool) the figure is 45% compared to 10%. In cervical screening, 41% of the northern regions are counterbalanced by 22% of the southern ones “.
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Being able to count on pharmacists too
The North-South gap was already evident before the pandemic, but many southern regions have not yet managed to make up for the delays accumulated during the health emergency. “Extraordinary efforts are needed to improve membership levels in these areas. As regards, for example, the search for occult blood in the faeces for the detection of colorectal cancer, the involvement of pharmacists can be foreseen. To bridge the territorial gap, our scientific society will launch a major awareness campaign aimed at the Southern Regions in the coming weeks ”, adds Perrone.
Learn to live according to health
Encouraging adherence to screening is crucial, but first of all there is the need to adopt healthy lifestyles. “In 2022, 390,700 new cancer diagnoses were estimated in Italy. 40% of cases can be avoided by acting on modifiable risk factors”, underlines the president of Aiom. “In particular, tobacco smoke is the main risk factor, associated with the onset of approximately one tumor out of three and as many as 17 types of neoplasia, in addition to lung cancer. The social differences in smoking, which see people with fewer economic resources or a low level of education more exposed, in our country remain large and significant over time, against a reduction that involves more the less disadvantaged individuals”. In 2021, the smoking habit among citizens who declare that they face many economic difficulties in making ends meet was 37% and similar to what was observed in 2008, while among those who do not have financial problems, the share of smokers dropped from 27% to 20% between 2008 and 2021.
The weight of a sedentary lifestyle
Not only. According to estimates by the ‘World Cancer Research Fund’, 20-25% of cancer cases are attributable to an energy balance that is too rich, linked to the combination of excess weight and sedentary lifestyle – underlines Perrone. “In Italy, 31% of citizens are sedentary and 10% are obese, but these percentages reach, respectively, 45% and 17% among those who are in economic difficulty or have a low level of education”, underlines Perrone . “It is necessary to strengthen the actions aimed at spreading the conscious adoption of a healthy and active lifestyle in all ages, integrating individual change and social transformation, through the development of health promotion programs”.
The barrier of bureaucracy
Those who ‘attend’ public health facilities with a certain diligence know well how much time it takes even just to find out where to go and what to do, not to mention all the administrative procedures to be completed. It is estimated that in our country, more than 50% of the time of each oncological visit is absorbed by bureaucratic obligations. This is why specialists ask to hire staff who can deal with these aspects. Only in this way will they have more time available to visit patients. “A research carried out in 35 hospital structures, for a total of 1469 patients visited, showed that, during an appointment, for 11 minutes dedicated to visiting the person, a further 16 are spent filling out forms, booking appointments, visits, exams, beds and armchairs for hospitalizations or day hospitals, prescriptions, sending e-mails”, he explains Rossana Berardi, member of the Aiom National Executive. A figure that is probably even underestimated, because many centers dedicate fixed days to these activities”.
Administrative figures to streamline times
News events confront us every day with the emergency of the shortage of doctors caused by many factors: the pandemic, the limited number of medical faculties maintained for too many years, the high number of retirements and the blockage of turnover. “The Regions could address this situation and free clinicians from bureaucratic activities. Like Aiom, we offer a model for supporting oncologists with new personnel. Administrative and paramedical figures, biologists or data managers able to support healthcare personnel during visits, to shorten their duration and increase their number. Less time spent filling out forms means more hours available for patient visits. It is a concrete solution, with immediate and measurable effects on the emergency, which would lead to an enhancement of the clinician’s work and a positive impact on the whole system”, adds Berardi.