European Oncology Nursing Society Research Articles

Aspects of occupational safety: a survey among European cancer nurses

PurposeNurses are particularly at risk for occupational exposure to hazardous cancer drugs, risking both acute and chronic health effects. Knowledge on the implemented safety precautions into minimizing these risks is limited. MethodsThe European Cancer Nursing Index (ECNI) was developed by the European Oncology Nursing Society (EONS) to illustrate the development and status of this profession. In this study, anonymous online survey data on occupational safety reported by European cancer nurses as part of the ECNI 2022, was analysed. ResultsA total of 630 cancer nurses from 29 countries responded to the survey. A majority reported that written guidelines (n = 553, 88%) on safe handling and administration of hazardous drugs, personal protection equipment (PPE) and cytotoxic spillage kits (n = 514, 82%) were available at their workplaces. 130 (21%) nurses reported that wipe testing to assess any residual hazardous drugs on workplace surfaces were conducted systematically at their workplaces. 185 (29%) nurses reported that nurses sometimes or always continued with their regular tasks (including handling hazardous cancer drugs) during pregnancy and breast feeding. 185 (29%) also responded that nurses at their workplaces did not receive an introductory education program before handling hazardous drugs. In total, 346 (55%) of the nurses reported that their workplace had a freedom to speak-up guardian or whistle blower policy for members of staff. ConclusionsEven if most nurses report that there are safety routines in place at their workplaces, the results reveal several serious occupational risks for European nurses handling hazardous cancer drugs. Actions are needed to improve and optimize occupational safety for nursing staff.

An Innovation in Cancer Nursing Education Across Europe: A Pilot Evaluation.

The European Oncology Nursing Society (EONS) is a pan-European not for profit society involving approximately 28,000 cancer nurses from 32 countries in the region. The European College of Cancer Nursing (ECCN) exists under the umbrella of EONS and was established in 2020 with a strategic priority to develop, promote and deliver educational opportunities for nurses across Europe. ECCN introduced a pilot on-line education programme for 20 nurses in January 2023. This study evaluated participating nurses' views and experience of learning on the pilot programme. The study adopted a mixed method approach guided by the four levels of the Kirkpatrick theoretical framework. A dominant focus on qualitative data was used with supplementary quantitative data. The Standards for Reporting Qualitative Research (SRQR) was followed. Eleven nurses completed the pre-pilot online questionnaire (response rate 65%) and seven (n = 7) completed the post-pilot questionnaire (41% response rate). Five (n = 5) nurses participated in two focus group interviews. Data analysis resulted in the development of four overarching themes: A wider world of cancer nursing; Shapeless mentorship; Impact on Practice; Learning online and what now? On commencement of online education programmes, nurses value a structured timetable and support from nursing management to maximise engagement with the learning materials.

Preparation and Evaluation of a Professional Development Series for Early-Career Oncology Nurses in Europe.

The European Oncology Nursing Society Nightingale Challenge was a professional development program delivered via seven one-hour webinars focusing on leadership, career development, and managing burnout. A total of 151 partici.

CN37 Patient and public involvement in research: Reflections and experiences of doctoral cancer nurse researchers in Europe

Patient and public involvement (PPI) means doing research with the patient or members of the public wherein they contribute to research design, conduct and dissemination. Evidence shows the need for guidance about PPI among early career researchers. Our discussions about PPI during a doctoral workshop showed differences in our PPI experiences and the support we received. This motivated us to share our reflections and experiences to highlight gaps in PPI training and support. Between September to November 2021, cancer nurses from seven European countries who attended a doctoral workshop delivered by the European Oncology Nursing Society submitted written reflections of their experiences of PPI within the context of their doctoral research. Ten written reflective pieces were inductively analysed using reflexive thematic analysis to generate initial themes. Audio-recorded focus groups (n=2) with four to six participants were conducted. Focus group data was deductively analysed using the initial themes as framework. Final themes were identified following interpretation and several discussions, until consensus was reached. Four themes were identified in the analysis: (a) evolving recognition and appreciation of PPI, (b) embracing PPI and impact on doctoral studies, (c) the influence of the research environment, and (d) the need to empower doctoral students to integrate PPI in their research journey. Factors such as training, level of support, available funding, and research environment influenced doctoral researchers’ awareness and experiences of PPI . Varying experiences of PPI awareness was noted across Europe showing disparity in guidance about PPI for early career researchers. We recommend provision of early PPI training for doctoral students to support and encourage involvement of patients and the public in their research. Opportunities for sharing PPI experiences to help improve PPI culture in research environments that support doctoral students should be explored.

CN35 The EONS Nightingale Challenge 2020: Evaluation of a professional development programme for young cancer nurses

The European Oncology Nursing Society (EONS) Young Cancer Nurses’ (YCN) study highlighted diverse needs for training and education to support career development among YCNs. The accessibility of personal development opportunities of this nature is variable in European countries. The EONS Nightingale Challenge was developed to respond to YCNs’ needs for career planning and leadership development. This presentation aims to present the evaluation of the inaugural EONS Nightingale Challenge.

CN30 Development of an advocacy accreditation system for cancer nurses

Cancer nurses across Europe are working under very different circumstances. Guidelines on occupational and patient safety vary between countries and healthcare organizations. European Oncology Nursing Society’s (EONS) Advocacy working group, set a strategic goal to create an accreditation system based on results of the survey that was conducted in order to gain knowledge on both patient- and occupational safety from European cancer nurses.

CN31 Patient and occupational safety in cancer care: Experiences from an on-going online education program

Research provides clear evidence of acute and chronic health effects from occupational exposure to hazardous antineoplastic drugs. Despite this, data collected by the European Oncology Nursing Society (EONS) highlights several concerns related to both patient and occupational safety. Collected data indicate that these risks are often overlooked or not even identified. One of the most important concerns is that a large proportion of European cancer nurses have no or very limited education in handling hazardous cancer drugs.

CN28 The nurses voice on patient and occupational safety in Europe

Cancer nurses are crucial in safe administration, management and delivery of care. Guidelines, education and access to Personal Protective Equipment (PPE) vary between countries and healthcare organizations. European Oncology Nursing Society’s (EONS) Advocacy working group, set a strategic goal to raise awareness on safety. To gain knowledge on both patient- and occupational safety from European cancer nurses, a survey was conducted.

Optimizing care for older adults with cancer: International Society of Geriatric Oncology Nursing and Allied Health Interest Group and European Oncology Nursing Society survey results from nurses regarding challenges and opportunities caring for older adults with cancer

The world population is aging. According to the World Health Organization Report on Cancer, there were an estimated 18 million new cases of cancer in 2018 and 10 million cancer deaths [ [1] World Health Organization WHO Report on Cancer. Setting Priorities, Investing Wisely and Providing Care for all. https://www.who.int/publications/i/item/who-report-on-cancer-setting-priorities-investing-wisely-and-providing-care-for-allDate: 2020 Google Scholar ].

Onkološko sestrinstvo i EONS (Evropsko onkološko sestrinsko društvo) uticaj u istočnoj Evropi

European Union (EU) has defined the process and norms of nursing education. As a source of data, Directive 2005/36/EC and Directive 2013/55/EU was used together with Croatian laws and regulations which are related to nursing education. Nursing education in Croatia is carried out through high school education and also at the university level. The situation is similar or the same in many other Eastern European countries. Experience in nursing education in different European countries can be useful in improving nursing education in Croatia. Cancer nursing specialization in the Republic of Croatia, as in many Eastern European countries, exists only on paper, unlike in Western Europe, the USA or Australia. Eastern European cancer nurses can be trained with the assistance of EONS (European Oncology Nursing Society) which is an umbrella organisation providing leadership in all areas of cancer nursing, research, practice, continuing education, communications and advocacy for better recognition of cancer nursing across Europe.

CN9 The European Cancer Nursing Index 2020: A tool for mapping cancer nursing status across Europe

Prior research by the European Oncology Nursing Society (EONS) has provided evidence for significant differences in various dimension of cancer nursing across Europe. EONS Advocacy working group has developed the European Cancer Nursing Index (ECNI) to illustrate the status and better promote cancer nursing among political and/or health contexts.

Oncology nurses’ knowledge about exploring chemotherapy related - Extravasation care: A cross-sectional study

Introductioncan cause significant tissue damage; alter limb function, pain and decreasing quality of life. Nurses play a significant role in the prevention, identification and follow-up of the complications. ObjectivesThis study was conducted to evaluate the oncology nurses’ knowledge about chemotherapy related - extravasation injuries, risk factors, preventive measures, and management practices. MethodsA descriptive cross-sectional design with a convenience sample was used. A sample of 110 oncology nurses completed the knowledge test. European Society for Medical Oncology (ESMO) - European Oncology Nursing Society (EONS) management of chemotherapy extravasation Clinical practice guidelines were used to develop the knowledge test. ResultsThe oncology nurses' knowledge of chemotherapy related-extravasation's definition and signs and symptoms was satisfactory. However, knowledge about risk factors was limited. Generally, the results showed that high percentage of the participants had correct information regarding the procedure domain. However, knowledge deficit regarding site of insertion, and cannula characteristics were reported. The results showed that there was knowledge deficit among the participants regarding all specific treatment practices. ConclusionsThe current study provides a baseline data about oncology nurses knowledge and practice regarding chemotherapy related-extravasation care. Continues education, seminars, and workshops should be conducted for oncology nurses to increase their knowledge and strengthen their competencies.

Protecting a rare commodity.

On 18 May the European Oncology Nursing Society (EONS) celebrated the first European Cancer Nursing Day. We did this to raise the profile of cancer nursing as a pan-European specialism with shared aims: to provide excellent care for cancer patients, and to publicise the wide variation in roles, educational requirements and terms and conditions.

Balancing health care needs in a changing context: nursing highlights from the 2016 European Oncology Nursing Society Congress (EONS10), 17-18 October 2016, Dublin, Ireland.

European cancer nurses have to face many challenges as a result of the rapidly changing economic and political context in which balancing health care needs has become strategic for healthcare delivery. Currently, cancer nurses must overcome many obstacles arising from clinical, organisational, and educational issues. Within this scenario, the European Oncology Nursing Society (EONS) shaped its tenth congress programme to boost discussion and reflections, to share experiences and research, and to see how cancer nurses try to anticipate and embrace changes. The aim of this was to promote innovative solutions and to address the many issues involved with cancer care.EONS10 was held on 17–18 October in Dublin, Ireland. The congress was attended by more than 500 delegates. The programme covered the following themes: caring for families and carers, inequalities and access to cancer care, caring for patients with haematological cancers, palliative care, communication and information exchange, community cancer care (i.e. parallel sessions), roles and responsibility for advanced nursing practice, International Psycho-Oncology Society (IPOS)-Academy workshops (i.e. workshops), cancer survivorship, clinical leadership and new roles, oncology nursing research, symptom experiences and management, palliative care (i.e. proffered papers), poster presentations, and satellite symposia. The aim of this paper is to highlight and discuss the contents of the EONS10 congress.

3rd ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 3)

For the purpose of advanced breast cancer (ABC) guidelines, ABC comprises both inoperable locally advanced breast cancer (LABC) and metastatic breast cancer (MBC).1 , 2 Advanced/metastatic breast cancer remains a virtually incurable disease, with a median overall survival (OS) of about 3 years and a 5-year survival rate of around 25%,3 , 4 even in countries without major accessibility problems. Survival is strongly related to breast cancer subtype, with the major advances seen in human epidermal growth factor receptor 2 (HER2)-positive ABC.5, 6, 7, 8, 9 ABC is a treatable disease with several available therapies and many others in development. However, their impact on survival and quality of life (QoL) of ABC patients has been slow3 and different for de novo versus recurrent ABC, with the latter becoming much harder to treat in recent years.10 Outcomes are also strongly related to access to the best available care, which includes not only the most efficacious medicines, but also multidisciplinary, specialised care, implementation of guidelines, high-quality pathology, imaging and radiotherapy (RT). Lack of any of these crucial pillars of modern oncological care inevitably results in substantially worse outcomes, as exemplified in the New Zealand report “I am still here”.11 While mortality rates have decreased in the majority of developed countries, most deaths are currently seen in less developed societies, and access issues explain the majority of these inequalities.12 The application of the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS)13 to the field of ABC (P Shimon, personal communication) shows that the quality of clinical research has improved over the last decade and that better therapies have been developed, providing hope that a substantial improvement in the median OS of ABC patients might soon be seen. However, some clinically relevant questions are still unanswered and may be difficult to address through traditional clinical trials, such as the best sequence of therapies for each individual patient. The application of computer analytics to big data and real-world data is one of the potential ways forward. In-depth discussion must take place regarding the impact of this ‘new’ level of evidence (LoE) in current treatment guidelines and their integration with clinical trial data. The 5th International Consensus Conference for Advanced Breast Cancer (ABC 5) took place in Lisbon, Portugal, on 14th-16th November 2019, bringing together 1500 participants from 94 countries worldwide, including health professionals, patient advocates and journalists. Since its first edition in 2011, the main goal of the ABC conference has been the development of high-quality international consensus guidelines for the management of ABC. These guidelines are based on available evidence and on expert opinion when evidence is lacking. They represent the best management options for ABC patients globally, assuming accessibility to all available therapies. Adaptation of these guidelines is often needed in settings where access to care is suboptimal. The ABC 5 guidelines are jointly developed by ESO and ESMO, and have been endorsed by several international oncology organisations, such as the European Society of Breast Cancer Specialists (EUSOMA), European Society for Radiotherapy and Oncology (ESTRO), European Society of Gynaecological Oncology (ESGO), Union for International Cancer Control (UICC), Senologic International Society (SIS)/International School of Senology (ISS), Federacion Latino-Americana de Mastologia (FLAM), European Oncology Nursing Society (EONS), European Society of Surgical Oncology (ESSO), Arbeitsgemeinschaft Gynakologische Onkologie e.V. (AGO) and the International Society of Geriatric Oncology (SIOG), and have official representation from the American Society of Clinical Oncology (ASCO). The ABC 5 conference was also organised under the auspices of the Organisation of European Cancer Institutes (OECI) and with the support of the Breast Cancer Research Foundation (BCRF), Susan G. Komen and the ABC Global Alliance. This manuscript summarises the guidelines developed at ABC 5, each of which are accompanied by the LoE, grade of recommendation (GoR), percentage of consensus reached at the conference and supporting references. In addition, the ESMO-MCBS version 1.113 (v1.1) was used to calculate scores for new therapies/indications approved by the European Medicines Agency (EMA) since the last ABC guidelines, as well as a few new therapies that have been scored but are still under EMA evaluation (https://www.esmo.org/Guidelines/ESMO-MCBS). A table with these scores is included (see supplementary Table S1, available at https://doi/org/10.1016/j.annonc.2020.09.010).

3rd ESO–ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3)

For the purpose of advanced breast cancer (ABC) guidelines, ABC comprises both inoperable locally advanced breast cancer (LABC) and metastatic breast cancer (MBC).1 , 2 Advanced/metastatic breast cancer remains a virtually incurable disease, with a median overall survival (OS) of about 3 years and a 5-year survival rate of around 25%,3 , 4 even in countries without major accessibility problems. Survival is strongly related to breast cancer subtype, with the major advances seen in human epidermal growth factor receptor 2 (HER2)-positive ABC.5, 6, 7, 8, 9 ABC is a treatable disease with several available therapies and many others in development. However, their impact on survival and quality of life (QoL) of ABC patients has been slow3 and different for de novo versus recurrent ABC, with the latter becoming much harder to treat in recent years.10 Outcomes are also strongly related to access to the best available care, which includes not only the most efficacious medicines, but also multidisciplinary, specialised care, implementation of guidelines, high-quality pathology, imaging and radiotherapy (RT). Lack of any of these crucial pillars of modern oncological care inevitably results in substantially worse outcomes, as exemplified in the New Zealand report “I am still here”.11 While mortality rates have decreased in the majority of developed countries, most deaths are currently seen in less developed societies, and access issues explain the majority of these inequalities.12 The application of the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS)13 to the field of ABC (P Shimon, personal communication) shows that the quality of clinical research has improved over the last decade and that better therapies have been developed, providing hope that a substantial improvement in the median OS of ABC patients might soon be seen. However, some clinically relevant questions are still unanswered and may be difficult to address through traditional clinical trials, such as the best sequence of therapies for each individual patient. The application of computer analytics to big data and real-world data is one of the potential ways forward. In-depth discussion must take place regarding the impact of this ‘new’ level of evidence (LoE) in current treatment guidelines and their integration with clinical trial data. The 5th International Consensus Conference for Advanced Breast Cancer (ABC 5) took place in Lisbon, Portugal, on 14th-16th November 2019, bringing together 1500 participants from 94 countries worldwide, including health professionals, patient advocates and journalists. Since its first edition in 2011, the main goal of the ABC conference has been the development of high-quality international consensus guidelines for the management of ABC. These guidelines are based on available evidence and on expert opinion when evidence is lacking. They represent the best management options for ABC patients globally, assuming accessibility to all available therapies. Adaptation of these guidelines is often needed in settings where access to care is suboptimal. The ABC 5 guidelines are jointly developed by ESO and ESMO, and have been endorsed by several international oncology organisations, such as the European Society of Breast Cancer Specialists (EUSOMA), European Society for Radiotherapy and Oncology (ESTRO), European Society of Gynaecological Oncology (ESGO), Union for International Cancer Control (UICC), Senologic International Society (SIS)/International School of Senology (ISS), Federacion Latino-Americana de Mastologia (FLAM), European Oncology Nursing Society (EONS), European Society of Surgical Oncology (ESSO), Arbeitsgemeinschaft Gynakologische Onkologie e.V. (AGO) and the International Society of Geriatric Oncology (SIOG), and have official representation from the American Society of Clinical Oncology (ASCO). The ABC 5 conference was also organised under the auspices of the Organisation of European Cancer Institutes (OECI) and with the support of the Breast Cancer Research Foundation (BCRF), Susan G. Komen and the ABC Global Alliance. This manuscript summarises the guidelines developed at ABC 5, each of which are accompanied by the LoE, grade of recommendation (GoR), percentage of consensus reached at the conference and supporting references. In addition, the ESMO-MCBS version 1.113 (v1.1) was used to calculate scores for new therapies/indications approved by the European Medicines Agency (EMA) since the last ABC guidelines, as well as a few new therapies that have been scored but are still under EMA evaluation (https://www.esmo.org/Guidelines/ESMO-MCBS). A table with these scores is included (see supplementary Table S1, available at https://doi/org/10.1016/j.annonc.2020.09.010).

Report on the 9th EONS Congress, Istanbul, Turkey, 18-19 September 2014: nursing highlights.

The European Oncology Nursing Society (EONS), in partnership with the Oncology Nursing Association of Turkey (TONA), organised the 9th EONS Congress in Istanbul, Turkey, 18–19 September 2014. The Congress venue was in Harbiye Cultural Centre and Istanbul Military Museum and offered two days of unprecedented scientific, educational, and networking opportunities for all stakeholders active in the field of oncology nursing around the world.EONS is a pan-European organisation dedicated to the support and development of cancer nurses. Through individual members and national societies EONS engages in projects to help nurses develop their skills, network with each other, and raise the profile of cancer nursing across Europe.This biennial Congress brings together cancer nurses across the globe from many fields of expertise to ‘Celebrate Excellence in Cancer Nursing’ through interactive sessions, lectures, and collegial networking. The format was specifically designed to meet the needs of nurses working in the field of cancer care, education, and research.

European Oncology Nursing Society breakthrough cancer pain guidelines

PurposeThe overall aim of the project was to update and inform nurses of current best practice based on previously published literature to enable nurses to assess and manage breakthrough cancer pain (BTCP) and thereby to provide optimal management of BTCP. MethodsThe EONS started a project in 2010 by recruiting a working group and a multidisciplinary advisory board to develop guidelines with the purpose of helping oncology nurses understand and recognise BTCP. ResultsThis paper presents and overview of the guideline. Key recommendations include; using an algorithm for assessment of BTCP, individualise treatment interventions, optimization of analgesia and reassessment of outcomes of interventions. ConclusionsBy implementing the EONS guidelines nurses will utilise the latest available knowledge in clinical practice and the understanding and management of BTCP will improve assessment and overall management of breakthrough pain in cancer patients.

Policy statement on multidisciplinary cancer care

BackgroundCancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients’ rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework. MethodsThe consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients’ rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval. ResultsThe working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems. ConclusionMDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.

EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum

BackgroundCare for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries.Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. MethodsThe expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th–15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and metastatic colorectal disease separately. Moreover, evidence based algorithms for diagnostics and treatment were composed which were also submitted to the Delphi process. ResultsThe total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. ConclusionsMultidisciplinary consensus on key diagnostic and treatment issues for colon and rectal cancer management using the Delphi method was successful. This consensus document embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.