The organization of care in pediatric radiotherapy across SIOP Europe affiliated centers:A multicenter survey in the framework of the 'Joint Action on Rare Cancers' project

BACKGROUND/PURPOSE: To reduce inequalities among SIOPE-affiliated countries, standard and optional levels to deliver 'Good Clinical Practice' compliant treatment in pediatric radiation oncology have been published. The aim of this project was to map the availability of pediatric radiotherapy resources across SIOPE-affiliated radiotherapy departments.MATERIALS/METHODS: An online survey with 34 questions was distributed to 246 radiotherapy departments across 35 SIOPE-affiliated countries. In addition to demographic data, 15 general items related to the organization of the radiotherapy process, and 10 radiotherapy-specific items were defined. For each of the 25 items, sum scores were calculated per center and country. Mann-Whitney U tests were used to analyze associations.RESULTS: Between March-June 2019, 121 departments (49 %) out of 31 countries (89 %) completed the survey. At center level, involvement of core disciplines in tumor boards (28 %), and integration of dedicated pediatric radiation therapy technologists (24 %) are limited, while rare &amp; complex brachytherapy procedures are performed in many centers (23 %). For general and radiotherapy-specific items respectively, a relevant variation of sum scores was observed across countries (Δgeneral: ≤10 points; ΔRT_specific: ≤5 points) and among centers within a country (Δgeneral: ≤9 points; ΔRT_specific: ≤6 points). Sum scores for general and radiotherapy-specific items were higher in countries with a high-income (p &lt; 0.01) and higher health development index (p &lt; 0.01). A larger annual number of irradiated pediatric patients was associated with higher sum scores for general items (p &lt; 0.01).CONCLUSION: This survey demonstrates the disparities in organization of pediatric radiotherapy departments between SIOPE-affiliated countries and centers within the same country. Investment is needed to reduce inequalities in pediatric radiotherapy care.</p

Recommendations for the organisation of care in paediatric radiation oncology across Europe:a SIOPE-ESTRO-PROS-CCI-Europe collaborative project in the framework of the JARC

Disparities in survival and long-term side-effects from paediatric cancer are observed across European Society for Paediatric Oncology (SIOPE) eaffiliated countries. The Joint Action on Rare Cancers (JARC) is a project supported by the European Union and member states aiming to formulate recommendations on rare cancers, including paediatric malignancies, to reduce inequalities and to improve health outcomes. Most paediatric cancers are treated by a combination of systemic agents, surgery and/or radiotherapy. Radiotherapy for children is becoming increasingly complex because of the growing availability of new modalities and techniques and the evolution in molecular biology. These added challenges have the potential to enhance disparities in survival and side-effects between countries, but also among centres in the same country. To tackle radiotherapy-related inequalities, representatives of SIOPE, European SocieTy for Radiotherapy and Oncology, Paediatric Radiation Oncology Society and Childhood Cancer InternationaleEurope defined 'standard' and 'optional' levels to deliver Good Clinical Practiceecompliant treatment in paediatric radiation oncology with a focus on patient-related care, education and training. In addition, more than 250 paediatric radiotherapy centres across the SIOPE-affiliated countries have been mapped. For a better understanding of resources in paediatric radiotherapy, JARC representatives are working on an online survey for paediatric radiation oncologists of each centre in SIOPE-affiliated countries. The outcome of this survey will give an insight into the strengths and weaknesses of paediatric radiotherapy across SIOPE-affiliated countries and can be relevant for European Reference Networks in terms of collaboration pathways and referrals in paediatric radiotherapy. (C) 2019 The Authors. Published by Elsevier Ltd

ECCO Essential Requirements for Quality Cancer Care: Soft Tissue Sarcoma in Adults and Bone Sarcoma. A critical review

ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Sarcoma: essential requirements for quality care • Sarcomas – which can be classified into soft tissue and bone sarcomas – are rare, but all rare cancers make up more than 20% of cancers in Europe, and there are substantial inequalities in access to high-quality care. Sarcomas, of which there are many subtypes, comprise a particularly complex and demanding challenge for healthcare systems and providers. This paper presents essential requirements for quality cancer care of soft tissue sarcomas in adults and bone sarcomas. • High-quality care must only be carried out in specialised sarcoma centres (including paediatric cancer centres) which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries. • It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis and follow-up, to treatment, to improve survival and quality of life for patients. Conclusion Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for soft tissue sarcomas in adults and bone sarcomas. The ECCO expert group is aware that it is not possible to propose a ‘one size fits all’ system for all countries, but urges that access to multidisciplinary teams is guaranteed to all patients with sarcoma