REVIEW ONCOLOGY

Biomarkers and genomics in prostate cancer

Biomarkers and genomics are making their entrance in daily clinical practice in many tumour types. In prostate cancer, their use is relatively limited. This article reviews biomarkers and genomics used in different clinical settings such as screening, diagnosis, prognosis, prediction and surrogate endpoints for overall survival and shows an unmet need in prostate cancer.

(BELG J MED ONCOL 2014;8(4):104–8)

The development of a safety culture: a fanciful hope in the health care sector?

Patient safety is a dimension of health care quality and a part of organisational safety culture. A deficit in safety culture represents an increased risk for ‘system’ errors. Errors in the health care sector are frequent and seriously harm a significant amount of patients. These errors must be seen as the end-product of accumulation of latent and active failures within the system and not systematically as the result of an individual mistake. The management of system failure to increase patient safety requires a cultural change. A long-lasting ‘blame and shame policy’ is seriously hampering this cultural change as under-registering of near misses and adverse events are the norm!

Organisational safety culture is multi-faceted and multidimensional. The main characteristics of the safety culture will be highlighted, as well as the methods to assess and detect a weakening safety culture. The health care sector faces an enormous challenge and the journey to better and safer care is a never ending road full of stumbling blocks hindering progression, especially in an environment where reduced financial potential will soon become the norm.

(BELG J MED ONCOL 2014;8(3):66–71)

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO)

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire ‘cancer journey’. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today’s and tomorrow’s professional cancer care.

Reprinted from Annals of Oncology 2014;25(1):9–15 with permission of Oxford University Press.

(BELG J MED ONCOL 2014;8(2):30–7)

Caring for the oncologist: caregiver stress and staff support in oncology

Although oncology is a very rewarding profession, it can be demanding and stressful. Work-related stress, a lack of meaning in work and problems with work-life balance may lead to distress and burnout. The phenomenon of oncologist distress and burnout is reviewed with a focus on care for the caregiver. A person-oriented approach focusing on promoting personal wellness, factors that bring satisfaction to work, resilience, and positive emotions may provide important coping strategies, adding to the standard focus on job-related factors. Guided intervision may benefit the oncologist and his team by providing a forum for discussing job- and team-related issues, gaining insight through reflection and providing support and meaning-making.

(BELG J MED ONCOL 2014;8(2):38–43)

Bone complications in cancer patients

Bone complications are frequently observed in cancer patients. They may be the result of the disease or due to the anticancer treatment. Osteoporosis is seen in up to 30% of cancer patients depending on tumor type and treatment and screening for osteoporosis is indicated in selected patients. It should be prevented by the use of calcium and vitamin D and exercising programs and, if present, should be adequately treated by drugs registered for the treatment of osteoporosis. Bone metastases are observed in up to 75% of metastatic cancer patients depending on the tumor type. Skeletal-related complications, occurring in 50–70% in patients with bone metastases, can be prevented and delayed by the use of bisphosphonates or denosumab. Prevention of the development of bone metastases has been shown by anti-tumor treatment while the role of modification of the micro-environment by bisphosphonates and denosumab needs further study.

(BELG J MED ONCOL 2014;8(1):3–8)

Operational Risk Management (ORM): the aviation safety model can be transposed into the medical sector

Summary

Operational Risk Management is one of the most important attributes of High Reliability Organisations in the industrial sector. In this article it is questioned whether the Health Care Sector is a high reliability organisation. The application of safety models, widespread in the industrial sector is absolutely feasible in the medical sector. One should move from a shame-and-blame policy to a just culture. Pro-active search and reporting of unexpected events, incidents and accidents, coupled with root cause analysis and Deming’s principle of continuous plan-do-check-act is the only way to improve system safety and reduce errors. These industrial methodologies have been implemented with success in our radiotherapy department since 2009. From reporting of incidents we were able to move to steering continuous education and process management. Facing the high human and economical societal burden linked to lack of a robust operational risk management in the health care sector, it is an ethical duty for leaders to define new values and behaviours, both defining a new culture!

(BELG J MED ONCOL 2013;7(5):137–41)

Radiation pneumonitis: occurrence, prediction, prevention and treatment

Summary

Radiation pneumonitis is the most important dose-limiting toxicity in the treatment of thoracic malignancies amendable for high-dose radiotherapy such as lung or oesophageal cancer.
Several patient-specific factors (e.g. age, smoking history, pre-existing inflammatory lung disease, tumour location and performance score) as well as treatment-related factors (e.g. radiation dose and volume, chemotherapy, hormonal therapy) have been studied as potential predictors of the risk of radiation pneumonitis. The most robust parameters that correlate with radiation pneumonitis are Dose Volume Histogram-related, such as the mean lung dose, the percentage of a volume receiving a certain dose such as the V20 and more complex models. All of these show a low overall accuracy with an area under the receiver-operator curve of about 0.65, although they might be still clinically useful by virtue of their high negative predictive value.
Besides research in the underlying genetics of radiation pneumonitis, the interaction between radiotherapy and most targeted agents has not been elucidated.
At present, validated Dose Volume Histogram parameters can be used in clinical practice. Drugs administered concurrently with irradiation of the lungs should only be carried out in combinations with proven safety in prospective trials.

(BELG J MED ONCOL 2013;7(4):105–10)