In 2008 the Organization of European Cancer Institutes (OECI) wrote an open letter to the European Commission arguing in favour of a project for cancer centre research assessment in Europe.  The OECI, established in 1977 to promote greater cooperation among European cancer centres and institutes in the field of cancer research, believes that in order to fill the gap of translational oncology and to improve the effectiveness of oncology treatment in Europe, cancer centres should be accredited as comprehensive cancer centres (CCC).

Following the model of the US National Cancer Institute registration system for cancer centres, in 2002 the OECI started an accreditation project with three aims:

            a)  develop a comprehensive accreditation system for oncology care, taking into account prevention, care, research, education and networking;

            b) set up an updated database of cancer centres in Europe, with exhaustive information on their resources and activities (in care, research, education and management);

            c)  develop a global labeling tool dedicated to comprehensive cancer centres in Europe. This OECI accreditation tool was launched in autumn 2008 for all cancer centres in Europe (Saghatchian M, et al. Tumori 2008).

Within the ESMO special symposium devoted to the discussion of the first results of the project (Sunday, October 10, 2010), Richard Sullivan (Centre for Global OncoPolicy Integrated Cancer Centre, London) stressed the importance of the assumption about other people's assessment frameworks. Often the assumptions underlying our classifications are part of tacit knowledge and are based on different values, that need to be spelt out if we want to establish a common framework for discussion. The following important questions need to be made explicit: what are we trying to assess, and why? As a general point, every assessment framework deals with the following four methodologies: a) the standard of care being offered, b) the research and development (R&D) aspect; c) the education and training of its professionals, and d) the organisation and management of the centre.

There are objective and subjective assessment methods. An example of the former one is the bibliometric approach developed by Sullivan and co-authors (Sullivan R, et al Eur J Canc 2010) to investigate changes in research activity, relative commitment and collaborations between countries/regions with similar healthcare and similar population and development parameters. The authors analysed United Kingdom, France, Germany, Canada and Sweden and two different cohorts (1995-1999 and 2000-2004) to study the impact of changes on research publications as a surrogate for overall research activity. In this case, the number of research publications (calculated in two different ways) was the explicit denominator of the assessment approach. The denominator must always be made explicit in this kind of assessment of a cancer centre, as it can vary from being the number of publications, the numbers of patients being treated, the numbers of researchers working in a centre, the numbers of grants being received, or a combination of more than one, as pointed out by Sullivan.

Besides these objective methods, there are also subjective assessment frameworks that are as important, and need also to be taken into account. Examples of subjective methods are those offered by the psychology and social sciences, which offer a wide range of tools and narrative based frameworks useful to assess the centres. The incorporation of subjective together with objective framework in the assessment of a cancer centre may be tricky, but it’s a factor that cannot be overlooked.

Another input for novel assessment methodology comes from the analysis of the US Cancer Centre model. Sullivan described what Europe can learn from the US in a recent research paper, where he analysed the salient features of both US Cancer Centres and networks, with a focus on issues around sustainable funding, training and network development (Sullivan R, Mol Onc 2009).

Finally, Sullivan stressed the Western-centre nature of these assessments, which are currently too narrowly focused only on the US and the EU. Next generation of assessment frameworks will need to look also at low and middle income countries (LMIC) and at the nature of cancer centres there. As a final remark, Sullivan raised the point that, as quality or value (of a cancer centre) is a complex interdependent phenomenon, it requires multiple metrics, and the subjective part of the assessment cannot be excluded. Therefore assessment frameworks for cancer centres need to look at a multiplicity of factors and aim to be complex adaptive systems.

References and additional reading

Lewison G, Purushotham A, Mason M, et al. Understanding the impact of public policy on cancer research: a bibliometric approach. Eur J Cancer. 2010;46(5):912-9.

National Cancer Institute designated cancer centres: http://cancercenters.cancer.gov/http://cancercenters.cancer.gov/  (accessed October 18, 2010)

OECI open letter to the European Commission:  www.oeci-eeig.org/Combat_Cancer_RM.aspx (accessed October 18, 2010)

Saghatchian M, Hummel H, Otter R, et al. Towards quality, comprehensiveness and excellence. The accreditation project of the Organisation of European Cancer Institutes (OECI). Tumori. 2008;94(2):164-71.

Sullivan R. Has the US Cancer Centre model been 'successful'? Lessons for the European cancer community. Mol Oncol. 2009 Apr 1.