The paper by ESMO ‘The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO)’ [1] conveys some important key messages for the whole oncology community. A working group (WG) involving 21 oncology and related societies would like to comment on the paper from a multidisciplinary perspective in the conviction that a more transparent and open definition of individual professional roles better supports the patients' care and facilitates best practices and progress in comprehensive cancer care

Abrahamsson, P.-A.

Aranda, S. K.

Astier, A.

Audisio, R. A.

Boniol, M.

Bonomo, L.

Brunelli, A.

Bultz, B.

Chiti, A.

De Lorenzo, F.

Eriksen, J. G.

Goh, V.

Gospodarowicz, M. K.

Grassi, L.

Kelly, J.

Kortmann, R. D.

Kutluk, T.

Plate, A.

Poortmans, P.

Poston, G.

Saarto, T.

Soffietti, R.

Torresin, A.

Valentini, V.

van Harten, W. H.

Verzijlbergen, J. F.

von Kalle, C.

University of Strathclyde Institutional Repository

Strathprints Institutional RepositoryValentini, V. and Abrahamsson, P.-A. and Aranda, S. K. and Astier, A. and Audisio, R. A. and Boniol, M. and Bonomo, L. and Brunelli, A. and Bultz, B. and Chiti, A. and De Lorenzo, F. and Eriksen, J. G. and Goh, V. and Gospodarowicz, M. K. and Grassi, L. and Kelly, J. and Kortmann, R. D. and Kutluk, T. and Plate, A. and Poston, G. and Saarto, T. and Soffietti, R. and Torresin, A. and van Harten, W. H. and Verzijlbergen, J. F. and von Kalle, C. and Poortmans, P. (2014) Still a long way to go to achieve multidisciplinarity for the benefit of patients : commentary on the ESMO position paper (Annals of Oncology 25(1): 9-15, 2014). Annals of Oncology, 25 (9). pp. 1863-1865. ISSN 1569-8041 , http://dx.doi.org/10.1093/annonc/mdu245This version is available at http://strathprints.strath.ac.uk/55335/Strathprints is  designed  to  allow  users  to  access  the  research  output  of  the  University  of Strathclyde. 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Any  correspondence  concerning  this  service  should  be  sent  to  Strathprints  administrator: strathprints@strath.ac.uk1©TheAuthor2014.PublishedbyOxfordUniversityPressonbehalfoftheEuropeanSocietyforMedicalOncology.Allrightsreserved.Forpermissions,pleaseemail:journals.permissions@oup.com.Stillalongwaytogotoachievemultidisciplinarityforthebenefitofpatients:commentaryontheESMOpositionpaper(AnnalsOncologyJan;25(1):9 ?15,2014)V.Valentini1,P ?A.Abrahamsson2,S.K.Aranda3,A.Astier4,R.A.Audisio5,M.Boniol6,L.Bonomo7,A.Brunelli8,B.Bultz9,A.Chiti10,F.DeLorenzo11,J.G.Eriksen12,V.Goh13,M.K.Gospodarowicz14,L.Grassi15,J.Kelly16,R.D.Kortmann17,T.Kutluk18,A.Plate19,G.Poston20,T.Saarto21,R.Soffietti22,A.Torresin23,W.H.vanHarten24,J.F.Verzijlbergen25,C.vonKalle26,P.Poortmans27,*1RadiationOncologyDepartment,CatholicUniversityoftheSacredHeart,Rome,Italy.EuropeanSocieTyforRadiotherapyandOncology(ESTRO),PastPresident2DepartmentofUrology,SkåneUniversityHospital,Malmö,Sweden.EuropeanAssociationofUrology(EAU),SecretaryGeneral3SchoolofHealthSciences,UniversityofMelbourne,Melbourne,Australia.UnionforInternationalCancerControl(UICC),BoardMember4A.Astier,DepartmentofPharmacy,HenriMondorUniversityHospitals,Créteil,France.EuropeanSocietyofOncologyPharmacy(ESOP),VicePresident5DepartmentofSurgery,UniversityofLiverpool,StHelensTeachingHospital,,StHelens,UnitedKingdom.EuropeanSocietyofSurgicalOncology(ESSO),PresidentElect6UniversityofStrathclydeInstituteofGlobalPublicHealthatiPRI,InternationalPreventionResearchInstitute,Lyon,France.Euroskin,Past ?President7DepartmentofRadiologicalSciences,CatholicUniversityoftheSacredHeart,Rome,Italy.EuropeanSocietyofRadiology(ESR),President8DepartmentofThoracicSurgery,St.JamessUniversityHospital,Leeds,UK.EuropeanSocietyofThoracicSurgeons(ESTS),SecretaryGeneral9DivisionofPsychosocialOncology,DepartmentofOncology,UniversityofCalgary,Calgary,Canada.InternationalPsycho ?OncologySociety(IPOS),President10A.Chiti,DepartmentofNuclearMedicine,IstitutoClinicoHumanitas,Rozzano,Milan,Italy.EuropeanAssociationofNuclearMedicine(EANM),PresidentElect11EuropeanCancerPatientCoalition(ECPC),President12DepartmentofOncology,OdenseUniversityHospital,Odense,Denmark.EuropeanUnionofMedicalSpecialists(UEMS),UEMSSectionofRadiationOncologyandRadiotherapy,President13DivisionofImagingSciencesandBiomedicalEngineering,StThomasHospital,London,UK.EuropeanSocietyofOncologicImaging(ESOI),President14UniversityofToronto,PrincessMargaretCancerCentre,Toronto,Canada.UnionforInternationalCancerControl(UICC),President15InstituteofClinicalPsychiatry,DepartmentofBiomedicalandSpecialtySurgicalSciences,UniversityofFerrara,Ferrara,Italy.IPOSFederationofPsycho ?OncologySocieties,Chair16AssociationofEuropeanCancerLeagues(ECL),President17DepartmentofRadiationTherapy,UniversityofLeipzig,Leipzig,Germany.PaediatricRadiationOncologySociety(PROS),PresidentElect18DepartmentofPediatricOncology,HacettepeUniversityCancerInstitute,Ankara,Turkey.UnionforInternationalCancerControl(UICC),PresidentElect19MyelomaPatientsEurope,OperationsManager Annals of Oncology Advance Access published July 10, 2014 at INSERM on July 29, 2014http://annonc.oxfordjournals.org/Downloaded from 220UniversityofLiverpool,DepartmentofSurgery,AintreeUniversityHospital,Liverpool,UK.EuropeanSocietyofSurgicalOncology(ESSO),President21CancerCenter,HelsinkiUniversityCentralHospital,Helsinki,Finland.EuropeanSocietyforPalliativeCare(EAPC),Memberoftheboardofdirectors22DepartmentNeuro ?Oncology,University,Turin,Italy.EuropeanAssociationofNeuro ?Oncology(EANO),President23MedicalPhysicsDepartment,NiguardaCaGrandaHospital,Milan,Italy.EuropeanFederationofOrganizationsforMedicalPhysics(EFOMP),ChairElectedofEducationandTrainingCommittee24W.H.vanHarten,ExecutiveBoardMemberNetherlandsCancerInstitute,Amsterdam,TheNetherlands.OrganizationofEuropeanCancerInstitutes(OECI),President25DepartmentofNuclearMedicine,ErasmusMC,Rotterdam,TheNetherlands.EuropeanAssociationofNuclearMedicine(EANM),President26C.vonKalle,NationalCenterforTumorDiseases(NCT)HeidelbergandGermanCancerResearchCenter(DKFZ)Heidelberg,Germany.EuropeanAssociationforCancerResearch(EACR),BoardMember27RadiationOncologyDepartment,Dr.B.VerbeetenInstitute,Tilburg,TheNetherlands.EuropeanSocieTyforRadiotherapyandOncology(ESTRO),President*Correspondence:(E ?mail:poortmans.ph@bvi.nl) at INSERM on July 29, 2014http://annonc.oxfordjournals.org/Downloaded from 3x ConflictsofInterestdisclosure:NoconflictofinterestsThepaperbyESMOThecurrentandfutureroleofthemedicaloncologistintheprofessionalcareforcancerpatients:apositionpaperbytheEuropeanSocietyforMedicalOncology(ESMO)(1)conveyssomeimportantkeymessagesforthewholeoncologycommunity.Aworkinggroup(WG)involving21oncologyandrelatedsocietieswouldliketocommentonthepaperfromamultidisciplinaryperspectiveintheconvictionthatamoretransparentandopendefinitionofindividualprofessionalrolesbettersupportsthepatientscareandfacilitatesbestpracticesandprogressincomprehensivecancercare.Westronglysupportabalancedpositioningofdisciplinesrelatedtocancerpatientscare,andwesupportESMOinthisinitiative:havingwellestablishedandrecognizeddisciplinesisthestartingpointofacomprehensivefightagainstcancer,pursuingtogethertheoptimumcareofthepatientastheultimategoal.Ashealthcareprofessionalsweareallaimingforthewellbeingofthepatient,improvingandensuringthebesttreatmentsandqualityoflifebasedbothonmultidisciplinarityandontailored,personalizedmedicine.However,wefindthatsomestatementspresentedintheESMOpaperareofconcern,especiallywhenitcomestothepersistentcentralpositioningofmedicaloncologyduringthewholecancerjourneyandthatthemedicaloncologistincertainsituationsmightbeasurrogateforthemultidisciplinaryteam.TheEPAACPolicystatementonmultidisciplinarycancercare,publishedin2013(3)andsignedby20societies,includingESMO,includesthefollowing:Multidisciplinaryteams(MDTs)areanallianceofallmedicalandhealthcareprofessionalsrelatedtoaspecifictumourdiseasewhoseapproachtocancercareisguidedbytheirwillingnesstoagreeonevidence ?basedclinicaldecisionsandtoco ?ordinatethedeliveryofcareatallstagesoftheprocess,encouragingpatientsinturntotakeanactiveroleintheircare(3).Itisunrealistictoday,andevenmoresointhefuture,thatoneprofessioncanoverseethewholecomplexityofoncology.Thewholecancercommunitystrivestoimprovecancercare.Researchreliesonnetworksofknowledgeandexpertise.Everydisciplineneedsthemutualsupportandfindingsoftheothersinordertoadvancepatientcare.Overall,thewholeisgreaterthanthesumofitsparts.TheESMOpositionpaperstatesthat:Medicaloncologistshaveaspecialqualificationinthecarefortheincreasingnumberofco ?andmultimorbidpatientsandintheintegrationoftheirneedsinthe at INSERM on July 29, 2014http://annonc.oxfordjournals.org/Downloaded from 4MDT(1);whileweagreethatmedicaloncologistsindeedhaveaspecialqualificationinthecarefortheincreasingnumberofpatientswithsometimescomplexco ?morbidityandintheintegrationoftheirspecificneedsintheMDT,severalothermedicalandpsychosocialdisciplinesthatareactiveinthefieldofoncologyarewellpositionedtohandlethesecomplexneedsaswell.Theclosecollaboration,andnotthepreeminentpositionofonephysicianoveranother,istheidealsettingforoptimalcancercare.Ifotherwise,thiswouldimplytheunrealisticsituationwherethemedicaloncologistwouldneedtobetrainedinalloncologicaldisciplinesinordertorecognizeallpossibleworkingmechanismsandsideeffectsrelatedtoalltypesoftreatmentsandsubsequentlymanagethemoptimally.Thepositioningofadiscipline,especiallyinamultidisciplinaryenvironmentsuchascontemporaryoncology,cannotbeself ?referential;onthecontraryitshouldbebasedonoptimalcollaborationwithallotherdisciplinesandnot,asstatedintheESMOpositionpaper,oncollaborationwithotherprofessionalswhereappropriate:Preservingacancerpatientsqualityoflifeinallphasesofdiseaseandaftersuccessfultreatmentalsoincludescontinuouslyassessingthepatientsphysicalandpsychologicalsymptomsandmakingsurethattheseproblemsarefullyrecognisedandadequatelyaddressed.Whereappropriate,thisisdoneincollaborationwithexpertsofothermedicalandnon ?medicaldisciplines(1).Thecollaborationwithallotherdisciplinesisnotandcannotbeanoptionlefttothedecisionofonesinglediscipline,whicheverdisciplinethatmightbe.Multidisciplinarityisalsomirroredinresearch,towhichthecontributionofmedicaloncologyisunquestionable,butwecannotsharethepositioningofmedicaloncologyasthedisciplinewhichhascontributedprobablymorethananyothermedicaldisciplinetothedevelopmentanduseofnovelcancertreatmentoptions(1).Medicaloncologistscannotsafelyapplyanynewtreatmentswithoutstrongsupportfrombasicscientiststohelpinunderstandingandapplyingthesenewtechnologies.Similartotheprogressesmadeinradiationtherapy,surgery,cancer ?relatedhealthcaresciencesandotherdiagnosticandclinicaldisciplines,medicaloncologyhasadvancedgreatlyinthelastdecades.Itisthisjointprogressthathasallowedalldisciplinestomoveforwardtogetherinthefightagainstcancerandwhichoffersfurtherchallengingopportunitiestoalloncologyandrelateddisciplines,ratherthantoonesingletreatmentoption.TheESMOpositionpaperstatesthatthewellbeingofthepatientandprogressincancercarearecentralandthecontributionofmedicaloncologytotheMDTsisaffirmed.TheWGstronglysupportsthesestatements,sharingentirelythegoalthatESMOwantstoachieve.However,itshouldbestressedthatmultidisciplinarityisthewayforwardbyjoiningforcesandcombiningeffortstowards at INSERM on July 29, 2014http://annonc.oxfordjournals.org/Downloaded from 5optimalinter ?professionalcollaboration.Collaboration,recognitionofeachindividualdisciplineandthecentralityofthepatient ?physician ?careproviderrelationshipwillleadtoabetterenvironmentforthepatientwithalldisciplinescollaboratingandcross ?fertilizingeachother.WethinkthattheESMOpolicystatementisafirstandfirmpositivestepinsettingthescenefromthemedicaloncologyperspective,andwearesurethatotherconsequentpropositionswillfollowtoprovideamoreintegratedparticipationinthemultidisciplinaryframework,wherethecollaborativeparticipationofmedicaloncologyiswarmlywelcomed.TheESMOpositionpaperopensthediscussionforimprovementandexchangeofideas:theWGwouldbegladtocontributetothisprocess,promotingapositiveevolutionofallinvolvedcancerdisciplinesinordertoadvancethedevelopmentofatrulymultidisciplinarystructureandmodusoperandi.References1 ?Popescuetal.,Thecurrentandfutureroleofthemedicaloncologistintheprofessionalcareforcancerpatients:apositionpaperbytheEuropeanSocietyforMedicalOncology(ESMO),AnnalsofOncology25:915,2 ?Valentinietal.,ESTRO2012StrategyMeeting:VisionforRadiationOncology,RadiotherapyandOncology103(2012)991023 ?BorrasJ.Metal.,Policystatementonmultidisciplinarycancercare,EurJCancer(2013),Feb;50(3):475 ?80 at INSERM on July 29, 2014http://annonc.oxfordjournals.org/Downloaded from 

Still a long way to go to achieve multidisciplinarity for the benefit of patients : commentary on the ESMO position paper (Annals of Oncology 25(1): 9-15, 2014)

Still a long way to go to achieve multidisciplinarity for the benefit of patients : commentary on the ESMO position paper (Annals of Oncology 25(1): 9-15, 2014)

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