Vital statistics

Roberto Labianca sets out the results of the Esmo Moses III survey and a strategy for better cancer care in Europe

The medical oncology status in Europe survey was first launched by Esmo nine years ago to provide key information for political action and the daily activities of oncologists throughout Europe.

The third report (Moses III), published in 2008, was created to examine two areas which Esmo considers to be of the utmost importance: the teaching of medical oncology in Europe and the benefit of a multidisciplinary approach to treating cancer.

The Moses III questionnaire was sent to 42 countries in Europe. Forty-one countries, including all 27 EU members, compiled the survey. Esmo national representatives worked as primary sources of data collection, while national medical oncology societies and ministries of health, when needed, were asked to collaborate and certify the data.

In 85 per cent of countries surveyed, the teaching of oncology is included in the curriculum for undergraduate medical students, with an average duration of six years. Medical oncology, however, is foreseen only in 53 per cent of European countries that offer a uniform curriculum at national level, and is actually a separate and/or mandatory course included in the last years of graduate teaching in six of them. Needless to say, there is significant room for improvement and evidence for the need to develop uniform guidelines at European level.

European educational systems are rapidly integrating oncology as an essential course in undergraduate teaching programmes. However, the definition of oncology, clinical oncology and medical oncology is still not clear across countries, and often includes different topics in different countries.

In the majority of the countries surveyed (82 per cent), postgraduate specialisation and/or sub-specialisation in oncology exists, yet the planning, content and structure of postgraduate teaching differs. A specialisation in medical oncology is officially recognised in only 53.6 per cent of countries that have uniform postgraduate training (28).

Postgraduate specialisation is reported with an average of four to five years of postgraduate training, and the majority of countries allow full or partial training abroad.

Twenty-one countries (52.5 per cent) report that a medical oncologist working in a public institution is required to follow a continuing medical education (CME) process in order to continue practicing, while in 12 countries (32.4 per cent) CME is also required for medical oncologists in private practice.

While these percentages represent a significant improvement on the results of 2005’s Moses II survey, CME is extremely important for medical oncologists, given the rapid advances in diagnosis, staging and treatment of cancer patients that result in increasing survival.

According to a joint statement on quality cancer care by Esmo and the American society of clinical oncology (Asco), “Optimal treatment of cancer should be provided by a team that includes…medical oncologists, surgical oncologists, radiation oncologists and palliative care experts, as well as oncology nurses and social workers.” While 76 per cent of the countries surveyed have a multidisciplinary board, the composition, roles and responsibilities of team members are clearly defined and regulated in only 40 per cent.

While the collaboration of all medical specialists in cancer treatment is a value-added approach, the pivotal role of the medical oncologist is not yet a standard. There is evidence that all medical specialities (GPs, organ specialists, medical oncologists, radiation oncologists, surgical oncologists, palliative care specialists) are involved, to varying degrees, and in different phases of cancer treatment and care, but this still varies considerably depending on the disease.

In breast cancer, for example, the medical oncologist is involved in all phases, with a prevalent role in the administration of chemotherapy. Similarly, the medical oncologist is involved in all phases of treatment and care of gastrointestinal cancers. However, in a few countries, the gastroenterologist plays a stronger role, even in the management of medical treatments.

For diseases such as lung and prostate cancer, the organ-based specialist (pulmonologist, urologist) seems to still play a significant role in chemotherapy and/or hormonal therapy administration in some countries, which, needless to say, is suboptimal in light of the complexities of modern treatments.

In summary, in 2007, the status of medical oncology in Europe is characterised by a slow but evident increase in the level of education in medical oncology and in the role of medical oncologists, a persistent lack of homogeneity within the different national settings and considerable room for improvement in the organisation of the discipline.

The pattern of multidisciplinary collaboration in cancer care was deeply explored in this survey and the role of medical oncologists in multidisciplinary teams is seen to be improving over time. Organ-based specialists still play an important role, varying from country to country and depending on the specific disease.

Highly qualified medical oncologists, within the framework of a multidisciplinary team, can ensure the best treatment for cancer patients.

Esmo calls for support from all EU member states to guarantee and maintain an optimal level of training and treatment and to vote in favour of the recognition of medical oncology as a professional qualification at EU level.