Personalised medicine to relieve the health service

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Smaller patient groups and targeted treatments are the future of cancer care in Norway.

It is no longer a question of if but when personalised medicine will be a reality for all cancer patients in Norway. This was a key message in a recent meeting arranged by the public-private consortium CONNECT during Arendalsuka, where the resource crisis in the health service was discussed.

Forward-looking health authorities

Ulrich Spreng, Chief Medical Officer of the South-Eastern Regional Health Authority (Helse Sør-Øst), underlined how critical personalised treatments will be in the future. Spreng sits in the Decision Forum of New Methods, the national system that manages the introduction of new treatments in Norway. The Decision Forum looks at three criteria; the severity of the disease, the effect of the treatment and the resources it requires.

“If you can target treatment better according to an individual patient’s genetic profile, there will be a greater effect. This makes it easier to implement that drug since it is a different relationship between resources and effect than when you treat a large patient group where many do not have an effect. It is important for us to separate a total patient group into subgroups according to their genetic profile. This is very exciting for New Methods!” Spreng commented.

Urgent lack of resources

The Norwegian health service faces a lack of resources and personnel, according to an investigation by the Health Personnel Commission in 2022. Gro Live Fagereng, Coordinator Precision Cancer Medicine at Oslo University Hospital, agreed this is a major challenge:

“We have limited time and finances in the health service, so we must prioritise the available resources. Both personalised medicine and research in general form the basis for making the best priorities. We need to invest in research to make the most of our resources. I hope and believe we will have a more systematic and learning health service in the future; that we will learn more from patients, so we can update treatments and make better priorities.”

Åsmund Flobak, oncologist at St. Olavs Hospital, explained how personalised medicine enables us to learn from patients:

“Traditionally, we have treated patients on a group level, but we know that patients are different; some respond and some do not. The goal is to find out which biomarkers relate to which treatments. We have worked to establish publicly financed precision diagnostics through InPreD and we give patients precision treatment through IMPRESS. A third of us will at some point get cancer, so we must implement better treatments.”

Watch this video (in Norwegian) to understand personalised medicine:

Health economists also agree that this strategy can help to save resources.

“When a patient gets the right treatment, you avoid giving a treatment that doesn’t work well enough first and there are fewer side effects. The consequence is less use of resources in the health service and we can live better lives,” commented Erik Magnus Sæther, Partner at Oslo Economics.

Public-private collaboration needed

Karoline Knutsen, Manager Market Access at Legemiddelindustrien (LMI), said that the vision for the future looks grim:

“The number of people of working age will decrease, while there will be more elderly in need of health services. We will see more chronically ill people with complex diseases. We believe new technologies and treatments are part of the solution, so more of us can keep working. The success of implementation of personalised medicine relies not just on financial investments, but also on contributions from many key players and stakeholders. Everyone must sit around the same table.”

CONNECT was set up to be that table, as a public-private consortium driving the implementation of precision cancer medicine in Norway. Since 2020, CONNECT has gathered 30 partners, including industry, patient organisations, university hospitals and several governmental institutions.

“We need to nurture this collaboration, develop it and use it in more areas,” commented Thomas Axelsen, Head of Politics at the Norwegian Cancer Society. “Personalised medicine in cancer needs to happen, no matter what. It is just about how fast we want it to happen. If we do it faster, we can save patients’ lives.”

Political ambitions

The government’s ambition is also high in this area, as seen in the Strategy for Personalised Medicine launched in January 2022.

“Personalised medicine should be an integrated part of the specialist health service. We need to develop the health service in a way that maximises value creation, both for the individual and for society as a whole,” said Truls Vasvik, State Secretary of the Ministry of Health and Care Services.

“Our doors are always open. We need to talk together about the development of competences, research and new price models; how we can get documentation of small patient groups and single treatments with uncertain long-term effects,” added Vasvik.

Arendalsuka: – We need to attract the big companies

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Norway needs more big companies to deliver on the Mission on Cancer.

The European Union has launched the Mission on Cancer with the goal to improve the lives of 3 million Europeans. In the recent meeting Fremtidens kreftbehandling during Arendalsuka, key experts and politicians gathered to discuss the implications of this for Norway. See the meeting here. See the meeting here. 

“With missions, we need to mobilise all resources in society towards a common goal. This is a new way to work and it challenges the established system. It is a historic investment from the EU; they are leaving no stone unturned in the fight against cancer,” said Astrid Bjerke, strategic adviser for the Norwegian Cancer Society.

A Norwegian Cancer Mission Hub has already been set up in Norway by several stakeholders, including Cancer Society, Oslo Cancer Cluster, The Research Council, The Norwegian Health Directorate, the Cancer Registry of Norway, and more.

“Norway is a part of the Mission on Cancer and this is important both for the ministry and from political leadership. EU has seen that we have to work together in the area of health. It is important that Norway is a part of this, because it also gives us possibilities.

“We have a great health service and fantastic health data, which we need to take better advantage of. We have a high degree of knowledge and fabulous research environments, as well as a population with a high degree of trust. Many positive things are happening, but we need to attract the big companies and their competence,” said Cathrine Lofthus, Secretary General of the Ministry of Health and Care Services.

Successful industry collaborations

Idar Kreutzer, director of The Confederation of Norwegian Enterprise (NHO), gave several historic examples of how Norway has built industries based on public-private collaboration, such as water power and the oil industry.

“We were impressed when we saw the power of the development of vaccines during the pandemic, which was a real collaboration between authorities, researchers and industry – with impressive results! The health industry is already exporting for more than NOK 20 billion per year, but the potential is even larger and Norway has perfect conditions to grow a health industry,” said Kreutzer.

One example of a current collaboration between academia and industry is the Oslo Cancer Cluster Innovation Park, which is expanding and has recently signed a lease agreement with the global company Thermo Fisher Scientific.

“We are doing many of the right things in Norway from basic research to patient treatment, but we need to look at the whole ecosystem. We built this ecosystem in miniature around the Radium Hospital, because this is where most of the cancer patients come through and most cancer research is done. It has been a difficult journey, but we have a very exciting pipeline with several up-and-coming companies and promising treatments,” said Jónas Einarsson, CEO of Radforsk Investment Fund and founder of Oslo Cancer Cluster.

Is there political will?

There seemed to be broad political consensus around the Cancer Mission among the politicians at the meeting.

“Missions and the EU’s work in this area is a part of our new cancer strategy and we have to collaborate on this, as well as collaborate with the EU. The mission concept is nothing new. It is first and foremost about achieving collaboration between the health service and the industry. Our cancer strategy will lay the basis for this: to gather all resources around a common goal,” said Even Røed, the Labour Party (Norway).

“We need to replace the income from oil and gas with new industries, which need to have large potentials. All Nordic countries have managed to make their health industries grow. Now we have the opportunity in Norway. The health service, academic milieus and industry are already gathering momentum, but there is a lack of political will. Norway has joined the Mission on Cancer, but how will it be implemented in Norway? There needs to be political will to build the health industry,” said Alfred Bjørlo, the Liberal Party (Norway).

“This is a really exciting method, to involve civil society, industry and academic milieus. I am most concerned about this being politically anchored. Will we see it when the new Cancer Strategy is presented? Will we see the Minister of Health together with the Minister of Industry and a representative from the European Union? Will we be connected to the Europen Union, or will this be a Norwegian hobby project, where we don’t take advantage of the big advantages we have?” asked Kristoffer Robin Haug, Green Party (Norway).

 

The meeting was organised by Oslo Cancer Cluster, the Norwegian Cancer Society, Legemiddelindustrien LMI, MSD Norway, Janssen Norway and AstraZeneca Norway. Thank you to our collaboration partners!

 

Missions: a new way of doing politics

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How can Norway succeed with the EU’s Mission on Cancer?

“This challenges the Norwegian way of doing politics,” commented Espen Solberg, Head of Research at NIFU – Nordic institute for studies in Innovation, Research and Education, at the recent breakfast meeting Fremtidens kreftbehandling about the Mission on Cancer.

“Politicians need to be bold, set goals and create a plan. They need to ask: where are we in three, four or five years? We don’t do this very much in politics. Politicians usually work in different fields. A mission requires all fields to work together,” continued Solberg.

The state as entrepreneur

The European Commission has set the ambitious goal of improving the lives of 3 million Europeans affected by cancer by 2023. This is the Mission on Cancer, one of five missions the European Commission has identified. Missions are a new way to bring concrete solutions to some of the greatest challenges of our time.

“This is a methodology that models a way to do public innovation, to solve problems that do not have a solution, and where you need to mobilise knowledge from different fields. All successful missions are characterised by concrete challenges to solve, for example technological, in a specific area. Cancer can obviously be one such mission,” commented Lars Peder Nordbakken, economist, Civita.

Both Nordbakken and Solberg agreed that the state needs to be the main driver and act as an active entrepreneur for a mission to be successful. All key players need to be involved and it is important to find the best competency in the area.

Should Norway find its niche?

Camilla Stoltenberg has led the Norwegian Institute of Public Health through the corona pandemic, a kind of mission in its own right.

“In my opinion, cancer treatment is too narrow. I think that if we are to succeed in Norway, prevention and promoting health are the most important things to do. We have better preconditions to assert ourselves internationally in these two areas and I believe we can do a fantastic job if we focus on them,” commented Stoltenberg.

Leif Rune Skymoen, CEO of the Norwegian Pharmaceutical Association, emphasised the value of focussing on cancer treatments and diagnostics.

“The industry will be an important contributor of competency, investments and tools in diagnostics and treatments to fight cancer. Cancer is a field where Norway has very good research environment and strong companies developing future cancer treatments and diagnostics. The Cancer Mission presents opportunities such as funding and new partnerships, which will be positive also for Norway,” commented Skymoen.

Where is the political vision?

With a new national cancer strategy underway, the question on everyone’s minds is: are the politicians indeed bold, with set goals and a clear plan? The politicians themselves think there is still a way to go.

“We are not good enough at connecting to these opportunities. The most important thing we do is to take advantage of what is happening on an EU level, both for research and industry. This challenges the way we do politics,” said Truls Vasvik, Arbeiderpartiet (Norwegian Labour Party).

“We need to discuss how Norway in the best way can get a strong connection to EU’s Mission on Cancer. The point of missions is to connect to the process, not just sit and wait for the results. It is not just about funding schemes, but a comprehensive investment. We need a more thorough discussion about how we as a society connect to this,” said Alfred Bjørlo, Venstre (Norwegian Liberal Party).

A national hub

Norway is already involved in the EU Mission on Cancer through different funding programmes, for example Horizon Europe and EU4Health, as well as through a national mission hub.

“The Missions methodology breaks down the sectorial approach and forces us to collaborate across health, research, education, and industry. It also contributes to faster implementation of research. It can also create public engagement and enthusiasm among the public,” said Ole Alexander Opdalshei, deputy secretary general, Norwegian Cancer Society.

“Together with Oslo Cancer Cluster, the Norwegian Research Council and other key players, we have put together a national hub so the developments on a European level also will benefit Norwegian cancer patients. We connect different milieus and create new constellations for collaboration,” continued Opdalshei.

Read more about the Norwegian Cancer Mission Hub

 

Fremtidens kreftbehandling is a political meeting series organised by Oslo Cancer Cluster, LMI – Legemiddelindustrien and Kreftforeningen, with support from AstraZeneca Norway, MSD Norway and Janssen Norway. Please save the date for our next meeting in Arendal on Tuesday, 15 August 2023, 08:00-09:00, at Clarion Hotel Tyholmen.

Oslo Cancer Cluster

Statsbudsjettet 2023

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Her er de viktigste postene for Oslo Cancer Clusters medlemmer i statsbudsjett for 2023.

Forskning og utvikling

Regjeringen foreslår å bevilge 43,6 milliarder kroner til forskning og utvikling (FoU). Det tilsvarer en realnedgang på 1,1 prosent. Totalt 78,1 millioner kroner skal gå til arbeidet med å gjøre helsedata enklere og mer tilgjengelig for forskning. Formålet er å sikre mer og bedre helseforskning, som skal bidra til bedre helsetjenester, mer innovasjon og bedre utnyttelse av de norske registrene vi i dag har.

– Norge er, med personnummer, registre og et nasjonalt helsevesen, ett av få land i verden som har muligheten til å redusere tiden for klinisk utvikling signifikant, og gi bedre pasientbehandling. Med et begrenset budsjett i forhold til våre naboland, og kutt i Folkehelseinstituttet, vil økt samarbeid med private aktører bli stadig viktigere på dette feltet, sier Ketil Widerberg, daglig leder i Oslo Cancer Cluster.

Samunnsoppdrag og forskning

Regjeringen foreslår å bevilge 3,7 milliarder kroner til deltakelse i EUs rammeprogram for forskning og innovasjon, Horisont Europa, og til de forpliktelsene som henger igjen fra forrige rammeprogram, Horisont 2020.

Oslo Cancer Cluster mener at regjeringen bør se disse bevilgningene i sammenheng med en videre satsing på samfunnsoppdrag, missions, slik at den norske innsatsen bedre skal stemme overens med det vi kan hente tilbake fra EU. EU-kommisjonen har som kjent identifisert fem samfunnsutfordringer som de ønsker konkrete og ambisiøse løsninger på innen 2030.

Kreft er en av de fem utfordringene.

– Kreft er en av de virkelig vanskelige utfordringene i EU, der de største firmaene og de beste statlige instituttene ikke klarer å finne løsningen på egen hånd. EU putter 4 milliarder Euro inn i EU’s Beating Cancer Plan. De store europeiske landene posisjonerer seg ved å styrke organisasjoner og starte spissede initiativer, for å sikre relevans, sier Ketil Widerberg.

6. oktober, samme dag som regjeringen la fram forslaget til statsbudsjett, la de også ut den reviderte Langtidsplanen for forskning og høyere utdanning 2023-2032.

Planen tar opp samfunnsoppdrag som metode, og lanserer en nasjonal satsing på to samfunnsoppdrag: bærekraftig fôr, og å inkludere flere unge i utdanning, arbeids- og samfunnsliv.

– Det er bra at regjeringen støtter EUs samfunnsoppdrag i den nye langtidsplanen. Vi håper at de legger innsats på koordinering, mobilisering og oppbygging av sterke forsknings-, utviklings- og innovasjonsmiljøer, sier Widerberg.

Viktige kreftscreeninger

28,5 millioner kroner skal gå til å få hjemmetest som en del av livmorhalsprogrammet. Regjeringen foreslår også å bruke 10 millioner kroner for å gjøre leseprosessene i screeningprogrammene i mammografiprogrammet mer effektive ved å bruke kunstig intelligens. Til det nye, nasjonale screeningprogrammet for tarmkreft, foreslås en samlet bevilgning på 203 millioner kroner i 2023. Tilbudet gis til kvinner og menn det året de fyller 55 år, og skal gjøres landsdekkende innen 2024.

Oslo Cancer Cluster understreker at det er viktig å prioritere screening og hjemmetester, fordi dette er virkemidler som fungerer for å oppdage kreft i tidlige stadier, og forhindre alvorlige sykdomsforløp og død.

– Ny teknologi, som kunstig intelligens, vil på flere områder effektivisere screening, samt gi muligheter for utvikling av ny teknologi og innovasjon. Her vil samarbeid med internasjonale miljøer bli sentralt, sier Widerberg.

Mer til metodevurdering

Systemet for Nye metoder vurderer nye behandlingsmetoder for innføring i spesialisthelsetjenesten. Regjeringen skriver i sitt forslag til statsbudsjett at de vil sørge for at systemet for Nye metoder videreutvikles i takt med den medisinskteknologiske utviklingen, og foreslår derfor 28 millioner kroner til “styrking av metodevurderingskapasitet og veiledning i Folkehelseinstituttet og Legemiddelverket i 2023”.

Statens legemiddelverk får også 8 millioner kroner i økt bevilging til å styrke regulatorisk og vitenskapelig veiledning og saksbehandling ved kliniske studier.

De regionale helseforetakene får 104,7 millioner kroner i tilskudd til tiltak innenfor persontilpasset medisin. Tilskuddet skal benyttes til å finansiere sekvenseringsutstyr i helseforetakene, det nasjonale kompetansenettverket for persontilpasset medisin, infrastruktur for presisjonsdiagnostikk og etablering av nasjonalt genomsenter.

Styrker eiendom i Siva

Eiendomsvirksomheten i det statlige foretaket Siva foreslås styrket med 100 millioner kroner i 2023. 35 millioner blir tilført som risikokapital, mens de resterende 65 millionene blir tilført som egenkapital.

– Dette er viktig for kreftinnovasjon, fordi eiendomsvirksomheten til Siva har vært, og er, sentral for utviklingen av Oslo Cancer Cluster Innovasjonspark og innovasjonsmiljøet ved Radiumhospitalet, sier Widerberg.

Siva er en av eierne i Oslo Cancer Cluster innovasjonspark og inkubator. Innovasjonsparken planlegger å utvide, etter ønske fra forskningsmiljøer og industri. En utvidelse av parken vil innebære flere laboratorier, og mer nødvendig plass til bedrifter innen helsenæringen.

Grønn helsenæring

Regjeringen vil ha mer grønn nærings- og eksportomstilling, og foreslår derfor å omprioritere deler av midlene i det næringsrettede virkemiddelapparatet. Foreslåtte tiltak er blant annet ny utlysning under Grønn plattform med en ramme på 600 millioner kroner, å øke rammen for Innovasjon Norges Grønne vekstlån, å tilførse kapital til Siva, og å styrke Innovasjon Norges arbeid med strategiske eksportfremmesatsinger.

– Det er viktig for oss å understreke at helsenæringen er en grønn næring, der eksport trenger en strategisk satsing. Helsenæringen hører naturlig hjemme i en norsk satsing på grønn eksport, sier Widerberg.

 

Mer om statsbudsjettet

 

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