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The European Initiative for Quality Management in Lung
European Lung Cancer Congress 2015, Geneva The European Initiative for Quality Management in Lung Cancer Care (EIQMLCC) Torsten Blum Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring 0 Disclosure slide • No disclosures • No conflicts of interest 15-18 April 2015, Geneva, Switzerland Organisers Partners Lung Cancer is …. … common and increasing … deadly WHO. 2008 … expensive EUROCARE 5. Lancet Oncol 2014; 15: 23–34 Targets in lung cancer care Aim: to chronify lung cancer Reck M al.. Lancet 2013; 382:709-719 3 Targets in lung cancer care: -targeted therapies beyond subgroups? Reck M al.. Lancet 2013; 382:709-719 4 Lung cancer care G e n e r P a r l e v P e o n p t u i l o a n t i o n Who can offer multimodal Tx? Symptoms Incidental Findings Diagnostics MDT Meeting Who uses national cancer registry data? Cure Therapy Follow-up Screening Lost to Follow-up Prevention Rehabilitation Can everybody offer PET-CT? End of Life Care Death Who can offer early palliative Tx? Death Certificate Only undetected ERS Thoracic Oncology Assembly: -Action Plan Sculier JP et al.. ERJ 2010; 36:1227-1228 Gaga M et al.. AJRCCM 2013; 188(4):503-7 Gamarra F et al.. ERJ 2013; 42:568-571 ERS Thoracic Oncology Assembly: 2010 - European Initiative for Quality Management in Lung Cancer Care „Lung cancer care and its management have to be seen in the context of a divergent, in part little-known European healthcare landscape.“ The European Initiative for Quality Management in Lung Cancer Care (EIQMLCC) aims to sustainably improve the quality of lung cancer care across Europe! ERS Thoracic Oncology Assembly: 2014 - European Initiative for Quality Management in Lung Cancer Care First comprehensive snapshot on lung cancer care in Europe: • 38 European countries, 350+ centres reached • Narrative literature search • Surveys on national and local level • Assessment of lung cancer guidelines • Prospective feasibility study on Pan-European lung cancer data registration Yes, there are inequalities in lung cancerBlum care in Europe! T al. ERJ 2014; 43:1254-1277 EIQMLCC – the next stage How to improve care and outcome in lung cancer? Effective smoking prevention programs Screening for lung Cancer (?) Further improvement of therapies, chronification of lung cancer (?) Improvement of lung cancer care by improving and harmonizing standards in Europe Lung Cancer: - How to improve quality of care Blum T et al. Forum 2012 European Initiative for Quality Management in Lung Cancer Care (EIQMLCC): - Guideline project – overall assessment AGREE II What is the best guidance for lung cancer? 67% Up-to-date or methodological power? 63% 63% OVERALL GUIDELINE ASSESSMENT Meanl 41,4% Min. 8,3% Max. 87,5% Waste of human ressources 42% 29% to have75% more than 25% 80 lung cancer 71% guidelines 88% 25% in Europe !!! 12% 75% 17% 8% 25% 25% 29% Vision to have only one living and multi-society lung cancer guideline 54% 38% 38% 50% for Europe 17% 2011 2012 2013 2014 2015 Guideline updates and needed resources Pathology Therapy NSCLC IV Update of German Lung Cancer Guideline: Quality indicators • first version: 2010 Screening Goeckenjan G. et al. Pneumologie 2010; 64(Suppl. 2): e1-164 • update 2015: • improved methodology • but: selected content update … and guess what German doctors will read in 2018?!? Palliative care Patient guideline Tailored guideline-development ? 13 Focus on dissemination & implementation, otherwise risk to waste your invested resources Education Eur Respir J 2013; 42: 568–571 14 European Initiative for Quality Management in Lung Cancer Care: - Current problems & chances for improvement G e n e r P a r l e v P e o n p t u i l o a n t i o n Symptoms ! Incidental Findings Diagnostics MDT Meeting ! ! Screening ! Cure Therapy Follow-up Lost to Follow-up Prevention Rehabilitation Access to care Waiting times End of Life Care ! Death Death Scientific guidance on lung cancer care Certificate Only Collection of demographic and clinical lung cancer data ! undetected How to confirm diagnosis: -individual or team decision? Diagnostics Bronchoscopy EBUS VATS CT-guided Biopsy Thunnissen E et al. Virchows Arch 2014; 464:347-358 16 Palliative care: -How to integrate it best? Therapy Smith TJ et al. J Clin Oncol 2012; 30:880-887 Blum T et al. Eur Respir J 2014 17 ERS Thoracic Oncology Assembly – the next stages Let´s improve quality and overcome inequalities! Joint European Guidelines in Thoracic Oncology European Registry in Thoracic Oncology European Thoracic Oncology Centres Jakobsen E et al. J Thor Oncol 2013; 8: 1238-1247 ERS Thoracic Oncology Assembly – the next stages Let´s move on! Let´s overcome inequalities! ERS Thoracic Oncology Assembly: –EIQMLCC & beyond European Initiative for Quality Management in Lung Cancer care General: First systematic approach to assess quality Literature search: Rare evidence on various aspects of Survey project: High variation in lung cancer care provision Next steps: and provision of lung cancer care in Europe -Providing guidance on quality of thoracic oncology care -Improving and harmonizing standards of thoracic quality of lung cancer carein Europe oncology centres and cancer registration Vision: Guideline project: among European countries Highly variable methodological quality, high rates of redundancies EuLuCA project: High participation rate 21 Thank you, EIQMLCC members! Baldwin, David Beckett, Paul Blum, Torsten De Ruysscher, Dirk Dickgreber, Nicolas Faivre-Finn, Corinne Gaga, Mina Gamarra, Fernando Grigoriu, Bogdan Hansen, Niels-Chr. G. Hubbard, Richard Huber, Rudolf Maria Ivankovska, Snejanka Ivanov, Yavor Jakobsen, Erik Jovanovic, Dragana Kollmeier, Jens Massard, Gilbert Meert , Anne-Pascale Milroy, Robert Paesmans, Marianne Pasleau, Francoise Peake, Mick Putora, Paul Martin Quoix, Elisabeth Rich, Anna Scherpereel, Arnaud Schönfeld, Nicolas Sculier, Jean-Paul Sitter, Helmut Skaug, Knut Spiro, Stephen Strand, Trond-Eirik Taright, Samya Thomas, Michael Van Schil, Paul E. Vansteenkiste, Johan Wiewrodt, Rainer European Initiative for Quality Management in Lung Cancer Care 22 Thank you, EIQMLCC-Coordinators and Colleagues of local centres! Albania Austria Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark England Estonia France Germany Greece Ireland Italy Latvia Lithuania Luxembourg Milda Nanushi Otto Burghuber Paul van Schil Lejla Burnazovic/Prof. Mehić Assia Konsulova Miroslav Samarzija Jana Skrikova Erik Jakobsen Mick Peake Tanel Laisaar Arnaud Scherpereel Rudolf Huber Mina Gaga Ross Morgan Cosimo Lequaglie Alvils Krams Edvardas Danila Marc Schlesser Malta Moldava Netherlands Norway Poland Portugal Romania Scotland Serbia Slovenia Spain Switzerland Turkey Ukraine Slovakia Wales Iceland Stephen Brincat Alexandru Corlateanu Ronald Damhuis Trond-Eirik Strand Joanna DomagalaKulawik Renato Sotto-Mayor Razvan Curca Robert Milroy Dragana Jovanovic Tanja Cufer Inmaculada Alfageme Paul-Martin Putora Tuncay Göksel Nazar Lukavetskyy Elena Kavcová Neil Mc Andrew Steinn Jonsson 23 Good lung cancer care is team work for patients, thus let‘s join our forces! Locally and globally! Thank you! Titel Präsentation, Thema, Verfasser, Datum 24
