© 2007 European Society for Medical Oncology
editorial |
National integration of European standards
1 Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
2 Karolinska Hospital, Stockholm, Sweden
* (E-mail: bajetta{at}istitutotumori.mi.it)
Over the last 20 years, increasing life expectancy has become a major determinant of increasing cancer incidence, and the World Health Organization has estimated that with this ageing of populations there could, by 2020, be 16 million new cases per year and 
10 million deaths. In Europe, where primary prevention, screening and application of modern cancer therapies have led in recent years to generally decreasing trends in age-standardized mortality rates, it has nevertheless been estimated that there will be 1.25 million cancer deaths in 2015, almost 130 000 (11%) more deaths than in 2000 [1]. Moreover, studies such as EUROCARE-3, which have registered and evaluated survival data in European cancer patients have concluded that cancer survival is related to the level of health investments and macroeconomic variables within a country, resulting in significant differences in outcome [2]. In recent years, the adequate career development of young oncologists has become a key issue for many cancer societies [3–5]. Medical oncology, in particular, is a relatively young discipline and yet finds itself at the forefront of a revolution in cancer treatment [6]. To address these geographic differences in outcomes and ensure the continued supply of well-trained oncologists best able to deliver high standards of patient care and contribute to ongoing research programs, the unification and standardization of professional and institutional accreditation has been identified as essential [7].
As part of its mission to advance the art, science, recognition, and practice of oncology the European Society for Medical Oncology (ESMO) has taken steps to introduce models of integration in attempts to unify already existing guidelines and requirements for medical oncologists. These have included: Recommendations for a Global Core Curriculum in Medical Oncology, where the main goal has been the development of uniform standards of education and infrastructure to optimize cancer care [8]; the ESMO Examination, which aims to providing a common system of evaluation of medical oncologists in Europe [9, 10]; ESMO-MORA, a medical oncology recertification/continuing medical education (CME) program facilitating ESMO members' updating of their knowledge [9, 10]; ESMO Clinical Recommendations, treatment guidelines outlining a necessary set of requirements for basic standards of cancer care (see e.g. [11, 12]); the development of ESMO Policy on Supportive and Palliative Care [13], and the Designated Centers of Integrated Oncology and Palliative Care program, by which cancer centers can receive special recognition for achieving a high standard of integration of medical oncology and palliative care.
Although medical oncology has been recognized as an independent specialty in a number of European countries, a multidisciplinary approach to cancer patients is nevertheless necessary. To fully understand the existing challenges, ESMO surveyed European oncologists with the aim of identifying the best model in which the work of a multidisciplinary team can be implemented.
The ESMO ‘Medical Oncology Status in Europe Survey’ represents another evaluation tool. The survey data, available on the ESMO Web site, reveals wide differences in oncology training programs, lack of homogeneity in the organization of cancer health care services, as well as discrepancies between increasing costs and availability of anticancer drugs [14].
What is equally apparent from this survey, and from the anecdotal reports of oncologists working around the world, is that no organization or society has the capacity to achieve lasting and valuable change alone. Significant efforts must be put into developing collaborations between oncology societies with a view to building real consensus on how to improve patient care. In this respect, the collaborations of ESMO and the American Society of Clinical Oncology (ASCO) may serve as models for interaction among other societies within the European Union, with the recent ASCO-ESMO Consensus Statement on Quality Cancer Care underlining the most important criteria to assess adequate patient care [15].
With this in mind, ESMO and the Italian Association of Medical Oncology (AIOM) have in 2006 initiated a national–European model of collaboration, attempting to establish coherency between national standards and broader European ones. Working with an agenda that includes a better future for young medical oncologists, setting the standard for patient care within Italy, certifying professional skills, and developing funding for clinical research, both organizations hope to establish patterns of work that can be used throughout Europe. Both societies are collaborating closely for the success of the ESMO Conference Lugano, 3–5 July 2007, which provides an update on cutting-edge developments in oncology for both seasoned and young oncologists. In addition, the 2010 ESMO Congress venue is Milan and plans by AIOM are already under way to support ESMO and the local organizers in their outreach to Italian oncologists and national media. That there will be difficulties is acknowledged by both sides, but working in an atmosphere of mutual trust and with the clear understanding that the potential gains in terms of patient care are real and significant, they go forward hopefully. To do otherwise would be to disregard one of the great challenges of European oncology.
References
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