Multidisciplinary teamwork, although a widely-accepted practice in medicine, still has a long way to go in actual clinical and research work considering new challenges encountered by physicians such as the introduction of new diagnostic and treatment agents and their impact on standard therapies.
In onco-urology— and similar to developments in other medical fields— the difficulties in establishing clinical trials for new agents is one such challenge often faced by researchers. The most recurrent questions are issues in prioritising clinical research questions and the gap between clinical research and actual practice. Complicating these matters are the rate of drug development and their entry into the healthcare system.
“Clinical trials become more complex with every new agent. Close collaboration between specialties is essential to ensure appropriate case selection and that each study maximiszes its potential to enhance knowledge,” said Prof. Peter Hoskin, consultant clinical oncologist of the Mount Vernon Hospital Cancer Centre in Northwood (UK).
Hoskin represents the European SocieTy for Radiotherapy & Oncology (ESTRO) at the 10th European Multidisciplinary Congress on Urological Cancers (EMUC18) which will take place in Amsterdam, The Netherlands, from 8 to 11 November. He will speak on the European CanCer Organisation’s (ECCO) essential requirements for quality cancer care (ERQCC), a project that aims to improve outcomes for cancer patients through the adoption and the implementation of essential requirements for quality cancer care across Europe.
The annual EMUC is a collaboration of the European Society for Medical Oncology (ESMO), ESTRO and the European Association of Urology (EAU) to boost professional links and provide scientific updates in genitourinary cancers within the context of multidisciplinary synergies.
Hoskin said that an international and interdisciplinary platform such as the EMUC offers an excellent opportunity not only to introduce key changes in clinical practice but also to highlight issues that affect MDT work.
“The management of urological cancers is a multidisciplinary effort and optimal treatment is best achieved by a close collaboration among diagnostic and therapy specialties, which are all represented at the EMUC,” he added.
ERQCC for prostate cancer
Hoskin will provide an update on the ECCO’s ERQCC project, particularly on the final drafts of the Breast Cancer and Prostate Cancer manuscripts. The manuscripts are expected to be finalised in time for the ECCO 2018 European Cancer Summit in Vienna in September.
“The work of ECCO in producing the ERQCC documents, which will be presented at EMUC 18, is an important step to define the basic requirements for modern cancer care based on multidisciplinary teams,” according to Hoskin. “This provides an authoritative document for countries within Europe to aspire and aim for a minimum standard across the wide range of health care systems.”
Using new technology
Regarding novel developments, Hoskin noted the rate of adopting new technologies in cancer treatment can make a crucial difference in the delivery of optimal care. Although financial costs and reimbursement systems widely differ across Europe, cancer experts are convinced that using innovative approaches are essential in early diagnostic tests, patient selection and in predicting disease progression.
“Harnessing state-of-the-art techniques including intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), stereotactic body radiotherapy (SBRT) and brachytherapy, and ensuring good quality assurance and adopting optimal schedules based on clinical trial data, are crucial aspects in our field,” he said.
Hoskin also reiterated the need to properly execute clinical trials. Experts often raised the issue that the core activities of a clinical trial are mostly perceived as supplemental responsibilities. These so-called ‘peripheral’ activities are then assigned to a variety of staff which are obligated to accommodate them besides their full-time work.
With regards MDT work in hospitals, Hoskin said MDT composition and the time given to these teams are also of equal importance.
“One of the main challenges for many is an efficient organisation which ensures that all specialties are represented at the MDT and that there is sufficient time for case discussion,” he said.
At EMUC18, the Scientific Programme will look into the various clinical and research dilemmas confronting onco-urology experts. Addressing core topics in prostate, kidney and bladder cancers, expert lecturers and speakers from both sides of the Atlantic will present insights on best practices, look into decision-making dilemmas and anticipate prospects in drug development and their use in specific patient populations. Interactive voting and collating the various views of the participants, and presenting them within the context of how it affects MDT work is one of the features of EMUC.
Article by Joel Vega