Prostate Cancer Unit Initiative in Europe: A position paper by the European School of Oncology
Introduction
Prostate cancer is the most common cancer diagnosed in men, with 417,000 new cases every year in Europe [1]. Multiple therapies and observational strategies are available for this malignancy. According to the patient's state of disease, surgery, external radiotherapy, brachytherapy, hormonal therapy, chemotherapy, radionuclide metabolic therapy as well as active surveillance, watchful waiting and supportive care can be considered [2], [3], [4], [5], [6], [7], [8], [9]. As a result, several health care professionals play a significant role in the care of prostate cancer patients, including, non exhaustively, urologists, radiation oncologists, medical oncologists, pathologists, nuclear medicine physicians, imaging specialists, psychologists, nurses, sexual therapists, physiotherapists, geriatricians, and experts in palliative and supportive care potentially involved in specific disease settings [10].
Comprehensive multidisciplinary management of prostate cancer patients streamlines patients’ access to care, rehabilitation and counseling delivered by a team of qualified experts [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]. The integration of care provision by multiple professionals is the best way to implement simultaneous care, thus enabling the coordination of care and facilitating patients’ transition from curative to palliative treatments [26]. This is in line with the policy statement of the European Partnership for Action Against Cancer (EPAAC), which stresses a paradigm shift in cancer care from a disease-focused management to a patient-centered approach and highlights the importance of multidisciplinary teams for optimal coordination among professionals and communication with patients [27].
On the assumption that there is a critical need in Europe to provide prostate cancer patients with high quality, standardized and integrated care, the European School of Oncology (ESO) through its Prostate Cancer Programme developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). ESO initiated a discussion in the European uro-oncologic community and advocacy groups on the need and requirements for establishing PCU. The first step was the publication of the article “The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology” in 2011 [10], which sought to open the debate in peer-reviewed journals [28], [29], [30] and within national and international scientific societies (i.e. European Association of Urology—EAU, European Society for Medical Oncology—ESMO, European Society for Therapeutic Radiation Oncology—ESTRO, Italian Society for Uro-Oncology—SIUrO), with dedicated sessions on the pros and cons of the multiprofessional management of prostate cancer patients.
At this point, in early 2012, the natural evolution of the project was considered the accreditation and certification of PCU in Europe. ESO (AC, RV) signed a collaboration agreement with the Organisation of European Cancer Institutes (OECI – MS), a non governmental organization running an accreditation and designation programme of Cancer Centres in Europe since 2008, and the Deutsche Krebsgesellschaft (DKG – SW), the German Cancer Society, which developed a certification system for prostate cancer centers in 2008, with 97 centers certified and quality-of-care indicators [31], [32]. The agreement was aimed at setting standards for quality comprehensive prostate cancer care and designating care pathways in PCUs and the project was launched as Prostate Cancer Unit Initiative in Europe.
This paper (writing committee: TM, RV and AC) describes the achievements obtained thus far with the aim of reaching a broader consensus on the minimum criteria for defining and ultimately facilitating the process to accrediting PCU in European countries.
Section snippets
Material and methods
The first activity of the PCU Initiative in Europe was the creation of a multiprofessional Task Force with representatives from cancer specialties (urologists—MA, PA, MB, VM, SCM, BT, HVP; radiation oncologists—AB, KH, DH, MH, MM, CP, TW; medical oncologists—DB, MDS, MM, CNS), psychologists (MW), nurses (LDC, EVM), patient advocate organizations (Europa Uomo represented by LD, GF), cancer center managers and quality experts (CH). The Task Force was chaired by the ESO Prostate Cancer Programme
Results
The work and dedication of the Task Force led to a consensus on 40 standards and items, distinguished as mandatory and recommended, for designing PCU (Table 1, Table 2, Table 3, Table 4, Table 5, Table 6) and covering several macro-areas defined as standards: general requirements and critical mass, core team, non core team and associated services, clinics, organization and case management, different services, treatment and observational options, equipment.
Every standard contained one or more
Discussion
A detailed comprehensive 2 year long debate on the minimal requirements identified in the 2011 discussion paper [10] was undertaken by all members of the multidisciplinary Task Force of the PCU Initiative in Europe. Involvement of Europa Uomo representatives gave added value to the discussion and enabled consideration of the patient's perspectives on key issues such as the need for objectivity in the proposal of therapeutic and observational options, without the specialty driven bias, and for
Conclusion and future activities
The PCU Initiative in Europe enabled the setting of standards and items for defining PCU in Europe. Delivering core criteria which had relevance, feasibility and applicability was the most important point of the work of the multiprofessional Task Force in guaranteeing the acceptance and spread of PCU in most European countries.
Given the importance of employing a workable methodology for prostate cancer care delivery, the emerging innovations in diagnosis and care and the continual improvement
Author contribution
All involved authors stated that they have read the manuscript, have agreed to the submission and have participated in the study to a sufficient extent to be named as authors.
Conflict of interest statement
The authors declare no conflict of interest.
Acknowledgements
There was no funding source to this paper.
Thanks to ESO Chief Operating Officer Chatrina Melcher for overseeing the activities in support to the PCU Initiative in Europe and to ESO Prostate Cancer Programme Managing Coordinator Rita De Martini for organizational and coordination activities.
R. Valdagni is Prostate Cancer Programme Coordinator of the European School of Oncology and works as Director of the DivisionRadiation Oncology 1 and of the Prostate Cancer Programme at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (IT), where he also chairs the Prostate Cancer Unit.
References (40)
- et al.
Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012
Eur J Cancer
(2013) - et al.
Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
Ann Oncol
(2013) - et al.
Active surveillance for low-risk prostate cancer: developments to date
Eur Urol
(2015) - et al.
The requirements of a specialist Prostate Cancer Unit: a discussion paper from the European School of Oncology
Eur J Cancer
(2011) The multidisciplinary clinic
Int J Radiat Oncol Biol Phys
(2005)- et al.
The multidisciplinary meeting: an indispensable aid to communication between different specialities
Eur J Cancer
(2006) - et al.
Multidisciplinary teams in cancer care: are they effective in the UK
Lancet Oncol
(2006) - et al.
Multidisciplinary care in oncology: medicolegal implications of group decisions
Lancet Oncol
(2006) - et al.
The need for a multidisciplinary approach to cancer care
J Surg Res
(2002) - et al.
In regard to Kagan: ‘The multidisciplinary clinic’ (Int J Radiat Oncol Biol Phys 2005;61:967–8)
Int J Radiat Oncol Biol Phys
(2005)
Optimizing treatment for men with advanced prostate cancer: expert recommendations and the multidisciplinary approach
Crit Rev Oncol Hematol
Multidisciplinary management of advanced prostate cancer: changing perspectives on referring patients and enhancing collaboration between oncologists and urologists in clinical trials
Urology
A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions
Urol Oncol
Policy statement on multidisciplinary cancer care
Eur J Cancer
Prostate cancer unit: the patient's perspective
Eur Urol
The prostate cancer unit: a multidisciplinary approach for which the time has arrived
Eur Urol
Prostate cancer units: has the time come to discuss this thorny issue and promote their establishment in Europe
Eur Urol
Multidisciplinary care and management selection in prostate cancer
Semin Radiat Oncol
Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review
Eur Urol
Guideline for the management of clinically localized prostate cancer
Cited by (21)
ECCO Essential Requirements for Quality Cancer Care: Prostate cancer
2020, Critical Reviews in Oncology/HematologyThe European Prostate Cancer Centres of Excellence: A Novel Proposal from the European Association of Urology Prostate Cancer Centre Consensus Meeting
2019, European UrologyCitation Excerpt :In the field of PCa, the concept of hospital certification has already been addressed. For example, the ESO in collaboration with EAU and supported also by EAUN, EBU, EONS, ESTRO, IPOS, and DKG developed the concept of a “PCU”, which was based on minimal requirements and mandatory and suggested standards [5,25]. Differently from the EPCCE, the “PCU” was not aimed at identifying centres of excellence, but it was a general consensus about the minimal requirements that a hospital should achieve.
On Having Grey Hair
2019, European UrologyThe Impact of Exercise during Radiation Therapy for Prostate Cancer on Fatigue and Quality of Life: A Systematic Review and Meta-analysis
2018, Journal of Medical Imaging and Radiation SciencesCitation Excerpt :It further reflects the importance of involving different multidisciplinary team members to provide best advice in CRF management in this population. These findings are strengthened by a recent publication by the European School of Oncology [42] where physiotherapists are recommended to be included to reduce posttreatment complications and promote rehabilitation for these patients. The National Cancer Comprehensive Network has also developed guidelines to manage CRF [43].
Towards sustainable cancer care: Reducing inefficiencies, improving outcomes—A policy report from the All.Can initiative
2017, Journal of Cancer PolicyCitation Excerpt :Are we avoiding duplication? The need for a multidisciplinary approach to care has been broadly recognised as being critical to improving standards throughout the entire cancer care pathway [27,55,56]. However, it is not applied systematically, often because of lack of available personnel or remuneration for the clinicians involved.
Aiming for a holistic integrated service for men diagnosed with prostate cancer – Definitions of standards and skill sets for nurses and allied healthcare professionals
2017, European Journal of Oncology Nursing
R. Valdagni is Prostate Cancer Programme Coordinator of the European School of Oncology and works as Director of the DivisionRadiation Oncology 1 and of the Prostate Cancer Programme at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (IT), where he also chairs the Prostate Cancer Unit.
- 1
In memoriam Prof. Donal Hollywood, President-Elect of the European Society for Radiotherapy & Oncology 2011–2013.