The high and growing global burden of cancer urges the need for effective implementation of primary cancer prevention (PCP) programmes targeting modifiable risk factors. However, evidence-based programmes with proven effectiveness under controlled environments often fail when implemented in the real world due to ineffective adaptation and implementation strategies addressing context-specific barriers, leading to programme failures and public health inequities. The PIECES project will develop, assess, and disseminate a cancer-specific methodological implementation framework, the integrated PCP Implementation Toolkit (PCP-IT). PCP-IT will provide an evidence-informed systematic process for (1) identification, selection, and tailoring of PCP programmes, and (2) developing evidence-informed implementation strategies tailored to local barriers and constraints. The PCP-IT will include a comprehensive repository of PCP programmes, their Theories of Change, and materials for systematically adapting the programmes to local needs and cultural constraints. The project involves 16 consortium members and implementation sites from 10 countries of diverse socio-cultural backgrounds and access to up to 77.7 million inhabitants. PIECES provides an ideal naturalistic laboratory to improve and study the up-scaling and implementation of a wide range of primary PCP programmes targeting major risk factors: tobacco, alcohol, low physical activity, HPV infection, sun exposure, and diet. A multi-site case comparison study will be conducted to assess and optimise implementation outcomes. An in-depth realist evaluation using various sociological theories will be conducted to explain the processes by which the outcomes are achieved. The consortium will employ a high-level external Advisory Board with renowned experts, facilitate continuous engagement with stakeholders, and align with the EU and relevant scientific societies to ensure the future continuity of both the repository and PCP-IT. This action is part of the Cancer Mission cluster of projects on ‘Prevention and early detection’.

MyPeBS addresses the crucial and timely question of the future of breast cancer screening in Europe. Indeed current standard mammographic screening, with entry stratified by age alone, has recently been largely questioned. Despite a demonstrated mean 20% reduction in breast cancer-specific mortality, together with reduction of late-stage disease in women older than 50, it is associated with potential harms including false positive recalls and over-diagnosis. Individual breast cancer risk estimation, through models including clinical variables, mammographic breast density and more than 100 genetic polymorphisms, now has substantial clinical and scientific bases. Personalized screening strategies, based on individual risk levels, could potentially improve the individual benefit/harms ratio of screening (earlier cancer detection and less intensive treatments in high risk women, less false positives and over-diagnoses in low risk ones), and increase the cost-efficacy for health insurances. MyPEBS will conduct an international randomized phase III trial to validate this hypothesis. It will primarily assess the ability of an individual risk-based screening strategy to be non-inferior, and possibly superior, to the standard of care screening, in reducing the cumulative incidence of stage II+ breast cancers. The trial, conducted in 5 countries (France, Italy, UK, Belgium and Israel) will include 85000 European women aged 40-70, all followed for 4 years. MyPEBS will also evaluate if an individual risk-based screening strategy, compared with the standard, reduces screening-related harms (unnecessary biopsies, overdiagnoses) in low-risk women, is overall at least as cost-effective as well as more accepted by women resulting in a larger screening coverage. After analyses of all components, the final objective of MyPEBS is to deliver recommendations for the best future breast cancer screening strategy in Europe.

More than 50% of cancer patients develop pain before death: 80% can be treated with drugs, but 20% show a low response or have serious adverse effects. Although non-pharmacological interventions such as neurosurgical procedures have been tested, these alternatives are not a preferred option to treat cancer pain due to their high cost, risk, invasiveness and not always proven efficacy. PAINLESS addresses a core component of pain relief, by using an innovative, evidence-based approach. The objective is to adapt and implement a novel, cost-effective, home-based intervention based on neuromodulation to reduce pain and improve quality of life of cancer patients with chronic pain. On the assumption that treatment of chronic pain can benefit from research on the brain mechanisms of pain, we will first attempt to improve our understanding of the role of central pain modulation. The project will be organized in 3 studies: 1) A cohort, longitudinal study (n=450) to explore whether the biomarkers of central pain modulation mechanisms can be predictive of the future occurrence of chronic pain in cancer patients; 2) A cross-sectional study to characterize and stratify cancer patients with vs. without chronic pain (750 patients with the proposed biomarkers and taking into account a number of moderator variables); 3) A pilot study (n=450) to assess the feasibility an efficacy of at-home delivery of transcranial low intensity electric stimulation (tES) for the palliative care of cancer patients suffering from pain PAINLESS will develop a customized web portal to share knowledge and to improve management of the patients; perform techno-economic analyses and Health Technology Assessment of the solution; analyze the possibilities of implementation in different European healthcare systems and results exploitation; and undertake an ambitious dissemination and communication strategy. We will also propose a wide range of measures to ensure compliance with the highest ethical standars.

CBIG-SCREEN aims to tackle inequality in cervical cancer screening (CCS) continuum. Though CCS programmes drastically reduce cervical cancer mortality, they remain largely inaccessible and underused by subpopulations of vulnerable women, creating inequality in the European healthcare system. CCS programmes rarely reach the subgroups at highest risk, adding to the challenges underserved populations already face in their efforts to maintain their socioeconomic and physical health. CBIG-SCREEN will create a Europe-wide knowledge framework around barriers to CCS and generate policies, programmes, communications and other required services to meet the needs of underserved sub-populations of women with inherent high-risk of cervical cancer and low (perceived) access to proper healthcare routes. CBIG-SCREEN will be working collaboratively with vulnerable and underserved women to identify the interventions that will more effectively engage and retain them in CCS programmes in European countries. Through stakeholder engagement, mathematical analyses, and structured reviews of current policies, our consortium will collect, analyse, and share knowledge about shortcomings and opportunities for improving CCS continuum that will directly translate to policy recommendations and be used to adapt and extend national CCS with interventions tailored to vulnerable subpopulations. By deploying screening programmes aimed specifically to serve vulnerable women we can thus leverage limited resources to quickly reduce CCS mortality. Our interventions aim to reduce health inequality by increasing screening ratios among vulnerable women from 26% to 45% and intend to offer support to policymakers and national programmes to help Europe reach or exceed the WHO 2030 target of screening >70% of women for cervical cancer. CBIG-SCREEN project will realise the needed improvements in the European screening policies to address the current inequities and thus accelerate cervical cancer elimination.

CHALLENGE: Adolescence and early adulthood are critical stages for development. A diagnosis of a life-threating disease like cancer in adolescents and young adults (AYAs), coupled with immediate and late effects of treatment, force AYAs to face mortality early in life. Testicular Cancer (TC) is the most diagnosed cancer in AYAs assigned male at birth aged 15-39 years. The incidence of TC has doubled over the last four decades, with highest incidence rates in individuals of European ancestry. Interventions to educate and support AYA TC survivors, and reduce symptom burden and late effects of TC treatment should be prioritised. SOLUTION: Project TRANSCEND-XR will ethically co-create, test, and scale up in real-life settings an innovative digital intervention to increase AYA TC survivors’ knowledge of the late effects of TesticulaR cANcer treatment and address their unmet Supportive CarE NeeDs using eXtended Reality. PLAN: TRANSCEND-XR will ensure that (i) the needs of AYA TC survivors, their care partners, and healthcare professionals are explored and disparities addressed; (ii) the TRANSCEND-XR intervention is robustly and ethically co-created, refined, and validated; (iii) there is understanding of intervention effectiveness, cost-effectiveness, process of delivery, and what AYA TC survivors ethically value about it in real-life settings. Evidence-based plans to translate knowledge into practice and policy, exploit outputs, and sustain TRANSCEND-XR in long-term, robust governance and effective patient and public involvement are established. IMPACT: TRANSCEND-XR will revolutionise the understanding and management of late effects from TC treatment among AYA survivors, improving their quality of life, throughout Europe. It will serve as a proof of concept for ethically developing, evaluating, and implementing immersive educational digital health solutions to support AYA cancer survivors. This action is part of the Cancer Mission cluster of projects on “Quality of life (AYA)".