Ruth Vera – President, SEOM, Spain

Ruth Vera highlights how the Spanish Society of Medical Oncology (SEOM) works to be the premier partner in the Spanish oncology ecosystem and the main cancer problems Spain is currently experiencing. Furthermore, she suggests how Spain can improve its oncology care and her aspirations for the future.

Could you introduce SEOM to our international audience?

The Spanish healthcare system differs from other healthcare systems in Europe in that students specialize in medical oncology. Following the completion of your degree you become a fellow for five years and during this period people specialize and practice only their particular speciality. As such there exist a variety of different specialists in Spanish society, which includes oncologists. Thus, we believe that it is important to have a single, unified Spanish society of medical oncologists. Within SEOM (Sociedad Española de Oncología Médica) there are various groups focused on different tumours and different forms of cancer, however, all of the oncologists in Spain work under the umbrella of SEOM.

What are SEOM’s current aims and objectives?

Fundamentally, we believe that effective oncology must be interdisciplinary. As such, we are now leading cooperation with other specialities. We currently work with a number of other medical societies including the pharmaceutical society due to our belief that an interdisciplinary approach is the only way to tackle cancer effectively.

At the moment, we are at an interesting point in our development trajectory. Our mission is shifting and now we are currently working to demonstrate the importance of precision medicine. We are working with the government in order to ensure that this study is undertaken.

Nevertheless, ensuring access to medicines is an ongoing task for us. As in other countries, access is a major issue in Spain. However, this is made more complicated in Spain due to the fact that the country is comprised of 17 different regions. As such we have medicines that are approved in Spain that should be available across the country, but which are not in certain regions. We undertook an analysis in 2015 in order to determine the scope of the problem and we are currently working on another analysis in order to determine what has changed and whether the issue has gotten better or worse. We hope to be able to work with the authorities to identify workable solutions, with the aim of becoming a partner of the government, instead of just critics of their policies. We have a group that began six years ago called the Commission of Access and we aim to change the position of that group so that it is an official partner to both government and industry.

What are SEOM’s capabilities?

Funding for research is limited in Spain. Thus, SEOM offer grants. Last year we invested EUR 700 thousand in 22 different projects. These grants fund research in Spain and abroad, particularly Britain. We also raise awareness and launch communications campaigns.

Where does your funding come from?

We are funded by industry. However, we receive this money without conditions so there are no strings attached. Money for grants is provided to us generally through companies that have a special interest in oncology. With regard to grants, the selection process and the decision-making is undertaken by an independent SEOM commission. We also receive funding from other companies that are not a part of the pharmaceutical industry. While we do source some money from charities, this is particularly difficult in Spain due to the lack of appropriate legal frameworks.

While there are many people who would like to donate money to our organisation, unfortunately, the process is made especially difficult in Spanish law. In comparison to the United States and the United Kingdom, where charities have become real catalysts for R&D, Spain’s laws do not offer adequate protection for this kind of entity. As such, we have long been a proponent for a change the law in this regard and improve the legal position of charities in Spain.

How would you describe SEOM’s relationship with private industry and the government?

We have a good relationship with both private industry and the government. We have established a long-standing partnership with the authorities, which has been developed over an extended period of time. We collaborate with them in a number of different ways. In particular, we have worked with the government on the fellowship of speciality programme in universities and with the branch of the government that works on issues relating to pharmaceuticals and access to medicines.

With industry, we have a trust-based relationship. We cooperate on projects that are of interest to us. In particular, we work together in relation to education. By next year the new master’s degree in medical oncology will have begun. There are a lot of companies who are interested in funding grants for medical oncologists in Spain. As such, we have been able to offer grants to 90 percent of those who fit the requirements. This master’s degree will be open to people who are not members of SEOM and to people who are from countries outside of Spain as well. We have received a number of applications from people from Latin American countries due to the shared language.

What are the main issues in Spain in relation to cancer at the moment?

The biggest problem is likely to be access. In particular, issues surrounding equity will be important in the future. Ironically advancements in medical technology may create a larger gap between the haves and the have-nots. Due to the regionalism of Spain there is a significant difference between hospitals in different parts of the country. As such we urgently need assurance that the government will take action. In two years there could be a major divide. To prevent this increasingly large gap it is important that the government takes action as soon as possible.

Due to the fact that cancer is increasingly becoming a disease that is affected by a range of treatment pathways, how does the care continuum work in practice in Spain given the country’s regionalism?

This is one of the most important areas that we have focused on. Two to three months ago we published our first publication about survivors of breast cancer. We worked with a range of organizations to work out ways in which care could be improved in different regions. It is great news that cancer survival rates are increasing. However, there is a lot of work to do. New problems are created. We are now working on publishing a similar document relating to colon cancer. Our idea is to create a document which can be used to work with the government. We have a lot of publication data and we hope to be able to share that with the primary care apparatus as we believe that this would be incredibly beneficial.

Is there enough investment going into cancer? Where do you see the shortfalls and how optimistic are you that the new government might do better in this regard?

I appreciate that investment is limited. However, the general expectation is that primary care should be undertaking a greater workload without increased resources. Although I am optimistic by nature, I am worried by the current state of affairs. Spain is currently suffering from a growing brain drain. Top researchers and scientists are not being offered the financial incentives to pursue their careers in Spain. There are simply not enough resources to be able to incentivise that.

While the previous government was more focused on finances, the new socialist government may be more socially minded. However, to some extent, the course is already set. There is not enough stability to enact significant change. Furthermore, the government is somewhat fragile due to their lack of parliamentary support and the nature of the coalition. They have to compromise due to their weak position. We hope to work with them however and we hope the best for them. The best for them is the best for us.

As the president of the SEOM have you got any final words for our international audience?

Spain is a country of medical oncologists that has a lot to offer in regards to cancer. We produce a high level of research and I believe that that will have a strong impact. Significantly we do not have frontiers. We are European and think as Europe. Thus, I am very optimistic and believe that Spain is a great country which can go a long way in producing high-quality research.