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Gathering Around Cancer, Croke Park Conference Centre, Dublin, 16-17 November 2023

By David Lynch - 01st Feb 2024


Reference: February 2024 | Issue 2 | Vol 10 | Page 3


Therapeutic advances across a range of cancer types

Therapeutic breakthroughs and the growth in importance of ‘personalised care’ were among the main themes explored in a series of specialty updates delivered on the opening day of the Gathering Around Cancer 2023 meeting in Croke Park, Dublin.

In an update on prostate cancer on Thursday 16 November 2023, Dr Lynda Corrigan, Consultant Medical Oncologist, Tallaght University Hospital, Dublin, said her area of specialty was increasingly able to ‘individualise’ treatment “in an era of growing therapeutic choice”.

“It is fair to say there have been great strides in the developments of new therapeutics for prostate cancer over the last 10 years,” Dr Corrigan said.

She added that cancer treatment is increasingly marked by “individualising [patient] treatment choice by incorporating a patient’s clinical, bio-chemical, and radiological factors to determine whether they need more intensified treatment.

“I think that is where we are moving with prostate cancer in this era of multiple therapeutics.”

Dr Corrigan said that outcomes for men with prostate cancer “will improve as therapeutics move to earlier disease states”. “The key now is patient selection for avoidance for over and under treatment. We need to select the right patient for the right treatment.”

Addressing the specific role of clinicians in this changing era of prostate cancer care, Dr Corrigan said “our job is to advocate for access to therapeutics”.

She also said the job of clinicians was “to continue to grow our international academic and industry networks to bring prostate cancer clinical trials to Irish men”.

Also speaking on the opening day, Dr Jane Sui, Consultant Medical Oncologist, Mater Private Hospital, Dublin, delivered an update on lung cancer. “There is an explosion of many therapeutic approaches in lung cancers,” Dr Sui told delegates. She said that this “explosion” in approaches included those in “early stage and metastatic settings”.

In her talk, Dr Sui also highlighted the importance of genomic testing in non-small cell lung cancer. She said this testing was important “to identify biomarkers at the time of diagnosis to inform therapeutic strategy and personalised cancer care”.

Mr Conall Fitzgerald, Head and Neck Surgeon at St James’s Hospital, Dublin, provided an update and overview on head and neck surgical oncology. He told delegates that “when we are taking about head and neck cancer we are not really talking about one disease, we are talking about a whole range of different diseases”.

Highlighting data from the National Cancer Registry Ireland, Mr Fitzgerald said that “generally head and neck cancer has shown a mild increasing trend in the last 20 years”.

“When we look projecting forward, it’s thought that there will be a significant increase in head and neck cancer rates by 2045, mostly driven by an increase in the age of our population, and HPV-related disease in the male population for whom [HPV] vaccination has only really been expanded out in recent times.”

On the HPV vaccination, he said: “Hopefully, we will see the impact of that in due course but, for now, it is anticipated that we will see an increase in the rates of head and neck cancer over the next 20 years or so.”

On the specialty and its current patients, Mr Fitzgerald said there were “exciting treatment advances and trial opportunities”. He noted that “we are very lucky we have some excellent clinical trials… across the country” for patients. Mr Fitzgerald hoped that the number of patients on such trials would increase in the future.

Elsewhere in his presentation, he pointed to the “complexity” of head and neck cancer patients. “Complexities remain to be understood,” Mr Fitzgerald said, adding that “further research will provide answers” to develop cancer care treatment for future patients.

Continuing the theme of recent developments in therapeutics, Prof Jack Gleeson, Medical Oncologist, Cork University Hospital, spoke to delegates on advances in kidney cancer treatment.

“What we see that is over the past 10 years… there has been a significant expansion of treatment options that we have for first-line kidney cancer treatment,” said Prof Gleeson. “This is on the back of a much better understanding of the underlying cancer biology.”

Ms Jacqueline Daly, a cancer patient advocate, also addressed the specialty update session on the importance of cancer community support. Ms Daly, who works with East Galway and Midlands cancer support, said that the group collaborates closely with local hospitals.

“But we give practical support, we give emotional support to people who have been diagnosed with cancer. We don’t give medical advice ever. But what we try to do is to be there for someone when that terrible news has been delivered that they have a cancer diagnosis.”

Impact of climate change and cancer care

Prof Seamus O’Reilly, Consultant Medical Oncologist, Cork University Hospital

Climate change will have an impact on the health system, including cancer care provision, the Gathering Around Cancer 2023 meeting was told. Prof Seamus O’Reilly, Consultant Medical Oncologist, Cork University Hospital, spoke on the topic of climate change and cancer at the conference.

Prof O’Reilly said that “the impact of climate change on cancer care, and healthcare is profound”. He noted that there is a “cascade of events” contributing to the crisis. These include the impact of extreme weather events, such as the smoke generated by wildfires, on cancer patients in recovery.

As well as the impact of climate change on patient care, Prof O’Reilly also highlighted the impact of healthcare provision on carbon emissions. “Modern healthcare is not an innocent bystander in this,” Prof O’Reilly told delegates.

He noted the UK’s health system’s carbon footprint is the same as the entire output of the nation of Croatia. “And the carbon footprint of American healthcare alone is the same as the entire nation of the UK.”

Prof O’Reilly added that 1 per cent of global carbon emissions relate to radiology procedures. He said there needed to be greater awareness of the impact of healthcare on climate change.

Prof O’Reilly said it was concerning that “only 15 per cent of medical students are taught about climate change in our universities”. In a positive development, however, he outlined the work of the new national green clinical trials initiative. This has recently integrated with the “RCSI green initiative to look at how we can improve our trials in terms of carbon footprint and how we can engage with climate change initiatives”.

Prof O’Reilly also referred to a ‘green charter’ produced by Cancer Trials Ireland. He said that doctors can play a positive role by becoming more aware of the climate impact of the medicine they prescribe and the diagnostic testing they utilise. “What we can do is reduce the carbon footprint of healthcare by doing less,” he said.

Prof O’Reilly stated that some 30 per cent “of what we do is excessive healthcare and may be of low value benefit”.

“We heard today [at the conference] about nurse-led clinics, well something like that will reduce medical waste because it will make prescribing more efficient.”

Prof O’Reilly also highlighted research that looked at the carbon footprint created by in-person medical conferences compared to the lower impact of online conferences. He acknowledged that this posed difficulties, as in-person conferences provided greater opportunities for meaningful professional networking and engagement compared to those conducted online.

He also highlighted that many medical societies need the finance generated at in-person conferences to function.

Prof O’Reilly discussed the vital role of public health legislation in this area. He said that healthcare needed to reduce “inappropriate” prescribing. “We [also] need to integrate climate awareness into what we do,” he said. “We need to be stronger voices in our community on how this is impacting our patients.”

OECI accreditation process ‘robust and independent’, conference hears

Mr Simon Oberst, Director of Quality and Accreditation at the Organisation of European Cancer Institutes

While some perceive peer review systems as “a soft touch”, the processes of the Organisation of European Cancer Institutes (OECI) are “very robust”, a senior OECI representative told the Gathering Around Cancer 2023 meeting in Croke Park, Dublin.

“I really do believe in peer review systems,” the OECI’s Director of Quality and Accreditation Mr Simon Oberst told the session on accreditation on 17 November.

“Some people think peer review is a ‘soft touch’, as you know, ‘I scratch your back and you scratch mine’, I assure you it is not,” he remarked. “Although we know you as friends and we have worked with you in helping to develop your processes and standards, when it actually comes to the peer review and the report, we are very robust and we are very independent, and then we work with you for the improvement process.”

The OECI, which is a non-governmental organisation, aims to ensure patients have equal access to a high quality of cancer care in multidisciplinary teams; cancer research and innovation are fully integrated into patient care pathways; and patients are at the centre of their care.

It has 123 member institutions and over 70 centres and networks are participating in its accreditation and designation (A&D) programme, including most of the top centres in Europe. The programme is designed to enable a complete quality system for cancer diagnosis, care, education, and research by using OECI standards and indicators and peer review.

The OECI accords three designations through this programme (cancer centre, comprehensive cancer centre, and comprehensive cancer network).

Currently, two Irish centres are accredited as OECI cancer centres — the Trinity St James’s Cancer Institute and the Beaumont RCSI Cancer Centre. Four Irish centres are seeking OECI accreditation.

The domains of the A&D programme include governance, organisational quality, patient involvement and empowerment, multi-disciplinarity, prevention and early detection, all modalities of diagnosis, treatment and care, translational and clinical research, and education and training.

Strengths and weaknesses

During his presentation, Mr Oberst outlined that the OECI sees many strengths in the European cancer care community, such as the “world-class research” being conducted in some centres.

However, there are also “massive inequalities in Europe” across the patient pathway. “We see in some of those central and eastern European countries the late detection of cancer and a reactive approach. We see delayed innovation… often due to a siloed approach and unfortunately a lack of core funding for research.”

Areas of opportunity included the need for more outcomes research, strengthening the patient voice, investment in omics, and a “massive push” on prevention and early detection.

He observed that a common threat to cancer care and research in Europe was the “massive workforce crisis”.

Structures

Mr Oberst spoke about forming cancer centres within university hospitals and the networks around them.

“That [process] requires new organisational structures, new agreements with universities, with freestanding research institutes…. Our emphasis is not on the separate legal entity — we do not say that a comprehensive cancer centre needs to be a separate legal entity with directors and all that jazz; the emphasis should be on practical workability and integration.”

He outlined: “The main steps of formation really are, number one, to form that cancer centre board bringing together the clinical, management, and research and education. Secondly, you absolutely need to have an integrated strategy for five or even 10 years which covers care, research, and education.”

Other important elements included strong clinical governance, clear patient pathways, a high-performing clinical trials unit, and a “rational and achievable” research strategy.

Some of the challenges in establishing cancer centres may include lack of centralised funding; resistance or scepticism; and difficulties recruiting to senior academic posts.

The OECI has also developed a new set of standards for cancer networks, covering areas such as governance, patient pathways, MDT structures, and research collaborations. “And the big one, of course, — the difficult one — IT inter-operability, which is a huge issue as you all know here in Ireland,” he added. Mr Oberst noted that Ireland’s national cancer strategy reflected largely the same criteria.

Earlier, Dr Jean-Benoit Burrion, Chair of the OECI’s A&D board, spoke at the conference on comprehensive cancer care and research in the broader EU context.

He noted that the European Commission had been working on shaping the oncology landscape in Europe through various programmes, the latest of which is the Europe’s Beating Cancer Plan.

This document was being implemented in parallel with the EU Cancer Mission plan from the research and innovation directorate. Of interest to cancer centres, the Europe’s Beating Cancer Plan sets out an objective to establish an EU network of national comprehensive cancer centres and ensure that 90 per cent of eligible patients have access to such centres by 2030. The Cancer Mission plan aims to support the creation of a network of comprehensive cancer infrastructures. These actions have led to the projects CraNE and CCI4EU, to which the OECI has been contributing.

Dr Burrion also provided an overview of the cancer centre accreditation landscape in Europe which, aside from the OECI, includes two systems run by organisations in Germany (Deutsche Krebshilfe, which operates a programme similar in approach to that of OECI, and Deutsche Krebsgesellschaft, which runs a tumour-specific programme).

Topical

Member of the Gathering Around Cancer organising committee, Dr Megan Greally, Consultant Medical Oncologist, Beaumont Hospital, Dublin, told Update that the committee was keen to maintain a focus on accreditation, as several Irish centres are engaged in this process. She also noted that other topical areas, such as surgery for GI cancer and drug access, were reflected in the two-day conference agenda.

Also speaking to Update, Prof John McCaffrey, Consultant Medical Oncologist and Clinical Director of the Cancer Directorate at the Mater Misericordiae University Hospital, and member of the conference organising committee, noted that the “OECI process is our process of accreditation, and it allows us to look at who our relationships are with, and are we doing things to standard”.

“Trinity and the RCSI have completed the process, and UCD [University College Dublin], UCC [University College Cork], and UCG [now University of Galway], are all in the process of doing it with their cancer centres.” He noted that the two OECI speakers are “very senior” in the organisation, “So the fact that they came here, they are keen to help us get it right.”

Prof McCaffrey agreed engaging in the process was time-consuming. “But you need to have a dedicated staff member as the coordinating person and the rest of it is going through your institution and looking at what you do correctly and what you do not do correctly and pointing out through an accreditation process, where you need to get things right,” he said. “Like the multidisciplinary process, everybody does it, but do you do it properly?… And ultimately, with all of these processes, it has the patient at the centre… all of these things are meant to improve patient outcomes, and that is why we are all signed up to it.”

Meanwhile, Prof McCaffrey noted that the first version of Gathering Around Cancer had taken place just over 10 years previously, “and it just gets better and better every year”. He also acknowledged the event would not happen without the support of the pharmaceutical industry by way of unrestricted grants.

The other member of this year’s organising committee was Prof David Gallagher, Consultant Medical Oncologist and Consultant Medical Geneticist at St James’s Hospital, Dublin.

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