ESMO 2012 emphasises palliative care

The European Society for Medical Oncology (ESMO) has awarded its ESMO Designated Centre of Integrated Oncology and Palliative Care accreditation to 16 new oncology centres

The awardees this year include 13 based in Europe, one in Egypt, one in Singapore and one in India. “This demonstrates the truly international scope of ESMO’s work. It shows how ESMO wants to help humanity, not just European oncology patients,” said Professor Raphael Catane, from the Institute of Oncology, Sheba Medical Center, Israel, who is one of the founding members of the ESMO Palliative Care Working Group.

First set up in 2003, this ambitious project aims to improve the infrastructure for the provision of palliative care globally. The initiative came partly in response to the World Health Organization (WHO) report ‘Cancer pain relief and palliative care’. The report, published in 1990, called for the integration of efforts directed at maintaining the patient’s quality of life in all stages of cancer treatment. It emphasised that factors causing patient distress exist from the time of diagnosis and that supportive interventions are needed concurrently with efforts to control the underlying cancer.

“In addition to making efforts to prolong the life of oncology patients, ESMO felt we needed to ensure that quality of life was good. We’ve made considerable efforts to change the mindset of doctors and patients that taking care of symptoms need not diminish efforts to prolong life. From the outset of diagnosis we wanted to integrate palliative care into the practice of medical oncology,” said Professor Catane.

But new research now suggests that palliative care may also contribute to improvements in survival. A landmark study published in the NEJM in 2010 by Dr Jennifer Temel, from the Massachusetts General Hospital, Boston, USA, showed that patients with metastatic non-small cell lung cancer randomised to palliative care early after diagnosis not only had better quality of life and less depressive symptoms, but also survived longer than those receiving standard oncologic care alone.

The accreditation, judged anonymously by ESMO Palliative Care Working Group members, assesses centres according to 13 rigorous criteria. These criteria include close integration of oncology and palliative care services for all cancer patients; centres being committed to a philosophy of continuity of care and non abandonment; high levels of home care; support for family members; routine physical and psychological assessments; expert medical and nursing care in evaluation of pain relief; availability of emergency care; provision of respite care; in-patient end of life care; basic or clinical research related to quality of life; physician education around integration of oncology and palliative care.

Any oncology department or cancer centre can apply, with ESMO emphasising that size is not important, what matters most is the quality and extent of integration of services.
The criteria have come to be regarded as a “roadmap” for how to build palliative care services. Unsuccessful applicants are invited to further develop their programmes and reapply. “What’s really valuable is that we give feedback which works as a teaching tool, showing centres how they can improve,” says Professor Catane.
Receiving the certification allows centres to use the title ‘ESMO Designated Centre of Integrated Oncology and Palliative Care’ and also be eligible to receive fellows in palliative medicine, supported by ESMO fellowships.

For successful applicants, however, there is no room for complacency, since accreditation needs to be renewed every 3 years. Of the current 127 (including the 16 new centres) accredited centres, 50 have been reaccredited once (27 this year) and 21 twice (8 this year). “With personnel, policy and financial aspects changing all the time, we want to ensure that integration of palliative care continues,” said Professor Catane.

Dr Matti Aapro, from the Clinique de Genollier, Switzerland, a member of the ESMO Supportive and Palliative Care Faculty, adds. “The programme is laid out in a very ‘user-friendly’ manner which allows many centres to continue to improve their skills while already recognised as a ‘designated center’.”
Undoubtedly, the much sought after accolade has contributed to increasing the profile of palliative care within oncology units across the world. “ESMO's initiative has certainly raised a lot of interest, as demonstrated by the growing list of centres that adhere to this programme. It’s one of many ways to encourage the development of truly multidisciplinary cancer centres which look at the patient's needs in all aspects of cancer treatment,” said Dr Aapro.

“While further penetration of ESMO’s palliative care policy is still needed, the work of the ESMO Palliative Care Working Group has undoubtedly enhanced the lives of thousands of cancer patients in Europe and beyond,” said Professor Catane.