The Stockholm declaration signals a cultural change in Europe's approach to cancer research. An interview with Ulrik Ringborg

Article Outline

 
• 
  • View Large Image
  • Download to PowerPoint

Prof. Ulrik Ringborg is Director of Cancer Center Karolinska, President of the Organisation of European Cancer Institutes (OECI), and one of the original signatories of the Stockholm Declaration.

For cancer research, as in other areas of scientific endeavour, Europe's strong basic science tradition is one of its great strengths. Networks of researchers, be they in radiobiology, immunology, or genetics, connect and work together throughout the continent and produce excellent science. But to really move forward in the fight against cancer-related morbidity and mortality, we need a far greater level of cooperation – across the continent and across disciplines. Subject-specific groups can only do one type of research, and are generally limited to the confines of their field. If radiobiologists are only interested in radiobiologists, and immunologists in immunologists, who is interested in the patient?

The central premise of the Stockholm Declaration is that those with responsibility for the total structure of cancer research – the people running the Europe's large comprehensive cancer centres – are the ones that should have the patient as the focus of their work. So, linking centres within a formal collaboration, as the Declaration suggests, should also put the patient's perspective at the centre of broad cancer research efforts, while enabling us, as a community, to reach the necessary critical research mass to make innovative advances in treatments and care.

Linking comprehensive cancer centres would create a formidable platform, but to retain its innovative capability it must be dynamic, not rigid, and it must be evaluated right from the start. It can start small, as the Declaration suggests, but to really make an impact there should be the flexibility for it to get larger over time. However, we must be careful not to fall into the trap of creating an exclusive club for selected centres while other research institutions are forgotten. The platform must have positive consequences for activities and organisations outside its membership by dissemination of information and knowledge and by supporting all European research. This network, the Declaration signatories believe, is a way to make European cancer research visible on a global scale.

This idea has not come out of the blue. It emerged from an analysis done as part of the Eurocan+ plus project, which concluded that the main problem with European cancer research is fragmentation in research, funding, and regulation. This situation is both a cause and a consequence of insufficient integration between basic and clinical sciences in the research process. And it is preventing Europe from accumulating the critical mass necessary to carry out large clinical and translational trials that turn basic science advances into clinical innovations. The only organisations that make any attempt to bridge this gap now are the comprehensive cancer research centres, which is why the Declaration focuses its attention of these organsiations. However, even for these large centres to reach critical mass, they need to work together in a more formal way than they have so far.

In our discussions about the Eurocan+ plus findings, which led up to the Stockholm declaration, we concluded that there was too little communication between basic research centres and comprehensive cancer centres. So we proposed that Europe should create a research platform that formed a link between basic research centres and their clinical counterparts, while also linking together the comprehensive cancer centres. These associations would provide cancer centres with important new biological information and, if the centres work together, it will be possible to coordinate research that answers important patient questions. Through this process of cooperation, the network will also have the dual function of supporting harmonisation of infrastructure, which in turn would facilitate further collaboration.

Bringing together these ideas, the meeting in Stockholm on November 6 that launched the Declaration in the form you see published in this journal, included representatives of 19 centres in Europe and all of the most influential comprehensive cancer centres. Nobody refused an invitation. The meeting's purpose was initially to discuss and debate the conclusions to be drawn from the Eurocan+ plus project. Our aim was to forge a consensus to clearly send a message to the European Commission that we understand the problem, we all agree, and we have solutions to overcome it. With this clear statement, we wanted to spell out that if we proceed with these plans suggested in the Stockholm declaration, we should be able to develop world class cancer research infrastructure – just what the European Commission has asked for in its green paper. The Declaration that resulted from these discussions signals a cultural change in our approach to cancer research in Europe.

Key to the argument for immediate action is that the goal is easily achievable because the centres are there already. Forming this platform is a process that can start immediately, provided that the Commission can give both political and financial support, and the idea is accepted by decision makers in Europe. What is more, the risks of not pursuing this project are substantial. If we do not have such a construct in Europe we will continue with fragmentation. We will be unable to run all types of cancer research because we don't have the critical mass. We will not be able to make the translational research process more efficient. And this means long delays between discovery and use of new technologies in routine care. A final point, crucial to the future of research in the EU, is that we will not have the exchange of researchers that we want between centres and between countries. This issue is key to recruiting young researchers and keeping them in Europe, rather than letting them move to strong centres in the US.

So for European research, a platform such as that outlined in the Stockholm Declaration is not just a desirable move, it is a necessity. It meets the requirements of the European Commission for greater cooperation, better infrastructure, and improved education and retention of researchers. And it also heeds the calls of the pharmaceutical industry who have long been advocating closer collaboration between academia and industry, and better links between comprehensive cancer centres, in order to keep up with the competitive situation globally. Creating a platform like that suggested in the Declaration will give us a way to coordinate more effectively and facilitate better translation of research findings, with patient problems in focus. If we do not do this, collaborations will continue to be random and slow.

The Stockholm Declaration is a signal that the cancer community now has a shared view of this problem, no small achievement in itself. But to solve it, change must start in the European Commission. Once they acknowledge the advantages, then national governments and research centres can start the process of better collaboration, and benefits to patients will not be far behind.