Balance between the centralisation and availability of cancer care: Institute of Biostatistics and Analyses develops the European model of a Comprehensive Cancer Care Network
The Czech Republic has become a key player in European activities focusing on the development and assessment of cancer care; the Cancer Control Joint Action (CanCon) undoubtedly belongs to the most prestigious ones. Based on the Czech information system of cancer care, the Czech Republic has been selected as a model country for the development of a Comprehensive Cancer Care Network (CCCN). This part of the CanCon project is coordinated by Prof Lucio Luzzatto from the Tumour Institute of Tuscany (Istituto Toscano Tumori, ITT), who paid a visit to Brno on 24 April 2015 not only to learn about the Czech results up to now, but also about cancer research and health care provided to cancer patients in the Czech Republic in general, and in the South Moravian Region in particular.
The first item of Prof Luzzatto’s programme in Brno was a visit to the Institute of Biostatistics and Analyses of the Masaryk University. The meeting was attended by Prof Jan Zaloudik (Director of the Masaryk Memorial Cancer Institute), Prof Jaroslav Sterba (Senior Consultant of the Department of Paediatric Oncology at University Hospital Brno), Prof Vlastimil Valek (Senior Consultant of the Department of Radiology at University Hospital Brno), and Assoc Prof Ladislav Dusek (Director of the Institute of Biostatistics and Analyses of the Masaryk University, and the official representative of the Czech Republic in the CanCon project). Dr Dusek presented the current state of development on a model of CCCN, as well as the nationwide information system, which is used to map and to assess the Czech cancer care. This information system makes it possible to monitor and to assess the availability of cancer care, the flow of cancer patients, the performance of prevention programmes, quality of diagnostics, and results of treatment. In this area, as even Prof Luzzatto noted, the Czech Republic leads the way among European countries.
In the afternoon, the Italian guest paid a visit to the Masaryk Memorial Cancer Institute (MMCI). Assoc Prof Dalibor Valik and Prof Jan Zaloudik introduced the institute’s history, care provided to cancer patients, and cancer research activities. At the beginning of his lecture entitled “Causes of cancer, the organization of cancer services, and the role of chance”, Prof Luzzatto focused on the organisation of cancer care, noting that the best care to cancer patients is provided by those health care facilities which are also involved in cancer research. At the same time, more demanding diagnostic and therapeutic processes need to be centralised in facilities which have the most experience and an adequate background; the opposite approach might lead to a “risk of diluting excellence”, said Prof Luzzatto. A good organisational model, however, must ensure that cancer care is available to all patients, including an equal access to modern treatment methods – and this is not easy to achieve. As an example of solution, Prof Luzzatto described the Tumour Institute of Tuscany, which is physically located in three Italian university cities (Florence, Pisa, and Siena), but formally represents a single institute. Figuratively speaking, the institute does not bring patients to one centre; on the contrary, it distributes cancer care all over the region. This approach requires a very careful setting of all procedures related to the patient pathway through cancer care, quality standards, and other essential elements. “With a bit of exaggeration, we cannot let happen a situation that after an operation, for example, the surgeon tells the patient to find a good radiotherapist for himself/herself”, explained Prof Luzzatto. Establishing a really comprehensive cancer care network is therefore a challenge, which is dealt with by different European countries with varying degrees of success. Thanks to the Czech National Cancer Control Programme and other activities in the area of cancer care, the Czech Republic ranks among the more successful ones.
The second part of Prof Luzzatto’s lecture was dedicated to the causes of malignant tumours and to cancer treatment approaches. Prof Luzzatto compared the influence of inheritance and of the environment on the development of diseases in general and on the development of selected cancer types, and summarised the current position of different cancer treatment modalities. At the end of his lecture, Prof Luzzatto noted that although each person is in the hands of Goddess Fortuna as regards cancer development, there are many risk factors which can promote this process, and many other factors which might decrease the risk of cancer development. Risk factors can be avoided in many cases, including smoking, which is the most important among the negative environmental factors.
After a discussion with the MMCI staff, Prof Luzzatto visited the Central European Institute of Technology (CEITEC). As he previously specialised in haematology, Prof Luzzatto discussed with Prof Sarka Pospisilova, coordinator of the Molecular Medicine programme, genomic research of various types of leukaemia, and the ways of transferring this knowledge to clinical practice. They also discussed the pathogenesis of chronic lymphocytic leukaemia, namely the prognostic significance of the mutation status of immunoglobulin genes, the significance of specific B-cell receptors, as well as the issue of leukaemic cell clones and their monitoring in the course of the disease.
This visit by the Italian expert has confirmed that the Czech Republic is in a fair way to become a leading European country as regards cancer care. It is however obvious that there is much work ahead of us.
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