Let's talk quality: an essential debate for colorectal cancer care
Peter Naredi, President of the European Cancer Organisation
Quality matters. To all cancer patients, their carers and families, and, of course, to all cancer healthcare professionals.
For that simple reason, the European Cancer Organisation has embarked on a long term project to set out consensus checklists for tumour types called “Essential Requirements for Quality Cancer Care” (ERQCC).
Via the unique forum that the European Cancer Organisation provides in bringing together 25 professional organisations in oncology, as well as its active Patient Advisory Committee, the Essential Requirementsnts explain the organisational components and actions necessary to deliver high quality cancer care to patients who have a specific tumour type. Colorectal cancer and sarcoma are the first two tumour types to conclude expression of essential requirements.
The essential requirements for the organisation of colorectal cancer care (published February 2017) make recommendations on core organisational issues such as:
- cancer care pathways;
- patient involvement;
- colorectal cancer centres; and
- multidisciplinary working.
Cancer care pathways
Care for colorectal cancer patients should be organised in care pathways that chart the patient’s journey from their perspective rather than that of the healthcare system. Pathways should incorporate current evidence set out in national and European guidelines. The overall pathway for colorectal cancer comprises: suspected colorectal cancer and referral; information and support for patients; diagnosis; staging; and cancer treatment management.
After diagnosis, it must be clear to the patient which professional is responsible for each step in the treatment pathways and who is following the patient during the journey (usually called a case manager or patient navigator).
Follow-up and survivorship are major issues in colorectal cancer. Typically, care pathways include surveillance for cancer recurrence but patients often have to seek help elsewhere for long term side-effects of treatment, by going to both acute and community facilities. Continuity and integration of all care must be implemented as gaps in long-term care can cause much distress.
Patient involvement
Patients must be involved in every step of the decision-making process. Their satisfaction with their care must be assessed throughout patient care pathways. It is also essential that patient support organisations are involved whenever relevant. Patients must be offered information to help them understand the treatment process from the point of diagnosis. They must be supported and encouraged to engage with their health team to ask questions and obtain feedback on their treatment wherever possible.
Cancer healthcare providers must publish on a website, or make available to patients on request, data on centre/unit performance, including:
- Information services they offer
- Waiting times to first appointment
- Pathways of cancer care
- Numbers of patients and treatments at the centre
- Clinical outcomes
- Patient experience measurements
- Incidents/adverse events
Colorectal cancer centres
It is essential for all patients to be treated in a multidisciplinary centre; that members of the multidisciplinary team see a certain annual number of cases; and that members of the core team dedicate significant time to treating patients with colorectal cancer. Based on the existing evidence, the Essential Requirements recommend that for a hospital to be considered as a colorectal cancer centre it should manage at least 100 new CRC cases a year. All colorectal cancer units must have a follow-up programme in place in accordance with guidelines.
Multidisciplinary working
Treatment strategies for all colorectal cancer patients must be decided on, planned and delivered as a result of consensus among a core multidisciplinary team (MDT) that comprises the most appropriate members for the particular diagnosis and stage of cancer, patient characteristics and preferences, and with input from the extended community of professionals.
To properly treat colorectal cancer, it is essential to have a core MDT of dedicated health professionals from the following disciplines: gastroenterology/endoscopy; pathology; radiology/imaging; surgery; radiotherapy; medical oncology; interventional radiology; and nursing.
The expanded MDT for colorectal cancer, who must be available when their expertise is required is made up of: nuclear medicine; oncology pharmacy; geriatric oncology; psycho-oncology; diet and nutrition; palliative care; rehabilitation and survivorship; and neuro-oncology.
The full Essential Requirements document subsequently outlines further the specific roles of each of these professions in delivery of high quality care to colorectal cancer patients.
Achieving the vision
The above components, and more, make up the vision for practice developed by the European cancer Organisation's member organisations and its Patient Advisory Committee, for high quality care.
The challenge now is, of course, to bring the vision into being.
The European Cancer Organisation, its members and supporting partners, will now embark on a range of activities to ensure:
- patients develop awareness of the organisation of care they should come to expect;
- healthcare professionals themselves demand change to achieve health systems that make best use of their contributions; and
- decision-makers grow familiarity with destination to which they should be steering healthcare reform in order to
- deliver the best to patients in need.
Article published in Government Gazette Vol 2, 2017 (page 71).
Access the full Essential Requirements for Quality Cancer Care: Colorectal Cancer. Critical Review in Critical Reviews in Oncology/Hematology (February 2017 issue).
