REVIEW ONCOLOGY

Isolated lung perfusion as additional treatment for lung metastases

The golden standard for the treatment of lung metastases remains complete surgical resection. Prognostic factors for patients with lung metastases are histology, number of metastases and disease-free interval. However, the chance of recurrent disease in the treated lung remains high after complete resection, even in combination with systemic chemotherapy. Systemic toxicity limits the dose of the latter, resulting in only limited local pulmonary control. Therefore, new techniques are developed to deliver a high-dose of chemotherapy selectively into the lung, reducing the risk of systemic toxicity. One of these techniques is isolated lung perfusion, which is comparable with isolated limb perfusion. This experimental surgical technique allows delivery of a very high-dose of chemotherapy with or without biological response modifiers to the lung, without the risk of systemic exposure. Experimental studies with this technique have shown its superiority in achieving higher tissue concentrations of chemotherapy in the target organ as well as improved survival in comparison with systemic chemotherapy. As shown in several phase I studies, this technique is technically feasible with minimal morbidity and minimal impact on pulmonary function. In a recent phase II study, an improved local pulmonary control was found in comparison with the literature. This review discusses the current status of isolated lung perfusion as well as newer, less invasive techniques to deliver high-dose chemotherapy selectively to the lung.

(BELG J MED ONCOL 2015;9(1):5–10)

Geriatric oncology in Belgium

As in other developed countries, the management of older cancer patients has become a major public health concern in Belgium owing to an increasing incidence and to other challenging specificities of this population. Since 2009, the Cancer Plan has played a leading role in the development of geriatric oncology in our country by supporting numerous pilot projects. By the year 2015, a scientific analysis of each of these projects will provide important information to the public authorities and care givers in order to organise the management of older cancer patients in an optimal way in Belgium. In this article, we describe the present landscape of geriatric oncology in Belgium focusing on epidemiological data and pilot projects supported by the Cancer Plan 2009–2011 and 2012–2015.

(BELG J MED ONCOL 2014;8(5):206–12)

Current management of malignant pleural mesothelioma

Malignant pleural mesothelioma remains a lethal disease and its incidence is expected to increase until the 2020’s. Disease extent and performance status at diagnosis are the clinical prognostic factors, besides epithelioid subtype which confers a better outcome than the less common sarcomatoid one. Currently, only administration of palliative chemotherapy has a proven impact on outcome. Treatment of early stage malignant pleural mesothelioma should be offered in a multimodality setting, including at least a systemic and a locoregional treatment. The role of radical surgery remains controversial. Optimal treatment schedules are not defined yet. The standard first line palliative treatment consists of platinum in combination with an antifolate, either pemetrexed or raltitrexed. As the outcome in first line remains modest, it is ethical to include these patients in clinical trials comprising a chemotherapy backbone. For maintenance therapy there’s still no standard in malignant pleural mesothelioma. In second line treatment, referral of patients for inclusion in trials is highly recommended.

(BELG J MED ONCOL 2014;8(5):197–205)

Biomarkers and genomics in prostate cancer

Biomarkers and genomics are making their entrance in daily clinical practice in many tumour types. In prostate cancer, their use is relatively limited. This article reviews biomarkers and genomics used in different clinical settings such as screening, diagnosis, prognosis, prediction and surrogate endpoints for overall survival and shows an unmet need in prostate cancer.

(BELG J MED ONCOL 2014;8(4):104–8)

The development of a safety culture: a fanciful hope in the health care sector?

Patient safety is a dimension of health care quality and a part of organisational safety culture. A deficit in safety culture represents an increased risk for ‘system’ errors. Errors in the health care sector are frequent and seriously harm a significant amount of patients. These errors must be seen as the end-product of accumulation of latent and active failures within the system and not systematically as the result of an individual mistake. The management of system failure to increase patient safety requires a cultural change. A long-lasting ‘blame and shame policy’ is seriously hampering this cultural change as under-registering of near misses and adverse events are the norm!

Organisational safety culture is multi-faceted and multidimensional. The main characteristics of the safety culture will be highlighted, as well as the methods to assess and detect a weakening safety culture. The health care sector faces an enormous challenge and the journey to better and safer care is a never ending road full of stumbling blocks hindering progression, especially in an environment where reduced financial potential will soon become the norm.

(BELG J MED ONCOL 2014;8(3):66–71)

Caring for the oncologist: caregiver stress and staff support in oncology

Although oncology is a very rewarding profession, it can be demanding and stressful. Work-related stress, a lack of meaning in work and problems with work-life balance may lead to distress and burnout. The phenomenon of oncologist distress and burnout is reviewed with a focus on care for the caregiver. A person-oriented approach focusing on promoting personal wellness, factors that bring satisfaction to work, resilience, and positive emotions may provide important coping strategies, adding to the standard focus on job-related factors. Guided intervision may benefit the oncologist and his team by providing a forum for discussing job- and team-related issues, gaining insight through reflection and providing support and meaning-making.

(BELG J MED ONCOL 2014;8(2):38–43)

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO)

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire ‘cancer journey’. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today’s and tomorrow’s professional cancer care.

Reprinted from Annals of Oncology 2014;25(1):9–15 with permission of Oxford University Press.

(BELG J MED ONCOL 2014;8(2):30–7)