WP leader: Catalonia Institute of Oncology, Spain (Josep M. Borras Andres)
The Bratislava Statement: consensus recommendations for improving pancreatic cancer care
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Pancreatic cancer is one of the most lethal tumours, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, however, there are no effective treatments or high-visibility research efforts. This alarming situation is emblematic of a larger group of cancer diseases, the so-called “neglected cancers”. In a bid to address this group of diseases in a coordinated way at the European level, a workshop was organised under the umbrella of the iPAAC Joint Action, involving representatives from medical societies, patient associations, cancer plan organisations, and other relevant European health care stakeholders.
After conducting a systematic review of the literature, a central discussion took place during a meeting in Bratislava on 16–17 September 2019. This led to a definition of the key steps that health care systems can rapidly implement to address pancreatic cancer while maximising the value of health care resources. This consultation also set the groundwork for prioritising pancreatic cancer as well as other neglected cancers at the national and European level.
This initiative resulted in twenty-two consensus recommendations for providing high-quality care for patients with pancreatic cancer. Substantial improvements can be achieved in patient outcomes by organising pancreatic cancer care around state-of-the-art reference centres, staffed by expert multidisciplinary teams. This organisational model requires a specific care framework that encompasses all levels of health care services, incorporating quality criteria and performance assessments.
Tackling reimbursement for radiation oncology and cancer surgery: challenges and options
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The evolving field of cancer therapy poses a real challenge for designing a reimbursement policy that can cope with providing a fair payment of the evidence-based standard of care and with the rapid pace of innovation. Within the framework of WP8 Challenges in cancer care, a review of the different reimbursement models for cancer surgery and radiation oncology was carried out. Based on this analysis, a meeting with experts, industry and patient representatives were convened to discuss possible alternatives and options that could deal with the need of a fair reimbursement and support to emerging innovation. This initiative resulted in a set of recommendations to be taken into consideration when developing or updating a reimbursement system for radiation and surgical oncology in order to support and promote a comprehensive perspective, avoid fragmentation, and support valuable innovation.
Literature review for definition of neglected cancers and list of variables to study pancreatic cancer
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Pancreatic cancer is one of the most lethal tumours, with survival standing at 8% or less at 5 years, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care. Relevantly, pancreatic cancer is not the only example of a group of malignancies called neglected cancers. The term also encompasses tumours of the brain, liver, and central nervous system, among others. iPAAC has placed special emphasis on the so-called neglected cancers, through the development of new key indicators to assess clinical cancer pathways and health-related costs, with focus on pancreatic cancer. A systematic literature review and an analysis on population-based data on solid cancers incidence, mortality, and survival were conducted. This work allowed to quantify the health impact of these cancers and to create a list of “neglected cancers”, providing in turn a definition that highlights their specificity beside common and rare cancers.
Multidisciplinary teams (MDTs) and the potential impact of new technologies and systems for improving integrated cancer care
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The adoption of information and communication technologies (ICT) is becoming a tangible reality for multidisciplinary teams (MDTs), especially in the decision-making processes undertaken during multidisciplinary team meetings (MTMs). In fact, health systems have increasingly recognised MDTs as a core element for high-quality care, heightening the need for their efficient and effective functioning. Although good practices exist for achieving the integration of ICT in team-based decision-making, numerous obstacles and conditions limit its role in MDT tasks. The problems of interoperability of computer systems, both within and between hospitals, is a clear example, as is the the fact that hospital information systems are structured around types of clinical reports and services rather than around care processes. Despite these difficulties, the use of ICT is gradually advancing. The study identified 10 instruments or functionalities that were related to MDT activities that entailed the use of ICT/HIS, with implications for transforming the way professionals obtain information, communicate and make decisions.
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Pancreatic Cancer
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Pancreatic cancer is one of the most lethal tumours, with survival standing at 8% or less at 5 years, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care.
iPAAC has placed a special emphasis on neglected cancers, of which pancreatic cancer is a prominent example. As part of its Work Package 8 'Challenges in Cancer Care', the European Cancer Organisation was invited to bring together key stakeholders from the healthcare professional and patient communities to agree a consensus roadmap for the provision of pancreatic cancer care across the care continuum.
'The Essential Requirements for Quality Cancer Care: Pancreatic Cancer' provide a guide patients, health professionals, managers and policymakers on achieving higher quality cancer care throughout the treatment journey of a patient with pancreatic cancer. Topics covered include membership of the core and extended plenary cancer care teams, care pathways and timelines and other matters related to organisation and provision of care, such as patient information and survivorship and performance and quality concerns.
This Essential Requirements for Quality Cancer Care: Pancreatic Cancer complements other iPAAC’s initiatives, such as the systemic literature review on centralisation of pancreatic cancer care and a standard and indicators for pancreatic and colorectal cancer care networks (these are due for publication in 2021).
Literature review on pain prevalence in cancer patients and Recommendations
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The aim of the Innovative Partnership for Action Against Cancer (iPAAC) is to define strategies to improve the quality of cancer care by optimising the use of healthcare resources and promoting realistic and evidence-based responses to existing needs. While cancer care has evolved, showing better organisation and specificity with regards to treating different cancer diseases, cross-cutting and disease-based challenges remain.
One of the cross-cutting cancer care challenge is pain management (WP 8 task 5). Pain should be regarded as a priority in cancer care and a factor of continuity across cancer treatment, survivorship care and palliative care. The implementation of pain measurement in practice should be seen as the basis to include pain and other symptom assessment in cancer clinical records, databases and registries. In this report, specific attention is given to long term survivors developing chronic pain.
In order to identify the need of pain control, a literature review of data on pain prevalence has been performed, pointing out prevalence of chronic pain, its causes and its relationship with underlying cancer with specific focus on the prevalence of pain in cancer survivors.
WP8 tasks 5 and 6 on pain management and palliative care have been the focus of a special group meeting promoted by iPAAC at the XI European Association for Palliative Care (EAPC) Congress on October, 2020. The meeting remit was to share, discuss and disseminate iPAAC contributions on pain control barriers in cancer patients and in cancer survivors, PROMs implementation in clinical practice and in research and palliative care integration with oncology. The meeting built on the communication between EAPC, International Association for the Study of Pain (IASP), Organization of European Cancer Institutes (OECI) and European Cancer Patient Coalition (ECPC) representatives.
Integration between oncology and palliative care
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The recommendations included in the CanCon EC Joint Action are the basis from which to improve oncology and palliative care integration using standardized care pathways, referral guidelines, and collaboration to achieve the best outcomes for patient-centred care. An integrated approach helps to develop new models of care, educational and research programmes, adequate resource allocation, and sufficient investment.
The aim of WP 8.6 of Innovative Partnership for Action Against Cancer Joint Action is to identify areas that require an update in respect to Cancon recommendations, to assess palliative care needs in oncology based on epidemiological data and to review the literature on models of integrations between palliative care and oncology, at the time of diagnosis and early therapy, particularly for life-threatening and poor prognosis cancers.The increasing recognition of the role of palliative care for advanced cancer patients is yet combined with incomplete accessibility of high quality services for all EU citizens and with lack of common policy for the integration of palliative care in the oncology care continuum.
WP8 on pain management and palliative care have been the focus of a special group meeting associated with European Association for Palliative Care (EAPC) Congress on October, 2020. The meeting remit was to share, discuss and disseminate iPAAC contributions on pain controll barriers in cancer pain patients and in cancer survivors, PROMs implementation and palliative care integration with oncology. The meeting built on the communication between EAPC, International Association for the Study of Pain (IASP), Organisation of European Cancer Institutes (OECI) and European Cancer Patient Coalition (ECPC) representatives. The presentation of integration between oncology and PC is reported in Appendix 1 (EAPC World Congress 2020). See also Appendix 2 (European Palliative Care Reseach Seminar, on Integration of oncology and palliative care , PRC Seminar) .
WP8 description and objectives
The aim of the work package is to define strategies to improve the quality of cancer care by optimising the use of healthcare resources and promoting realistic and evidence-based responses to existing needs. While cancer care has evolved, showing better organisation and specificity with regards to treating different cancer diseases, cross-cutting and disease-based challenges remain. Specific tasks are the following:
- To review and assess of the situation for neglected cancers with a special focus on pancreatic cancer, highlighting the challenges and opportunities for improving detection, diagnosis and access to expert clinicians in order to increase the quality of care and outcomes, and raising awareness within the EU Policy and Research agenda.
- To identify the potential use and existing barriers for shared information systems, decision support systems, information and communication technologies, and ‘big data’ in the context of MDTs and cancer care management, and its consequences for the implementation of MDTs in EU countries.
- To propose a set of measures aimed at improving the sustainability of cancer care in European countries, taking into account the challenges posed by trends in cancer incidence, assessment of clinical effectiveness, efficient resource allocation, affordability, and equity of access to good quality cancer care.
- To assure that pain control is considered a priority in cancer and to distinguish the needs of long term survivors from those of palliative care patients. Identify evidence based guidelines and areas for improvement in guidelines implementation, education of oncologists and in organization of multidisciplinary approaches including oncologists, pain and palliative care specialists
- To highlight a homogenous approach to palliative care based on CANCON recommendations including patient care pathways, national policy and sustainability, innovative therapies, cancer registry and clinical databases. Identify areas of development and challenges posed by innovative therapeutic approaches such as early integration of palliative care in the oncology care pathways, focusing on the available models of integration and on how palliative care and oncology can respond to the availability of personalized medicine guiding the use of target therapies