HomeLung cancer policy network meets our co-founder

Lung cancer policy network meets our co-founder

From Lung cancer policy network blog post

We speak to Ebba Hallersjö Hult, Co-founder and Head of Vision Zero Cancer, a mission-oriented innovation hub coordinated by Stockholm School of Economics Institute for Research, Sweden.

What led you to work in the field of lung cancer?

I have a background in political science and international relations, and I am one of the founders of Vision Zero Cancer, a multi-stakeholder platform against cancer which was established in November 2019.

With Vision Zero Cancer, we decided to start with lung cancer as it is the most common cause of cancer-related death among both men and women in Sweden. Lung cancer is associated with great suffering and economic burden for the people with the disease and society. Today we have the technological means to detect lung cancer earlier and treat it more effectively, to transform lung cancer from a deadly disease to one that is chronic or curable. Now, we just need to implement these technologies into routine care.

Eliminating lung cancer as a cause of death requires a holistic approach that is effective across two axes: 1) prevention—early detection—treatment—quality of life; and 2) research—translation—implementation. At Vision Zero Cancer, we are therefore building a holistic project portfolio – ranging from early detection and screening of lung cancer, to implementation of precision medicine, and new organisational models and tools for prevention, rehabilitation and quality of life. In addition, we are investing in research into ecosystem development. We are also developing methodology to build a collaborative innovation capacity. Our ambition is to increase the impact of innovation through new forms of governance and collaboration.

What does an average work-day look like for you?

As well as leading the coordination of Vision Zero Cancer, I oversee a national testbed for precision diagnostics and clinical trials in precision cancer medicine, which is a spin-off flagship project that we created together with Genomic Medicine Sweden and SciLifeLab. I lead our operations from Stockholm School of Economics Institute for Research, and I have a team of colleagues across Sweden.

Managing large consortia with a comprehensive project portfolio and many different stakeholders across various sectors is a true exercise in mission orchestration. Every day I learn something new.

A typical day involves several meetings, policy work and management tasks. I spend a lot of time with partners, steering groups in different projects, and participates in workshops or seminars – in Sweden and abroad. I also take an active role in organising and hosting study visits, workshops and other events as part of the convenor and catalyst function that Vision Zero Cancer plays in the Swedish cancer ecosystem.

I also work across three European Union (EU) projects related to the implementation of Europe’s Beating Cancer Plan and the EU Mission on cancer: Establishing of Cancer Mission Hubs (ECHoS), Personalised Cancer Medicine for all EU citizens (PCM4EU), and Precision Cancer Medicine Repurposing System Using Pragmatic Clinical Trials (PRIME-ROSE).

In addition to the Lung Cancer Policy Network, I am a member of All.Can and I represent Vision Zero Cancer in DigiCore and ECO Community 365.

What is working well in your country, and what could be improved?

All Swedish residents are covered by health services, and results are comparably good when measuring performance of cancer care, with low cancer mortality and high cancer survival rates. The quality of cancer care has continued to improve in recent decades following the launch of a National Cancer Strategy in 2009. The strategy included establishing regional cancer centres, enhancing multidisciplinary teams’ decision-making skills, regularly updated national clinical guidelines, and rapid access to new medicines, as well as further development of clinical quality. In Sweden, cancer costs are slightly higher per person than the EU average.

Prevalence of risk factors for cancer is generally low in Sweden, but some disparities between socioeconomic groups are concerning, which is something we need to work on. While prevalence of smoking in Sweden is the lowest in the EU, the difference between people on higher and lower incomes is among the largest.

Sweden has three nationwide, population-based outreach screening programmes that are tax-financed and free of charge for the target populations. Coverage rates for breast and cervical cancer screening are among the highest in the EU, but there are persisting disparities in participation from people with different levels of income and education.

An updated cancer strategy is currently being developed, with a focus on improving early detection, rehabilitation, and the transition from childhood to adult cancer care. The new strategy will also look at the implementation of precision diagnostics and treatment, e.g. whole-genome sequencing as clinical routine for all children living with cancer.

The prognosis for lung cancer has improved during the last decade thanks to advanced diagnosis and treatment methods. Despite this, the five-year survival rate is only around 24% for men and 31% for women.

Vision Zero Cancer has contributed to the policymaking process with a national health economic assessment conducted by the Swedish Institute for Health Economics (IHE), proving the value of lung cancer screening. We have also supported policy decision-making through two independent studies on attitudes towards participation in lung cancer screening among Swedish native speakers and foreign-born Swedish citizens within the target population. Both studies, conducted by Kantar Sifo AB and The Social Few, showed that 9 in 10 smokers and ex-smokers were positive about participating in lung cancer screening. The overwhelming majority of study participants preferred to get information about screening when visiting a general practitioner, health centre or an existing screening programme.

A first lung cancer screening pilot project is ongoing in Stockholm, with promising results. I hope this will lead to the decision to start preparing for the implementation of a nation-wide screening programme.

What motivated you to join the Lung Cancer Policy Network?

I was invited to join the Lung Cancer Policy Network through colleagues at AstraZeneca, one of the founding partners of Vision Zero Cancer. We share the overarching ambition to eliminate lung cancer as a cause of death.

What would you like to see from the Network as it develops?

The Network is a great initiative to join forces across the globe, learn from each other and build momentum for the implementation of lung cancer screening – taking a systems perspective.

The Network has already developed many useful resources in a collaborative way, which is highly appreciated. Now we must make sure these resources are widely circulated so they can be used practically.

It is important to maintain an agile way of working, and a collaborative spirit, as the Network grows and evolves over time. It is important to continue to create and publish resources on implementation across the globe, as well as to participate in international congresses and national events.

What changes would you like to see in lung cancer care on a global level?

Today we have the technological means to detect lung cancer earlier and treat it more effectively, to transform lung cancer from a deadly disease to a chronic or curable one. Now, we just need to implement these technologies into routine care. There is no single answer as to how to do this, but we do know that no one can do it on their own, and that we need to think and collaborate in new ways.

More investment is needed in research and across the care pathway, including primary and secondary prevention. The single most important measure for curing people is early detection. Today, too many get diagnosis of lung cancer at a late stage, as early symptoms can be diffuse and difficult to detect. I would like to see equitable access to targeted screening, early detection and precision diagnostics for targeted treatment.

What recent research have you found the most interesting or exciting?

The development of novel predictive biomarkers and therapeutic targets, leading the way for the next generation of precision medicine and improving clinical outcomes. We greatly increase the chances for successful treatment with early detection and screening. There is hope for a cure.

Outside of work, what do you spend your time doing?

I live with my family on an island in the Stockholm archipelago with fantastic wildlife and nature where we enjoy walks, golf, water sports and boating in the summer, and cross-country skiing and skating in the winter. Above all, I enjoy travelling, and interacting with people from different backgrounds and cultures. In addition to Sweden, I have had the opportunity to study and work in Italy, Spain and Ukraine, which I believe has shaped my character. My Scottish grandmother gave me my motto: ‘the world is a book, and he who stays at home reads only the first page’.

The Lung Cancer Policy Network brings together a unique mix of experts in lung cancer from around the world, united in their passion to eliminate lung cancer as a cause of death.

We regularly share profiles of our members so that you can find out more about what led them to work in lung cancer and what changes they would like to see in lung cancer prevention and care on a global level.

Home”Breaking new ground on all fronts” – Oncology in Sweden about Vision Zero Cancer

”Breaking new ground on all fronts” – Oncology in Sweden about Vision Zero Cancer

In the latest issue of Oncology in Sweden, a number of people from Vision Zero Cancer were interviewed about the beginning, the vision, how it is going to become reality and the importance of collaboration and inclusiveness to make a change.

“Our vision is that no one should have to die from cancer in Sweden and the goal of our unusual collaboration is to investigate what we need to do to reach it.”

The journalist Evelyn Pesikan talked to several members of the core team about their roles and hopes for Vision Zero Cancer. But also about hands-on actions and forms of collaboration.

Read the interviews

Vision Zero Cancer

Vision Zero Cancer challenges the prevailing ecosystem and connects new ones. We are going to turn cancer from a deadly into a curable or chronic disease.

Who we are

HomeResearcher studies Vision Zero Cancer for future innovation

Researcher studies Vision Zero Cancer for future innovation

Are milieus like Vision Zero Cancer a good way to accelerate innovation? At Stockholm School of Economics, doctoral student John-Erik Bergkvist is researching this – the methodology for building a vision-driven innovation milieu.

John-Erik Bergkvist, PhD student at House of Innovation, Stockholm School of Economics

Vision Zero Cancer aims to be an innovation milieu that engages actors from different sectors and disciplines to achieve a common vision: that no one should have to die of cancer. The phenomenon of vision-driven innovation milieus is not new – but there is not much research on it, yet. Doctoral student John-Erik Bergkvist, at House of Innovation, Stockholm School of Economics, is working on changing that.
“Vision Zero Cancer is an exciting organization,” he says. “They are based on a call from The Swedish Innovation Agency, Vinnova, around vision-driven health. Based on ideas that innovation can be accelerated through cooperation and a clear direction.”

It is based on the idea that it’s rarely one actor that accounts for the entire value. In the case of cancer care, there are many actors. The pharmaceutical industry, the medtech industry, doctors, nurses, IT-functions – all that is required for good cancer care. The idea is that these actors should not innovate individually but explore joint missions in a broader ecosystem.

Previous research has mainly focused on collaborations between organizations or ways of coordinating ecosystems that are centered around a certain product. Vision Zero Cancer is more about creating an arena and conditions for long-term dialogue – so that collaboration becomes natural. Preferably in slightly unexpected constellations.
“Theoretically, it’s about changing informal and formal institutions. The assumption in Vinnova’s call is that broad arenas for knowledge exchange can give birth to new ideas and increase innovation capacity in the ecosystem as a whole.”

Words such as cross-sectoral, cross-disciplinary, flexible, and dynamic permeate the call.
“It is based on the idea that it’s rarely one actor that accounts for the entire value. In the case of cancer care, there are many actors. The pharmaceutical industry, the medtech industry, doctors, nurses, IT-functions – all that is required for good cancer care. The idea is that these actors should not innovate individually but explore joint missions in a broader ecosystem. And try to get the ecosystem to bring about system transformation.”

Healthcare is more than just the treatment itself; it is also a matter of organizing to carry out the treatment. In which knowledge of how to do it effectively is needed.

John-Erik Bergkvist will follow how Vision Zero Cancer is built up and received, which drivers and hindering factors there are. A longitudinal case study. This will be the theme of one of the articles in his doctoral thesis, which usually contains four to five articles.
“The rest is made up of experimental studies around what factors matters to those who are going to engage with the ecosystem, how innovative ability is affected by education and how receptive different professions are to the ideas of other professions”

The fact that Vision Zero Cancer is an innovation milieu within healthcare was something that attracted John-Erik Bergkvist, who has experience within healthcare from before. His CV includes positions as an analyst at the Swedish Agency for Health and Social Care Analysis and analyst at the Swedish Government Offices’ writing an Official Government report on the subject ‘The future specialist nurse – new role, new opportunities’. He is well versed in the challenges facing healthcare. Organization is one of them.
“Healthcare is more than just the treatment itself; it is also a matter of organizing to carry out the treatment. In which knowledge of how to do it effectively is needed.”

There is certainly scepticism about initiatives perceived as “external” fabrications. However, Vision Zero cancer exhibits characteristics that are beneficial. They consist of a wide mix of people “from within” healthcare. And not only from the profession, but also patients, the pharmaceutical industry and the medtech industry

By studying Vision Zero Cancer and the conditions for innovation, John-Erik Bergkvist hopes to be able to generate knowledge about its way of organizing and draw general conclusions that can be used for similar milieus. To learn if vision-driven innovation environments are something for the future. In this he is supervised by Associate Professor Anna Essén.
“John-Erik’s research contributes to the vision by critically reviewing what Vision Zero Cancer actually does. Sometimes you don’t do what you think you’re doing. It increases Vision Zero Cancer’s own ability to reflect and thus the capacity to adapt, improve, and achieve its goals.

Anna Essén, assistant professor at House of Innovation, Stockholm School of Economics

Anna Essén points out that innovation milieus are nothing new but have existed in different contexts in the past. With varied results.
“There is certainly scepticism about initiatives perceived as “external” fabrications. However, Vision Zero cancer exhibits characteristics that are beneficial. They consist of a wide mix of people “from within” healthcare. And not only from the profession, but also patients, the pharmaceutical industry and the medtech industry.”

Vision Zero Cancer matches actors with complementary ideas – it thereby reduces transaction costs and allows actors to leverage their investments. No one can build a complete solution for a transformation of cancer care themselves. A viable approach is therefore to enable actors to combine and recombine their nisched ideas and offerings with other’s contributions. I think Vision Zero Cancer is making a difference here already – by facilitating such combinations.

The network of actors is something that Anna Essén sees as a strength.
“Vision Zero Cancer matches actors with complementary ideas – it thereby reduces transaction costs and allows actors to leverage their investments. No one can build a complete solution for a transformation of cancer care themselves. A viable approach is therefore to enable actors to combine and recombine their nisched ideas and offerings with other’s contributions. I think Vision Zero Cancer is making a difference here already – by facilitating such combinations.”

Vision Zero Cancer challenges the prevailing ecosystem

Fewer people shall get ill and die from cancer. For that to work, we need to think in new ways. Both in terms of developing new solutions and getting better at using what is available.

What we innovate

HomeHow Sweden will become a global leader yet again

How Sweden will become a global leader yet again

More and more patients need radiotherapy. But radiation therapy treatment is an area where research in Sweden has gone from leading to lagging behind internationally. How do we reverse the trend? How do we ensure that radiation therapy research continues to develop and become even better so that more patients survive and can live a better life with less side effects?

Kjell Bergfeldt, MD, PhD. Foto: Staffan Claesson

Sweden was for a long time a leader in the field of radiation therapy research. But in the last 20 years we have been falling behind – fever scientific articles are published, less money goes towards research and people who hold it as an occupation are getting more scarce. Kjell Bergfeldt, MD, PhD, with more than twenty years of experience as an oncologist has the task of developing Swedish radiation therapy and is working to change all of this.
– Half of all cancer patients are estimated to receive radiotherapy at some point during their illness. Developed radiation therapy can improve the lives of many people.

Innovations such as the MRI camera and PET scanning have made the images sharper and more detailed. Treatment planning programmes have been developed to make radiation therapy more precise. Dr Bergfeldt sees it as a form of precision therapy where artificial intelligence and machine learning can help improve treatment further.
– In the past, we had to include space for uncertainty in the planning which meant that the volumes that were irradiated could become large and cause severe side effects. With better images and software, we have improved radiation therapy treatment and there are great opportunities to improve it further. If we can isolate the area of the tumor better, it may be possible to increase the dose. As long as there is a risk of hitting healthy organs, we want to keep the dose down.

– Half of all cancer patients are estimated to receive radiotherapy at some point during their illness. Developed radiation therapy can improve the lives of many people.

For lung cancer there is a particular challenge.
– The brain is located in an exact place. The part that the radiation is aimed to hit is still. But the lungs move with your breathing. Therefore, the tumor is moving. How do you beam on a moving organ? The technology to do so has evolved rapidly but yet it is not fully implemented everywhere.

The fact that the technology has become more advanced has also made the management of it more complicated within healthcare. This leaves one more thing that must be developed. Competence.
– The number of patients receiving radiation treatment is constantly increasing. However, the number of nurses and doctors who can master the increasingly complex technology and who are doing research in the field is not increasing at the same rate. In order to provide the best treatment, we need to attract more doctors, nurses and medical physicists who are focused on radiation therapy.

After all, Dr Bergfeldt wants to be optimistic. He talks about the possibilities of a Sweden that drives research development and the provided treatments within radiation therapy again.
– I want to be able to say that we are once again among the best in the world in this area as a whole, that patients get the absolute best options available and that we develop research environments that create conditions to attract even more research, that lead to more development and even better treatments – in short: an upward facing spiral.

– The number of patients receiving radiation treatment is constantly increasing. However, the number of nurses and doctors who can master the increasingly complex technology and who are doing research in the field is not increasing at the same rate. In order to provide the best treatment, we need to attract more doctors, nurses and medical physicists who are focused on radiation therapy.

So how are we to achieve this?

In the report Swedish radiation therapy loses ground (In Swedish only), which Dr Bergfeldt is one of the authors of, specialized resident physicians, earlier placements with the field of radiation therapy during medical training and targeted marketing is suggested to increase interest. There are also proposals to strengthen the research, to once again be involved in furthering the development. For example, by appointing professors, creating opportunities of employments that allow research to be done half of the time and on top of that engaging funds that are needed to help with the financial aspects.

Dr Bergfeldt is part of a newly started national project that will help future-proof these parts of Swedish radiation therapy. Within the project he will continue to work on some of the report’s suggested actions.
– We will focus on supplying the skills needed and making it easier to get the right help in actualizing and implementing the ideas from the research projects. The goal is for Sweden to regain a place among Europe’s leading nations when it comes to research on radiation therapy.

The project includes representatives from different professions, from clinical and academic. Dr Bergfeldt would also like to see the business community involved in developing the research and implementation of radiation therapy and becoming partners who can help test the ideas developed.
– Historically, the cooperation between research and industry has been strong in this area. Which is required to produce products that are made available to patients as intended.

A few years ago, I would have said that a vision zero was unattainable. But today, the chances of curing cancer are progressing and getting better.

Well-functioning cooperation is a prerequisite for doing this, Dr Bergfeldt says. And collaborate is exactly what the innovation hub Vision Zero Cancer wants to do.
– With Vision Zero Cancer, I’m glad that we have found each other and found forms of cooperating. The way I see it is that there are great conditions for mutually beneficial cooperation.
He also welcomes the fact that actors of common interest are pulling in the same direction: that no one should have to die of cancer.
– A few years ago, I would have said that a vision zero was unattainable. But today, the chances of curing cancer are progressing and getting better. And in cases where it isn’t curable, the treatments can expand life length and increase the quality of life in the years to be lived.

Better treatment, better lives

We want to find more precise treatment, focusing on the goal and on providing as little side effects as possible. Both during and after treatment. Because it is not just about survival, it is about continuing to live.