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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 1 2 4 8 16 32 64 Histologie