A bright future for SA oncology

More than 800 oncology and related professionals from all around South Africa turned out for the 2016 ICON National Conference – making it the largest and most vibrant ICON conference to date – with an exceptionally high standard of academic presentations.

For the more than 800 professionals working in oncology and the related sectors who made the journey to Emperors Palace earlier this month to attend the 2016 ICON National Conference, the journey was resoundingly worthwhile.

Conference organiser and Chair Dr Lee-Ann Jones says the positive energy over the weekend was palpable and that delegates were loud in their praise of the event, which featured a full oncology academic programme as well as four parallel streams. These programmes for oncology social workers, chemotherapy nurses and pharmacists, radiotherapists and medical physicists and practice administrators were enthusiastically attended and emphasised the holistic approach to cancer care that ICON champions.

“Three international speakers who shared best practice examples from the UK, Switzerland, and the US also served to highlight that ICON is decidedly on the right track in terms of our protocols and innovative approaches to expanding access while containing costs of cancer treatment in South Africa,” says Jones.

These high standards were evident in the quality of the academic programme as well, says Jones, which featured more than a dozen presentations on specialist areas from Body Stereotactic Radiosurgery to the new MASCC ESMO Antiemetic Guidelines.

There were many academic highlights over the three days, but Jones says that three themes in particular stood out.

1. A focus on best practice

In addition to excellent plenary sessions on the importance of guidelines (Dr Fergus Macbeth, NICE, UK) and the emerging evidence from Texas Oncology of the efficacy of pathways in improving treatment outcomes while reducing cost (Dr Russell Hoverman), there was a steady stream of presentations at the conference that highlighted best practice guidelines and treatments.

The first clinical session of the weekend, for example, which was presented by Dr David Anderson on prostate cancer: Brachytherapy Guidelines and Competencies, unveiled a set of competency guidelines for Brachytherapy that have been pioneered by Dr Anderson and endorsed by SASCRO.

Dr Anderson also presented findings of a survey of ICON doctors who perform Brachytherapy to assess alignment with these guidelines. This is the first time that such a survey has been carried out and fortunately indicated that there is a good correlation.

Dr Wilhelm van Zijl, who was next up on the programme, also presented new data on the sequencing of treatments in the metastatic setting of prostate cancer. He looked specifically at the current international guidelines and compared these to actual data on survival gains by certain sequencing of treatments, making recommendations as to which disease factors can used to predict who would be better on which treatment.

There was a full programme on Saturday morning covering the vast topic of breast cancer. Dr Ettienne Myburgh presented on the clinical importance of gene array assays in clinical decision-making. He also provided an excellent overview of the options of assays that are available in South Africa and their clinical relevance, demonstrating, for instance, that with use of these assays – it is possible to achieve a 37% reduction in use of adjuvant chemotherapy – and that this was cost neutral if the chemo costs under R110 000.

Dr Rika Pienaar gave an excellent presentation on the case for neo-adjuvant treatment in breast cancer, highlighting its poor utilisation at present. The involvement of multi-disciplinary teams is much needed to drive this process and ICON will work to promote this rational approach.

And of course headline speaker Dr Matti Aapro presented evidence on the use of bone-modifying agents in the treatment of breast cancer as well as the latest ABC-3 guidelines on the treatment of metastatic breast cancer. His talk was both entertaining as well as packed with pragmatic approaches for the ICON oncologists to implement in their day-to-day practice.

Further clinical topics included lung cancer. Dr Sza Wai Chan presented the South African experience in EGFR mutated metastatic non-small cell lung cancer, which indicated that approximately 20% of patients with non-small cell lung cancer should qualify for treatment with a tyrosine kinase inhibitor.

An excellent overview of the evidence for the use of G-CSF together with current utilisation data within ICON was presented by Dr Marc Maurel.

2. A balanced programme

A second key theme in the academic stream of the conference was how balanced it was, says Dr Jones. The programme featured several presentations on radiotherapy including a session with Professor Bernard Donde on IRMT competencies and the competencies required for this. Professor Jeannette Parkes presented an ICRU 83 guidelines & QUANTEC update – describing how the guidelines have recently changed. And lastly, Dr Louis Kathan presented on the evidence in support of the use of stereotactic body radiosurgery (SABR).

“This is of particular relevance because ICON will be including indications for SABR in its 2017 protocols,” comments Dr Jones.

3. Showcasing ICON data

A third notable element of the conference was the volume of ICON collated data that was presented or used in the presentations. “ICON is, if nothing else, a rich data source and the eAuth® system is allowing medical professionals to gather unprecedented amounts of data to showcase disease incidence and current practice within South Africa,” says Jones.

The ICON data on the treatment of metastatic breast cancer from 2014 and 2015, which is based on approximately 3, 2 million insured lives, was presented by Dr Lee-Ann Jones. This revealed that 1 in 5 new patients present with metastatic disease (stage 4). Two-thirds of these patients received chemo at some point in a year while 50% received endocrine treatment. Radiotherapy was offered to one-third of patients.

Another fascinating insight into the disease that has emerged from this analysis is that the incidence of breast cancer in South Africa’s population (at least in this sample) – correlates very closely to what is reported in US. South Africa’s incidence is 120/100 000 lives in female population compared to 123/100 000 in US.

The ICON data on the surgical treatment of colon rectal cancer patients with liver metastases with an option to cure was presented. The ICON claims data was analysed and this data shows that the incidence of this disease for this population to be 50/100 000 compared with the US incidence 41.9 per 100 0000 lives.

“The data also shows that almost half of all patients who were receiving chemo for colorectal cancer at any one time were receiving it for metastatic disease – and of these, 1 in 5 are potentially curable with surgery,” comments Jones.

On a more concerning note, the data also revealed that the ICON population has limited access to biological agents, which have been shown to improve resection rate, because of affordability.

“What is useful about this kind of information is that ICON can now take this and work proactively to find a solution. While it is a small group of patients it is an important one because the treatment can be potentially curable,” says Dr Jones.

Looking to the future

“Part of ICON’s ongoing mission to overcome cost and access challenges in the oncology environment.”

Jones says that what emerged overall from the conference is that there is still a very strong ‘can do’ attitude in South African oncology, which is energising and exciting. “And it feels very much like the ICON network is the glue that holds us altogether,” she said.

“There is no doubt that the ICON conference was bigger and better this year and that the network is really coalescing around the vision of the organisation,” comments Dr Ernst Marais, Chief Operating Officer at ISIMO and Co-Chair of the ICON 2016 conference.

“Thanks are due to exceptional energy of this year’s organising committee including Belinda Bailey, Yogi Govender, Jennifer Fuller and Linda Greeff in pulling this one together. We also need to extend a big thank-you to all those who have supported ICON with research and energy and who contributed to the academic programme. And lastly, a big thank-you to our sponsors without whom the event would not have been possible.

Conference sponsors included:
Platinum sponsor: Eurolab
Gold sponsor: Varian Medical Systems
Silver sponsors: Elekta and Sanofi
Bronze sponsors: Astellas Oncology; Janssen; Merck; BARD; Key Oncologics; Pierre Fabre South Africa; Dis-Chem Oncology; MSD; SUN Pharma; and Bristo-Myers Squibb.