Purpose: Physical activity (PA) has been suggested to help increase the survival of individuals with cancer. The objective of this review was to systematically evaluate and summarize the available evidence investigating the effect of PA on the survival of individuals with cancer. Methods: Electronic databases (CINAHL, EMBASE, and MEDLINE) were systematically searched for randomized controlled trials and cohort studies. Selected studies were assessed by two independent investigators for methodological quality, using the PEDro scale. Results: Ten prospective cohort studies met the inclusion criteria. Quality-assessment scores averaged 5/10 on the PEDro scale, with two articles obtaining a score of 6/10. The majority of studies found that individuals participating in higher levels of physical activity had a reduced risk of cancer-related mortality. This trend was observed specifically for breast, colon, and colorectal cancers. On average, it appears that engaging in higher levels of metabolic equivalent hours per week may help to improve survival rates among individuals diagnosed with cancer. Conclusion:Patients diagnosed with cancer demonstrated a trend toward increased survival with greater levels of PA. However, because only prospective cohort studies were included in the study, the conclusions drawn should be regarded with caution.Key Words: cancer, exercise, physical activity, survival, systematic review RÉ SUMÉObjectif : L'activité physique (AP) a é té suggé ré e comme moyen d'aider à la survie des individus atteints de cancer. L'objectif de cette analyse consistait à é valuer systé matiquement et à ré sumer l'ensemble des preuves disponibles relativement aux effets de l'activité physique sur la survie des personnes atteintes de cancer. Mé thode : Une recherche systé matique a é té ré alisé e dans les bases de donné es é lectroniques (CINAHL, EMBASE et MEDLINE), afin de ré pertorier les essais cliniques comparatifs randomisé s et les é tudes par cohortes. La qualité mé thodologique des é tudes sé lectionné es a é té é valué e par deux chercheurs indé pendants à l'aide de l'é chelle PEDro. Ré sultats : Dix é tudes prospectives par cohortes satisfaisaient les critè res d'inclusion. Les ré sultats de l'é valuation de la qualité se chiffraient en moyenne à 5/10 sur l'é chelle de PEDro ; deux articles ont obtenu une note de 6/10. La majorité des é tudes ont permis de constater que les individus prenant part à de l'activité physique plus soutenue couraient moins de risque de mourir du cancer. Cette tendance a é té particuliè rement observé e pour le cancer du sein, du cô lon et pour le cancer colorectal. En moyenne, il semble que le fait de participer à des niveaux plus é levé s d'é quivalents mé taboliques par semaine peut aider à amé liorer les taux de survie chez les individus ayant reç u un diagnostic de cancer. Conclusion : Les patients ayant reç u un diagnostic de cancer ont dé montré un plus grand taux de survie avec un niveau plus é levé d'AP. Toutefois, en raison de l'inclusion d'é tudes sur cohor...

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Innovation in the development of new drugs has to balance the needs of health actors and administrators, the pharmaceutical industry and patients. Differing perspectives on what constitutes an innovation, where research and development should be directed and how new drugs should be evaluated and priced cause ongoing tensions within the regulatory framework. In the current climate, where Europe's health systems face rising demand for health services and increasingly restricted resources, the efficiency of pharmaceutical regulation and drug development is under even greater scrutiny. How can regulation foster innovation and industry growth while also serving the public health needs of society, and what is the EU's role in pursuing this objective? Drawing on a provision which formerly existed in Norwegian pharmaceutical legislation, this article explores the potential of a medical need clause (MNC) in addressing these issues. In restricting market authorisations to those drugs that offer an added therapeutic value, might a MNC foster innovation and spending efficiency in Europe's health systems?

Until 1994, pharmaceutical products seeking market authorisation in Norway were required to demonstrate a fulfilment of unmet medical need. This clause enabled the national regulator to dramatically limit the number of products on the market whilst encouraging price competition to keep drug expenditure low and was credited with encouraging the development of drugs with genuine added therapeutic value and reducing the incidence of antimicrobial resistance. Norway was forced to abandon its Medical Need Clause (MNC) when it joined the European Economic Area as it was incompatible with the acquis communautaire of the European Union. This article reviews Norway's experience with its MNC in light of contemporary debates in European health policy. It discusses the potential contribution of an MNC-style regulation to improving health, reducing illness, ensuring sustainable health systems and fostering pharmaceutical innovation. It concludes by asking how these findings can inform current European Union debates over the growing cost of prescription drugs and direction of pharmaceutical development.

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