How are the challenges faced by medical oncologists in Europe different from issues facing their colleagues in the United States? At the 35th ESMO Congress, held October 8-12 in Milan, Italy, The ASCO Post asked a few attendees to comment on the practice of oncology in their country.

"In Belgium, many or most oncology drugs are paid for by the government, though not for all the same indications as in the United States. For instance, bevacizumab (Avastin) is reimbursed in colorectal cancer but not in lung cancer, where the benefit is so small. But we must wait longer for drug approval. For example, I can't prescribe ipilimumab or the BRAF inhibitor in melanoma yet, but my patients are asking about it. Still, we have universal health coverage, and some patients have additional insurance, so most patients are getting the care they need."
-Lore Decoster, MD, Brussels, Belgium

"We have a high approval rate for new oncology drugs, so I can't complain about patient access. But my fear is that, since the global economic crisis is also affecting our health-care budget, the future could be more problematic. Currently, oncology drugs get priority fast-track approval, but I don't know if this status will be maintained. I worry that the availability of drugs may become a problem, especially for patients who do not have additional insurance to supplement the care that the government provides."
-Tim Van Den Wyngaert, MD, Antwerp, Belgium

"Many UK oncologists are concerned about access to new cancer drugs. We would like to be able to give all our patients the best evidence-based treatments, and there is tension between this and the public health side of things because money is limited. We have some patients treated within the National Health System, and we have a subset with additional insurance. The treatment for the same problem might be different for these two populations within one physician's practice, and there is also some geographic variability. Furthermore, I'm involved in phase I trials, and I find that the regulatory burdens for investigator-led studies are becoming more difficult."
-Richard Baird, PhD, Sutton, UK

"My main concern is how to implement all the new oncology drugs: how to select the right patients for them and when to use them. While reimbursement is good, and ultimately The Netherlands gets every new drug, it takes longer than in the United States. Fast-track approval in the U.S. is about 6 months, but it is at least twice that long in The Netherlands, and that is frustrating. Similar to the situation in the U.S., oncologists in The Netherlands are not completely satisfied with how they are paid. We receive a fee per diagnosis, not per treatment [ie, bundling], and we have found that the government is losing money with this system. We need to rethink this."
-Winald Gerritsen, MD, PhD, Amsterdam, The Netherlands

We have access to most oncology drugs, and I believe in many ways our health-care system is better than in the United States. Our medical oncologists are as good as those anywhere, but our physical conditions are not as good. For example, we need better facilities, and we need hospice. Some hospitals are quite good, but others are not.
-Tariq Salman, Izmir, Turkey