Transcript Where are we going wrong? The story behind unneccessary

Where are we going « wrong »?
• Lack of coordination between the disciplines
• Implication for the Patient
– Not informed on the next steps
– Not informed on when where and what by whom
(loss of autonomy)
– No guidelines publically available
• BUT does the medical training focus on
coordination or on being good in its
profession???
• Are the medical specialist well trained?? Huge
difference over Europe!
Where are we going « wrong »?
• Availability of guidelines on diagnosis and
treatment
• BUT are these evidence based? If so why are
they different between regions or countries??
• And what is evidence –based? what is the
right treatment? Personlised medicine
• GLs:Not applicable to all patients (how to
explain this to patients but also to insurance
companies)
Where are we going « wrong »?
• Depending on the GDP or NHE more or less
high tech equipments available: MRI,PET
scans, radiotherapy….but usually very
expensive drugs are available in poor
countries!!!
• Role (lobby) of pharmaceutical industries
EUROCARE-4
5-year relative survival, all cancers
countries are orded by Total Expenditure on Healh
Europe
Berrino F. et al, The Lancet Oncology, 2007
Where are we going « wrong »?
• What is a dedicated team? Or what is a
« good » hospital??
• How to measure this?
• Volume per specialist ??? Volume per
hospital?? NO: but volume per team
But how to deal with this in a poor country with
only a few inh/km2?
Model for comprehensive
oncological pathway
Where are we going « wrong »?
• Starting a population-based screening
programme (political decision)
– without any possibility to treat the referred
patient adequatly (no specialized surgeon, no
radiotherapy equipment…)
– Without any possibility of evaluation of the effect
of the screening (no monitor instrument as a CR
including stage)
Where are we going « wrong »?
• More survivors due to better survival: new
« problem »:
• Rehabilitation into the society
• Back to work
• Who can give this kind of support to the
patients? Who is paying for this?
Where are we going « wrong »?
• Antismoking campaigns? Not succesful
because of the lobby of the tobacco industry:
political issue!!!
• Health is less important than the economy:
« the cheapest patient is the one who dies
very fast, and never reaches his retirement »
In conclusion
• We miss the comprehensive approach (NCCP)
• We forget to consider the patient as a respectful
« normal » person
• We always blame the doctors but they work
within the health care system as build in their
country
• We are still dealing with what is GOOD as we re
not aware of all the factors responsible for
GOOD outcome
• we still miss very important information on
cancer care indicators
Growth of cancer
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2
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Histologie