Improving European healthcare with evidence-based information
For almost 40 years, the European Association of Urology has addressed the most pressing concerns of urological diseases. Prof. Dr. Nicolas Mottet and Prof. Dr. Hein Van Poppel — on behalf of the EAU — elaborate how it strives to assist medical professionals and researchers in developing reliable patient information on 11 urological diseases in 16 European languages
Urological diseases represent a collection of various symptoms and conditions, most of them predominantly related to age. Furthermore, with the rise in the elderly population within Europe, we expect an increase in urological problems. Among urological cancers, prostate cancer is the first malignancy in men, the third cause of death from cancer in men, and leading cause of health expenses.
Initially considered a simple disease, prostate cancer is now considered a very heterogeneous disease. This heterogeneity implies that its management can no longer be considered a “one size fits all.” It must be individualized and therefore becomes more complex, requiring a close collaboration of multiple specialists in addition to urologists, such as pathologists, radiologists, biologists, radiotherapists, and medical oncologists. On top of this, the individual patient demands, personal objectives, quality of life, priorities and individual life expectancy are also key decision drivers.
Major progress has been made, such as the recognition that 50% of the situations are almost indolent, while others are at risk of evolving in the following years, and a minority will have a rapid progression. The recent development of new technologies, new drugs and new approaches requires clarification between experimental and evidence-based data. The latter is the cornerstone of any decision. The amount of published information makes it an impossible challenge for any individual to be fully informed.
The same applies for every urological disease. Most urologists take care of all urological situations with a mission to offer the highest possible level of care. To achieve this, help is needed. That’s why the European Association of Urology’s (EAU) Guidelines exist and are continuously developed.
Urological Guidelines for clinical practice
Guidelines must fulfil some criteria: they must be evidence-based, unbiased and independent; they must be up to date, multidisciplinary when different specialties are involved, and they must involve patients. The EAU Guidelines fulfil all these prerequisites.
The EAU Guidelines cover all urological problems, including chapters on urological cancers (prostate, bladder, upper urinary tract, kidney, urethra, testis and penile) and chapters on non-oncological situations such as kidney and bladder stones, infections, lower urinary tract symptoms, pelvic pain, infertility, male sexual dysfunction, neuro-urology, paediatric urology, among others. They all share the same multidisciplinary approach, rules and methodologies and are regularly updated.
An illustration: The prostate cancer guideline panel is composed of 6 urologists, 4 radiotherapists, 2 medical oncologists, 1 radiologist, 1 pathologist and 1 patient representative. The prostate cancer guidelines are now fully endorsed by the International Society of Geriatric Oncology (SIOG), the European Society of Uro-Radiology (ESUR) and the European Society of Radiation Oncology (ESTRO). They are implemented and updated annually, based on structured literature searches, and on systematic reviews (SR). Each SR represents almost one year’s work, including 1 senior member leading the work, 1 librarian, 1 methodologist, and 2 to 4 associates for data extraction. These SRs are the only way to perform an extensive impartial and unbiased summary, leading to practical guidance. The prostate cancer panel is running 5 SRs to be finalized between 2016 and 2017. A new one devoted to long-term side-effects and quality of life of each treatment has just started, with a patient representative in the leading group. Each year new literature searches will be added.
The EAU Guidelines represent a major effort of Europe’s urological and medical communities in order to improve the delivery of care. They are available for free from the EAU’s website (www.uroweb.org) and are published as detailed summaries in the EAU’s journal European Urology. The Guidelines are recognized as an important source of guidance for practicing urologists, and clinicians from bordering specialties, all around the world. They are often used as resource for national guidelines.
A formalised endorsement by other associations was achieved in December 2015 for almost all 28 European Union member states, and 14 countries outside Europe including China, Russia, Indonesia, Australia and New Zealand among many others. Endorsement implies support or general approval of its content, acknowledging the value and quality of these documents. EAU Guidelines cannot replace the need for national guidelines. These often exist alongside the EAU Guidelines, adapted to some specific national situations.
The EAU Guidelines also form the basis of the EuropeanSchool of Urology (ESU). The ESU’s aim is to coordinate and organize all postgraduate teaching and education activities of the EAU at the highest possible level. These activities exist in various forms. The annual European Urology Residents Education Program (EUREP) is one of the ESU’s flagship teaching programmes: it lasts 1 week, and is devised for final-year urology residents. A wide variety of ESU Courses are scheduled during the Annual EAU Congress, at EAU Section and Regional meetings, and during individual National Societies’ meetings. They are UEMS/EACCME-accredited. In recent years, e-courses and webinars have also been introduced.
Not only medical specialists require unbiased, evidence-based information. More and more patients are looking for information about their condition and possible treatments. As well-informed patients are better-equipped to talk about issues that worry them, the EAU develops patient information for several urological diseases. It provides reliable information on 11 urological diseases in 16 European languages, which takes into account the latest scientific evidence, expert recommendations, and the needs of patients. On prostate cancer, the patient information leaflets that have been produced, explain what needs to be understood concerning screening, early detection, diagnosis, different management modalities including active surveillance, surgery (open and robot), radiotherapy (external and brachytherapy), hormonal treatment, chemotherapy and novel treatments.
This information is in line with the EAU Guidelines to guarantee consistency in content and quality throughout all of its translations and relevant to patients living in different countries. This truly European collaboration encourages a meaningful dialogue between the doctor and the patient, leading to better care.
The confirmation of the EAU Guidelines’ impact on healthcare delivery is an ongoing process. It should hopefully confirm that all these major efforts from a multidisciplinary medical community are worth undertaking and reach its objectives: improving patients care by improving medical specialists’ knowledge
Prof. Dr. Nicolas Mottet is Professor and Chairman of the Department of Urology at the CHU in Saint-Etienne, France, and chairman of the EAU Prostate Cancer Guidelines Panel. Prof. Dr. Hein Van Poppel is Professor of Urology at the UniversityHospital in Leuven, Belgium, and is EAU Executive, responsible for Education.