Organisation Of European Cancer Institutes Research Articles

Towards improvement of oncology care through digital technology: A snapshot of Resilience remote patient monitoring (RPM) system implementation across 19 hospitals in Europe.

1518 Background: In clinical trials, RPM based on patient reported outcomes (PROs) has been shown to reduce symptom burden, increase dose intensity, improve quality of life and overall survival, and is recommended by international guidelines in routine oncology practice during systemic treatment (Di Maio et al., Ann Oncol 2022). Resilience developed a digital RPM system for oncology (CE marked, class IIa medical device) which prompts patients weekly with a notification to complete a survey including common symptoms from the NCI’s PRO-CTCAE questionnaire. Severe or worsening symptoms trigger an alert notification to the patient’s cancer care team, as well as personalized self-management advice, empowerment and educational material to patients. In this study we report the real-world implementation of Resilience RPM system in France and Belgium. Methods: Aggregated system-level metrics were collected covering all participating hospitals between Nov 2021 - Dec 2022. Qualitative and quantitative assessments focused on patient and provider utilization of Resilience RPM system was done. The implementation included a continued interaction between Resilience and hospital personnel for training, coordination and technical support. Results: 19 hospitals deployed Resilience in France and Belgium, including two Organization of European Cancer Institutes (OECI)-designated cancer centers and community oncology hospitals. Three integrated RPM with their electronic medical record. Overall, 1262 pts were registered (age range, 20-94), 40% with breast, 20% gastrointestinal and 8% genitourinary cancers. In the last 6 months, the main RPM interface was the mobile app (70%). Patient adherence with weekly RPM surveys was 85%, with a median time from prompt receipt to survey completion of 5h20min. RPM retention for 3 months, regardless of disease status, was 80%. Irrespective of severity, the most commonly reported PROs were performance status decline (94%), pain (89%) and anorexia (82%). The most common severe alert notifications were for nausea (33%), pain (31%) and anorexia (23%). The median time to alert management by the care team was 12h (70% within 24h), with 70% of alerts managed by a nurse navigator follow-up call, 5% by a referral for internal/external appointments, 0.5% with an emergency room referral and 0.4% with a hospitalization referral. 87% (32/38) of providers were satisfied with integrating the solution into their organization and 80% (30/38) felt patients were better managed through use of Resilience RPM. Conclusions: Implementation of the Resilience RPM system was feasible across a diverse group of 19 cancer centers in France and Belgium, with high levels of patient and provider participation and engagement. Resilience RPM offers an evidence-based approach to improve the quality and patient-centeredness of cancer care.

Foundation Program in Oncology and Hematology for Newly Recruited Nurses

There is a constant need to educate and upskill nurses who are new to oncology settings. This article describes the outcomes of an education quality improvement (QI) project at an Organisation of European Cancer Institutes.

A focused ethnography in the context of a European cancer research hospital accreditation program

BackgroundA quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP.MethodsA focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts.ResultsFour main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations.ConclusionsThe accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.

Analysing the attributes of Comprehensive Cancer Centres and Cancer Centres across Europe to identify key hallmarks.

There is a persistent variation in cancer outcomes among and within European countries suggesting (among other causes) inequalities in access to or delivery of high‐quality cancer care. European policy (EU Cancer Mission and Europe’s Beating Cancer Plan) is currently moving towards a mission‐oriented approach addressing these inequalities. In this study, we used the quantitative and qualitative data of the Organisation of European Cancer Institutes’ Accreditation and Designation Programme, relating to 40 large European cancer centres, to describe their current compliance with quality standards, to identify the hallmarks common to all centres and to show the distinctive features of Comprehensive Cancer Centres. All Comprehensive Cancer Centres and Cancer Centres accredited by the Organisation of European Cancer Institutes show good compliance with quality standards related to care, multidisciplinarity and patient centredness. However, Comprehensive Cancer Centres on average showed significantly better scores on indicators related to the volume, quality and integration of translational research, such as high‐impact publications, clinical trial activity (especially in phase I and phase IIa trials) and filing more patents as early indicators of innovation. However, irrespective of their size, centres show significant variability regarding effective governance when functioning as entities within larger hospitals.

Securing sustainable price levels of innovative anticancer drugs: How to move forward?

BackgroundNovel cancer treatments come with high price tags that compromise access to treatment and the sustainability of healthcare systems. Innovative policies are needed to reach a system that balances innovation and reasonable prices. However, structured approaches to explore, test, and compare innovative proposals are lacking. MethodsWe surveyed experts to evaluate seven promising proposals to reduce drug prices: Transparency, Combined European purchasing, Public drug development, Public clinical trials, Two-part-pricing, Orphan drug reform, and De-linkage. Experts were asked to rank proposals, identify main risk and success factors, and to reflect on missing proposals. The survey was distributed via the networks of the European Cancer League and the Organisation of European Cancer Institutes. ResultsRespondents (n = 41) originated from 19 European countries and included stakeholders in health economics, law, medicine, drug discovery, and healthcare policy.Transparency (M = 2; SD = 2 1) and Combined purchasing (M = 3; SD = 1 9) were ranked as the most promising proposals, Two-part pricing (M = 5; SD = 2 3) and De-linkage (M = 6; SD = 2 4) were considered as the most controversial. Main risk categories were a negative impact on R&D (n = 47), technical feasibility (n = 38), and reduced access to medicines (n = 33). Main success categories were international collaboration (n = 34) and agreement of pricing mechanisms (n = 25). Experts considered value assessment and strengthening of the competitive market as additional proposals for further analysis. ConclusionWe recommend expanding on these results to further specify actionable policies that can be tested. Pilots should consider uncertainties and conducted with a focus on international collaboration, preferably in cooperation with the pharmaceutical industry.

The tip of the iceberg? Budget restrictions and patient perspectives on cancer drug costs: An international survey in 29 hospitals and 56 patient organizations

BackgroundThe rising cost of cancer drugs are a challenge for health systems, providers, and sometimes patients’ individual financial capacities. We conducted a survey in European countries on negotiation options for providers and effects of high costs on providers and patients. Patients and methodsWe asked health care providers (members of the Organisation of European Cancer Institutes (OECI) hospitals) viewpoints on discount mechanisms, budget restrictions and patient related issues. Secondly, representatives from the member organisations of the European Cancer Patients Coalition (ECPC) were approached concerning consequences for patients, such as access and receiving appropriate treatment. ResultsResponse rates were 38% for OECI and 11% for ECPC. Among 29 participating OECI members, a wide range of discount mechanisms and payments methods are being used in cancer drug purchasing processes. 90% (26/29) of institutions allow joint drug price negotiations; however, only 69% (18/26) use this strategy Two-thirds of institutional responders are of the opinion that treatment choices are being affected by cost issues. 79% (n = 56) patient representatives of ECPC member organizations responded that patients may be missing out on best possible treatments due to high drug costs and 43% thought that patients may not be aware of that. ConclusionOur findings revealed a lack of systematic approach towards purchasing agreements, and a limited use of potentially powerful mechanisms such as joint negotiations. Furthermore, a large majority of patient representatives (79%) and providers (66%) indicated that the drug cost issue is likely to influence treatments decisions. Access issues and coverage delays seem to be present in all countries regardless of level of GDP.

Bridging research and clinical care - the comprehensive cancer centre.

Comprehensive cancer centres (CCCs) are at the heart of the landscape of cancer research, education and care in Europe. They are vital hubs where the historic gaps in the research to clinical care continuum are bridged. CCCs have established hallmarks, but a greater emphasis is needed in Europe to create more effective CCCs using the partnership model of university medical centres and university research departments and institutes. This review will summarise the organisational structures and processes essential for producing quality outcomes for patients and effectiveness in the translational process. The Organisation of European Cancer Institutes and European Academy of Cancer Sciences have established complementary quality accreditations systems to test the clinical and research excellence of CCCs. The EU should have an ambition to create more CCCs based on university hospitals, for each 5–10 million population and in every Member State.

Vision 2030 for the optimal approach to cancer research and care in Europe: A mission or a network of networks?

A mission-oriented approach to cancer care in Europe was proposed by Julio Celis and Dainius Pavalkis in 2017. The major proposed objective is to achieve long-term survival of 3 out of 4 cancer patients by 2030. The authors are president or president-elect of Organization of European Cancer Institutes (OECI) EU Life or European Cancer Community Organization (ECCO). The goal is laudable and ambitious. However, it can only be successful if it is coordinated with active involvement of all stakeholders and interacts with an already well-organized, recognized, and certified European Accreditation and Designation quality approach to identify and select the potential candidates to participate in such a virtual network. The building of a virtual European Cancer Institute based on coordinated networks should refer to unquestioned criteria using a solid and proven methodology operated by an independent arbitration body. The cancer community must share a fundamental responsibility to act collectively and in today's era of the World Wide Web, it is time to think out of the box and consider the possibility of establishing networks of networks.

Towards quality, comprehensiveness and excellence. The accreditation project of the Organisation of European Cancer Institutes (OECI).

There are important gaps in the health status of citizens across Europe, as measured by life expectancy, mortality or morbidity data (Report for the European Commission on the health status of the European Union, 2003). Among the main determinants of the major causes of mortality and morbidity, stated in this report, stands recurrently access to quality healthcare. There is a fundamental need to define quality indicators and set minimal levels of performance quality criteria for healthcare. There is a need to integrate research into healthcare and to provide patients with equity of access to such high quality care. Oncology is a specialty particularly suited to experimenting a first application of accreditation at European level. The Organisation of European Cancer Institutes is a growing network of cancer Centres in Europe. The focus of the OECI is to work with professionals and organisations with regard to prevention, care, research, development, patient's role and education. In order to fulfil its mission, the OECI initiated in 2002 an accreditation project with three objectives: * to develop a comprehensive accreditation system for oncology care, taking into account prevention, care, research, education and networking. * to set an updated database of cancer centres in Europe, with exhaustive information on their resources and activities (in care, research, education and management) * to develop a global labelling tool dedicated to comprehensive cancer centres in Europe, designating the various types of cancer structures, and the comprehensive cancer centres of reference and Excellence. An accreditation tool has been established, defining standards and criteria for prevention, care, research, education and follow-up activities. A quantitative database of cancer centres is integrated in the tool, with a questionnaire, that provides an overall view of the oncological landscape in OECI cancer centres in Europe. Data on infrastructures, resources and activities have been collected. This OECI accreditation tool will be launched in autumn 2008 for all cancer centres in Europe. It serves as a basis for the development of the labelling tool for cancer structures in Europe, with a focus on Comprehensiveness and Excellence labels. Quality assessment and improvement is a critical need in Europe and is addressed by the OECI for cancer care in Europe. Accreditation is a well accepted process and is feasible. Standards and criteria as well as an accreditation tool have been developed. The OECI questionnaire gives an accurate vision of cancer institutions throughout Europe, helping assessing the needs and providing standards. The accreditation project is a long-term complete and voluntary process with external and internal added value, an active process of sharing information and experience that should help the whole cancer community reach comprehensiveness and excellence.

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).

Cancer immunotherapy: from the lab to clinical applications-Potential impact on cancer centres' organisation.

This report covers the Immunotherapy sessions of the 2016 Organisation of European Cancer Institutes (OECI) Oncology Days meeting, which was held on 15th–17th June 2016 in Brussels, Belgium. Immunotherapy is a potential cancer treatment that uses an individual’s immune system to fight the tumour. In recent years significant advances have been made in this field in the treatment of several advanced cancers. Cancer immunotherapies include monoclonal antibodies that are designed to attack a very specific part of the cancer cell and immune checkpoint inhibitors which are molecules that stimulate or block the inhibition of the immune system. Other cancer immunotherapies include vaccines and T cell infusions. This report will summarise some of the research that is going on in this field and will give us an update on where we are at present.

A scientific initiative born at the right place in the ideal moment

The birth of a journal is always an exciting occasion from every standpoint. This statement turns particularly evident when, like in the present situation, one is witnessing the launching of an internationally driven medical/biomedical journal that will be anchored in the hospitals and academic and research institutions that constitute the Porto Health Sciences Pole. This pole is localized at the Asprela Campus and is one of the best Clusters on Health and Life Sciences involving Assistance, Research and Innovation in Europe. The scope and functionality of the Porto Health Sciences Pole has been recently reinforced by the creation of two Hospital-Faculty consortia (University Center of Medicine resulting from the articulation of the Faculty of Medicine of the University of Porto with São João Hospital Center and Clinical Academic Center through the articulation of ICBAS with Porto Hospital Center) and by the inauguration of the Instituto de Investigação e Inovação em Saúde – i3S (Institute for Research and Innovation in Health of the University of Porto) which has been built and started being managed in October by a Consortium of the University of Porto with IBMC, INEB and Ipatimup. The mission of i3S is to integrate complementary competences in Cancer, Host-interaction and Response, and Neurobiology and Neurologic Disorders, in order to become a leading international player in health and life sciences and technologies. Putting all this together with the creation, in 2014, by IPO-Porto and Ipatimup, under the auspices of the Organisation of European Cancer Institutes — OECI, of the first Comprehensive Cancer Center of Portugal (PCCC — Porto Comprehensive Cancer Center), and the dynamics of the interaction of hospitals with pharma and medical devices companies promoted by Health Cluster Portugal, it seems obvious that it would be impossible to find a better site and a most adequate opportunity for launching the Porto Biomedical Journal (PBJ). As an enthusiastic member of some of the tribes that will benefit a lot from the mutual reinforcement of the several institutions that constitute the Porto Health Sciences Pole and PBJ, I just want to say “Welcome and long life to the Porto Biomedical Journal”.

OECI accreditation at Veneto Institute of Oncology IOV -- IRCCS, general framework and multidisciplinary approach.

The aim of this article is to describe the accreditation process of the Veneto Institute of Oncology (IOV-IRCCS) according to the Organisation of European Cancer Institutes (OECI) model, with particular reference to the standards for the multidisciplinary approach. Through the analysis of the process and the activities of each multidisciplinary team (MDT) and the development, at a regional level, of diagnostic, therapeutic, and care pathways (PDTA), all the necessary steps to meet the OECI standards have been determined. Adjustment is ongoing. We are working on the inclusion of the MDT registration forms in the electronic medical records and on the possibility to extend the OECI model to the MDT not based at IOV, but participated in by IOV professionals. The sarcoma MDT has achieved results demonstrating that the OECI framework has allowed the professionals involved in the multidisciplinary meeting to systematically share the clinical information of the patient, who can benefit from better continuity of care. The model has also provided greater clarity in the management of patients who are enrolled in clinical trials and deviate from Guide Lines (GL)/PDTA. The accreditation process according to the OECI model has added value to the IOV's already well-developed multidisciplinary activities.

The organization of clinical trials for oncology at IRCCS Istituto Nazionale Tumori "Fondazione G. Pascale" Napoli and the impact of the OECI accreditation process.

The Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori "Fondazione G. Pascale" (INT-Pascale) is the largest Clinical Care and Research Cancer Center in Southern Italy. The mission is prevention, diagnosis, and care of cancer and innovative research in oncology. In 2013, INT-Pascale joined the Organisation of European Cancer Institutes (OECI) accreditation and classification project along with other Italian IRCCS cancer centers. One of the major OECI requirements that a cancer center must fulfill in order to achieve and maintain OECI certification is a strong emphasis in translational and clinical research: increasing the number of patients enrolled in clinical trials, establishing easily accessible databases for operators, and informing all possible stakeholders, including patients. A characterizing theme of INT-Pascale is a strong commitment to clinical experimental studies. In the 2007-2014 period, 440 clinical trials were activated at INT-Pascale; in this period, the number of clinical trials and observational studies has had an increment achieving in 2014, respectively, the share of 60 clinical trials and 35 observational studies activated. Optimization of clinical trials management and dissemination of the clinical research culture at INT-Pascale are main objectives to be achieved through several actions and procedures being implemented as a component of the OECI improvement plan. Participation in the OECI program has represented an important challenge to improve quality and processes related to promoting, prioritizing, and monitoring clinical trials at INT-Pascale.

OECI accreditation of the European Institute of Oncology of Milan: strengths and weaknesses.

The European Institute of Oncology began the process to reach the accreditation promoted by the Organisation of European Cancer Institutes (OECI) in 2012. This accreditation integrates the quality and safety path started in 2001 with accreditation by the Joint Commission International. Despite the presence of diversified accreditations and certifications and the clear need of time, effort, and commitment, the models are complementary. Each model is not to be considered as an end but as a tool for improvement: e.g., mixing accreditation standards led to an improvement in the quality and safety of processes. The present article details the OECI accreditation experience of the European Institute of Oncology, in particular the following strengths of OECI standards: collaboration among several involved parties (patient, volunteer, patient's general practitioner) in the clinical and quality/safety processes; a larger involvement of support personnel (psycho-oncologists, dieticians, physical therapists); and the development of clinical/translational research and innovation in prevention, diagnosis, and treatment to guarantee the best available practice in diagnosis and treatment. The OECI accreditation is specific to oncology and therefore its standards are tailored to a cancer center, both in terms of language used in the standards manual and in terms of patient needs. The OECI accreditation system puts an auditor team with a standards manual in charge of verifying quality and confirms the definition of IEO as a Comprehensive Cancer Center.

The Comprehensive Cancer Care Network of Romagna: the opportunities generated by the OECI accreditation program.

Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS is a public-private partnership among 3 public sector bodies and 6 private nonprofit organizations and represents the hub of the Oncology Network of Romagna, which provides a wide range of services for the population ranging from primary prevention to palliative care. In 2012, IRST took part in the ministerial research project of the Organisation of European Cancer Institutes (OECI) accreditation program for Comprehensive Cancer Centers. The self-assessment period lasted 6months and was coordinated by a multidisciplinary project team headed by a project leader. Each project team member coordinated a subgroup whose task was to analyze specific standards from qualitative and quantitative questionnaires. During the self-assessment period for the areas in which IRST did not meet OECI requirements, the project team outlined several improvement plans. At the end of the self-assessment period, the OECI Accreditation & Designation Board approved the documentation presented by IRST and a peer review visit was scheduled. The OECI report suggested establishing a more specific and stronger centralized management and leadership of all the oncologic activities carried out in other centers. In accordance with these suggestions, IRST and the Local Health Authority of Romagna laid the foundations for a new management model for the Oncology Network of Romagna: the Comprehensive Cancer Care Network (CCCN). The CCCN is a territory-oriented model (population approach) based on a principle of cooperation and collaboration among the network nodes.

Participation of Italian Cancer Centres of the Alleanza Contro Il Cancro (ACC) in the Organisation of European Cancer Institutes (OECI) Accreditation and Designation program: a successful first national initiative.

The Organisation of European Cancer Institutes (OECI) launched a program for accreditation and designation (A&D) of cancer centers in Europe based on voluntary participation in 2008. In 2012, the Italian Ministry of Health decided to fund cancer centers in Italy, members of the Alleanza Contro il Cancro (ACC), to go through the OECI accreditation program. Ten centers participated in the program and 10 completed the full cycle of the OECI A&D process in consecutive series over a 2-year period. The process was successfully completed within the planned timeline and the overall findings were presented to the Italian Ministry of Health and representatives of all the participating centers in November 2015. The program had a considerable team-building effect, which will likely continue as the improvement plans are implemented. Centers fed back to OECI that the A&D program had led to better formal organization of multidisciplinary teams (MDTs) and cancer care pathways, and had helped them to harmonize the integration of research into clinical practice. Centers also concluded that they benefited from recognition through an international accreditation system, and that it had led to them developing better patient information and involvement. The importance of the improvement plans that each center had to produce following the audit reviews cannot be underestimated. The OECI concludes that implementation of the A&D program at the national level is feasible despite national peculiarities related to health planning and organization in each member state. This is a good example of an EU project working well, with member states helping each other and learning from best practice, to improve the overall quality of cancer care and research and to establish consistency. The initial accreditation is the first part of an ongoing process of improving comprehensive cancer care, integrating bench to bedside.

The European accreditation of Istituto Tumori Giovanni Paolo II of Bari.

The National Cancer Institute of Bari (Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS) has been involved since the conception of the project of the Italian Ministry for Health aimed to validate the applicability of the Organisation of European Cancer Institutes (OECI) accreditation and designation (A&D) model to the Network of Italian Cancer Centers, IRCCS, of Alleanza Contro il Cancro. The self-assessment phase of the Institute started in September 2013 and ended in June 2014. All documents and tools were transferred to the OECI A&D Board in June 2014 and a 2-day peer review visit was conducted in October 2014 by an international qualified audit team. The Institute received its final designation and certification in June 2015. The OECI A&D Board, in its final report, came to the conclusion that Istituto Tumori "Giovanni Paolo II" of Bari has a strong research component with some essential elements of comprehensive cancer care still under development; the lack of a system for using outcome data for the strategic management approach to decision-making and missing a regular internal audit system eventually helping further quality improvement were reported as examples of areas with opportunities for improvement. The OECI A&D process represented a great opportunity for the cancer center to benchmark the quality of its performance according to standard parameters in comparison with other international centers and to further develop a participatory group identity. The common goal of accreditation was real and participatory with long-lasting positive effects. We agree with the OECI comments about the next areas of work in which the Institute could produce future further efforts: the use of its powerful IT system as a means for outcome analysis and empowerment projects for its cancer patients.

The OECI model: the experience of INT Milan with a focus on the integration of psycho-oncology support.

The procedure for Organisation of European Cancer Institutes (OECI) accreditation identified the formation of MDTs for the diagnosis and scheduling of primary treatment with integration of supportive care as a key strength at Istituto Nazionale Tumori (INT). The opportunities for improvement highlighted by the OECI peer review inspired a study on the evaluation of psychological distress, with a view to integrating this evaluation into global patient management and to defining standardized criteria for the provision of psychological services. This article describes the OECI accreditation experience at INT and the study conducted between January and May 2015 on the evaluation of patients' distress levels during cancer treatment, defining a score-based cutoff point that triggers the intervention of a psychologist. The Distress Thermometer was used as a tool for evaluating psychological distress, performed by nurses on admitting the patient. A total of 261 questionnaires were completed by patients admitted to the medical oncology and hematology departments, with an average distress value of 4.1, and 60% of patients experiencing clinically detectable emotional distress. Emotion-related problems had a significant association with a greater level of distress, while there were few reports of relationship issues as a cause of distress. As a result of the improvement initiative supported by the psychological distress evaluation study, we validated the screening questionnaire to be included at the initial patient evaluation stage with a cutoff point triggering the intervention by a psychologist at a score of ≥7.