The statement can be download here.
The European Partnership for Action Against Cancer (EPAAC) was proposed by the European Commission to support the member states in their efforts to tackle cancer by identifying and sharing information and expertise in cancer control. Many scientific societies, patient groups, industries, and cancer plans joined the EPAAC under different objectives organized by Work Packages (WP). The European Association for Palliative Care, (EAPC) took part in this project.
The WP7 on Health care had among its objectives one that aimed specifically to set up the criteria for identifying and assessing best practices, focusing on organizational approaches:
- OBJECTIVE 1: To identify and assess best practices across European health services, promoting the exchange of experiences focusing on innovative organizational approaches, including patients’ perspectives
- SPECIFIC OBJECTIVE 1.1: To set up criteria for identifying and assessing best practices, focusing on organisational approaches: multidisciplinary care and national and regional networks and workshop with experts. Methods: Review of published experiences, mapping of existing national and regional networks, and workshop with experts.
Considering that different providers and levels of care are usually involved in the process of diagnosis, staging, treatment and follow-up for each cancer patient, the EPAAC considered that it is important to answer the question of how good interdisciplinary collaboration is to be achieved in day-to-day clinical practice, and the degree to which the effectiveness of interventions are dependent on the organizational contexts in which cancer care is delivered.
From the perspective that clinical decisions on cancer patients can no longer be made in isolated positions by clinicians or services and, furthermore, it seems necessary to ensure integrated frameworks for decision making and care provision as a whole. The benefits underlying a team approach concern multiple dimensions of care delivery. Such a perspective on cancer care had been widely highlighted by the Lisbon round table held under the Portuguese EU Presidency (Gouveia J et al, 2008).
WP7 Objective 1.1, underpinned by this rationale, focused multidisciplinary care and national/regional networks as the two approaches with the greatest ability to evolve cancer care toward integrated forms. As a framework for this objective, a systematic review of the literature regarding the effectiveness of multidisciplinary teams (MDTs), as well as reviewing several case studies of national and regional cancer networks was developed. This research aimed to give an in-depth view of the care based on teams’ performances while assessing their impact on physician practice patterns and patient outcomes. Nowadays, different organizational models of tumour boards and cancer units coexist in European health systems, but no institutional reference frames such diversity by setting specific objectives and operational criteria for MDTs. In other words, multidisciplinary care is today an implicit and very common standard in cancer healthcare services but lacks specific guidance. The room for collaboration, cooperation and shared experiences among countries and stakeholders provided by EPAAC could be seen as a good opportunity to address this issue and a reach a consensus on a position statement for Europe.
After developing the systematic literature review, this was presented at a meeting that took place in Barcelona with the representatives from all the associations related to cancer management at any stages including patients’ representatives.
The final version of the statement was supported by different societies involved in its development: European CanCer Organization (ECCO), European Society for Therapeutic Radiology and Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS), European Cancer Patient Coalition (ECPC), EuropaColon.
It was also was presented to the advisory board of the EPAAC with representatives of all Ministries of Health during the meeting held in Malta, May, 2013. It was supported by all the board members. The Statement is on the EPAAC website and circulated to cancer plans.
The policy statement was sent to the European Journal of Cancer and it was accepted for publication. Read the dedicated article on EJC (full text)
The EAPC was invited to participate in this discussion, the evidence of the relevance of palliative care as part of MDT is limited but we can use this document to develop or roll out to cancer patients.