Preparing a Resilient Oncology Workforce for the Present and Future

Andreas Charalambous, Co-Chair of the European Cancer Organisation’s Workforce Network, and President-Elect of the European Cancer Organisation, opened the session with Network Co-Chair Geerard Beets.

The concept of the oncology workforce is broad. There are inequalities in education and training across Europe and staff shortages, so the field must be made attractive to people. Moreover, the COVID- 19 pandemic showed that the oncology workforce should be taken care of, and that safety and life-work balance concerns are crucial. A resolution, to be voted on at the end, was announced.


Protecting Healthcare Workers

In an interview by Andreas Charalambous with Nicolas Schmit, European Commissioner for Jobs and Social Rights, the Commissioner said that Europe’s Beating Cancer Plan will take a comprehensive approach and that the European Commission’s Directorate-General for Employment, Social Affairs and Inclusion (DG Employment) has been closely involved, as the workplace is a potential source of exposure to carcinogens.

workforce with schmit2

Row 1 - Andreas Charalambous (European Cancer Organisation’s Workforce Network); Geerard Beets (European Cancer Organisation’s Workforce Network); Alexandru Eniu (College of the European School of Oncology). Row 2 - Lynda Wyld (Surgical Oncology at the University of Sheffield); Mirjam Crul (European Cancer Organisation’s Workforce Network); Kathi Apostolidis (European Cancer Patient Coalition). Row 3 - Nicolás González Casares MEP; Nicolas Schmit (European Commissioner for Employment, Social Affairs and Inclusion).

The first aim is to reduce exposure to dangerous substances and improve and adapt current EU directives on carcinogens. This includes healthcare worker protection, as dealing with cancer treatments involves risks, often exposing nurses and doctors to hazardous materials such as cytotoxins.

The second aim is to invest in workforce training, to promote skilling, re-skilling and up-skilling, and lifelong learning. This needs to be strengthened for all healthcare professionals but especially nurses.

The third is access to the labour market for people who have had cancer and recovered. They may have lost their job or have problems with re-integration into the labour market. They may need support for re-entry into the workplace as they do not always have the capacity for a full-time job. Retraining and re-skilling, as well as social protection, are important, and inequalities across Europe need to be tackled as health systems and social protections are not all the same.

Charalambous then asked whether there will be a specific emphasis on younger people. Schmit replied that careers in the oncology professions need to be made more attractive and young people motivated to choose these jobs. For many, their work is not sufficiently appreciated. Working conditions can also be tough, and many face stressful situations. Healthcare professionals are often underpaid and it is not seen as a key job by society.

The safety of the workforce is paramount. Occupational safety and health should be included more in designing working practices, alongside greater awareness of stress. To those ends, DG Employment is preparing a new strategy for occupational health and safety.

The COVID-19 pandemic starkly illustrated how healthcare professionals are on the frontline, with many doctors and nurses dying due to a lack of protective equipment. This must end, and healthcare systems must be improved to integrate the health conditions of workers.

For too long, health has been seen as a cost, and the approach of emphasising only cost-effectiveness has brought us to a critical situation.


Recognising Specialist Surgery

Lynda Wyld, Professor of Surgical Oncology at the University of Sheffield, said cancer surgery has advanced in recent decades, with improvements in cure rates and postoperative quality of life. However, there are wide variations across Europe, and surgical training remains static.

Surgery is regulated at two timepoints: medical graduation; and at the completion of training in a field, which is limited by not recognising subspecialty qualification. Surgeons can train in any aspect of surgery and they are given the same weight on paper, such that a general surgeon can set up to treat any cancer without any expertise.

Examinations have been developed in specialist areas but uptake is currently low. Breast surgery, however, is an example of the evolution of specialist surgery, and it is hoped it will soon be recognised in the UK.

A number of societies have also joined forces to launch the European Breast Surgical Oncology Certification, with a certification both for trainees and for fully trained surgeons. The hope is it can serve as a model and potentially allow patients to determine whether a surgeon is trained in a specialist field.

European Cancer Summit 2020 Co-Chair Isabel Rubio agreed with the need to recognise subspecialties, adding that surgical oncology, as well as oncology nursing, needs to be recognised in EU Member States.

Eleonora Varntoumian, from the European Oncology Nursing Society, noted that cancer nurses administer chemotherapy without training or guidelines to follow. She believes that education is therefore key to improve quality care standards for cancer patients everywhere. 


Broadening the Scope of Education 

Kathi Apostolidis, President of the European Cancer Patient Coalition, noted that the European Code of Cancer Practice enshrines the right to equal access to affordable and optimal cancer care,[5] which has been a key priority for their organisation for many years.

The best treatment requires several specialists, and innovation is not just about new medicines but also advances in surgery, radiotherapy, pathology, biomarkers and nursing. The EU Cancer Mission highlights education as key but it also is crucial to create a culture of education across Europe that incorporates all aspects of medicine, including the arts and philosophy.


Moving CME Online

Alexandru Eniu, Chair of the College of the European School of Oncology (ESO), said advances in oncology are so rapid that the quality of education is essential. Many things are changing from one month to the next, and continuous medical education has taken on a new meaning. Training also needs to be improved to close the East-West divide.

The COVID-19 pandemic has shown virtual training is possible. In response, ESO more than doubled the number of their online events and created online pathways for cancelled events. Modules were moved online, as were final examinations. The result was that the Breast Cancer in Young Women Symposium 5 (BCY5) had four times the number of participants, at 30% of the cost of the in-person event.

A crucial aspect, however, is CME accreditation for distance learning. The European School of Oncology has supported the development of a distance- learning accreditation, and BCY5 was the first event to receive it.


A Shortage of Nurses

Nicolás González Casares MEP, Member of the European Parliament’s Special Committee on Beating Cancer, and himself a nurse, said Europe may be fighting a virus but it is time to reflect on the future of cancer care. Unexpected problems always arise and the best-qualified oncology healthcare professionals are needed.

Also important are shared standards and multidisciplinary care, and a framework to allow the recognition and movement of doctors, nurses and researchers for both work and training. There is a shortage of nurses in Europe, and inequalities between Member States that are fueled by low wages. The lack of oncology nurses requires training and continuing education to allow for specialisation.

Referring to the COVID-19 pandemic, he said that telemedicine is important but nothing can replace contact with patients. That means more time with patients, which means more staff, to allow everyone more time during the course of the disease, as well as at the end of their lives.


Lifelong Learning for Nurses

Returning to the interview, Schmit said DG Employment is hoping to tackle job shortages but beyond that the healthcare ecosystem needs to be addressed to ensure that the right skills are supplied at the right quality.

Lifelong learning needs to be organised for nurses, who need opportunities to up-skill. We have to appreciate the work done by those in fighting cancer who are on the frontline in the fight against the pandemic. Their extremely valuable work has to be recognised not only by applauding but also by society and in how we treat them.