The first ever comparison of pancreatic cancer treatment in Europe shows that most countries do not pay enough attention to the disease. In spite of causing almost as many deaths as breast cancer, pancreatic cancer is neglected by healthcare.

In 4 out of 5 countries, the report says, “treatment outcomes data are not monitored and there is no agreed best practice, among them Malta.”

This shows the Euro Pancreatic Cancer Index (EPCI), published by the Sweden- based research organisation Health Consumer Powerhouse (HCP).

– “Malta should focus on the very basics in pancreatic cancer care: training doctors to detect the cancer early and monitor basic treatment data,” says Dr. Arne Bjornberg, head of HCP Index production. “Poor documentation hinders efficient cancer care. In Malta, the lack of reporting is even worse than in neighbouring countries which make most assessments futile. But I am afraid that such negligence causes the death of Maltese patients.”

– Pancreatic cancer has a deserved reputation as a ‘silent killer.’ The cancer is generally detected too late, which makes treatment almost impossible. Doctors need better training to detect the disease early. It is the fourth largest cause of cancer deaths in the EU, killing more than 100 000 Europeans every year. Unlike for other cancers, this number is rising! Most people diagnosed with pancreatic cancer patients will die within the first year of diagnosis, the Report says.

“Despite the burden posed by the disease, most countries have no best practice for treatment. 4 out of 5 countries cannot present treatment outcomes data. Chances of survival are twice as high in the best performing European countries as among those with weakest performance,” the Report says.

The overall picture is far from bright, but there are fore-runners in pancreatic cancer treatment, explains Anne-Marie Yazbeck, EPCI project manager. “The Netherlands, Denmark, France and Ireland show good examples. Doctors seem more aware of the disease and treatment outcomes are comparatively well monitored and documented. What is encouraging is that we can identify strategic steps towards progress. Monitoring and documentation of pancreatic cancer treatment are components where Malta should improve significantly!”

Need for best practice .The Index points to pillars in a potential pan-European best practice for pancreatic cancer:

• Primary care doctors trained to be alert of pancreatic cancer and how to recognize the combination of vague symptoms.

• Early detection is absolutely essential to allow efficient treatment. • Rapid access to specialist diagnosis and surgery.

• Treatment outcomes have to be monitored and documented in a systematic, easily available way.

• Patient information about treatment options, with lists of certified pancreatic cancer surgeons and cross-border care opportunities.

The Index – the first ever comparison of pancreatic cancer care in Europe – covers the following areas, using 30 indictors: Patient right, information and accessibility to care, Prevention, Treatment outcomes, Diagnostics, Pharmaceuticals and Palliative care.

As the EPCI country benchmark shows there is a wide spread out Index outcomes, with an unusual mix of high- and medium income countries in the upper half of the Index rank.

The Project Manager said that The Netherlands come out top (as in many other HCP Indexes) with 879 of possible 1000 points, followed by Denmark (872), France (812), Ireland (807) and the United Kingdom in a decent 5th position (800), in spite of having some of the worst survival rates in Europe, Malta (525) is 29th.

The Ministry for Health responded to the results of the Index by saying, “The Euro Pancreatic Index 2014 was conducted by the Health Consumer Powerhouse (HCP), to provide a comparison of pancreatic cancer care in the 28 EU member states, Norway and Switzerland.

“This company usually consults the official governmental bodies on their chosen indicators prior to the release of this publication. Indeed, as customary, it did contact the Ministry for Health and corrections have been suggested where erroneous data was reported. While some corrections were made, it must be pointed out that some indicator scores were not changed despite having being reviewed and corrected.”

It added, “while the Ministry welcomes the ranking given to Malta in relation to the areas of patient rights, information and accessibility, prevention and palliative care it is extremely disappointed that HCP chose to ignore information provided by the Ministry in relation to diagnostics and treatment.”

The Ministry pointed out that “this misreporting of the treatment and diagnostic services available, seriously undermines the public’s confidence in the health system especially in this particularly vulnerable patient group.

“One should note that this is an independent private organisation, made up of a small team of individuals which is not, in any way, an official body linked to the European Commission or its entities.”

Their operation is supported by unrestricted grants from a number of major pharmaceutical companies. In fact this index was funded through an unrestricted grant from Celgene, an American company manufacturing pharmaceuticals for cancer, said the Ministry

“In the area of patient rights, information and accessibility Malta ranked 7th at par with countries such as Slovakia, Sweden and Italy. Scoring top in the area of time between decision to treat and initiation for treatment, the system offers accessibility to patients following diagnosis.”

The Ministry stated, “in fact the recent setting up of treatment within Gozo General Hospital confirms the Ministry’s drive to maintain a high level of accessibility for the treatment of cancer in Malta. The Ministry has recognised the need to reduce the waiting time for CT and MRI scans which remains an issue across Europe.

“Recent initiatives such as the MRI twilight service and utilisation of CT equipment at Gozo General Hospital for patient referred from Malta have been some of the steps taken to reduce the waiting lists for such services.”

Malta ranked 5th in the area of prevention, a score similar to that achieved by Spain, Switzerland, Ireland and Cyprus. The Ministry said, “the index highlights the improvements made for two of the major risk factors of pancreatic cancer – smoking and alcohol consumption. Obesity, also a risk factor, is, on the other hand, not doing as well.”

The Ministry said that it “acknowledges that obesity is a major issue in Malta and has been working to tackle it through a number of initiatives such as the Healthy Weight for Life Strategy, the recent development of the Food and Nutrition Policy and Action Plan which is currently open for consultation as well as plans of a Nutrition and Food Consumption survey to be carried out in the next years.

“The HCP chose to report 5 year survival rate as the outcome in this index. Malta supplied data for 1 year relative survival for pancreatic cancer given the well-known median survival in the literature and the small numbers we are reporting.”

The Ministry continued, “our figure was not reported. Belgium was given a high score with a reported relative 5 year survival of approximately 9.5% for patients diagnosed from 2004 – 2008 while the UK, which received a middle score has a relative 5 year survival of approximately 3.7% for patients diagnosed in 2005 – 2009. The 5 year relative survival for patients diagnosed in Malta from 2005 – 2010 is 5.1% which compares relatively well with that reported for other countries.”

The Ministry said that it is “very disappointed that HCP chose to ignore all the feedback provided regarding the scores for these sub-disciplines giving the impression that no data is available.”

“In fact Malta supplied feedback for all the indicators in the index and should have scored high for the indicators relating to diagnostic laparoscopy, evidence based chemotherapy and adjuvant chemotherapy; all of which are health care procedures available in our health system and applied by professionals with experience in the field.”

HCP scored Malta 3rd in the area of palliative care comparable to countries such as Slovenia and Ireland. “Indeed with the opening of the new oncology centre later on in 2014, the number of paliative beds available for the treatment of cancer patients will increase,” said the Ministry.

The Ministry regrets it said, “that the report insists on portraying incorrect information on a number of aspects thus giving Malta a low overall score in this index despite high rankings in the sub disciplines where data was correctly reported.”

“In the area of cancer surveillance Malta is heavily engaged in international networks and supply data to organisations such as IARC and European projects such as EUROCARE that report internationally standardised and comparable indicators on cancer outcomes.”

“Nonetheless the Ministry will continue to spearhead developments and improvements in the area of cancer prevention and control in order to further enhance the quality of life for patients suffering from cancer,” the Ministry for Health concluded.

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