European Cancer Organisation Essential Requirements for Quality Cancer Care: Hematological malignancies

Abstract

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCCs) are primarily organizational recommendations, giving politicians, managers, oncology teams, patients, and patient advocacy groups a non-technical overview of the elements needed to provide high-quality care throughout the patient journey. They are not clinical guidelines, but define the actions necessary to deliver high-quality care to patients with specific cancer types, here applied to hematological malignancies in Europe.

The recommendations set out an aspirational but realistic standard that should be within reach for most countries, given adequate resourcing. They include the need for (1) fast and easy access to accurate diagnostic tests; (2) clearly established pathways for referral to specialist centers; (3) services to be centralized; (4) continuous monitoring of patient well-being; (5) treatment strategies to be agreed by a core multidisciplinary team; and (6) patients and their families to be involved at all stages of decision-making.

The foundation of ERQCCs is quality. This has become increasingly important in all aspects of healthcare as new and complex treatments come into use and pressure grows on resources. Improving quality means delivering cancer care that is timely, safe, effective, and efficient; that puts the patient at the center; and that gives all people in Europe equal access to high-quality services.

Variations in cancer outcomes and disparities in management and funding across Europe make quality frameworks essential.¹ The European Guide on Quality Improvement in Comprehensive Cancer Control (2017) underscored this fact, recommending comprehensive cancer centers and integrated care networks.² However, while some progress has been made in concentrating expertise for specific tumor types such as breast and prostate cancers, dedicated multidisciplinary units are lacking for most cancers, including hematological malignancies. Recent initiatives such as Europe's Beating Cancer Plan have added a new momentum to quality initiatives, emphasizing multidisciplinary collaboration and timely access to quality treatment, aligning closely with ERQCC principles.

Hematological malignancies (blood cancers) are the fifth most common cancer group in economically developed regions. They include leukemias, lymphomas, and myelomas, with over 100 clinically meaningful subtypes defined by the World Health Organization's Classification of Tumours of Haematopoietic and Lymphoid Tissues and the International Consensus Classification.^3-6 The European Society for Medical Oncology (ESMO) and the European Hematology Association (EHA) have issued clinical practice guidelines for many of the subtypes and these are regularly updated.

The European-Commission-funded HAEMACARE project has produced crude, age-specific, and age-standardized incidence rates for hematological malignancies in Europe, categorized according to morphological subtype.⁷ These were derived from data on 66,371 diagnosed lymphoid malignancies and 21,796 myeloid malignancies recorded between 2000 and 2002 by 44 European cancer registries.

The age-standardized incidence rates were 24.5 (per 100,000) for lymphoid malignancies and 7.55 for myeloid malignancies. Among lymphoid malignancies, the most prevalent subtypes were plasma cell neoplasms (4.62), small B-cell lymphocytic lymphoma/chronic lymphatic leukemia (3.79), diffuse B-cell lymphoma (3.13), and Hodgkin lymphoma (2.41). Meanwhile, the most common myeloid malignancies included acute myeloid leukemia (2.96), other myeloproliferative neoplasms (1.76), and myelodysplastic syndromes (1.24). Lymphoid malignancies with unknown morphology were most prevalent in Northern Europe (7.53), whereas unknown morphology myeloid malignancies were the most common in Southern Europe (0.73).

Overall, the incidence of hematological malignancies was the lowest in Eastern Europe, with lower rates observed in women. Southern Europe showed the highest incidence for most lymphoid malignancies, while the United Kingdom and Ireland showed the highest incidence for myeloid malignancies. Variations in diagnostic and registration criteria significantly contribute to disparities in incidence, alongside differences in the distribution of hematological malignancy risk factors.

Essential requirements for the organization of quality care for people with hematological malignancies are summarized in Table 1.

The core multidisciplinary team should include representation from the following areas.

The information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for hematological cancers. The ERQCC expert group is aware that it is not possible to propose a “one size fits all” system for all countries, but its recommendations aim to set out a realistic standard of quality that is within reach.

All authors were part of a working group planning content of the paper, and then submitting individual contributions based on their own interests and speciality. In addition, John G. Gribben and Leticia Quintanilla-Martinez co-chaired the group and supervised the writing of the paper, which was completed by medical writer Simon Crompton. All authors assessed and commented on successive drafts of the paper.

The authors declare no conflict of interest.

The administration and writing of this paper were supported and paid for by the European Cancer Organisation.