Showlist about ecl
We Are Making a Difference in Cancer Prevention and Control
Cancer Plan IV
The Danish Cancer Society was happy to welcome Cancer Plan IV in the fall of 2016. The Danish gov-ernment allocated cumulative funds in total 2.2 billion DKK to new initiatives to tackle the cancer burden until 2020. Cancer Plan IV sets out three national targets:
1) In 2025 Cancer patient survival in Denmark is at the same level as the best of our Nordic neigh-bouring countries.
2) In 2030 there is a smoke-free generation of children and young people.
3) In 2020 90 pct. of cancer patients will have their personal patient-responsible physician for the cancer care.
The Cancer Plan also sets out initiatives to strengthen quality of cancer treatment to e.g. develop clinical guidelines and education and training for cancer surgeons. Furthermore, the Cancer Plan supports rehabili-tation and palliative care. Initiatives to improve early diagnosis continue, and in 2017 a service check of The Danish Cancer Pathways will be initiated.
The Danish Cancer Society, leading cancer researchers, The Association of Medical Specialists and own-ers of regional hospitals have decided to make Denmark an even more attractive country for cancer re-search. The aim is to improve cancer treatment continuously and to introduce new treatment break-throughs as early as possible in the clinics. The Government has with Cancer Plan IV prioritised to allocate resources for the establishment of a Danish Comprehensive Cancer Centre, which coordinates and imple-ments national research and clinical initiatives.
Patient responsible physician
The Danish Cancer Society and The Association of Medical Specialists proposed to appoint a patient re-sponsible physician for each cancer patient to oversee and take responsibility for the cancer care in the hospital. The patient responsible physician is aimed to support the patients’ experience of coherence, co-ordination and security in his/her course of disease. The patient should know the name of the physician who takes the overall responsibility for his/her diagnosis and treatment. With Cancer Plan IV the Gov-ernment has prioritised that the regions implement patient responsible physicians and the Government has subsequently entered into an agreement with the Danish Regions and all involved parties including the Danish Cancer Society, about the role and duty of the patient responsible physician.
Tobacco Free Portfolios/Bronwyn King: Non-investment and divesting shares in tobacco industry
The Danish Cancer Society has been inspired of and do collaborate with Tobacco Free Portfoli-os/Bronwyn in activities encouraging finance sector to non-invest and divest in tobacco industry. Tobacco Free Portfolios is currently working with more than 100 financial institutions including Sovereign Wealth Funds, pension funds, insurers, banks and fund managers. They aim to inform finance leaders about the tobacco epidemic, UN Tobacco Treaty and the importance of tobacco control with regard to the Sustaina-ble Development Goals. They encourage the finance sector to join the health sector and governments across the world in comprehensively and collaboratively addressing one of the greatest health challenges of our time. The Danish Cancer Society and Tobacco Free Portfolios collaborate to convince the Danish finance sector on getting the Danish financial sector to avoid investments in the tobacco industry.
The Danish Cancer Society Research Center (DCRC)
The Danish Cancer Society Research Center (DCRC) was established on 1 January 2012 as a merger be-tween the Institutes of Cancer Biology and Cancer Epidemiology. The Center, which holds a dynamic, international and competitive research environment spanning basic, translational, epidemiological and clin-ical aspects, employs some 225 researchers and technicians and a varying number of scholars and guest researchers. The DCRC is furnished with modern office facilities, fully equipped laboratory space includ-ing access to state-of-the-art machinery and animal house. The Center is headed by prof. Jørgen H. Olsen.
The scientific work of DCRC is organized within eight research units:
• Diet, Genes and Environment headed by prof. Anne Tjønneland
• Virus, Lifestyle and Genes headed by prof. Susanne Krüger Kjær
• Cell Death and Metabolism headed by prof. Marja Jäättelä
• Genomic Integrity headed prof. Jiri Bartek
• Survivorship (SVP) headed by prof. Christoffer Johansen
• Cell Stress and Survival headed by prof. Francesco Cecconi
• Translational Cancer Research headed by prof. Nils Brünner
• Statistics and PharmacoEpidemiology headed by chief statistician Klaus Kaae Andersen
In addition,the Center holds three junior groups:
• Brain Tumor Biology Group headed by Petra Hamerlik
• Cell Division Laboratory headed by Marin Barisic
• Computational Biology Laboratory headed by Elena Papaleo. The group supply the entire Center with bioinformatics support.
The total amount of external research grants allocated to DCRC in 2016 was 78 million DKK equivalent to some 10½ million EUR. The Center published some 300 publications published during the year, the vast majority in major scientific journals with global circulation (http://www.cancer.dk/research)). In 2016, a senior DCRC researcher received the prestigious Nordic Fernström Prize, and two junior researchers were allocated the Sapere-Aude Prize from the Danish Research Council and one of Fellowship issued by Lundbeckfonden, both prizes (and accompanying grants) being among the finest distinctions in Danish research.
Selected results published during 2016:
New knowledge on the genetic background of glioblastoma
Glioblastoma, the main type of brain cancer, is a life-threatening disease with an exceptionally high mor-tality rate. In 2016, researchers at the DCRC showed that the gene BRCA1 and the associated enzyme RRM2 plays an important role in the course of this disease. The BRCA1 gene acts as a kind of bodyguard as it regulates RRM2 and protects the DNA in the cancer cells from damage. This helps the cancer cells to survive, and accordingly, patients who have high levels of BRCA1 products survive for a shorter period than patients with low levels.
The conclusion is partly supported by the observation that the length of survival of 145 Danish glioblas-toma patients is inversely correlated with the level of BRCA1 products in their brain tumor tissue, and partly by the finding in mice of an inverse correlation between the rate of tumor expansion and the level of BRCA1 products. Furthermore, the animal experiments showed that the abrogation of the BRCA1 function through genetic manipulation caused the mice to live significantly longer than non-manipulated control mice. The scientists also examined the drug triapine, which has previously been shown to protect normal brain cells in pre-clinical studies of Alzheimer disease. It might also help patients with glioblasto-ma, since the drug imitates the mechanisms which are activated when BRCA1 is downregulated and RRM2 is inhibited. In experiments with glioblastoma mice, the animals survived on average 25 days, while glioblastoma mice, treated with triapine survived on average 58 days. The researchers hope that it may be possible in the future to add triapine to the treatment of glioblastoma in patients with high levels of BRCA1 products. Work is currently being done to validate the results using a number of pre-clinical models, and the DCRC researchers collaborate with clinicians in order to bring this drug into clinical trials in near future.
Drugs for treatment of allergy may enhance the action of chemotherapy
In a cross-disciplinary research project, DCRC researchers have shown that certain types of over-the-counter drugs for allergy are able to increase the action of chemotherapy. Epidemiological studies based on available register information has shown that the overall mortality is decreased in cancer patients treat-ed for a concomitant allergy compared with that of patients not treated for an allergy.
Laboratory experiments show, that the beneficial effect of allergy drugs on cancer cells only is seen for the so-called CAD anti-histamines, which have specific physical and chemical properties. The largest ef-fect was seen for the anti-histamines loratadin and ebastin. Patients, who were treated simultaneously with chemotherapy and loratadin had a 24 pct. lower risk of dying from their cancer compared to patients who used other types of anti-histamines in addition to the chemotherapy. For ebastin the decreased risk of dying was 19 pct. Looking into specific types of cancer, registry-based investigations showed, that pa-tients with non-small cell lung cancer who were prescribed the anti-histamine loratadin in addition to their chemotherapy, had a 36 pct. lower risk of dying from the cancer, than controls using non-CAD anti-histamines.
Apart from enhancing the action of chemotherapy, laboratory experiments showed that the CAD antihis-tamines were able to re-sensitize chemotherapy resistant cancer cells.
The researchers are continuing their work, and are currently working on setting up clinical trials on pa-tients with metastatic prostate cancer.
Extra support increases the survival among women with breast cancer and depression
DCRC research has shown that women first diagnosed with a depression and subsequently with breast cancer, have a 10 pct. lower survival rate compared to that of other women with breast cancer. The sur-vival are poorer in these women, even if diagnosed at an earlier stage. This is because breast cancer pa-tients with depression are less likely to adhere to the recommended treatment plan. Our research has shown that a targeted support, which makes these women capable of following the recommended treat-ment, results in a survival rate that is equal to the survival of breast cancer women without depression. The results indicate that offering individual help and support to this particular group of women may actually save lives.
An updated research strategy for the Center for the period 2017-2019 was finalized in 2016 and is availa-ble on: https://www.cancer.dk/dyn/resources/File/file/4/6294/1492756525/dcrc-2017-19-strategy.pdf
Documentation & Quality
Data driven quality improvement is our key objective in Documentation & Quality. Based on valid, timely and comprehensive data we work to push and support innovation and enhancement of Danish cancer care. Through documentation and research, we support improvement of cancer patients’ survival, quality of life, safety and experiences with the Danish health care system including more and more their involvement in their own therapies.
Our activities in 2016 include most of them on an ongoing basis:
• Strategic partnerships with regions and hospitals on patient involvement, including shared decision making and Patient Reported Outcome Measures (PROMs)
• Hosting NORDCAN secretariat
• Updating cancer statistics
• National, representative surveys on cancer patients’ experiences with cancer care in Denmark, prepar-ing 2016 the launch of a survey in 2017 with 10.000 newly diagnosed cancer patients
• Studies of geographic variation in surgical outcomes in cancer care and similar studies to identify rea-sons for low cancer survival in Denmark
• Data and inputs to our new Cancer Plan IV
• Extending our Cancer register with clinical activity and quality data
• Professional advice to internal and well external stakeholders, e.g. the notion of the Patient Re-sponsible Doctor or common ‘agreements with general general practitioner (GP)s’.
• We participate in several international benchmarking projects, ECL initiatives, e.g. Access to Medi-cines, and InterReg projects.
Patient Support & Community Activities
The Danish Cancer Society has finished the building of six modern counselling centres in the vicinity of the large oncology centres in Denmark, and is currently planning a new counselling centre at Herlev Hos-pital in 2017. The counselling centres follows a new concept combining modern architecture and open (walk in) counselling services with focus on empowerment of patients. The centres offer information, psy-chosocial support from professionals and volunteers, support groups, advice on social rights, exercise etc. Among the activities are physical training sessions for cancer patients during treatment as part of early rehabilitation in collaboration with the treating hospital. An evaluation among users has shown a high sat-isfaction with the services and the access to the centres. Male users and less educated users have increased in number. As part of these efforts, we will implement new interactive digital tools to support our ser-vices. In 2016 the telephone counselling service 'Kræftlinjen' has started on line video counselling to sup-plement telephone counselling.
The efforts focuses on empowerment of users, the involvement of volunteers in patient support activities, support to families, and more focus on, how to reach new target groups such as men, ethnic minorities and socially vulnerable users. In 2016, we took several initiatives to increase these activities. We implemented a model for the counselling centres to offer support and social networks for men with cancer in 13 coun-selling centres in 2016. The counselling centres also have a mentor program for men with cancer, matching newly diagnosed men with male survivors with the same cancer. In another national project, the Navigator project, more than 100 volunteers are educated to support socially vulnerable cancer patients during treatment and rehabilitation. The project is now implemented in 10 counselling centres all over Denmark. The department is also involved in a research project on how to involve vulnerable patients in treatment decisions.
In 2016, information activities concerning the use of Complementary and alternative medicine - CAM among cancer patients was increased due to an increased demand. Patient Support & Community Activi-ties is involved in projects to promote evidence based information on CAM for cancer patients and train-ing health care professionals how to communication with cancer patients about their use of CAM.
In order to increase the knowledge about the patient support activities of the Danish Cancer Society, Pa-tient Support & Community Activities in 2016 started an ambitious communication plan to increase the knowledge among patients, health care professionals and the population in general about the support ac-tivities offered for free by the Danish Cancer Society.
We increased the focus on how to support young cancer patients as the Danish Cancer Society adopted a strategy for expanding peer support groups and a number of activities for young patients. We implement-ed a project with peer visits to young patients at cancer treating hospitals in 2016, which is evaluated in 2017.
A large project ‘Om Sorg’ works to promote peer support groups led by teachers at schools for children, who have lost a parent or have seriously ill relatives. The project is also promoting action plans at all schools for handling loss and grieve among school children.
Patient Support & Community Activities is increasingly working with the involvement of users, e.g. pa-tients and relatives in the activities of the Danish Cancer Society. Thus patient representatives are ap-pointed to scientific committees and working groups. We ask a digital panel of approx. 1300 patients and relatives regularly about their experiences and opinions, and the information is used to create knowledge and debate about themes of relevance for patients and relatives.
Patient Support & Community Activities increased its focus on social rights for cancer patients in 2016, and the department has made a report mapping the most urgent social and economic needs of cancer pa-tients, focusing on dental care and sickness leave among other issues.
Patient Support & Community Activities has a widespread local organisation all over Denmark and sup-port the implementation of rehabilitation and palliative care activities in Danish municipalities.
Cancer Prevention & Information
Prevention of alcohol-related cancer
The Danish Cancer Society has in collaboration with the Danish foundation TrygFonden continued the campaign ”Fuld af liv”, which aims at reducing alcohol consumption among kids, teenagers and young adults – and to postpone their alcohol debut. Danish youth has a European record of intoxication: 32 per-cent of Danes aged 15-16 years have been intoxicated during the past 30 days. This is more than in any other European country, where the average number is 13 percent.
In 2016, we involved more than 4,000 high school students in a competition about making the best movie campaign with the message “Drink less – experience more”. The movie should make young people reflect on the Danish alcohol culture and inspire them to party without high amounts of alcohol. After participat-ing in the competition, 68 percent of the students answered that participation had made them think more about the Danish alcohol culture.
“Fuld af liv” participated in a democratic youth festival with about 10,000 young students, teachers and other professionals. We participated with a wide range of activities i.e. debates, speed dating and work-shops in order to engage the youth in our effort to limit their alcohol use.
Prevention of skin cancer
The Danish Cancer Society has in collaboration with the philanthropic Danish foundation TrygFonden continued the “Sun Safety” campaign. The aim is to prevent skin cancer by teaching the Danes how to protect themselves from the sun and to avoid sunbed use.
In 2016, we launched the campaign “Mindre hud i solen” (“Less skin in the sun”) with focus on covering the skin with clothes and hat in the sun. The campaign movie consisted of six episodes with a duration of 6-8 minutes each. In total, those six episodes were played more than 320,000 times, and viewers saw on average 84 percent of one episode.
In alliance with the organization Dansk Dermatologisk Selskab (Danish Dermatologic Society) we fo-cused on early detection of skin cancer with the campaign “Tjek din hud” (“Watch your skin”). The cam-paign included a movie reminding Danes – and especially women 35-55 years of age – to watch their skin, as well as concrete information about how to do this. Of women who knew the campaign, 30 percent had checked their skin for suspicious birthmarks after watching it.
Physical activity and diet
Forty-seven pct. of the Danish population are currently overweight, and that number increases continuous-ly. Overweight, including poor diet and lack of physical activity, ranks second among risk factors causing cancer in Denmark, and overweight is associated with eleven documented types of cancer. Dealing with overweight is difficult, as overweight cause irreversible metabolic disturbances. Consequently, experts argue that overweight should be considered a chronic disease, as it does in the US and Canada, and thus requires treatment as such. Approximately 50.000 cases of cancer are preventable until 2045, if we can eliminate overweight in the Danish population, and additionally, normal weight patients suffering cancer have a better survival rate than patients that are overweight.
Obesity prevention is essential and one approach is targeting children, making sure they achieve the rec-ommended 60 minutes of physical activity every day. In 2016, we concluded the project Activating Schoolyards (In Danish: Drøn på skolegården) designed to increase physical activity by redesigning schoolyards to appear applicable for teaching combined with physical activity. Seven primary schools now successfully have integrated this organizational initiative.
Also targeting children in primary schools, we continued working on the project Play and Learn (In Dan-ish: Leg på streg) in 2016. This project offers a simple and cheap opportunity to sketch predetermined lanes for active learning in already existing schoolyards. The lanes can be sketched in one day, and the available teaching- and learning materials are simple and easy to incorporate as a supplement to existing materials. One quarter of all Danish municipalities are currently incorporating the concept in their schools.
Another approach to obesity prevention is initiating partnerships with the food industry as well as grocery stores in order to act in unison in the matter of reducing the amount of calories consumed by the Danish population. In 2016, we concluded a successful collaboration with the University of Copenhagen, Tryg-Fonden and REMA 1000 involving shelf management, redesigning the weekly brochures offers to pro-mote healthier products and reformulating processed food in order to reduce the amount of calories sold. In 2015, The Danish Cancer Society in collaboration with REMA 1000 successfully reduced the calorie sales among the Danish population by 27.3 billion (equivalent to at 5 % reduction) without reducing turn-over. Link to report (in Danish): https://www.cancer.dk/dyn/resources/File/file/5/5815/1474888741/letindkoebet.pdf
Denmark has the highest prevalence of cervical cancer among the Nordic countries. Each year, approxi-mately 375 women in Denmark are diagnosed with cervical cancer and about 100 women die of the dis-ease. Due to negative publicity in the media, based on reports of girls, who believe they have adverse ef-fects of the vaccine, there has been a dramatic drop in participation in the HPV vaccination programme. Among girls who turned 12 years of age in 2015 only 17 percent are fully vaccinated. The Danish Cancer Society takes the low participation rate very seriously and works intensively to improve the participation in the vaccination programme. Among other initiatives, we performed qualitative interviews and a survey among parents of girls aged 10-14 years of age. We also opened a telephone hot-line in 2016, where par-ents and others can call and get information about HPV vaccination.
Screening for cervical cancer
In Denmark, the participation rate in the cervical cancer-screening programme is only about 75 pct. We work in different ways to increase this rate to at least 85 pct.
Recent qualitative interviews with non-attending women aged 30-50 show that many women do not know the importance of having regular pap smears. Many save the screening invitation letter for a long time, because they actually want to participate. However, busy everyday lives entangled in work and fam-ily mean trouble finding the time for seeing their GP. In 2016 we launched a short campaign, “An invita-tion letter of great importance” including postcards distributed to cafés around the country and movies on Facebook focusing on the invitation letter and the importance of making an appointment with the GP when receiving the invitation. In only two weeks, the film had a reach of about 300.000 views on Face-book. The campaign aimed at raising the knowledge about the screening programme and can be seen as an addition to recent campaigns in the Danish Regions also focusing on increasing the participation rate in screening for cervical cancer.
Link to the film: “An invitation letter of great importance”
Campaign about symptoms of cancer – “The 7 signs of cancer”
In Denmark, we discover cancer in a later stage than in countries, with which we normally compare. If we discover cancer in an early stage, there is a greater chance for survival. 2016 was the second year of the “7 signs of cancer”, a campaign about symptoms of cancer by the Danish Cancer Society. The aim of the campaign is to make Danes aware of specific cancer symptoms – so they consult their GP in time. The main target group is men and people with lower education, 50+.
In 2016, the strategy was to engage friends and family as an important support in order to nudge the tar-get group to consult their GP. According to the evaluation, more than 100,000 Danes consulted a GP with symptoms that might be signs of cancer. The evaluation of the campaign also showed that the campaign succeeded in reaching especially men and people with a short education.
Smoking is still the greatest avoidable risk factor for cancer. Smoking is the cause of every third cancer death in Denmark. In 2016, 21 percent of all adults (15+) smoke. Sixteen percent smoke on a daily basis and five percent now and then. There has also been a positive development in the percentage of Danes who have a smoke-free home: More than 90 percent of homes with children are now totally smoke-free home. In 2010, the number was only 70 percent.
In April 2016, the Danish Cancer Society announced a partnership with the Danish foundation Tryg-Fonden. The vision is a smoke-free future and the goals are maximum five percent adult smokers in 2030 and no children smoking in 2030. In 2016, we have invited many other organisations to join us on our way to the goal, got a lot of media attention and even received governmental support.
In September 2016, we launched a new version of the app Xhale which helps young people quit smoking. Xhale delivers on-the-go assistance through a personalized experience with push messages, films, a blog and exercises. The users receive tailored content based on questions – both when signing up and through-out their quitting process. The app Xhale was one of the World Summit Award Winners 2016 in the cate-gory Health & Well Being. Up to this date, more than 20,000 have downloaded the app and signed up for the smoking cessation program in the app.