Meeting Report: Advancing Requirements for Quality Breast Cancer Care

28 August 2020

Following over 18 months of evidence accumulation, consensus finding and drafting, the European Cancer Organisation and the European Society of Breast Cancer Specialists (EUSOMA) were pleased to announce in 2020 the publication of a new milestone publication: ‘The Requirements of a Specialist Breast Centre’.

The Requirements of a Specialist Breast Centre have been produced by EUSOMA and endorsed by the European Cancer Organisation as part of the Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. The fresh consensus statement outlines a quality framework for the provision of breast cancer care that all European health systems should strive for.

Dr Fatima Cardoso: The concepts behind the Requirements of a Specialist Breast Centre

Describing overall concepts related to the paper, Dr Fatima Cardoso, representing the European School of Oncology (ESO) and European Society of Medical Oncology (ESMO), provided historical context in respect to breast cancer being pioneering in its early recognition and promotion of the role of multidisciplinarity in achieving best care, treatment and outcomes for the patient. Robust screening and early diagnosis policies, alongside availability of new and better treatment strategies, has enabled breast cancer survival rates to improve dramatically in most countries. However, much more remains to be done in improving treatment for patients with advanced breast cancer. For this reason, in 2016, the European School of Oncology supported the formation of the ABC (Advanced Breast Cancer) Global Alliance, allowing stakeholders around the world to collaborate through its platform. More here.

The development of the Requirements of a Specialist Breast Centre is, in part, a response to the well identified need to ensure centres providing treatment and care to breast cancer patients do so with requisite experience. Numerous studies have evidenced the survival benefits reported in high volume hospitals. It is critically important that a wider public understanding is gained about this to empower patients when making decisions about their care and treatment options.

Aligned to this, is the need for systems that evaluate the quality of breast cancer care being delivered, for all patients, including those with advanced breast cancer. The ABC Global Alliance has been working with EUSOMA and the European School of Oncology to agree and articulate quality indicators to support this need. Certification against these indicators is a crucial tool to help breast cancer centres improve.

Dr Laura Biganzoli: An introduction to, and overview of, the Requirements of a Specialist Breast Centre

Dr Laura Biganzoli, EUSOMA Past-President, provided an overview of the core contents of the Requirements of a Specialist Breast Centre. This started with the agreed definition of what should be understood by the term ‘Breast Centre’.

"A Breast Centre is the place where breast cancer is diagnosed and treated.  It has to provide all the services necessary, from genetics and prevention, through the treatment of the primary tumor, to care of advanced disease, supportive and palliative care, survivorship and psychosocial support."

The inclusion of supportive care and psychosocial support are important new additions to this definition provided for by the 2020 paper.

The consensus of the author group is that a specialist breast cancer centre must be of sufficient size to manage at least 150 newly diagnosed cases of early breast cancer (all ages, based on surgery) coming under its care each year. The breast centre must also treat at least 50 cases of metastatic breast cancer a year, independently from the line of treatment”.

The requirements paper provides definition to the membership and roles within the core and extended multidisciplinary team involved in the provision of care and treatment to the patient. See figure 1 below.

Dr Biganzoli outlined changes to the descriptions and requirements of the described professions since 2013, reflecting a growing specialisation in breast cancer care, and the benefits of this. See video and slides for fuller description of the key updates.

Hearing from the cancer community:

Sema Erdem, of Europa Donna, remarked on the critical difference that treatment as a patient in a specialist multidisciplinary centre makes, and the positive news of this form of care provision becoming more commonly the case across Europe. The new Requirements of a Specialist Breast Centre help to further codify core elements of what the patient advocacy organisations such as Europa Donna call for, such as ensuring treatment provided by appropriately qualified and experienced healthcare professionals and quality assured breast cancer care. More here.

Kathi Apostolidis, President of the European Cancer Patient Coalition (ECPC), spoke to the complimentary activity, taking place under the authority of the European Commission’s Joint Research Centre, to formulate and promote European level breast cancer guidelines on such issues as screening, diagnosis and quality assurance. More here.

Zuleika Saz-Parkinson, European Commission Joint Research Centre, elaborated further, describing the methodologies and processes being used by the European Commission Initiative on Breast Cancer (ECIBC) to develop its standards and guidelines output.

Simon Oberst, Director of Clinical Development at the Cancer Research UK Cambridge Centre and Chair of the Accreditation and Designation Board of Organisation of European Cancer Institutes (OECI), spoke to where the Requirements of a Specialist Breast Centre sit within the wider approaches being taken across Europe to driving up quality of cancer care. The OECI Accreditation programme takes in to account many of the features of the Requirements including in respect of the provision of multidisciplinary care and increasing the onus on cancer centres being strongly involved in cancer research. More here.

Luzia Travado, Past President of the International Psycho-Oncology Society, raised the growing recognition that psycho-social care be considered a standard element of breast cancer care. More here.

Marko Skelin of the European Society of Oncology Pharmacy (ESOP) reminded of the critical role pharmacists can play in helping to improve adherence to treatment and achieving reduction of errors.

Jonas Van Riet from the European Society of Radiology (ESR) welcomed the emphasis within the Requirements of a Specialist Breast Centre on education. From the radiology perspective, ESR and sister societies have developed pan-European education programmes on breast imaging.

Closing the meeting, Janina Ochojska MEP described her experience as a breast cancer patient. She called for greater specialisation of breast cancer services and systems that fully coordinate multidisciplinary care. This should include strong attention to needs such as pain management and psycho-social needs. She supported a greater EU role in promoting best practice exchange between countries, as well as a dedicated EU Cancer Fund. Another key EU role she wants to promote is in respect to cancer data collection, exchange and analysis. “As Europeans, we can move mountains together.”

Click here to view the video recording from the event. 

MDT breast cancer

Figure 1. Members of the core and extended multidisciplinary team for breast cancer care and treatment. (Source: The Requirements of a Specialist Breast Centre)