In recent weeks, much has been said about medications. A cross-party war of words has raged awhile, but basic science is hardly elastic. Reference laboratories do not bend to political rhetoric. And pharmacovigilance or bioavailability are not some ethereal concepts, but solid and vital scientific measures that keep us alive and safeguard our wellbeing.

A recent European Parliament (EP) discussion discussed innovative medications and was structured around three statistical values related to cancer care in our country. And the points raised are at odds with each other. Innovative cancer drugs are usually so expensive that they are virtually unaffordable to the man in the street. Yet while the EP discussion chastised Government, it praised Malta's survival statistics. This is a contradiction in terms.

Medications

Therefore, it is crucial to explain the current state of affairs and ensure that our cancer patients are not unduly alarmed or indeed burdened by statements made out of context and succumbing to publication bias.

The Maltese government national formulary includes 113 core chemotherapy medications that are provided for free. This list includes innovative high-cost medications that account for the 16% quoted in the EP. This list grows through a phased approach. Admittedly, by its nature, the process is complex and we would do well to hasten its simplification. I am optimistic because a system that shall soon be using drones to transfer immunotherapy between islands is a system that strives to be future-proof. But in the meantime, the Maltese Government funds a list of other innovative medications through the following three pathways:

1. The Exceptional Medical Treatment Committee pathway which already provides some 22 medications to patients for free.

2. ⁠The funding of approximately 40 medications, indirectly through the Malta Community Chest Fund; a total of €41million were re-imbursed by Government this last year alone.

3. ⁠The treatment abroad of an average of 200 Maltese patients who every year receive state-funded complex treatment, mainly in the UK and Italy. 

Holistic care

The primary end-point of any research and/or clinical analysis of cancer care is prognosis, that is the survival rate of cancer patients after treatment. And it is here, that National, European and international standardised data confirm that Malta has one of the lowest cancer-related death rates in Europe, faring better than much larger and wealthier countries.

This clearly demonstrates a sustained public investment in universal health coverage, rapid access to robust diagnostic modalities and effective treatment. This is entwined with well organised screening programmes, robust radiological services and integrated care pathways that minimise the delay between diagnosis and intervention. Demographic data and age-standardised comparisons clearly show that Malta's results are real and credible.

These positive outcomes should form the evidence base that confirms a coordinated public health policy that provides accessible care, surveillance and patient-centred multi-disciplinary team (MDT) discussions that deliver the favourable survival benefits for cancer patients in Malta and Gozo. And the next step in these MDT discussions is the application of ambient AI, which I look forward to.

Some examples

I shall illustrate three different examples, two of which were touched upon in the EP discussion.

Firstly, colon cancer is a fairly well-understood condition and compared to other countries, colon cancer mortality is relatively lower in Malta. We have a structured screening programme that has been in place for a good few years and invitation uptake is significant.

Prelimary data suggest that colon cancer mortality declined in Malta after its introduction. But in parallel, we established rapid access referrals, improved our surgical and chemo-radiotherapy techniques and developed liver surgical and ablative techniques.

These latter control the cancer even when it has spread to the liver. Mortality from gynaecological cancers was mentioned, almost certainly referring to the currently prevailing poor ovary cancer-related prognosis. The discussion did not mention that last year we introduced a rapid access referral system and clinic, and honed surgical treatment through the implementation of complex cyto-reductive as well as robotic surgery. This will certainly result in improved prognosis in the coming years.

The last example is oesophageal cancer care. This is an aggressive and lethal cancer but the local AIMOM study confirmed that our local multi-modality (chemotherapy + radiotherapy + cutting edge surgery) provides survival statistics that are second to none.   

This is why the Ministry for Health and Active Ageing is confident in its assurance to the public that the quality of cancer care in Malta remains on the ascendant. It will remain a top priority for Government.

Jo Etienne Abela is the Minister for Health and Active Ageing