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What cancer-fighting immunotherapy does Spain offer?

Spain currently offers several different immunotherapy treatments for cancer, but recently there have been several developments with two new therapies approved for use in the public health system.

Published: 25 July 2024 11:29 CEST
What cancer-fighting immunotherapy does Spain offer?
Immunotherapy treatments against cancer have proven widely successful and keep on improving. (Photo by SAUL LOEB / AFP)

The Spanish Medicines Agency (Aemps) has recently approved a new CAR-T therapy, which is only the second public immunotherapy in the world for multiple myeloma, the second most common blood cancer behind chronic lymphatic leukaemia. 

This is a type of cancer that forms in certain white blood cells called plasma cells.  

The new CAR-T therapy has been manufactured entirely by Hospital Clínic in Barcelona. According to reports, there is no other hospital in the world that has manufactured a product of this type.  

CAR-Ts are a type of advanced immunotherapy, treating not only blood cancers, but tumours or diseases such as lupus or multiple sclerosis. It works by carrying out a genetic modification of the patient’s blood.  

The Aemps Committee for the Evaluation of Medicines for Human Use has given the green light for Hospital Clínic’s CAR-T ARI-0002 as an advanced therapy medicine in patients with multiple myeloma in a situation of relapse. This was announced this Friday at a press conference by the Barcelona hospital and the Department of Health. 

It now means that oncology departments across Spain will be able to use this type of therapy, without patients having to travel to Barcelona for treatment. 

Spain’s Health Ministry has also authorised the financing of another new immunotherapy treatment, designed to help fight a range of different types of cancers, mainly types of tumours.  

This will replace the current intravenous drip with a subcutaneous injection, reducing treatment time from one hour to seven minutes, without losing its effectiveness.

The injection, called atezolizumab, will be given to patients once every three weeks without need to remain in hospital for observation afterwards, meaning it’s not only easier for them, but it also saves health resources too.

Atezolizumab was authorised by the European Medicines Agency (EMA) last January and will be used treat the same nine conditions as the intravenous drug, mainly tumours of the lung, liver, bladder and breast.

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It will also be used for some of the most aggressive and difficult-to-treat forms of cancer, such as early-stage non-small cell lung cancer or for various forms of metastatic cancer; hepatocellular carcinoma and alveolar soft-part sarcoma, among others. 

Immunotherapy treatments for cancer differ from chemotherapy in that it helps the body identify and attack cancer cells better using its own immune system. This means it can continue to work even when the treatment has ended.  

Chemotherapy on the other hand kills fast growing cells, which can be cancerous as well as non-cancerous.  

Both treatments are still used for different types of cancer and different patients or even in combination with each other. Chemotherapy can work more quickly for example, but immunotherapy can help over a longer period of time and is less invasive and damaging to the body.

According to the recent IMscin002 immunotherapy trail, the subcutaneous injection is preferred by 79 percent of patients, because they find it less invasive, painful and annoying, which results in a higher quality of life.  

Nine out of ten healthcare professionals agreed that the injection is easy to administer and three out of four said it could save time too.

The approval of the new drug in Spain’s public health system is based on data from the phase III IMscin001 trail, in which seven Spanish centres participated, totalling 20 percent of the number of patients recruited for it worldwide. This showed that the injection was found to be just as safe and efficient as the intravenous option.

Spain is a world leader in CAR-T research, an immunotherapy that has already treated more than 1,000 patients in the country and that has proven to be effective against certain types of cancer, such as breast cancer or glioblastoma of the brain, but especially haematological cancers, such as leukaemia or lymphoma.

This means that we can expect an increasing number of immunotherapies for cancer to be available through Spain’s public health system in the coming years.

For the treatment of large B-cell lymphoma, mantle cell lymphoma, multiple myeloma, and acute lymphoblastic leukaemia in adults, the following hospitals in Spain offer immunotherapy:

  • Donostia University Hospital (Basque Country).
  • University Hospital Complex of A Coruña (Galicia)
  • Reina Sofia University Hospital (Andalusia).
  • Regional University Hospital of Malaga (Andalusia).
  • Central University Hospital Complex of Asturias (Asturias).
  • Marquis of Valdecilla University Hospital (Cantabria).
  • Virgen de la Arrixaca University Clinical Hospital (Murcia Region).
  • Morales Meseguer University Clinical Hospital (Murcia Region).
  • Son Espases University Hospital (Balearic Islands).
  • Puerta del Hierro Hospital in Majadahonda (Community of Madrid).
  • Ramon y Cajal University Hospital (Community of Madrid).
  •  Hospital 12 de octubre (Community of Madrid).
  • La Paz University Hospital (Community of Madrid).
  • La Princesa University Hospital (Community of Madrid).
  • Hospital Clínic de Barcelona (Catalonia)
  • Sant Joan de Déu Hospital (Catalonia)

For the treatment of acute lymphoblastic leukaemia in paediatrics, the following hospitals in Spain offer treatment:

  • University Hospital Complex of Santiago de Compostela (Galicia)
  • Reina Sofia University Hospital (Andalusia)
  • Regional University Hospital of Malaga (Andalusia)
  • Virgen de la Arrixaca University Hospital (Murcia Region)
  • Son Espases University Hospital (Balearic Islands)

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HEALTH

EXPLAINED: How to see a physiotherapist in Spain

If you need physiotherapy treatment in Spain, here's what to know about it, from how long you have to wait for a referral in public health to whether it's covered by private insurers, and what a physio session costs on average.

Published: 10 July 2024 10:23 CEST
EXPLAINED: How to see a physiotherapist in Spain

Physiotherapists evaluate and treat people with limited or painful movement due to injury, illness, or old age. They use specialised exercises and equipment to facilitate the movement of extremities and joints.

This could be done through a combination of exercises, massages and manipulation of the body.

Physiotherapy is very important in order to help patients’ quality of life and aid recovery. It can also help prevent further complications in a wide variety of conditions.

Whether you suffer from a bad back, a physical injury, arthritis or nerve damage for example, physiotherapy can help.

So, how can you access a physio in Spain if you need one?

Public health system

If you pay into the social security system, you will have access to public health in Spain.

The first point of call will usually be your GP who can refer you to a physio if they deem it to be necessary. But hospitals may also refer you if you came in through A&E because of an accident.

Unfortunately, there is a severe lack of these physiotherapists working in public health and it can often take a long time to be referred or for your turn to come up on wait lists, sometimes years.

According to the Annual Report of the National Health System, there are around 1,714 physiotherapists working in primary care and 5,882 in hospital care, that is, a total of 7,596.

This equals one physiotherapist for every 10,000 inhabitants, which can easily explain the problem.

READ ALSO: Paying for public healthcare in Spain: the pros and cons of the ‘convenio especial’ 

For reference, the World Health Organisation (WHO) recommends one physiotherapist for every 1,000 inhabitants.

In some clinics in the country there is in fact only one physiotherapist for 40,000 inhabitants, according to Isabel Moreno, spokesperson for SATSE, the Syndicate of Nurses at a state level, and a physiotherapist at a Madrid hospital.

“The waiting list sometimes balloons, from one to three months. That is outrageous, but it can be as high as six or eight months. It is not good for us because the patient’s recovery is delayed. The worse you are, the longer it will take you to move forward,” says Moreno.

The average waiting time across the country is 152 days for an appointment with the public physio. The Canary Islands, has the worst situation with an average of 15 months (469 days); then Cantabria, with more than 8 months (261 days); followed by Galicia, with more than seven months (227 days), and Andalusia, with more than six months (197 days).

Many patients complain that doctors just send them home with pain meds instead of being able to provide a solution.

READ ALSO: Record 850,000 people waiting to have an operation in Spain 

In some regions, such as Catalonia, they get around this problem, they have group rehabilitation sessions that run for example once a week for six weeks. For these, the wait time is much less, but it’s not true physiotherapy.

It usually involves teaching patients about pain management and showing them generic exercises to help their condition. It does not involve massage, manipulation or additional therapy such as heat or ice. Sometimes there may be machines to aid recovery, but not always.

The attention and exercises are not individual. You may be in a group of 9 other people with chronic back pain for example, all there for different reasons. While the exercises can help, they are not a substitute for personalised physiotherapy.

Many people who are waiting too long, turn to private and pay out of pocket instead.

Private Physiotherapy

Meanwhile, the situation looks a lot different for those who have private health insurance or who can afford to pay privately.

According to the latest data from the National Statistics Institute (INE), Spain has a total of 66,178 physiotherapists working in private healthcare.

Some private insurers will even let you book an appointment directly with a specialist, so you may not even need to wait for a referral from a GP.

But, not all of them will cover it. For example, some seguros (insurance policies) only cover it for certain illnesses rather than injuries and others will only cover it after you have contracted the insurance for 3-6 months first.

It’s best to look at your policy or contact your insurer to find out.

Many people therefore forced to pay extra, out of pocket.

According to the price comparison platform ChronoShare, the national average price per session is €30-50, often depending on the type of treatment you will receive.

This can add up to a lot if you need sessions every week for several months.

There are some English-speaking physiotherapists in Spain’s big cities and tourist hotspots but elsewhere you’ll probably have to explain your physical problems in Spanish. 

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