Spotlight: How Specialised Education can Improve Clinical Practice

Education is the lifeblood of ESMO and the Society prides itself on delivering the type of education that will benefit patients and doctors at the level of daily practice. To this end, ESMO made the decision several years ago to change the focus of its education to target oncologists by tumour type and specialisation. We spoke to the Chair of ESMO's Educational Committee and to several ESMO Faculty Coordinators about some of the key aspects of the change and why a more specialised education is important.

  • Date: 27 Mar 2018

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Bringing the bench to the bedside more quickly


Andrés Cervantes University of Valencia, Spain; ESMO Executive Board Member and ESMO Educational Committee Chair

Globally in medicine, and particularly in oncology, there are now numerous new basic, translational and clinical concepts, many of which will become important for clinical practice. And progress is faster than it’s ever been. Because of this, it is vital that practising oncology professionals have a good grasp of the main developments in basic science and how these will be applied in a clinical setting. To address this, ESMO is committed to providing unbiased materials for the ongoing specialised education of its members. In addition to being recognised as the standard of care for cancer patients, a multidisciplinary approach is also the key to providing effective educational resources. To achieve this, ESMO has enlarged its faculty to include representatives not only from what may have been regarded as the core areas of care but also from a variety of other disciplines, including molecular biology, imaging and pathology. This brings a greater depth to our resources. For example, we can draw on the broad expertise of the team members when deciding which topics to feature in the multidisciplinary tracks at our annual congress.

ESMO recognises that it has to provide doctors with a choice of different educational approaches and in this respect we are giving our members many diverse opportunities, from face-to-face meetings, to online activities and printed materials. As an example, ESMO Pocket Guidelines provide an easy-to-use link between knowledge and clinical practice. For me, ESMO’s home for education, OncologyPRO, gives members a well-structured, comprehensive source of all our materials. These resources really make a difference at the level of care, In trying to ensure that the information ESMO provides is readily accessible, OncologyPRO is structured to allow members to search for information by tumour type, making the site easier for oncology specialists to navigate. Keeping OncologyPRO up to date is a continuous challenge—what was relevant four or five years ago may not be so today—and our dedicated and expert communications and web teams are continually striving to find new ways to present information in an appealing way. ESMO is certain that specialised education will help doctors to bring the bench to the bedside more quickly and so allow patients to benefit from the latest treatment approaches.

Maximising the benefits of tumour sequencing


Judith Balmaña Vall d´Hebron Institute of Oncology, Barcelona, Spain; ESMO Cancer Genetics Faculty Coordinator

Cancer genetics today is almost unrecognisable from the field it was just a decade ago. Advances in technology, for example next-generation sequencing, have brought with them the capability to obtain huge amounts of information quickly and the costs of sophisticated equipment, which in the past were prohibitive, are now increasingly within the reach of many institutes. Breakthroughs in cancer genetics have enhanced what we know about the evolution of different tumour types and have allowed a greater potential to more specifically target therapies to cancer cells. All these factors come together to bring the impact of cancer genetics ever closer to the day-to-day world of the oncology physician. It is fantastic to see all this progress being made at such a rapid rate, but it does mean that practising oncologists require specialised education to help them to understand and keep up with all the changes that are taking place, and this will be an ongoing commitment.

The ESMO Cancer Genetics Faculty is pulling together the expertise of a multidisciplinary group to address the challenges of implementing genetic sequencing technologies in the diagnosis and treatment of patients with cancer. As tumour sequencing is being progressively implemented, we should educate oncologists in the different techniques being used and how they can effectively interpret genetic variants, identify their actionability and feel comfortable about recognising the ones that might require ruling out a germline origin.

I have been invited by the ESMO Translational Research and Personalised Medicine Working Group to author a V-Learning module about BRCA mutations across tumour types and I want to continue this educational process with other common cancer susceptibility genes. A specialised education in this field is mandatory to promote confidence among the oncology community and widen the benefits of performing tumour sequencing for targeted cancer therapeutics

Capitalising on collaboration


Aristotelis Bamias National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece; ESMO Genitourinary Cancer Faculty Coordinator

In recent years, much has changed for the better in the way we both understand and manage cancer. And much will continue to change in the future. We need to make sure that oncologists are prepared for these developments. Let’s be clear. Focusing on specialised education does not mean creating new specialities or sub-specialties, but experts in specific fields of medical oncology. This education should be received by oncologists who have progressed beyond their initial stage of learning, and who have probably completed their residency. Progress in personalised medicine and translational research has provided a greater number of opportunities for individual clinicians to become more aware of the role of other specialities in cancer management, and this can only be good. For example, non-muscle invasive bladder cancer used to be managed almost exclusively by urologists. There are now many studies looking at the use of systemic therapies in its management, including immunotherapies, and this will require more of a multidisciplinary team approach.

The Genitourinary Cancer Faculty incorporates experts from across disciplines, such as pathology and radiotherapy. By calling on the expertise of the wide range of specialists involved in cancer care for our educational materials we are, in effect, reflecting the multidisciplinary management approach, which is critical for the optimal management of patients with genitourinary malignancies. In this context, our faculty collaborates closely with societies from other disciplines, such as the European Society for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU), in order to create activities that will enhance interaction. In fact, a joint EAU-ESMO consensus conference on urothelial cancer is planned in November 2018. It is worth noting that while ESMO and EAU have very similar guidelines for the management of genitourinary tumours, certain important deviations (i.e. neoadjuvant chemotherapy for bladder cancer) are noted in everyday practice. I think that bringing specialists together will underline the significant contributions made by the different disciplines and will eventually increase adherence to clinical guidelines.

Looking ahead, the creation of ESMO Designated Centres, such as those already in existence for supportive care, may be a way forward for specialised education. Such centres would provide a multidisciplinary environment and necessitate close collaboration on a daily basis. Individuals attending could then implement the lessons learned in their own centres, thereby extending the reach of this education.

No second chances


Florian Lordick University Cancer Center Leipzig, Germany; ESMO Gastro-Intestinal Tumours Faculty Coordinator

Our greater understanding of the molecular changes underlying tumour growth and progression has led to the availability of many new molecularly targeted therapies and multimodal treatment strategies with the potential to improve patient outcome. We know that it is absolutely necessary to provide the right treatment at the right time because often there are no second chances. This is why it is vital that we understand what can and should be done at any particular timepoint in the disease trajectory, something that requires in-depth, specialist training. And this training is just as important to avoid overtreating patients, for example with inappropriate drug regimens, which can subject patients to unnecessary suffering and also place a financial burden on healthcare systems.

The ESMO Educational Committee is very active in providing excellent learning opportunities in gastrointestinal cancers, including at its meetings—such as the annual ESMO Congress and the ESMO World Congress on Gastrointestinal Cancer —and its preceptorships. Aware that these events reach a very wide audience, the ESMO Gastro-Intestinal Tumours Faculty strives to send its best speakers and educators. A relatively large group of around 40 core members, the faculty combines oncologists with colleagues from other areas, including radiotherapy, radiology and surgery, and is looking to broaden its reach even further by incorporating specialists from additional disciplines, such as palliative care. You might think it would be difficult to coordinate such a large group of people, but our now electronic way of life makes it fairly easy and I think that having such a wealth of knowledge across areas really enhances our output.

Judging by the overwhelming interest we get in our preceptorships—which are often oversubscribed—and the fantastic feedback, I am confident that the specialised education we are providing will have a positive impact on clinical practice.

Translating change into clinical practice


Olivier Michielin Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; ESMO Melanoma Faculty Coordinator

There are, and will always be, many features common between tumour types and their management and in this respect some aspects of education will continue to be applicable across cancers. However, specialisation and differentiation are becoming more and more important. For example, the anti-PD-1 and anti-PD-L1 checkpoint inhibitors have had a huge impact on the treatment of patients with melanoma, but this has not been replicated in all solid tumour types. And we still need to maximise their benefit in melanoma: to do this we have to explore optimal combinations, and more effectively understand why some patients fail to respond and why resistance occurs and how to overcome it. It is well recognised that different tumour types have different escape mechanisms. So that we can effectively manage cancers, we must have a really good understanding of the natural progression of a particular tumour type, to know at what point we treat the patient, with which treatment sequences and at what point we have to wait and see. This requires extensive education at a tumour-specific level.

This type of education calls for close cooperation between all those involved in managing the disease. With the development of molecular profiling, we have seen the role of the pathologist grow and their input is now pivotal. Surgery is also playing an important role in melanoma and we have to work with surgeons to be certain that we are basing treatment on the very latest data. As an illustration, it has recently been shown that radical lymphadenectomy does not improve disease-specific survival for the treatment of sentinel lymph node-positive melanoma. The implications for management are obvious but only if you have fully integrated the data—it is up to us to make sure that practitioners are aware of findings that impact practice.

We need to equip medical oncologists with the tools to guide us through this new era of oncology. Specialised, focused education will create clinicians with an in-depth knowledge of individual tumour types, who will be able to interpret the enormous amount of data flooding in at a faster and faster pace and translate it into clinical practice.

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