Where are we going « wrong »?

• Lack of coordination between the disciplines• Implication for the Patient– Not informed on the next steps– Not informed on when where and what by whom

(loss of autonomy)– No guidelines publically available

• BUT does the medical training focus on coordination or on being good in its profession???

• Are the medical specialist well trained?? Huge difference over Europe!

Where are we going « wrong »?

• Availability of guidelines on diagnosis and treatment

• BUT are these evidence based? If so why are they different between regions or countries??

• And what is evidence –based? what is the right treatment? Personlised medicine

• GLs:Not applicable to all patients (how to explain this to patients but also to insurance companies)

Where are we going « wrong »?

• Depending on the GDP or NHE more or

less high tech equipments available:

MRI,PET scans, radiotherapy….but usually

very expensive drugs are available in

poor countries!!!

• Role (lobby) of pharmaceutical industries

EUROCARE-45-year relative survival, all cancers

countries are orded by Total Expenditure on Healh

Europe

Berrino F. et al, The Lancet Oncology, 2007

Where are we going « wrong »?

• What is a dedicated team? Or what is a « good » hospital??

• How to measure this?• Volume per specialist ??? Volume per

hospital?? NO: but volume per team

But how to deal with this in a poor country with only a few inh/km2?

Model for comprehensive oncological pathway

Where are we going « wrong »?

• Starting a population-based screening programme (political decision) – without any possibility to treat the

referred patient adequatly (no specialized surgeon, no radiotherapy equipment…)

–Without any possibility of evaluation of the effect of the screening (no monitor instrument as a CR including stage)

Where are we going « wrong »?

• More survivors due to better survival: new « problem »:

• Rehabilitation into the society• Back to work• Who can give this kind of support to

the patients? Who is paying for this?

Where are we going « wrong »?

• Antismoking campaigns? Not succesful

because of the lobby of the tobacco

industry: political issue!!!

• Health is less important than the

economy: « the cheapest patient is the

one who dies very fast, and never reaches

his retirement »

In conclusion• We miss the comprehensive approach (NCCP)• We forget to consider the patient as a

respectful « normal » person• We always blame the doctors but they work

within the health care system as build in their country

• We are still dealing with what is GOOD as we re not aware of all the factors responsible for GOOD outcome

• we still miss very important information on cancer care indicators

Growth of cancer1

2

4

8

16

32

64

Histologie