REVIEW ONCOLOGY

Exchange of data between a Comprehensive Cancer Centre and the Belgian Cancer Registry: a single university institution experience

Summary

The main goals of hospital-based and population-based cancer registries are respectively to contribute to patient care by providing information on cancer patients and to produce statistics on the occurrence of cancer in a defined population in order to assess and monitor the impact of cancer in the community. To achieve these goals the use of complete quality data is essential. Therefore, cooperation between a hospital-based cancer registry (HBCR) and the Belgian Cancer Registry (BCR) was set up. A pilot study was conducted to exchange clinical data (date of death) between the HBCR and the BCR. Secondly, we wanted to analyse the completeness and the quality of data delivered by the HBCR to the BCR. For the pilot study, all new patients with a diagnosis of head and neck cancer in 2005 and 2006 were included. For the analysis of the completeness and quality of the data all invasive or in situ cancers with an incidence date of respectively 2005 and 2006 were included. The HBCR could be supplemented with 23 dates of death (42%). Overall, the completeness of the registration was near 100%. Except for the TNM-data of malignant melanoma the quality of the data delivered by the HBCR to the BCR showed a maximal rate of missing data of 1.7% (basis of diagnosis) and a maximal rate of conflicting data of 2.8% (basis of diagnosis combined with specific histology). Cooperation between the HBCR and the BCR gives an added value to both registries. The HBCR could be complemented with data from the BCR. The feedback report can increase the completeness and accuracy of the data of the HBCR because it provides a focus on the quality of the data.

(BELG J MED ONCOL 2013;7(3):74–79)

Imbalance between supply and need of medical oncologists in Belgium

Summary

Medical oncology was officially recognised as a specialty in Belgium in 2007. Only limited information is available as to the optimal number of medical oncologists to cover present and future needs. The objective of this study was to analyse the current and future supply, need and demand of medical oncologists in Belgium.
Two surveys were conducted to analyse the supply and need of medical oncologists, one among medical oncologists and a second among medical hospital directors. The evolution of demand due to demographic changes was forecast for the next two decades. A current shortage of medical oncologists, corresponding to roughly half of the current medical oncology workload, has been estimated and is mostly the result of a recent recognition of the specialty and the consequent reorganisation of hospitals. An increase of 28% in the demand during the next two decades is forecast because of an expanding and largely aging population. A worrisome imbalance between supply and need of medical oncologists in Belgium shows itself and an increased demand is forecast, mainly due to demographic changes. This analysis is only the first step of a more general assessment of the situation needed to identify the challenges of medical oncology as a new specialty and to address the multifaceted issues associated with treating cancer in the future.

(BELG J MED ONCOL 2013;7(2):38–45)

Highlights in Oncology 2012

Summary

2012 has been a rich year in progress on cancer care. Many studies highlighted this year capitalised on the growing insight into the complexity of cancer to develop sophisticated treatment approaches, including combinations of targeted drugs for difficult-to-treat cancers and expanded use of targeted drugs to multiple forms of cancer sharing the same genetic alteration. This article is based on the clinical cancer advances 2012 article published by the American Society of Clinical Oncology and lists the most important advances made in the different fields of oncology that are most likely to impact daily clinical practice.¹

(BELG J MED ONCOL 2013;7:10–14)

Stratified Medicine: a call for action

(BELG J MED ONCOL 2013;7:15–19)

Transforming growth factor β: friend or foe in disguise?

TGF-β is a major regulator and driver of many biological processes, but its main function is inhibition of cell cycle progression and apoptosis, thus establishing a tumour-protective effect in early stages of malignant transformation. However, mutational alterations can occur at different levels of the TGF-β signaling cascade. These mutations, combined with the significant influence of the tumour microenvironment on this cascade, can cause a functional shift of TGF-β from being a tumour suppressor to becoming a tumour promoter in more advanced cancers. In most tumours this will ultimately contribute to the formation of metastatic laesions. In the clinical setting of breast cancer, TGF-β plays a significant role in the acquisition of endocrine resistance. Thus, therapeutic intervention of TGF-β signaling might deliver significant benefits in the treatment of cancer. (BELG J MED ONCOL 2012;6:188–193)

The spectrum hypothesis and the technical revolution in radiotherapy at the origin of a major paradigm shift

“Predicting is difficult, especially predicting the future….”

The evolution in radiotherapy nowadays allows highly conformal treatment. Even for moving targets, the radiation therapy can be given with high precision, avoiding as much as possible the irradiation of healthy tissue. This allows reduction of the number of fractions and increase of the biological effect of the treatment. The literature shows us that this increase in biological effect opens the perspective of ablative radiotherapy as an alternative to surgery, whether this is for selected primary tumours or for limited metastatic sub-sites. This ablative radiotherapy will change the treatment paradigms in oncology radically. It is cost-effective, non-invasive and, as the treatment is given in a limited number of fractions not requiring a hospital stay, it has no negative impact on the quality of life of the patient. (BELG J MED ONCOL 2012;6:151–156)

Guidelines in oncology

Guidelines are important tools in relation to patient treatment and care in oncology. They are systematically developed statements to assist practitioner- and patient-decisions about appropriate health care for specific clinical circumstances. They are needed because of unexplained and inappropriate variations in clinical practice patterns, different cancer treatment outcomes, further limitations in resources affecting administration of high quality health care, difficulties of integrating rapidly evolving scientific evidence into daily clinical practice, guidance for involved stakeholders and quality control. A guideline development programme should be inclusive, transparent, consultative, evidence-based and adhering to internationally recognised standards of practice such as the AGREE Collaboration. There should be an implementation plan to ensure that guidelines are implemented in daily clinical practice since they have an important influence on cancer outcome. This article reviews the need, development, implementation, adherence and outcome of guidelines. (BELG J MED ONCOL 2012;6:112–117)