Targeting Cancer Treatment as Soon as Possible
Zoltán Polányi, director for market access, policy and communications at MSD Hungary.
Research by a group of clinicians from across the country led by MSD Hungary and published in late November tries to answer why so many Hungarian patients die with undiagnosed lung cancer. The Hungarian Undiagnosed Lung Cancer (Hulc) findings are surprising, but also offer a clear way forward to better outcomes, says Zoltán Polányi, the policy, market access and communications director at the pharmaceutical firm.
Hungary is routinely placed at the top of lung cancer death rates in Europe, and it also has a high percentage of the disease that is undiagnosed at death. But the MSD research noted that recent epidemiological studies have consistently reported lower figures for Hungary. How are those figures arrived at? Are we as Polányi puts it, “comparing apples and apples or apples and pears?”
First, a couple of significant clarifications are necessary. There are, on average, 1,200 undiagnosed LC patients in Hungary a year. Sometimes that may mean the tumor was not discovered until an autopsy after death. In many cases, cancer may have been detected, but there had not yet been time to perform a complex diagnosis, which is also the condition for beginning a targeted treatment.
“I would like to make a difference between ‘discovered’ and ‘diagnosed,’” Polányi explains.
“‘Diagnosed’ means that you have the biopsy, you can analyze whether it’s a mutant type, and what treatment you can give. ‘Discovered’ is something that you know is there, but you haven’t done the diagnosis yet.”
The second clarification falls into the “apples or pears” category. Hungary has a particularly good central database for anonymized research (not true of all countries, by any stretch) and may be reporting a lot more post-mortem LC for the simple fact that it conducts significantly more autopsies.
“We find these patients because there’s a very high rate of autopsy in Hungary: 35-40% of all deaths that happen in a hospital setting in Hungary will have an autopsy; in other countries, it is 5-10%,” Polányi points out.
“Sweden, for instance, had the same level of autopsy at around 40% in the ’80s. In Hungary, the proportion of autopsy has remained high, whereas, in other countries, it has declined – significantly – since then.”
One of the things the HULC team was keen to discover was who these people were. Put another way, were there socio-economic reasons why their cancer was undiagnosed? Were they poorer, with less education, from rural Hungary, perhaps elderly? Those factors sounded plausible, but were they actual? The team was in for a surprise.
“There is some data that suggests that there are more elderly, more who are living alone or are divorced. Those who don’t have family or children, or just a lower number of children, but it’s far from being as dominant as we anticipated at the beginning. You have undiagnosed patients in Budapest, university educated with family, kids, and a wife or husband,” Polányi says.
Although it might seem odd to suggest it, this is, in fact, excellent news. The worry was that these were “ghost” patients missing from the system who would be hard to trace.
“It was a pleasant surprise that these patients are in the system. They had, in the last year or two, made GP visits, they were seeing specialists: they were not invisible to healthcare. That’s a very good sign because, if we can ensure they are seen at an appropriate time, they will be able to get appropriate treatment and will have the chance to live longer,” he says.
The answer, therefore, is to improve the education around cancer, both for the general public and, more specifically, for the GPs who see patients most regularly and know the medical history. Polányi believes patients should be assessed on a level of risk, and those most in danger, smokers, obviously, but also those with a history of cancer in the family, should be prioritized for checks. With cancer, timing is everything.
“Lung cancer is tricky because it doesn’t have symptoms; it can easily go unnoticed until it’s too late. It’s not like melanoma or a head or neck cancer that you can see or feel. Colorectal and lung cancer are the two that can go unnoticed until a late stage, and then it is almost always too late.”
Flip the Statistics
Typically, two-thirds of lung cancers in Hungary today are discovered too late to be treated with curative intent. At best they can be treated with the intention to make the cancer chronic. Improve the screening, and that can fall to one-third. If it can be treated in time, the chances of survival are markedly improved.
“There is data we have discovered that, if patients are diagnosed in time and have surgery, the five-year survival rate is above 60%. Whereas, if you are diagnosed in a later stage, you cannot do the surgery, and then the survival in 2016 was 8%.”
All is not doom and gloom. The figures above were for patients diagnosed between 2011 and 2016. Research on the cohort since then is about to be revealed by Polányi’s team and submitted to a medical journal for peer review. That suggests the survival rate for late diagnosis lung cancer in Hungary has doubled since.
“But it does not change the fact that if you are diagnosed early and can have surgical intervention, your five-year survival chances are significantly higher. If you do that screening, two-thirds of the population could be identified in time for cancer to be surgically removed. This happened with breast cancer, and we have studies showing incredible improvement in melanoma survival in Hungary.”
That, Polányi says, is the point of the research. If his team can gather, analyze, get peer-reviewed, and publish the data, those that run the healthcare service, the government and the medical community, can take directed action.
Follow the Data
Since 2019, innovative pharmaceutical company MSD has had a department dedicated to scientific data research in Hungary. It is, Zoltán Polányi insists, “completely separate from our treatments, our product portfolio.” It focuses on the diseases with the highest mortality or incidence rate in the Hungarian population.
“We have been researching lung cancer for four years and have had seven international publications,” he says.
He acknowledges conversations with healthcare leaders asking if the research is designed to push the medicines MSD develops.
“I’m advocating for the appropriate treatment at the appropriate time. In most cases, it should be the scalpel because a cancer cut out in stage two will always be better than one treated with whatever “miracle product” in stage four. So, appropriate treatment at the appropriate time. The appropriate time for cancer treatment is as soon as possible. That’s the thing. And the appropriate treatment as soon as possible is the scalpel.”
National Cancer Day is observed in Hungary on April 10.
This article was first published in the Budapest Business Journal print issue of April 11, 2023.
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