Isabel Rubio: Workforce Crisis, Inequalities, and a Vision for Advancing Cancer Care in Europe

Isabel Rubio, President-elect of the European Cancer Organisation (ECO), joins host Yeva Margaryan to share her vision for advancing cancer care in Europe. In this insightful discussion, Isabel Rubio highlights the urgent need to implement the Europe Beating Cancer Plan, focusing on prevention, early detection, and equitable care across Member States.

Dr. Isabel Rubio is a Breast Surgical Oncologist at the University of Navarra Clinic in Madrid. She serves as the President of the European Society of Surgical Oncology (ESSO) and is the Past President of the European Society of Breast Cancer Specialists (EUSOMA). Previously, Dr. Rubio led the Breast Surgical Oncology Department at the Hospital Universitario Vall d’Hebron. Her clinical and research interests include sentinel lymph node biopsy, neoadjuvant treatments, surgical management of BRCA mutation carriers, and the role of prognostic markers such as genomic profiles and liquid biopsy.

I’m really honored to have been elected as President-elect of the European Cancer Organization, who is the voice of cancer in Europe. I believe that after the publication of the Europe Beating Cancer Plan, our main goal in the next two years will be to finalize the implementation of the Europe Beating Cancer Plan across the member states. I believe it’s so important to have that implementation, because if the member states are not implementing the recommendations for all the continuous cancer care, starting with the prevention and following through survivorship, then, you know, the Europe Beating Cancer Plan won’t be a reality as we all expect it.

I think there are many challenges and we probably need to look into step by step, and I believe that this is why the European Cancer Organization has these focus networks, because there are so many things that can be improved in any step of the patient journey that it’s impossible to do it all at the same time. I think that we will expect the finalizing of some of the European Union-funded projects that will help to implement some of the Europe Beating Cancer Plan. Some of them, like the SMART case that we are going to see tomorrow and PROTECT, are already finalized, so that’s a good thing.

But we keep going on trying to be part of these funded programs that will help to the implementation. You know, prevention is the most cost-effective strategy, but prevention needs to be followed also with continuous care, so we can’t get more early detection across all cancer types, but if we don’t follow with a program to implement and to improve the access to treatments, surgical, radiation therapy, medical treatments, then we will be stuck in the next step. So I think it’s a little bit of everything that we need to go.

We will try to work in every single step in the pathway, trying to improve and implement those challenges, and of course, you know, one of the huge problems in Europe and inside the member states are the inequalities in access to screening programs, to treatments, to any cancer care.

I think that one of the main issues that we need to have is data, because we need to have evidence, evidence base to make improvements in the single steps in the pathway. I believe that one of the, and we have seen today in the quality network, quality and health system network, we’ve seen that how important it is to have national registries, and to have national registries with good data, to be able to share between the member states this data.

And nowadays, the real world evidence will come from the real world data. So it’s imperative that the member states, the ones that have them, they are already, you know, working on improving it, but the ones that the member states that do not have cancer registries need to speed up the process, put the resources to have the data. And in that way, we can share the data between all the member states.

If we want to get any information and evidence base for any step in the pathway of the patient. We’ve heard also in this health system network this morning at the European Cancer Summit, how the Belgian cancer registry or the Swedish cancer registry are ongoing for many years now, and are showing the data of how can you improve what is suboptimal treatment of cancer patients. And I think this is the way to go.

So I think from the European Cancer Organization, we will push forward to these national cancer registries, and to share the data between all the members. So there is already this European Cancer Information System, where all the member states are welcome to share their data. The only issue that I would like to mention is that in those countries where there are no cancer registries, it will be good not to invent the wheel.

So, you know, those who are starting to implement the cancer registry in their own countries, should look into the cancer registries that are already there in Europe. Because in that way, we can share the same data. You know, there is no point of having different new cancer registries that do not comply with the majority of the cancer registries.

So I think this is something that we would like to express, and we would like to share with the member states. As we have seen yesterday in the workforce network, and we see as a reality in our daily practice, because we see how difficult it is to enroll more health professionals in cancer care. If you have seen the report from ECO about the workforce crisis, you have seen that of the survey that they have done in Europe, 50% of the health professionals feel that their employees are not taking care of their well-being.

So this means that we need to put a little bit more of humanity in our jobs. And we need to make sure that if there is a lack of health professionals, and when I mean health professionals, I mean nurses and every single specialist who is taking care of cancer patients. If there is a lack of professionals, and the idea is to give more work to the ones that are already there, the burnout will increase, then, you know, the sick leaves will be much higher.

So this is not the way to go. I think that with this survey, we have realized what’s the real problem in Europe. There is data also from the UK and other countries, which are the most dangerous specialists in terms of cancer care, radiation oncologists, pathologists, because there is a very huge group of specialists who are going to retire.

And we look into the idea that there is not enough specialists to replace all of them. And also we need to go a little back and look into the medical schools. So in many countries in Europe, when you finish medical school, you undergo an exam to get the specialization.

Well, we probably need to increase the number of specialists in Europe, increase the number of doctors who can undergo a specialization. And this is something that we also need to talk to at the member states with the medical schools and the organization of the specialist programs. This is one of the ways to go.

We need more specialists, and the way to get more specialists is to train them more. And this is in the way of increasing the numbers and in the way of improving your work. I think it’s also important to be aware at the institutions that there is something more than just continually seeing patients.

We are loaded with paperwork. And if we can just go back to the cancer registries and the registries of the patients, we need to have the idea that there needs to be data managers in the cancer centers. I mean, the doctors or the nurses are not the ones who really need to fill the data, because that’s not their job.

I mean, they are not trained to do that, and they don’t have time to do that. So we are trying to overcome this lack of data managers or a system where the institution has to register all the data. And the idea is to try to get the health professionals to fill the data in.

I mean, that’s not the way to go, because that will overload it with work. This is not their mission. Their mission is to take care of patients.

So I think this is something that we will also, you know, be pointing out, because it’s a way to go, that it will be the wrong way. Going back to the evidence base, we did, the European Cancer Organization did this study and this document looking into the cancer, called the Cancer Pulse, looking into the inequalities in Europe across the different pathways of the patient. And we find out that, you know, the reality is that there are many inequalities between member states, but also in each country, between different regions of the country.

And this is something that we already know, and we have data to prove that. Now, what we are looking is to, which are the populations that are really, has more difficulties to go into, to access to treatments, to go into the screening programs. And we are looking into those undeserved populations, low socioeconomic status, gender bias, and so on.

So now we have identified what is not working. Now the next step is how we can approach this. And we also have heard how they approve of medications are different in the different countries, in the different member states.

There is also a lack of specialization in cancer surgery in many member states. So not all the patients can access a high quality cancer surgery. And we know that that will not only affect the oncological outcomes, but it also will affect the quality of life of the patients if they have suboptimal surgeries.

So there is, you know, many issues in disparities, in inequalities that we need to address. And we are working in that. We are working in giving recommendations to the member states when they are implementing new strategies in cancer care to try to reduce these inequalities.

We see the difference between the Eastern countries in Europe and the Western countries. We see the difference because at the end, there is a need for the legislators to make legislation regarding, you know, tobacco, regarding many other air pollution, regarding, you know, the screening, regarding everything. So at the end, the countries will move forward to a better cancer care and prevention if there are legislations that, you know, reduce the access to all these factors that are risk factors for cancer.

And many of them are modified. And we know that there are many cancers that can be prevented and can be prevented by modifying all those risk factors. And this needs to have besides a legislation in the country.

So I think this is, we are, I think we are giving short steps, but we are in the way of trying to prevent those cancers that can be preventable. And for the other ones, you know, there is still a need to implement the screening programs, population programs in some countries in Europe that they don’t have it. And there is also a need to improve the screening programs, for example, for colorectal in some countries.

The new recommendations of adding screening programs for gastric cancer, lung cancer are still, you know, ongoing. We will have results from some European funded projects like SOLAS, AutoGuides for getting data on the real benefit of this screening method. So I think we are in the way of improving, reducing inequalities.

But, you know, it will take some time. We need to speed up the process a little bit. But I think that as soon as we have enough awareness of patients, enough awareness of the citizens, that it’s a right for them to have high quality cancer care.

I think we will get better in getting all this legislation out. If I may say, the European Cancer Organization is one organization that has 33 member societies and a patient advisory committee. And they all have the same mission and vision.

So it doesn’t matter where you come from related to your profession. We are only looking at cancer. And I think this is what makes the European Cancer Organization so different from the rest of the organization.

And what makes, like, you know, cancer is on the eye of all of us. Since many years ago, and we saw that Steliaki Akides was one of the chairs of the patient advisory committee at the European Cancer Organization many years ago. But since then, the patient advisory committee has been a really important part of the European Cancer Organization.

Because we cannot change anything if we don’t listen to the patients. And I like very much this sentence that says, you know, nothing about me without me. And I think this is in our heart.

And we need to work together. Because sometimes, you know, we are on this side of the table. And we don’t realize about some changes that need to be done.

And this is the way to go. So the patient center means not only that you go around the patient, but also that you have the patient listening the patient to what they have to say. We can keep collaborating with all the societies, with the European Commission, in terms of having more European funding projects that will improve the implementation of the European cancer plan in the different member states.

If we can keep doing that in the next four years, I will be very glad that we have succeeded in what our mission of the implementation of the beating cancer plan was. So I look forward to the new European Parliament that will still have health and cancer in the front line of their policies. I think that we are really looking for that.

I think health is one of the most important parts of human nature. And I think that cancer needs to keep being in the front line. Because this is the only way to finalize the implementation, or at least look into the nearest end of the implementation of the European cancer plan.

And this will be like the real success. The only thing I want to say is that we need to speak up. We need to speak up about the concerns that we have.

We need to speak up about what we need to improve cancer care. And the European Cancer Organization is open to anyone who wants to be part of our networks, of our committees. And I think that united, we can achieve what we want.

And we can achieve high-quality cancer care and reduce inequalities in the cancer approach.