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4. Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study

Author

Botta, L, Gatta, G, Capocaccia, R, Stiller, C, Canete, A, Dal Maso, L, Innos, K, Mihor, A, Erdmann, F, Spix, C, Lacour, B, Marcos-Gragera, R, Murray, D, Rossi, S, Hackl, M, Van Eycken, E, Van Damme, N, Valerianova, Z, Sekerija, M, Scoutellas, V, Demetriou, A, Dusek, L, Krejci, D, Storm, H, Magi, M, Paapsi, K, Malila, N, Pitkaniemi, J, Jooste, V, Clavel, J, Poulalhon, C, Desandes, E, Monnereau, A, Katalinic, A, Petridou, E, Markozannes, G, Garami, M, Birgisson, H, Walsh, P, Mazzoleni, G, Vittadello, F, Cuccaro, F, Galasso, R, Sampietro, G, Rosso, S, Gasparotto, C, Maifredi, G, Ferrante, M, Torrisi, A, Sutera Sardo, A, Gambino, M, Lanzoni, M, Ballotari, P, Giacomazzi, E, Ferretti, S, Caldarella, A, Manneschi, G, Sant, M, Baili, P, Berrino, F, Trama, A, Lillini, R, Bernasconi, A, Bonfarnuzzo, S, Vener, C, Didone, F, Lasalvia, P, Del Monego, G, Buratti, L, Serraino, D, Taborelli, M, De Angelis, R, Demuru, E, Di Benedetto, C, Santaquilani, M, Venanzi, S, Tallon, M, Boni, L, Iacovacci, S, Russo, A, Gervasi, F, Spagnoli, G, Cavalieri d'Oro, L, Fusco, M, Vitale, M, Usala, M, Vitale, F, Michiara, M, Chiranda, G, Sacerdote, C, Maule, M, Cascone, G, Spata, E, Mangone, L, Falcini, F, Cavallo, R, Piras, D, Dinaro, Y, Castaing, M, Fanetti, A, Minerba, S, Candela, G, Scuderi, T, Rizzello, R, Stracci, F, Tagliabue, G, Rugge, M, Brustolin, A, Pildava, S, Smailyte, G, Azzopardi, M, Johannesen, T, Didkowska, J, Wojciechowska, U, Bielska-Lasota, M, Pais, A, Ferreira, A, Bento, M, Miranda, A, Safaei Diba, C, Zadnik, V, Zagar, T, Sanchez-Contador Escudero, C, Franch Sureda, P, Lopez de Munain, A, De-La-Cruz, M, Rojas, M, Aleman, A, Vizcaino, A, Almela, F, Sanvisens, A, Sanchez, M, Chirlaque, M, Sanchez-Gil, A, Guevara, M, Ardanaz, E, Canete-Nieto, A, Peris-Bonet, R, Galceran, J, Carulla, M, Kuehni, C, Redmond, S, Visser, O, Karim-Kos, H, Stevens, S, Gavin, A, Morrison, D, Huws, D, Botta L., Gatta G., Capocaccia R., Stiller C., Canete A., Dal Maso L., Innos K., Mihor A., Erdmann F., Spix C., Lacour B., Marcos-Gragera R., Murray D., Rossi S., Hackl M., Van Eycken E., Van Damme N., Valerianova Z., Sekerija M., Scoutellas V., Demetriou A., Dusek L., Krejci D., Storm H., Magi M., Paapsi K., Malila N., Pitkaniemi J., Jooste V., Clavel J., Poulalhon C., Desandes E., Monnereau A., Katalinic A., Petridou E., Markozannes G., Garami M., Birgisson H., Walsh P. M., Mazzoleni G., Vittadello F., Cuccaro F., Galasso R., Sampietro G., Rosso S., Gasparotto C., Maifredi G., Ferrante M., Torrisi A., Sutera Sardo A., Gambino M. L., Lanzoni M., Ballotari P., Giacomazzi E., Ferretti S., Caldarella A., Manneschi G., Sant M., Baili P., Berrino F., Trama A., Lillini R., Bernasconi A., Bonfarnuzzo S., Vener C., Didone F., Lasalvia P., Del Monego G., Buratti L., Serraino D., Taborelli M., De Angelis R., Demuru E., Di Benedetto C., Santaquilani M., Venanzi S., Tallon M., Boni L., Iacovacci S., Russo A. G., Gervasi F., Spagnoli G., Cavalieri d'Oro L., Fusco M., Vitale M. F., Usala M., Vitale F., Michiara M., Chiranda G., Sacerdote C., Maule M., Cascone G., Spata E., Mangone L., Falcini F., Cavallo R., Piras D., Dinaro Y., Castaing M., Fanetti A. C., Minerba S., Candela G., Scuderi T., Rizzello R. V., Stracci F., Tagliabue G., Rugge M., Brustolin A., Pildava S., Smailyte G., Azzopardi M., Johannesen T. B., Didkowska J., Wojciechowska U., Bielska-Lasota M., Pais A., Ferreira A. M., Bento M. J., Miranda A., Safaei Diba C., Zadnik V., Zagar T., Sanchez-Contador Escudero C., Franch Sureda P., Lopez de Munain A., De-La-Cruz M., Rojas M. D., Aleman A., Vizcaino A., Almela F., Sanvisens A., Sanchez M. J., Chirlaque M. D., Sanchez-Gil A., Guevara M., Ardanaz E., Canete-Nieto A., Peris-Bonet R., Galceran J., Carulla M., Kuehni C., Redmond S., Visser O., Karim-Kos H., Stevens S., Gavin A., Morrison D., Huws D. W., Botta, L, Gatta, G, Capocaccia, R, Stiller, C, Canete, A, Dal Maso, L, Innos, K, Mihor, A, Erdmann, F, Spix, C, Lacour, B, Marcos-Gragera, R, Murray, D, Rossi, S, Hackl, M, Van Eycken, E, Van Damme, N, Valerianova, Z, Sekerija, M, Scoutellas, V, Demetriou, A, Dusek, L, Krejci, D, Storm, H, Magi, M, Paapsi, K, Malila, N, Pitkaniemi, J, Jooste, V, Clavel, J, Poulalhon, C, Desandes, E, Monnereau, A, Katalinic, A, Petridou, E, Markozannes, G, Garami, M, Birgisson, H, Walsh, P, Mazzoleni, G, Vittadello, F, Cuccaro, F, Galasso, R, Sampietro, G, Rosso, S, Gasparotto, C, Maifredi, G, Ferrante, M, Torrisi, A, Sutera Sardo, A, Gambino, M, Lanzoni, M, Ballotari, P, Giacomazzi, E, Ferretti, S, Caldarella, A, Manneschi, G, Sant, M, Baili, P, Berrino, F, Trama, A, Lillini, R, Bernasconi, A, Bonfarnuzzo, S, Vener, C, Didone, F, Lasalvia, P, Del Monego, G, Buratti, L, Serraino, D, Taborelli, M, De Angelis, R, Demuru, E, Di Benedetto, C, Santaquilani, M, Venanzi, S, Tallon, M, Boni, L, Iacovacci, S, Russo, A, Gervasi, F, Spagnoli, G, Cavalieri d'Oro, L, Fusco, M, Vitale, M, Usala, M, Vitale, F, Michiara, M, Chiranda, G, Sacerdote, C, Maule, M, Cascone, G, Spata, E, Mangone, L, Falcini, F, Cavallo, R, Piras, D, Dinaro, Y, Castaing, M, Fanetti, A, Minerba, S, Candela, G, Scuderi, T, Rizzello, R, Stracci, F, Tagliabue, G, Rugge, M, Brustolin, A, Pildava, S, Smailyte, G, Azzopardi, M, Johannesen, T, Didkowska, J, Wojciechowska, U, Bielska-Lasota, M, Pais, A, Ferreira, A, Bento, M, Miranda, A, Safaei Diba, C, Zadnik, V, Zagar, T, Sanchez-Contador Escudero, C, Franch Sureda, P, Lopez de Munain, A, De-La-Cruz, M, Rojas, M, Aleman, A, Vizcaino, A, Almela, F, Sanvisens, A, Sanchez, M, Chirlaque, M, Sanchez-Gil, A, Guevara, M, Ardanaz, E, Canete-Nieto, A, Peris-Bonet, R, Galceran, J, Carulla, M, Kuehni, C, Redmond, S, Visser, O, Karim-Kos, H, Stevens, S, Gavin, A, Morrison, D, Huws, D, Botta L., Gatta G., Capocaccia R., Stiller C., Canete A., Dal Maso L., Innos K., Mihor A., Erdmann F., Spix C., Lacour B., Marcos-Gragera R., Murray D., Rossi S., Hackl M., Van Eycken E., Van Damme N., Valerianova Z., Sekerija M., Scoutellas V., Demetriou A., Dusek L., Krejci D., Storm H., Magi M., Paapsi K., Malila N., Pitkaniemi J., Jooste V., Clavel J., Poulalhon C., Desandes E., Monnereau A., Katalinic A., Petridou E., Markozannes G., Garami M., Birgisson H., Walsh P. M., Mazzoleni G., Vittadello F., Cuccaro F., Galasso R., Sampietro G., Rosso S., Gasparotto C., Maifredi G., Ferrante M., Torrisi A., Sutera Sardo A., Gambino M. L., Lanzoni M., Ballotari P., Giacomazzi E., Ferretti S., Caldarella A., Manneschi G., Sant M., Baili P., Berrino F., Trama A., Lillini R., Bernasconi A., Bonfarnuzzo S., Vener C., Didone F., Lasalvia P., Del Monego G., Buratti L., Serraino D., Taborelli M., De Angelis R., Demuru E., Di Benedetto C., Santaquilani M., Venanzi S., Tallon M., Boni L., Iacovacci S., Russo A. G., Gervasi F., Spagnoli G., Cavalieri d'Oro L., Fusco M., Vitale M. F., Usala M., Vitale F., Michiara M., Chiranda G., Sacerdote C., Maule M., Cascone G., Spata E., Mangone L., Falcini F., Cavallo R., Piras D., Dinaro Y., Castaing M., Fanetti A. C., Minerba S., Candela G., Scuderi T., Rizzello R. V., Stracci F., Tagliabue G., Rugge M., Brustolin A., Pildava S., Smailyte G., Azzopardi M., Johannesen T. B., Didkowska J., Wojciechowska U., Bielska-Lasota M., Pais A., Ferreira A. M., Bento M. J., Miranda A., Safaei Diba C., Zadnik V., Zagar T., Sanchez-Contador Escudero C., Franch Sureda P., Lopez de Munain A., De-La-Cruz M., Rojas M. D., Aleman A., Vizcaino A., Almela F., Sanvisens A., Sanchez M. J., Chirlaque M. D., Sanchez-Gil A., Guevara M., Ardanaz E., Canete-Nieto A., Peris-Bonet R., Galceran J., Carulla M., Kuehni C., Redmond S., Visser O., Karim-Kos H., Stevens S., Gavin A., Morrison D., and Huws D. W.

Abstract

Background: The EUROCARE-5 study revealed disparities in childhood cancer survival among European countries, giving rise to important initiatives across Europe to reduce the gap. Extending its representativeness through increased coverage of eastern European countries, the EUROCARE-6 study aimed to update survival progress across countries and years of diagnosis and provide new analytical perspectives on estimates of long-term survival and the cured fraction of patients with childhood cancer. Methods: In this population-based study, we analysed 135 847 children (aged 0–14 years) diagnosed during 2000–13 and followed up to the end of 2014, recruited from 80 population-based cancer registries in 31 European countries. We calculated age-adjusted 5-year survival differences by country and over time using period analysis, for all cancers combined and for major cancer types. We applied a variant of standard mixture cure models for survival data to estimate the cure fraction of patients by childhood cancer and to estimate projected 15-year survival. Findings: 5-year survival for all childhood cancer combined in Europe in 2010–14 was 81% (95% CI 81–82), showing an increase of three percentage points compared with 2004–06. Significant progress over time was observed for almost all cancers. Survival remained stable for osteosarcomas, Ewing sarcoma, Burkitt lymphoma, non-Hodgkin lymphomas, and rhabdomyoscarcomas. For all cancers combined, inequalities still persisted among European countries (with age-adjusted 5-year survival ranging from 71% [95% CI 60–79] to 87% [77–93]). The 15-year survival projection for all patients with childhood cancer diagnosed in 2010–13 was 78%. We estimated the yearly long-term mortality rate due to causes other than the diagnosed cancer to be around 2 per 1000 patients for all childhood cancer combined, but to approach zero for retinoblastoma. The cure fraction for patients with childhood cancer increased over time from 74% (95% CI 73–75) in 1998–

Published
2022

6. How public health services pay for radiotherapy in Europe: an ESTRO-HERO analysis of reimbursement

Author

Lievens, Y., Defourny, N., Corral, J., Gasparotto, C., Grau, C., Borras, J., Chauvet, B., Coffey, M., Coza, O., Daisne, J., Hadjieva, T., Jarusevicius, L., Karadjinovic, V., Kouloulias, V., Kozma, E., Kristensen, B., Lopez, A., Mohammed, N., Petera, J., Rolles, M., Roques, T., Russi, E., Sedlmayer, F., Slobina, E., Smichkoska, S., Takácsi-Nagy, Z., Trigo, L., Troost, E. G. C., Untereiner, M., Valgma, M., and Loon, J.

Abstract

Reimbursement is a key factor in defining which resources are made available to ensure quality, efficiency, availability, and access to specific health-care interventions. This Policy Review assesses publicly funded radiotherapy reimbursement systems in Europe. We did a survey of the national societies of radiation oncology in Europe, focusing on the general features and global structure of the reimbursement system, the coverage scope, and level for typical indications. The annual expenditure covering radiotherapy in each country was also collected. Most countries have a predominantly budgetary-based system. Variability was the major finding, both in the components of the treatment considered for reimbursement, and in the fees paid for specific treatment techniques, fractionations, and indications. Annual expenses for radiotherapy, including capital investment, available in 12 countries, represented between 4·3% and 12·3% (average 7·8%) of the cancer care budget. Although an essential pillar in multidisciplinary oncology, radiotherapy is an inexpensive modality with a modest contribution to total cancer care costs. Scientific societies and policy makers across Europe need to discuss new strategies for reimbursement, combining flexibility with incentives to improve productivity and quality, allowing radiation oncology services to follow evolving evidence.

Published
2020

18. SP-0206: The European viewpoint: ESTRO-HERO experience

Author

Lievens, Y., primary, Borras, J.M., additional, Bogusz-Czerniewicz, M., additional, Coffey, M., additional, Dunscombe, P., additional, Hollywood, D., additional, Gasparotto, C., additional, Malicki, J., additional, Slotman, B., additional, and Grau, C., additional

Published
2013
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23. Like Frying Multiple Eggs in One Pan: a Qualitative Study Exploring the Understanding of Inter-speciality Training in Cancer Care

Author

McInally, W, Benstead, K, Brandl, A, Dodlek, N, De Munter, J, Gasparotto, C, Grau-Eriksen, J, Kelly, R G, Lecoq, C, O'Higgins, N, Oliver, K, Popovics, M, Rollo, I, Sulosaari, V, Dede la Los RíosSerna, C Díez, McInally, W, Benstead, K, Brandl, A, Dodlek, N, De Munter, J, Gasparotto, C, Grau-Eriksen, J, Kelly, R G, Lecoq, C, O'Higgins, N, Oliver, K, Popovics, M, Rollo, I, Sulosaari, V, and Dede la Los RíosSerna, C Díez

Abstract

High-quality cancer care is a key priority worldwide. Caring for people affected by cancer requires a range of specific knowledge, skills and experience to deliver the complex care regimens both within the hospital and within the community environment. In June 2022, the European Cancer Organisation along with 33 European cancer societies began working together to develop a curriculum for inter-speciality training for healthcare professionals across Europe. As part of the project, this research consisted of a qualitative survey distributed to the European Union societies via email. The aim of this paper is to disseminate the qualitative findings from healthcare professionals across Europe. Questionnaires were sent out to a convenience sample of 219 healthcare professionals and patient advocates with a response rate of 55% (n = 115). The findings identified that there were four key themes: 'What is inter-speciality training?', 'Barriers and challenges', 'Support throughout the cancer journey' and 'New ways of working'. These results are part of a larger needs analysis and scoping review to inform the development of a core competency framework which will be part of an inter-speciality curriculum for specialist cancer doctors, nurses and other healthcare professionals across Europe. Healthcare professionals will be able to access education and training through the virtual learning environment and workshops and by clinical rotations to other specialties.

24. European Society of Radiotherapy and Oncology (ESTRO) strategy 2024–2026: Growth and diversification in a rapidly changing world.

Author

Kirby, A.M., Guckenberger, M., Slotman, B.J., Clark, C.H., Eriksen, J.G., van der Heide, U., De Ioanna, S., Gasparotto, C., and Cortese, A.J.

Subjects
*BLACK swan theory, *DIGITAL technology, *COVID-19 pandemic, *VALUE capture, *VALUE creation
Abstract

• ESTRO members value access to high-quality scientific content alongside networking opportunities. • A 2023–4 ESTRO strategy review re-evaluated strategic priorities in the wake of a black swan event. • Key ESTRO strategic goals for the years 2024–2026 focused on improving research impact, strengthening and diversifying ESTRO's educational offerings and fostering proactive and mutually beneficial partnerships. • The ESTRO Board approved these objectives, alongside prioritising digital innovation, financial sustainability, and community engagement for ESTRO's continued growth and development. • In essence, ESTRO aims to advocate, empower, expand, and diversify its community, with the overarching goal of enhancing cancer care for patients in Europe, and beyond. In 2019, the European Society of Radiotherapy and Oncology (ESTRO) published its 2030 Vision "Radiation Oncology, Optimal Health, For All, Together". However, in 2020, the global pandemic, coinciding with the Society's 40th anniversary, had long-term consequences on global behaviours and on the financial environment for scientific associations worldwide. In 2022, ESTRO conducted a survey among its members, revealing their strong appreciation for networking opportunities and the creation of high-quality interdisciplinary scientific content. In response to the survey findings and to address the evolving landscape following the COVID pandemic, ESTRO initiated a strategic review process to respond to, and refocus on, the opportunities and challenges ahead. This paper, marking a turning point in ESTRO's strategy for achieving its Vision 2030 in a post-pandemic era, describes the 2022–23 strategic review process, discussions, and consequent recommendations. The comprehensive strategic review process involved: (i) pre-meeting preparations with surveys and strategic documents; (ii) a carefully themed three-day retreat in Brussels incorporating a blend of plenary sessions, workshops focusing on ESTRO's role, value creation and capture, strategic objectives; and (iii) a post-retreat phase including qualitative analysis and development of action plans. The strategic review emphasized the need for adaptive tactics for scientific associations to remain current and productive in the face of changing global conditions. The development of key strategic goals for the years 2024–2026 focused on improving research impact, strengthening and diversifying ESTRO's educational offerings and fostering proactive and mutually beneficial partnerships. The Board approved these objectives, alongside prioritising digital innovation, financial sustainability, and community engagement for ESTRO's continued growth and development. In essence, ESTRO aims to advocate, empower, expand, and diversify its community, with the overarching goal of enhancing cancer care for patients in Europe, and beyond. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study

Author

Laura Botta, Gemma Gatta, Riccardo Capocaccia, Charles Stiller, Adela Cañete, Luigino Dal Maso, Kaire Innos, Ana Mihor, Friederike Erdmann, Claudia Spix, Brigitte Lacour, Rafael Marcos-Gragera, Deirdre Murray, Silvia Rossi, Monika Hackl, Elizabeth Van Eycken, Nancy Van Damme, Zdravka Valerianova, Mario Sekerija, Vasos Scoutellas, Anna Demetriou, Ladislav Dušek, Denisa Krejci, Hans Storm, Margit Mägi, Keiu Paapsi, Nea Malila, Janne Pitkäniemi, Valerie Jooste, Jacqueline Clavel, Claire Poulalhon, Emmanuel Desandes, Alain Monnereau, Alexander Katalinic, Eleni Petridou, Georgios Markozannes, Miklos Garami, Helgi Birgisson, Paul M Walsh, Guido Mazzoleni, Fabio Vittadello, Francesco Cuccaro, Rocco Galasso, Giuseppe Sampietro, Stefano Rosso, Cinzia Gasparotto, Giovanni Maifredi, Margherita Ferrante, Antonina Torrisi, Antonella Sutera Sardo, Maria Letizia Gambino, Monica Lanzoni, Paola Ballotari, Erica Giacomazzi, Stefano Ferretti, Adele Caldarella, Gianfranco Manneschi, Milena Sant, Paolo Baili, Franco Berrino, Annalisa Trama, Roberto Lillini, Alice Bernasconi, Simone Bonfarnuzzo, Claudia Vener, Fabio Didonè, Paolo Lasalvia, Giulia Del Monego, Lucia Buratti, Diego Serraino, Martina Taborelli, Roberta De Angelis, Elena Demuru, Corrado Di Benedetto, Mariano Santaquilani, Serenella Venanzi, Marco Tallon, Luca Boni, Silvia Iacovacci, Antonio Giampiero Russo, Federico Gervasi, Gianbattista Spagnoli, Luca Cavalieri d'Oro, Mario Fusco, Maria Francesca Vitale, Mario Usala, Francesco Vitale, Maria Michiara, Giorgio Chiranda, Carlotta Sacerdote, Milena Maule, Giuseppe Cascone, Eugenia Spata, Lucia Mangone, Fabio Falcini, Rossella Cavallo, Daniela Piras, Ylenia Dinaro, Marine Castaing, Anna Clara Fanetti, Sante Minerba, Giuseppina Candela, Tiziana Scuderi, Roberto Vito Rizzello, Fabrizio Stracci, Giovanna Tagliabue, Massimo Rugge, Angelita Brustolin, Santa Pildava, Giedre Smailyte, Miriam Azzopardi, Tom Børge Johannesen, Joanna Didkowska, Urszula Wojciechowska, Magdalena Bielska-Lasota, Ana Pais, Ana Maria Ferreira, Maria José Bento, Ana Miranda, Chakameh Safaei Diba, Vesna Zadnik, Tina Zagar, Carmen Sánchez-Contador Escudero, Paula Franch Sureda, Arantza Lopez de Munain, Marta De-La-Cruz, Marìa Dolores Rojas, Araceli Aleman, Ana Vizcaino, Fernando Almela, Arantza Sanvisens, Maria Josè Sanchez, Maria Dolores Chirlaque, Antonia Sanchez-Gil, Marcela Guevara, Eva Ardanaz, Adela Cañete-Nieto, Rafael Peris-Bonet, Jaume Galceran, Maria Carulla, Claudia Kuehni, Shelagh Redmond, Otto Visser, Henrike Karim-Kos, Sarah Stevens, Anna Gavin, David Morrison, Dyfed Wyn Huws, Botta, L, Gatta, G, Capocaccia, R, Stiller, C, Canete, A, Dal Maso, L, Innos, K, Mihor, A, Erdmann, F, Spix, C, Lacour, B, Marcos-Gragera, R, Murray, D, Rossi, S, Hackl, M, Van Eycken, E, Van Damme, N, Valerianova, Z, Sekerija, M, Scoutellas, V, Demetriou, A, Dusek, L, Krejci, D, Storm, H, Magi, M, Paapsi, K, Malila, N, Pitkaniemi, J, Jooste, V, Clavel, J, Poulalhon, C, Desandes, E, Monnereau, A, Katalinic, A, Petridou, E, Markozannes, G, Garami, M, Birgisson, H, Walsh, P, Mazzoleni, G, Vittadello, F, Cuccaro, F, Galasso, R, Sampietro, G, Rosso, S, Gasparotto, C, Maifredi, G, Ferrante, M, Torrisi, A, Sutera Sardo, A, Gambino, M, Lanzoni, M, Ballotari, P, Giacomazzi, E, Ferretti, S, Caldarella, A, Manneschi, G, Sant, M, Baili, P, Berrino, F, Trama, A, Lillini, R, Bernasconi, A, Bonfarnuzzo, S, Vener, C, Didone, F, Lasalvia, P, Del Monego, G, Buratti, L, Serraino, D, Taborelli, M, De Angelis, R, Demuru, E, Di Benedetto, C, Santaquilani, M, Venanzi, S, Tallon, M, Boni, L, Iacovacci, S, Russo, A, Gervasi, F, Spagnoli, G, Cavalieri d'Oro, L, Fusco, M, Vitale, M, Usala, M, Vitale, F, Michiara, M, Chiranda, G, Sacerdote, C, Maule, M, Cascone, G, Spata, E, Mangone, L, Falcini, F, Cavallo, R, Piras, D, Dinaro, Y, Castaing, M, Fanetti, A, Minerba, S, Candela, G, Scuderi, T, Rizzello, R, Stracci, F, Tagliabue, G, Rugge, M, Brustolin, A, Pildava, S, Smailyte, G, Azzopardi, M, Johannesen, T, Didkowska, J, Wojciechowska, U, Bielska-Lasota, M, Pais, A, Ferreira, A, Bento, M, Miranda, A, Safaei Diba, C, Zadnik, V, Zagar, T, Sanchez-Contador Escudero, C, Franch Sureda, P, Lopez de Munain, A, De-La-Cruz, M, Rojas, M, Aleman, A, Vizcaino, A, Almela, F, Sanvisens, A, Sanchez, M, Chirlaque, M, Sanchez-Gil, A, Guevara, M, Ardanaz, E, Canete-Nieto, A, Peris-Bonet, R, Galceran, J, Carulla, M, Kuehni, C, Redmond, S, Visser, O, Karim-Kos, H, Stevens, S, Gavin, A, Morrison, D, and Huws, D

Subjects
Retinal Neoplasms, Retinoblastoma, Bone Neoplasms, Sarcoma, Ewing, EUROCARE-6, survival, Burkitt Lymphoma, population-based cancer registrie, Europe, Oncology, Humans, cure fraction, childhood cancer, EUROCARE, Child, chidlhood cancer
Abstract

Background: The EUROCARE-5 study revealed disparities in childhood cancer survival among European countries, giving rise to important initiatives across Europe to reduce the gap. Extending its representativeness through increased coverage of eastern European countries, the EUROCARE-6 study aimed to update survival progress across countries and years of diagnosis and provide new analytical perspectives on estimates of long-term survival and the cured fraction of patients with childhood cancer. Methods: In this population-based study, we analysed 135 847 children (aged 0–14 years) diagnosed during 2000–13 and followed up to the end of 2014, recruited from 80 population-based cancer registries in 31 European countries. We calculated age-adjusted 5-year survival differences by country and over time using period analysis, for all cancers combined and for major cancer types. We applied a variant of standard mixture cure models for survival data to estimate the cure fraction of patients by childhood cancer and to estimate projected 15-year survival. Findings: 5-year survival for all childhood cancer combined in Europe in 2010–14 was 81% (95% CI 81–82), showing an increase of three percentage points compared with 2004–06. Significant progress over time was observed for almost all cancers. Survival remained stable for osteosarcomas, Ewing sarcoma, Burkitt lymphoma, non-Hodgkin lymphomas, and rhabdomyoscarcomas. For all cancers combined, inequalities still persisted among European countries (with age-adjusted 5-year survival ranging from 71% [95% CI 60–79] to 87% [77–93]). The 15-year survival projection for all patients with childhood cancer diagnosed in 2010–13 was 78%. We estimated the yearly long-term mortality rate due to causes other than the diagnosed cancer to be around 2 per 1000 patients for all childhood cancer combined, but to approach zero for retinoblastoma. The cure fraction for patients with childhood cancer increased over time from 74% (95% CI 73–75) in 1998–2001 to 80% (79–81) in 2010–13. In the latter cohort, the cure fraction rate ranged from 99% (95% CI 74–100) for retinoblastoma to 60% (58–63) for CNS tumours and reached 90% (95% CI 87–93) for lymphoid leukaemia and 70% (67–73) for acute myeloid leukaemia. Interpretation: Childhood cancer survival is increasing over time in Europe but there are still some differences among countries. Regular monitoring of childhood cancer survival and estimation of the cure fraction through population-based registry data are crucial for evaluating advances in paediatric cancer care. Funding: European Commission.

Published
2022

27. Postgraduate education in radiation oncology during the COVID-19 pandemic - What did we learn?

Author

Eriksen JG, Boldrini L, Gershkevitsh E, Guckenberger M, van der Heide U, Heijmen B, Joiner M, Nout R, Pruschy M, Rasch C, Tan LT, Verellen D, Vozenin MC, Palmu M, La Porta L, and Gasparotto C

Abstract

Introduction: During the COVID-19 pandemic the ESTRO School who provides international non-profit postgraduate education in Radiation Oncology and related disciplines, including Medical Physics and Radiation Technology, had to close down all live educational activities and turn online, although having only limited experience. The paper describes the experience, discusses the limitations and benefits of online education and suggests directions for the future., Materials and Methods: Data about format and feedback from attendees and faculty members from the course activities held in 2019, 2020 and 2021 were made available from the ESTRO School., Results: In 2020, all but two out of thirty live courses that happened before the lockdown were canceled. Among the 18 courses scheduled in the second half of the year, seven went online with a short notice. Each course planned their activities quite differently, from compressed courses with consecutive full days online program to courses over several weeks with a few hours online a week. Both numbers of participants and different nationalities were higher than live courses in 2019 for the seven courses happening online, and courses were well evaluated by participants and faculties. Roughly-one-third of participants would prefer online courses in the future., Discussion: Although online education was well received by the majority, pros and cons exist and especially the personal discussions and networking were missed. Online education and live education are not comparable but can complement each other. Careful balancing these activities in the future is important and strategies for online andragogy are needed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Published
2022
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28. How public health services pay for radiotherapy in Europe: an ESTRO-HERO analysis of reimbursement.

Author

Lievens Y, Defourny N, Corral J, Gasparotto C, Grau C, and Borras JM

Subjects
Delivery of Health Care, Europe, Health Services economics, Humans, Public Health economics, Health Services standards, Health Services Needs and Demand statistics & numerical data, Neoplasms economics, Neoplasms radiotherapy, Public Health standards, Radiotherapy economics, Reimbursement Mechanisms statistics & numerical data
Abstract

Reimbursement is a key factor in defining which resources are made available to ensure quality, efficiency, availability, and access to specific health-care interventions. This Policy Review assesses publicly funded radiotherapy reimbursement systems in Europe. We did a survey of the national societies of radiation oncology in Europe, focusing on the general features and global structure of the reimbursement system, the coverage scope, and level for typical indications. The annual expenditure covering radiotherapy in each country was also collected. Most countries have a predominantly budgetary-based system. Variability was the major finding, both in the components of the treatment considered for reimbursement, and in the fees paid for specific treatment techniques, fractionations, and indications. Annual expenses for radiotherapy, including capital investment, available in 12 countries, represented between 4·3% and 12·3% (average 7·8%) of the cancer care budget. Although an essential pillar in multidisciplinary oncology, radiotherapy is an inexpensive modality with a modest contribution to total cancer care costs. Scientific societies and policy makers across Europe need to discuss new strategies for reimbursement, combining flexibility with incentives to improve productivity and quality, allowing radiation oncology services to follow evolving evidence., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Published
2020
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29. Radiation Oncology. Optimal Health for All, Together. ESTRO vision, 2030.

Author

Lievens Y, Ricardi U, Poortmans P, Verellen D, Gasparotto C, Verfaillie C, and Cortese AJ

Subjects
Europe, Humans, Neoplasms radiotherapy, Practice Guidelines as Topic, Radiation Oncology, Societies, Medical
Abstract

Radiation oncology has seen considerable change since ESTRO adopted its previous vision statement, less than 10 years ago. The Society has now formulated a new vision for 2030, which remains dedicated to its mission, whilst adapting to evolving contexts and the transforming landscape. Aligning with the new vision, ESTRO has developed strategic priorities for the coming years. This document, written on behalf of the Board and its leadership, describes ESTRO's strategic focus on translating science and evidence into practice, supporting professional development in the discipline, further strengthening the Society and on embracing an active policy-role., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Published
2019
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30. Recommendations for the organisation of care in paediatric radiation oncology across Europe: a SIOPE-ESTRO-PROS-CCI-Europe collaborative project in the framework of the JARC.

Author

Janssens GO, Timmermann B, Laprie A, Mandeville H, Padovani L, Chargari C, Journy N, Kameric L, Kienesberger A, Brunhofer M, Kozhaeva O, Gasparotto C, Kearns P, Boterberg T, Lievens Y, and Vassal G

Subjects
Adolescent, Adult, Child, Child, Preschool, Europe, Humans, Infant, Infant, Newborn, Young Adult, Radiation Oncology
Abstract

Disparities in survival and long-term side-effects from paediatric cancer are observed across European Society for Paediatric Oncology (SIOPE)-affiliated countries. The Joint Action on Rare Cancers (JARC) is a project supported by the European Union and member states aiming to formulate recommendations on rare cancers, including paediatric malignancies, to reduce inequalities and to improve health outcomes. Most paediatric cancers are treated by a combination of systemic agents, surgery and/or radiotherapy. Radiotherapy for children is becoming increasingly complex because of the growing availability of new modalities and techniques and the evolution in molecular biology. These added challenges have the potential to enhance disparities in survival and side-effects between countries, but also among centres in the same country. To tackle radiotherapy-related inequalities, representatives of SIOPE, European SocieTy for Radiotherapy and Oncology, Paediatric Radiation Oncology Society and Childhood Cancer International-Europe defined 'standard' and 'optional' levels to deliver Good Clinical Practice-compliant treatment in paediatric radiation oncology with a focus on patient-related care, education and training. In addition, more than 250 paediatric radiotherapy centres across the SIOPE-affiliated countries have been mapped. For a better understanding of resources in paediatric radiotherapy, JARC representatives are working on an online survey for paediatric radiation oncologists of each centre in SIOPE-affiliated countries. The outcome of this survey will give an insight into the strengths and weaknesses of paediatric radiotherapy across SIOPE-affiliated countries and can be relevant for European Reference Networks in terms of collaboration pathways and referrals in paediatric radiotherapy., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2019
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31. The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis.

Author

Borras JM, Lievens Y, Dunscombe P, Coffey M, Malicki J, Corral J, Gasparotto C, Defourny N, Barton M, Verhoeven R, van Eycken L, Primic-Zakelj M, Trojanowski M, Strojan P, and Grau C

Subjects
Europe, Humans, Incidence, Neoplasms epidemiology, Neoplasms pathology, Neoplasms radiotherapy
Abstract

Background and Purpose: The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated., Material and Methods: The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site., Results: In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries., Conclusions: The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Published
2015
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32. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project.

Author

Borras JM, Barton M, Grau C, Corral J, Verhoeven R, Lemmens V, van Eycken L, Henau K, Primic-Zakelj M, Strojan P, Trojanowski M, Dyzmann-Sroka A, Kubiak A, Gasparotto C, Defourny N, Malicki J, Dunscombe P, Coffey M, and Lievens Y

Subjects
Australia epidemiology, Cooperative Behavior, Europe epidemiology, Female, Humans, Incidence, Male, Neoplasm Staging, Neoplasms epidemiology, Neoplasms pathology, Treatment Outcome, Neoplasms radiotherapy
Abstract

Background and Purpose: The impact of differences in the distribution of major cancer sites and stages at diagnosis among 4 European countries on the optimal utilization proportion (OUP) of patients who should receive external beam radiotherapy was assessed within the framework of the ESTRO-HERO project., Materials and Methods: Data from Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) were used. Population based stages at diagnosis from the cancer registries of Belgium, Slovenia, the Greater Poland region of Poland, and The Netherlands were used to assess the OUP for each country. A sensitivity analysis was carried out., Results: The overall OUP by country varied from the lowest of 48.3% in Australia to the highest of 53.4% in Poland; among European countries the variation was limited to 3%. Cancer site specific OUPs showed differences according to the variability in stage at diagnosis across countries. The most important impact on the OUP by country was due to changes in relative frequency of tumours rather than stage at diagnosis., Conclusions: This methodology can be adapted using European data, thus facilitating the planning of resources required to cope with the demand for radiotherapy in Europe, taking into account the national variability in cancer incidence., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Published
2015
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33. Guidelines for equipment and staffing of radiotherapy facilities in the European countries: final results of the ESTRO-HERO survey.

Author

Dunscombe P, Grau C, Defourny N, Malicki J, Borras JM, Coffey M, Bogusz M, Gasparotto C, Slotman B, Lievens Y, Kokobobo A, Sedlmayer F, Slobina E, De Hertogh O, Hadjieva T, Petera J, Grau Eriksen J, Jaal J, Bly R, Azria D, Baumann M, Takacsi-Nagy Z, Johannson J, Cunningham M, Magrini S, Atkocius V, Untereiner M, Pirotta M, Karadjinovic V, Levernes S, Reinfuss M, Trigo ML, Cernea V, Dubinsky P, Šegedin B, Lopez Torrecilla J, Pastoors B, Taylor R, and Taylor S

Subjects
Europe, Guidelines as Topic, Humans, Radiation Oncology instrumentation, Radiation Oncology methods, Radiotherapy methods, Surveys and Questionnaires, Workforce, Neoplasms radiotherapy, Personnel Staffing and Scheduling standards, Radiation Oncology standards, Radiotherapy instrumentation, Radiotherapy standards
Abstract

Background and Purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe., Materials and Methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses., Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating., Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Published
2014
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34. Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey.

Author

Lievens Y, Defourny N, Coffey M, Borras JM, Dunscombe P, Slotman B, Malicki J, Bogusz M, Gasparotto C, Grau C, Kokobobo A, Sedlmayer F, Slobina E, Coucke P, Gabrovski R, Vosmik M, Eriksen JG, Jaal J, Dejean C, Polgar C, Johannsson J, Cunningham M, Atkocius V, Back C, Pirotta M, Karadjinovic V, Levernes S, Maciejewski B, Trigo ML, Šegedin B, Palacios A, Pastoors B, Beardmore C, Erridge S, Smyth G, and Cleries Soler R

Subjects
Data Collection, Databases, Factual, Europe, Humans, Incidence, Neoplasms radiotherapy, Surveys and Questionnaires, Workforce, Personnel Staffing and Scheduling statistics & numerical data, Radiation Oncology
Abstract

Background: The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database., Materials and Methods: An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO)., Results: A large variation between countries was found for most parameters studied. Averages and ranges for personnel numbers per million inhabitants are 12.8 (2.5-30.9) for radiation oncologists, 7.6 (0-19.7) for medical physicists, 3.5 (0-12.6) for dosimetrists, 26.6 (1.9-78) for RTTs and 14.8 (0.4-61.0) for radiotherapy nurses. The combined average for physicists and dosimetrists is 9.8 per million inhabitants and 36.9 for RTT and nurses. Radiation oncologists on average treat 208.9 courses per year (range: 99.9-348.8), physicists and dosimetrists conjointly treat 303.3 courses (range: 85-757.7) and RTT and nurses 76.8 (range: 25.7-156.8). In countries with higher GNI per capita, all personnel categories treat fewer courses per annum than in less affluent countries. This relationship is most evident for RTTs and nurses. Different clusters of countries can be distinguished on the basis of available personnel resources and socio-economic status., Conclusions: The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants, but also the stage in technology adoption along with treatment complexity and the different professional roles and responsibilities within each country. Our data underpin the need for accurate prediction models and long-term education and training programmes., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Published
2014
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35. Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey.

Author

Grau C, Defourny N, Malicki J, Dunscombe P, Borras JM, Coffey M, Slotman B, Bogusz M, Gasparotto C, Lievens Y, Kokobobo A, Sedlmayer F, Slobina E, Feyen K, Hadjieva T, Odrazka K, Grau Eriksen J, Jaal J, Bly R, Chauvet B, Willich N, Polgar C, Johannsson J, Cunningham M, Magrini S, Atkocius V, Untereiner M, Pirotta M, Karadjinovic V, Levernes S, Sladowski K, Lurdes Trigo M, Šegedin B, Rodriguez A, Lagerlund M, Pastoors B, Hoskin P, Vaarkamp J, and Cleries Soler R

Subjects
Data Collection, Europe, Humans, Neoplasms radiotherapy, Particle Accelerators, Radiotherapy economics, Radiation Oncology instrumentation, Radiation Oncology statistics & numerical data, Radiotherapy instrumentation, Radiotherapy statistics & numerical data
Abstract

Background: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO - the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries., Methods: An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 26-29), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO)., Results: A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.3-1.5) and 1.4 (range 0.4-4.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear relation between socio-economic status, as measured by GNI per capita, and availability of radiotherapy equipment in the countries. In many low income countries in Southern and Central-Eastern Europe there was very limited access to radiotherapy and especially to equipment for IMRT or IGRT., Conclusions: The European average number of MV machines per million inhabitants and per department is now better in line with QUARTS recommendations from 2005, but the survey also showed a significant heterogeneity in the access to modern radiotherapy equipment in Europe. High income countries especially in Northern-Western Europe are well-served with radiotherapy resources, other countries are facing important shortages of both equipment in general and especially machines capable of delivering high precision conformal treatments (IMRT, IGRT)., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Published
2014
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