ESTRO 2021 Abstract Book

ESTRO 2021 S1

ESTRO 2021 Abstracts

Saturday 28 August 2021

Teaching lecture: Multidisciplinary research in Europe

SP-0002 Multidisciplinary clinical cancer research: Can we make it better than just the sum of its parts? D. Lacombe 1 1 The European Organisation for Research and Treatment of Cancer (EORTC) , Director General, Brussels, Belgium Abstract Text Cancer clinical research plays a very important part in shaping clinical practice. While traditionally the commercial sector dominates the field of drug development, many questions remain unaddressed in the post marketing space. Optimisation of cancer therapies to define therapeutic strategies is central to establishing standards of care. Questions related to combination, duration, sequence and deescalation typically have been included in the remit of independent researchers. Across disciplines, patient- impactful datasets have been delivered by the non-commercial sector. Independent clinical research programmes attempt to include discipline-specific quality assurance programmes while addressing clinical situations that are not within the remit of the commercial sector. Altogether, these features contribute to the mission and vision needed to deliver patient-centric therapeutic progress. However, not only are multidisciplinary clinical research programmes more challenging than relatively simpler regulatory drug trials, but in addition they are faced with the same regulatory, legal and operational processes in an ever more complex and economically challenging environment. This is further exacerbated in the era of precision oncology, in which early registration of new and expensive anti-cancer agents reach markets with lesser maturity and greater uncertainty, while their cost is a threat to the performance of optimisation trials. High quality multidisciplinary clinical research programmes require central expertise as well as numerous resources at participating sites, adding challenges. Specific protocols address non-drug questions, but radiation oncology or surgery represent the minority of the global research agenda. The reasons are multifactorial and include a lesser degree of awareness and training in methodology both in the academic sector and in the relevant commercial sector, as well as a lack of public investment. Last but not least, as opposed to the drug sector, some technologies and the facilities to receive them must be put in place before they can be tested. As a result of all these reasons, independent investigators often turn to simpler forms of clinical research, such as prospective cohorts or registries. If these approaches do bring some benefits, they also convey a greater uncertainty about the robustness of their conclusions. Because they have to be inclusive of all data to avoid biases as much as possible, they also require an open-minded approach to data sharing, whether using centralised or federated models. Incremental therapeutic progress can be achieved optimally if pre-defined questions are answered using appropriate methodology. “Medical reversal” has been documented for several clinical situations when changing empirically the standards of care. When new methodologies and new solutions for access to data emerge, medical communities should be alerted in order to decide on new standards based on robust methodologies and clinically relevant endpoints. All methodological solutions have their benefits and limits. It is therefore critical that researchers apply them appropriately and reach conclusions taking the limits of the selected methodologies into account. In order to embrace the challenges of the new decade, multidisciplinary partnerships which optimise the expertise and know-how of medical societies and research organisations provide opportunities to prioritise common clinical challenges and conduct appropriate research programmes. Joining forces across disciplines and delivering solid evidence could help our efforts to influence health policy makers to support independent research. Abstract Text The complexity of cancer diagnosis and treatment, with the involvement of several medical specialties, levels of care and hospitals, makes the care organisation relevant in explaining quality of cancer care, both perceived by patients and in terms of clinical outcomes. Multidisciplinary teams (MDTs) working around disease-based tumor boards are the most appropriate way to deal with the clinical decision making, although they are implemented through different ways in the healthcare services. A review of the evidence showed the impact of this approach on improved quality of care and clinical outcomes, even though there are limitations related to the observational nature of most of these studies. Nevertheless, the implementation of MDTs is an ongoing process with different pace and approaches and other endpoints (e.g., care coordination, enrolment to clinical trials) than the clinical ones should be taken into consideration. There are deep changes co-occurring in these times and this could affect how MDTs are conceived and organized. First, the value-based health care would be discussed as an emerging paradigm in cancer care. The contribution of MDTs should consider this framework, which is focused on outcomes as assessed by patients and its associated costs. In this sense, the way patients interact with MDTs could be a relevant point, for instance with the use of PROMs, which together with the information provided by Clinical-Decision Support Systems, modify the exclusive use of medical information by healthcare professionals when making decisions. Networks are another organizational change in the way cancer care is delivered. Whatever way the SP-0003 Multidisciplinary cancer care: Adding value in times of change J.M. Borras 1 , J. Prades 1 1 University of Barcelona, Department of Clinical Sciences, Barcelona, Spain