Bernd Kasper

Multidisciplinary quality assurance and control in oncological trials: Perspectives from European Organisation for Research and Treatment of Cancer (EORTC)

Quality assurance (QA) programmes are one of the mainstays of clinical research and constitute the pillars on which European Organisation for Research Treatment of Cancer (EORTC) delivers multidisciplinary therapeutic progress. Changing practice treatments require solid evidence-based data, which can only be achieved if integral QA is part of the infrastructure sustaining research projects. Cancer treatment is a multimodality approach, which is often applied either in sequence and/or in combination. Each modality plays a key role in cancer control. The modalities by which QA is applied varies substantially within and across the disciplines. In addition, translational and diagnostic disciplines take an increasing role in the era of precision medicine. Building on the structuring effect of clinical research with fully integrated multidisciplinary QA programmes associated with the solutions addressing the chain of custody for biological material and data integrity as well as compliance ensure at the same time validity of clinical research output but also have a training effect on health care providers, who are more likely to apply such principles as routine. The principles of QA are therefore critical to be embedded in multidisciplinary infrastructure to guarantee therapeutic progress. These principles also provide the basis for the functioning of multidisciplinary tumour board. However, technical, operational and economic challenges which go with the implementation of such programmes require optimal know-how and the coordination of the multiple expertise and such efforts are best achieved through centralised infrastructure.

Health Care Resource Utilization and Costs among Adult Patients with Advanced Soft Tissue Sarcoma: A Retrospective Medical Record Review in the United Kingdom, Spain, Germany, and France

Objective To describe health care resource utilization and costs for patients with advanced soft tissue sarcoma (STS) in the United Kingdom (UK), Spain, Germany, and France. Methods Physicians abstracted data for adult patients with a diagnosis of advanced STS (other than Kaposis sarcoma or gastrointestinal stromal tumor) who received ≥1 lines of systemic therapy. Health care resource utilization related to advanced STS treatment was recorded; associated costs were estimated by applying unit costs. Results A total of 130 physicians provided data for 807 patients (UK: 199; Spain: 203; Germany: 204; and France: 201). The site of care during active treatment varied based on differences in the health care systems of these four countries. Total mean per-patient health care cost in the UK was £19,457; in Spain, €26,814; in Germany, €20,468; and in France, €24,368. Advanced STS-related systemic treatment costs were driven primarily by drug acquisition and administration costs. Treatment-related costs increased during later lines of therapy for all countries except France, where they decreased after first-line therapy. Pain control and antiemetics were the most common supportive care medications. Conclusions This study provides real-world data on resource utilization and estimated costs in advanced STS and could inform policymakers about treatment burden.

Sarkome beim alten und geriatrischen Patienten

Weichgewebesarkome beim alten und geriatrischen Patienten machen mehr als ein Drittel der Gesamtpopulation dieser seltenen Tumorentitat aus. Lokalisation und Grose der Tumoren sowie die verschiedenen biologischen Eigenschaften der Sarkom-Subtypen mussen in den verschiedenen Altersklassen beachtet werden. Haufig werden altere Patienten nur einer eingeschrankten Behandlung unterzogen. Es gibt jedoch keinen Grund, beispielsweise auf eine indizierte adjuvante Strahlentherapie zu verzichten. Ein hoheres Lebensalter darf auch nicht per se eine Kontraindikation fur einen multimodalen Therapieansatz unter Einschluss z. B. einer Chemotherapie sein. Allerdings mussen besondere Aspekte hinsichtlich Sicherheit der Behandlung, Komorbiditaten, Toxizitat und Lebensqualitat beachtet werden. Fur Patienten mit Primartumoren, die einer Resektion nicht zuganglich sind, kann eine definitive Strahlentherapie eine morbiditatsarme Behandlungsalternative darstellen. Der Einsatz eines geriatrischen Assessments und insbesondere der Einsatz von pradiktiven Instrumenten zur Abschatzung der zu erwartenden Chemotherapie-assoziierten Toxizitat sind in diesem Umfeld hilfreich. Osteosarkome beim alten und geriatrischen Patienten stellen eine Raritat dar. Die primare adaquate chirurgische Versorgung der Patienten scheint gerade in dieser Patientenpopulation prognostisch von zentraler Bedeutung zu sein, wahrend die Addition einer Chemotherapie das Uberleben der Patienten nicht signifikant verbessert.