Editor’s Note:
The World Conference on Lung Cancer (WCLC), organized by the International Association for the Study of Lung Cancer (IASLC), took place from September 9 to 12 in Singapore. Over 6,000 experts and scholars in the field of thoracic malignancies exchanged ideas and showcased cutting-edge advancements in both basic and clinical sciences. At the WCLC, Professor Richard Sullivan, Director of the Institute of Cancer Policy at King’s College London, shared his insights on global cancer-related medical technology and policy development with “ Oncology frontier”.
Richard Sullivan
Director, Institute of Cancer Policy and Co-Director of the Centre for Conflict & Health Research
01
Oncology Frontier : You have served as an advisor to organizations such as the World Health Organization and the World Bank. How does your advisory role influence global cancer research and related policy development?
Professor Richard Sullivan: The role of an advisor within organizations like the World Health Organization, the World Bank, and other United Nations agencies is crucial for understanding the thought processes of high-level policymakers. Within the UN system, we deal with a range of policy issues, not only cancer but also non-communicable diseases and the balance between development, gender, and health. As an advisor, understanding the issues that high-level policymakers care about is essential. Understanding the drivers behind macro-level policy formulation and advocacy is also crucial. This, in turn, influences the direction and strategy of specific research, laying the foundation for long-term exploratory research projects. Additionally, serving as an advisor allows us to provide real-time key intelligence to high-level policymakers, matching their timelines and potentially influencing their work progress and schedules. In academia, our alignment with high-level policymakers is often not entirely synchronous in terms of direction and timeliness. Therefore, being an advisor enables us to stay attuned to their needs in real-time, albeit with certain challenges in bilateral relationship coordination.
02
Oncology Frontier : One of your research areas involves the use of virtual reality in enhancing surgical simulation for global cancer surgery. Can you elaborate on how this technology is driving the development of cancer surgery, particularly in lung cancer?
Professor Richard Sullivan: Seven years ago, our team led a project on the future development of global cancer surgery, with the results published in “The Lancet Oncology.” One major finding was a significant gap in capacity and capability among cancer surgical personnel, including general surgeons, gynecologists, and anesthetists. It became evident that we would need technology to enhance the education and training of surgical practitioners, and virtual reality (VR) has become a major technology in high-income countries. When we talk about VR, it is primarily applied to minimally invasive and robotic surgeries, with a high cost and focus on advanced surgical applications. In low-income countries, where most surgeries are still conducted in a traditional open manner, there is a need for a new form of VR technology. Therefore, we collaborated with experts worldwide to develop open-source VR surgical simulations for pelvic open surgery. Currently, it is crucial to note that we observe a significant increase in the diagnosis of cervical cancer in low- and middle-income countries, especially in the field of lower pelvic surgeries. We have developed the first open-source, free, and affordable VR surgical simulation for total abdominal hysterectomy, which has shown promising results in trials in Zambia and will be published soon. It provides an affordable VR platform, and we hope this technology can be applicable to a broader range of surgical procedures, such as breast and colorectal surgeries.
03
Oncology Frontier : Global cancer control levels have been a concern, and there is an interest in reducing this imbalance through global cooperation and regulatory approaches. How can this imbalance be reduced?
Professor Richard Sullivan: Currently, there is a significant focus worldwide on the access to cancer drugs, especially ensuring fair access for low-income and middle- to high-income countries. One key bottleneck is the regulatory authorization of cancer drugs, mainly led by critical agencies such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). However, there are other agencies in the UK, MHRA, Canada, and the Far East. Many efforts are being made to adjust these regulatory procedures, but the situation is mixed. The work we are doing in terms of project tracking and other forms of regulatory collaboration is positive because regulatory agencies worldwide are now in discussions, proposing what level of evidence we should require for drug approval. However, this imbalance is still growing slowly. When cancer drugs enter the market, is there greater uncertainty about their actual benefits, cost-effectiveness, and affordability in a single ecosystem? Therefore, there is a significant tension between increasing opportunities to access innovative drugs and actually formulating regulatory pathways to ensure the provision of affordable drugs that bring clinically meaningful benefits. This requires further coordination and balancing.
04
Oncology Frontier : In the context of global health security, how can databases and data analysis play a role in addressing outbreaks of high-risk diseases, such as pandemics?
Professor Richard Sullivan: In the context of my work with the Institute of Cancer Policy and the Centre on Conflict and Health Research, we have been focusing on health security intelligence for the past decade. Of course, COVID-19 has been a real wake-up call for health data and policy formulation, especially in the early stages of a pandemic. We established the COVID-19 and Cancer Working Group, bringing together data and information sharing from around 59 major cancer centers worldwide to understand the impact of COVID-19 on cancer outcomes and observe infectious and clinical care pathways. This also underscores the necessity of building robust data information systems. We often talk about data, but the issue is that data alone is not enough. You need to be able to organize and appropriately analyze data, better determine the authenticity and accuracy of data, and then timely convey this information to policymakers so that they can respond promptly and adjust policies. Therefore, big data has become a crucial field, even in cancer epidemiology, integrating various forms of data, such as incidence, prevalence, mortality, survival rates, and quality of life data, to create databases that can influence policy formulation at different levels. We have been trying to handle health data in a more nuanced and subtle way to actually change policies. To achieve this expectation, what we need is well-curated data and real databases.
05
Oncology Frontier : How can global healthcare systems prepare for new challenges in the field of cancer treatment, especially with high-potential new therapies and technologies?
Professor Richard Sullivan: In the next decade, healthcare systems worldwide will face significant challenges posed by new technologies, which include not only drugs but also areas such as surgical procedures, radiotherapy, and imaging. All these new technologies will bring immense cost pressures. Under this cost pressure, we need to understand how to deliver services more efficiently across increasingly complex pathways and integrate these services into the system. It is increasingly apparent that we need adaptive health technology assessment programs to help policymakers determine which technologies are suitable for their context. Currently, these may not reach the level of the National Institute for Health and Care Excellence in the UK, but they can still assist countries in adapting to the management of these new technologies, deciding what is affordable, cost-effective, practically feasible, and favorable to equity without exacerbating the imbalances in a country’s development. All these factors combined mean that there is a need to strengthen governance and focus on health technology assessment projects, paying more attention to health economics, political economics, and the quality of services provided by these technologies. This will require true transformative thinking in terms of organization, country, research culture, and the way we engage in funding, whether domestic or bilateral development funds.
TAG: WCLC 2023, cancer treatment technology, cancer treatment policy
