ESMO holds first session dedicated to Community Oncologists

Issues regarding the tailoring of chemotherapy dosing in specific situations, awareness of drug-drug interactions with chemotherapy and concurrent medications and defining quality indicators for oncology practice, were all raised and discussed during the first ESMO Special Session on Saturday September 29th.

The ESMO Community Oncology Working Group was created in 2010 with the aim of representing professionals working outside academic institutions or comprehensive cancer centres who treat patients with a wide range of tumours.

“This working group believes that cancer care ought to be of the same quality if delivered in an academic institution or by an ESMO member oncologist practising in a community setting. The group therefore works with ESMO to support practising oncologists in delivering the best available care to their patients,” explained Dr Robert Eckert, Chair of the ESMO Community Oncology Working Group.

Dr Eckert from Weindlingen, Germany, explained that this special session ‘Excellence in Care and Chemotherapy: Goals and Challenges for the Oncology Team’ had been devised in direct response to results from a European survey which showed that community oncologists would like ESMO conferences to provide education relevant to their every day practice. Already, ESMO has implemented a number of measures for community oncologists, including OncologyPRO, ESMO’s online education portal, ESMO Clinical Practice Guidelines and additions to the ESMO web pages to ensure the efficient delivery of relevant information to oncologists everywhere.

Dr Walter Baumann, from the Scientific institute of office-based Haematologists and Oncologists, Cologne, Germany, outlined the issue of quality assurance in oncology and provided an overview of the WINHO (Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen GmbH) project, that aims to enhance ongoing quality reporting, ensure fair assessment of every outpatient care unit, consider peer-to-peer benchmarking and incorporate systematic support of practice quality improvement. Dr Baumann described how 46 quality measures for oncology practices have been defined from 67 measures selected from the literature concerning medical oncology treatment in general and treatment of breast and colorectal cancer in particular, with 6 measures used to pilot data collection. Dr Baumann advised that the first experience in Germany showed that many oncologists are willing to participate. However, there are still a number of challenges ahead for this initiative, including the need to ensure uniform data collection in a way that does not enlarge bureaucracy and that can be translated into quality improvements in everyday practice.

Professor Carsten Bokeymer from University Cancer Centre, Hamburg, Germany, reviewed the challenge of identifying the right chemotherapy dose for the right patient. During his talk, he highlighted several key patient groups where these issues are particularly relevant, including patients with obesity, those with renal insufficiency and dialysis patients, and those with liver dysfunction, and stressed that although safety data for dose modifications are limited, careful action is always required.

Professor David Kerr, from the Universities of Oxford and Cornell, addressed the serious issue of drug-drug interactions. During his talk, he highlighted key factors predisposing patients to drug interactions, multiple medications, advancing age, compromised liver or kidney function, more than one prescriber and comorbidities. He warned that drug interactions can often be overlooked or even explained as poor compliance or progressing disease, and advised that an improved knowledge of the drug interaction process, possibly by the development of a dedicated web-based service, could aid diagnosis of many cases of unexplained or unexpected responses to drug therapy.

Finally, Dr Elizabeth Schnoy, from Regensburg, Germany, outlined the principle goals of process safety in chemotherapy and explored processes that could be put in place to improve safety in terms of both the prescription and administration of chemotherapy.