Europe has breast cancer units – so why not PCa units?
The time has come to consider this problematic issue and promote establishment of PCUs in Europe, says Dr. Riccardo Valdagni, Coordinator of the European School of Oncology’s Prostate Cancer Programme and Director of the Radiotherapy
Prostate cancer is the most common cancer diagnosed in men, with 417,000 new cases every year in Europe. There is a critical need throughout Europe to provide prostate cancer patients with high quality, standardized and integrated care. This need is currently not being adequately addressed. That is why the European School of Oncology (ESO) – the international organization dedicated to improving the skills of all health professionals supporting cancer patients – has developed and promoted the concept of Prostate Cancer Units (PCUs). Their central principle is specialist, multi-professional care.
Intense debate continues to surround the diagnosis and treatment of prostate cancer: the benefits and drawbacks of screening, the relative merits of surgery, brachytherapy and radiotherapy, the right time for active surveillance and watchful waiting, the role of new drugs and their correct sequence.
But through all the dialogue, some plain facts are acknowledged that should cast a light on all aspects of diagnosis, treatment and continuing support. First, the patient’s own preferences, personality and circumstances have a central bearing on what the “right” diagnosis, treatment and support decisions actually are. Second, specialized interdisciplinary and multi-professional cancer care streamlines patients’ access to care, rehabilitation and counseling delivered by a team of qualified experts.
It means that, through all the complexities of prostate cancer, patients are most likely to receive the highest standards of care.
PCUs, where men with prostate cancer can be cared for by experienced prostate specialists working together, offer the best organizational structure for putting this into practice.
The model is European breast cancer units. These have been widely adopted following a 2003 European Parliament policy that called on Member States to establish a network of certified multidisciplinary breast units covering the entire population. Certification was based on fulfilling a set of criteria set down by the European Society of Breast Cancer Specialists.
Many member states have now reorganized their breast cancer services in line with these requirements, and the move has been strongly influenced by breast cancer patient advocacy groups such as Europa Donna – the European Breast Cancer Coalition.
In recent years some countries have started to manage prostate cancer along these lines. For example, the German Oncology Society, Deutsche Krebsgesellschaft, has been the accrediting and certifying body of PCUs in Germany, which are responsible for the diagnosis, staging, and management of prostate cancer patients.
However, despite a few national examples, prostate cancer has not yet seen the widespread re-alignment witnessed in breast cancer. The European School of Oncology believes that this can change.
ESO’s Prostate Cancer Programme first developed the concept of PCUs, and in an influential article in the European Journal of Cancer in 2011 set out minimal requirements for what was involved in terms of professional education and experience.
Then, in 2012, ESO launched an initiative that moved Europe-wide PCUs towards practical implementation. ESO entered into a collaboration with the Organisation of European Cancer Institutes (a non-governmental organisation that has run an accreditation programme of cancer centres in Europe since 2008) and the German Cancer Society (which developed a certification system for prostate cancer centres in 2008). The aim was to set standards for quality care and care pathways that would form the basis of accreditation and certification of PCUs in Europe. The project was launched as the PCU Initiative in Europe.
The initiative gathered a multi-professional task force of internationally recognized opinion leaders, representatives of European scientific societies and patient advocates to carry out the work.
More than two years of detailed discussion and debate followed. The involvement of representatives from Europa Uomo – the European coalition of groups supporting prostate disease patients –meant that patient perspectives were taken into account on key issues such as the danger of specialty bias when proposing therapeutic and observational options, and the need for written and electronic information on all aspects of disease and treatment phases.
The result was 40 standards for PCUs, covering everything from general organization to case management. This July saw their publication in the journal Critical Reviews in Oncology/Hematology. We hope this will lead to us reaching a broader consensus on the minimum criteria for defining PCUs and facilitating their organisation in European countries.
The PCU Initiative in Europe has delivered relevant and feasible core criteria that we hope will guarantee the acceptance and spread of PCUs in most European countries. We believe that the participation of scientific bodies in the initiative should win a broad support in the uro-oncologic community.
And, as patient advocacy groups increase patients’ awareness of the importance of being treated in top quality centres, the movement for PCUs throughout Europe could gain real momentum.