Dr. Christoph Zielinski, head of the organizational unit of the Comprehensive Cancer Center of Vienna (CCC), a representative of the Austrian oncological community, provides an insight into the key activities of the center. He also gives an overview of the current state of the Austrian healthcare and oncology ecosystem as well as how Austria can be considered the leading oncology nation in Europe.
As the Head of the Organizational Unit, could you introduce the CCC of Vienna to our international readers?
The CCC was founded in 2010 and is a diverse and major organization that is a joint operation between the Medical University of Vienna (MedUni Vienna) and the General Hospital of Vienna (AKH Vienna). The hospital aspect has resulted in the coordination of 21 tumour boards that see around 10,000 patients annually. These interdisciplinary tumour boards meet mainly on a weekly basis where we discuss patients, treatments and overall processes.
The university aspect has the responsibility in principal to implement two main concepts; the generation of scientific evidence and education. We currently are undertaking a series of coordinated research in basic science designed in topic-based clusters as well as conducting translational research in our 10 disease orientated, interdisciplinary clinical units. Equally, we conduct education programs to further medical professional development, such as the introduction of a new clinical oncology program at the MedUni Vienna. Furthermore, through our cancer school and various advocacy groups we give valuable cancer knowledge to affected patients and their family members.
Due to the activity and coordinated efforts, there has been an explosion of oncological scientific output of the CCC over the last seven years. An analysis has shown that the CCC has one of the top center outputs, only just behind the one research center of Harvard University. Overall, we are a major success story thanks to our unique interdisciplinarity concept of research, combining experts from many different fields, such as basic science, medical oncology and surgical disciplines as well as radiotherapy.
In your expert opinion, what is the current state of the Austrian healthcare environment?
First and foremost, Austria has excellent access to innovative drugs, which is relatively uninhibited compared to many other countries. Secondly, reimbursement decisions are made quickly. Lastly, the Austrian public has very rapid and easy accessibility to treatments and specialists. In relation to the oncological environment, patients generally are being treated in centers and Austria has the third highest cancer survival rates in Europe which is similar to France and Switzerland.
Where we are lacking is the enforcement of preventive measures. For example, smoking regulations are relaxed in Austria; therefore, we have a large problem with smoking-related diseases including lung cancer. Conversely, thanks to the implementation of a series of scientific developments and a drop-in hormone replacement therapies for post-menopausal women, death rates from breast cancer have dropped impressively. We must now replicate this preventative and pro-active treatment model for other cancers.
Overall, Austria has a good socialized medical system that allows patients to be checked-up at a professional level for the most part free. The problem lies in the lack of public encouragement measures being put forward to create the overall mentality regarding innovation and have it embraced by the political system. This is a concept the entire Austrian healthcare community must change.
One-third of Austrian clinical trials are in the field of oncology. What is being done to reward this process in Austria?
The government – unfortunately – is not doing much. Many members of the official science sector lack a long-term vision and do not see the need to invest in research or truly support universities in clinical studies. All the funding is done via third parties; that is the commercial industry, such as large pharmaceutical companies.
The relationship with the pharmaceutical industry is a complex situation: On one hand with their assistance we are financially capable to participate in the research behind many major advances of innovative treatments – on the other hand – their purpose in the end is to – understandably – generate revenues. We must therefore find a balance and tread the fine line between conflict of interest and participation in important advances.
How does the high cost of innovative cancer treatments impact on their market access?
This phenomenon is not particular to Austria as all mature markets encounter challenging circumstances in regard to expensive treatment, as social spending is being privatized. Not all of these innovations can be generalized regarding their efficacy. Therefore, we must as healthcare system develop a funding model that shares the risk of increased spending between pharma and society. Moreover, the emergence of many biosimilars will certainly take away some pressure from the system.
One aspect to note is the overall division of drug pricing and accessibility to innovative treatments across Europe. We have a richer section of the continent such as Austria, Switzerland and the Netherlands, and a less affluent area such as Romania and Bulgaria. This results in many EU patients travelling to Austria for medical advice and innovative drugs putting a certain strain on our system; therefore, as an entire European community we must work together to incite positive changes from west to east.
How does Austria become the European oncology hub?
I believe we have a great window of opportunity to take this title as we are situated in the heart of Europe and we are undertaking excellent interdisciplinary activity. In Austria, we have two internationally highly visible groups, the Austrian Breast and Colorectal Study Group (ABCSG) and the Central European Cooperative Oncology Group (CECOG). The latter brings together 23 countries and over 150 academics from central and south-eastern Europe. This allows us to be considered the hub for this designated region´s clinical trials. The biggest challenge we do face is linking the differing circumstances, economic and health related, in the east and west, though thus far we have been quite successful in this endeavour.
Looking forward, what does the future hold for Austria´s oncology ecosystem?
Overall, worldwide around one third of all medical developments are coming from oncology as many other diseases have reached a plateau in regard to discovery possibilities. In the last seven years the European Medicines Agency (EMA) has registered an abundance of oncology-related drugs and this number will only continue to grow during the upcoming years. This is due to increased opportunities as many cancers are considered chronic conditions due to patients living much longer.
In Vienna, we have been able to expand and establish the Vienna Cancer Center, the unification of all hospital oncology departments across the Vienna region. This facilitates the harmonization of resources, training, treatment schedules, and all in all, allows us to create a more patient orientated environment. Furthermore, we share clinical research processes between departments, and now have a population scope of 2.5 million people, developing a more fluent and productive research system for clinical trials here.
How will the EMA coming to Vienna change the overall Austrian healthcare environment?
For the last few years I have had a very active role within ESMO as the editor in chief of one of two scientific journals of the society, namely “ESMO Open – Cancer Horizons”. This has allowed me to deal directly with the EMA in regard to new registered oncology products by publishing EMA decisions on a regular basis. Based on this experience; I see the EMA coming to Vienna as a way of propelling Austria into an important seat in Europe and helping further develop innovation here. Vice-versa I see for the EMA Vienna as the perfect city: It is not too big, has an excellent infrastructure, is a wonderful place and geographically and culturally is the real heart of Europe.