Prof Cynthia Aristei and Prof Giuseppe Curigliano | EUSOMA – The European Society of Breast Cancer Specialists
Background
Breast cancer management has ultimately become more and more complex. For the teams that are involved in it, good clinical practice requires lifelong education and continuous updating to keep abreast of new technologies, anti-cancer drugs and other advances in the field.
EUSOMA‘s mission is to harmonize and improve the quality of breast cancer diagnosis, treatment and outcomes across Europe. The multi-disciplinary approach, involving specialists from diverse disciplines, is the basis of its method. Moreover, Breast Centres voluntarily adhere to EUSOMA certification to obtain a formal guarantee of quality of care. Writing and disseminating reference documents improve Breast Centre organization and, consequently, optimize patient care and quality of life.
The Multi-disciplinary Approach
Breast cancer care is best when patients are treated with a multi-disciplinary approach in specialist Breast Centres. Multi-disciplinary meetings (MDM) constitute a forum where diverse specialists collaboratively review and plan the care of breast cancer patients at any disease stage. Patients managed within them displayed a survival advantage over others. Better outcomes may have been due to shared clinical decision-making, less risk of medical error and personalized care pathways. In short, MDMs ensure that each patient receives the most appropriate care.
Over time, EUSOMA has provided specific recommendations for organizing MDM in order to foster a cohesive team, shared decision-making and patient recruitment to clinical trials.
Contemporary external factors have highlighted the urgency of optimizing MDM: the increase in breast cancer patients, their longer life expectancy and the complexity of modern cancer treatments with rapidly evolving diagnostic, therapeutic and palliative options. Furthermore, clinical workloads have increased due to shortages of specialists, constrained hospital budgets and the MDM themselves.
“Breast cancer care is best when patients are treated with a multi-disciplinary approach in specialist Breast Centres.”
Standard and Quality of Care
A key EUSOMA activity is Quality Control, which guarantees and raises Breast Centre standards. It is based on an overarching set of Quality Indicators (QIs) that EUSOMA developed. Regular implementation of updated QIs influences clinical practice because they are used to monitor compliance with evidence-based recommendations and see whether compliance impacts breast cancer management and outcomes. Although EUSOMA is active throughout Europe, some QIs are applied only in countries that are able to comply with them, as European Health Services differ in terms of cost-free at the point of care, reimbursement systems, drug approvals and diagnostic and therapeutic equipment.
For Quality Control assessment, each Breast Centre requires a database to insert selected diagnostic and clinical data of all breast cancer patients. A data manager, a member of the core team, collects and analyses data and is responsible for the database.
To support Breast Centres in improving local Quality Control and in benchmarking activity, EUSOMA developed a data warehouse. Each year, every certified Breast Centre uploads individual pseudonymized patient data and the EUSOMA Data Centre issues a report showing QI compliance and proposing actions to improve QI adherence, when required. According to EUSOMA, QI compliance is essential to certification.
Certification
Certification guarantees quality care, helps women select a Breast Centre and assures patients, families and institutions that the certified Breast Centre operates to high standards.
The voluntary EUSOMA certification scheme is a 3-year cycle based on questionnaires, site visits, document evaluation and analysis of data reports. It assesses the patient pathway, the Breast Centre team and its work, equipment, organization, services, data collection, protocols and QI performance. During the audit, the Breast Centre compares its performance with monitored QIs, documented procedures and protocols, the patient pathway and implementation of the multi-disciplinary approach. Finally, Breast Centres identify corrective actions that are needed to comply with requirements and define future strategies as well as necessary improvements.
Around 50 Certified Breast Centres in 11 countries form the Eusoma Breast Centre Network and participate in joint surveys and data analysis projects that are published in peer-reviewed journals.
Conclusion
EUSOMA is striving to create a dynamic pathway towards personalized care in a value-based health system. In MDMs, inter-professional collaboration raises the standard of care. Monitoring Quality Control highlights areas needing development and expansion, while Certification consolidates results and encourages innovation.
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