Current measures in healthcare systems are insufficient to reach the EU Green Deal goals. The social, economic and clinical consequences are significant. Reasons that current initiatives fall short include lack of awareness as to the problem, or potential solutions. There is complexity as to what process to choose, the low cost, the low carbon, the one that provides better care or the one which has the better social impact. The current system has insufficient investment in sustainable education, policy or research. Solutions work well in limited areas but are inefficient as a model for true systemic change. There is no agreed system of environmental foot printing in the health system and few partnerships with industry and patients to develop a truly sustainable system. Kidney care is a suited test case with its large resource footprint and well-defined care pathways. KitNewCare’s consortium will solve the problem with leading experts in kidney care, life cycle assessment methodology, education, dissemination and communication, health economics, and data management. KitNewCare will perform an EU-wide mapping of the sustainability landscape to reveal the hotspots across different clinical centres in each impact area. To locate solutions Quality Improvement Cycles will be utilised to analyse clinical pathways and industry innovations. KitNewCare will co-develop and pilot sustainable tools (such as the purposefully developed actionable dashboard, based on the 4-factor LCA model, which will monitor and benchmark the 4 different outcomes) innovative solutions, training, guidelines and recommendations as a proof of concept which can then be applied to the healthcare system; Our work will be informed by a stakeholder interaction and a Patient and Public Involvement programme to ensure proper design, uptake, dissemination and exploitation. This will enable decision makers and healthcare providers to reduce pollution, carbon emissions, and waste.

In 2017, on a world scale the total number of individuals with chronic kidney disease, acute kidney injury, and those on renal replacement therapy exceeded 850 million, a truly concerning figure that is twice the estimated number of people with diabetes worldwide and >20 times higher than the number of individuals affected by AIDS/HIV worldwide. The socioeconomic impact of kidney disease is huge and is anticipated to even further grow in the coming years. Awareness of the magnitude and the risks of this condition have remained low at the population level. Therefore, kidney disease has been, until recently, largely overlooked by health authorities and governments in most countries with as the result accumulation of major unmet needs in personalized medicine in kidney disease. The aim of PICKED (PersonalIzed medicine in Chronic KidnEy Disease) is to equip a generation of 10 doctoral candidates (DC) with interdisciplinary skills for the development of pathways to implement personalized medicine in chronic kidney disease and their complications on the level of its detection, progression and treatment. We anticipate that these DCs will significantly contribute to the increasing possibilities to stratify patients with kidney disease and the development of successful intervention procedures with potential to substantially impact the lives of over 10% of the European population. PICKED will realize this aim by coordinating the efforts of 10 beneficiaries and 8 associated partners across 7 European countries and 3 sectors, with lead supervisors covering a large range of disciplines ranging from biomarker-research to research into the legal, ethical and quality of life aspects for the implementation of personalized medicine in kidney disease.

Lymphoid leukemias and lymphomas represent frequent areas of the tumour pathology. Recent Integrative clinical and molecular studies allows to identify concrete disorders where a precise recognition leads to a specific treatment with a minimum toxicity and maximum clinical benefit. Even though there have been many progress during last years, there still persist numerous conditions with low survival probability and high side effects of the received treatments. The introduction of the precision medicine in lymphoid neoplasms is new and challenging due to the scarce knowledge about disease pathogenesis, targeted therapies and predictor markers, immunotherapy role and poor experimental models. T-cell lymphoma tumors present a dismal survival probability dismal (25% for Peripheral T-cell lymphoma) in patients, and the molecular mechanism underlying their high rate of lack response to treatments and relapse is poorly understood. Furthermore, patients with lymphoproliferative disorders often have complex (multiclonal) or mixed lymphoproliferative disorders. This project aim the consolidation of the precision medicine in the diagnosis and therapy of these disorders, thus facilitating the treatment of each patient according its disease, with specific therapy according to the integral characterization of its disease, thus reducing toxicity and improving the therapy efficacy. The project focuses on complex lymphoproliferative diseases characterized by clinical aggressiveness with low therapeutic response, tumor heterogeneity and patterns of dependency / interaction with the microenvironment. The success of the project requires in first instance to improve in the knowledge of the molecular basis of the disease and subsequently in the identification of precise tumour types and patient stratification, thus facilitating the identification of markers for targeted therapy, using gene expression and mutational signatures.

The increasing life expectancy of the population and the development of effective therapies result in a growing population of aged cancer survivors, which frequently have comorbidities for developing heart failure (HF). Anthracyclines (AC) are still first line treatment for many cancer types, but up to 35% of patients who received them develop cardiotoxicity and HF. The trade-off between cancer and chronic HF is of massive psychological burden for patients, and of devastating economic consequences for healthcare systems. We aim to test the efficacy of a novel intervention (remote ischemic preconditioning) to reduce the incidence of AC-induced HF. We have selected Non-Hodgkin lymphoma as the target population, since it is diagnosed at advanced comorbid age in both genders. This will also allow us study gender differences in AC-induced HF. A phase II randomized clinical trial enrolling 608 patients undergoing AC chemotherapy will be done. Primary endpoint will be based on serial cardiac magnetic resonances exams. Taking advantage of the recruited population and data gathered, we will further validate 2 novel cardiac magnetic resonance imaging methods: a novel early marker of cardiotoxicity, and a new sequence allowing a massive reduction of acquisition time. We will also study a personalized strategy to empower patients in clinical trial execution, which includes Patient-Reported Outcome and Experience Measures (PROMs and PREMs). Our final goal is to reach the patient level by implementing the novel strategy at the clinical level while paving the way for a future large phase III trial. For this endeavour, we count on a multidisciplinary consortium, where different stakeholders of this process are part of the study, from scientists to industry, and from healthcare providers (physicians and nurses) to patients. RESILIENCE deals with 2 of the most frequent non-communicable diseases in Europe (cancer and HF), responsible for a big proportion of healthcare expenditures.

Rare cancersRare cancers are associated with poor survival, accounting for 22% of new cancer diagnoses in Europe, and 30% of cancer deaths. Sarcomas are a heterogeneous group of life-threatening rare solid malignancies affecting soft and bone tissues, representing 10% of rare tumors and around 2% of adult tumors, with an incidence of 5.9/100,000/year in Europe. Appropriate management of sarcoma patients is hindered by the absence of referral policies to reference centers (RCs), incorrect or delayed diagnosis, non-adherence of therapies to clinical practice guidelines (CPGs), and lack of expertise by practitioners, which increases the risk of relapse and death. These problems worsen in the Community of Latin American and Caribbean States (CELAC) due to the scarcity or complete unavailability of RCs, expert pathologists, multidisciplinary tumor boards (MTBs), new cancer drugs, clinical trials, patient registry data, and financial resources. Hence, the SELNET project seeks to create a European and Latin American