Status of Art of Cancer Center in Europe

A. Paradiso
Scientific Director
NCC Bari, Italy

National Cancer Center

Bari, Italy
 NCC
Bari, Italy

Recent 5 years cancer survival(%) data in selected European Countries

EUROCARE-4 data. (Lancet Oncology,2007).

Eurocare-4 mean
Survival (%)
Overall 52.1
Men
47.3
Women
55.8
Breast cancer 79.0

Colorectal cancer 56.2

Lung cancer 10.9

Investments for Research in EU15 (Year 2003)
 NCC
Bari, Italy

THE TRIANGLE OF TRANSLATIONAL RESEARCH

epidemiological research
(registry-based, reality-based)

basic research clinical research

(laboratory-based) (clinical trials, evidence-based)
 NCC
Bari, Italy

Patient Management PALLIATION

Supportive Pain
SCREENING
REAHBILITATION

Radiodiagnostics Genetic Counselling FOLLOW UP

Prevention Program Clinics New biomarkers

Psycological distress
DIAGNOSIS
RADIATION ONCOLOGY
Radiodiagnostics

Microhistology SURGERY Linac Predictive Bt

Phisics Diagnostics
Citology Nuclear Imaging
Phisics MEDICAL TREATMENT
New Biomarkers Surgery hall Pathology Service
Bioimaging
IORT Genetic Counselling
Clinical Trials Predictive biomarkers/
patients

Immunohistochemicals
 NCC
Bari, Italy

Categorization of cancer structures:

the European philosophy

• Cancer Unit:
clinical facility with at least RT+Med Onc+Surg
• Clinical Cancer Center:
covering a sufficient degree of RT, MedOnc, Surg, RT
occasionally clinical trial activities
• Cancer Research Center:
capacity in cancer research focusing in one or more
areas of fundamental or translational oncology
• Comprehensive Cancer Center:
covering several aspects of oncology treatment and
research; high level of integration, infrastructure,
expertise and innovation
OECI Survey on Organization characteristics of CCC in Europe:
Infrastructures focused on cancer research

• Epidemiology 95%
• Genetics 95%
• Molecular Biology 90%
• Immunology 90%
• Stem cell 79%
• Animal facility 75%
• Biobank 90%
• QL assessment 63%
OECI Survey on Organization characteristics of CCC in Europe:
Clinical Facilities

• Preventive service 48%

• Screening high risk patients 91%
• Operating Rooms >5
• Radiotherapy >2 Lineac
• Nuclear medicine 82%
• Pathology 100%
• Hematology 85%
• Pharmacy-Chem 100%
• PschosocialUnit 100%
• Palliative Care 100%
• Supportive Care 60%
OECI SURVEY ON Organization characteristics of CCC in Europe:
Clinical Trials Ongoing

• Phase I Trial mean 10

• Phase II Trial mean 29
• Phase III Trial mean 41
• Phase IV Trials mean 9
 NCC
Bari, Italy

Education in oncology: the experience in the European

Cancer Centers. A survey.

5. Is the structured scientific programme

12. Do you organize educational activities addressed
differentiated for:
to patients?
35,0%
30,0% 80,0%
25,0% 29,5%
20,0% 2 4 ,6 %
2 3 ,0 %
60,0%
15,0%
10,0% 13 ,1%
40,0%
5,0%
0,0%
9 ,8 %
20,0%
Physicians Researchers Nurses Psycologists Other 0,0%
disciplines
Yes No
 NCI
Bari, Italy

National Cancer Center of BARI Beds 120

Day Hospital 32

Surgery hall 5
LIneac 2

TAC 3
RMN 2
Pet 1

Operators
MD 98
Nurses 350
Overall 610
National Cancer Center – Bari, Italy

e
ORGANIZATION STRUCTURE
Scientific Direction-Management Direction

Department of Experimental Laboratory Oncology

Department of Pathology and Diagnostic Facilities

Women’s Department

Gastrointestinal Department

Upper Aerodigestive Department

Department of Experimental Medical Oncology

Department of Critical-Palliative Care

 National Cancer Center- Bari Italy
t
Research Areas 2009-2011

Area 1 –EPIDEMIOLOGY, GENETIC RISK FACTORS, LIFE

HABITS AND PREVENTION STRATEGIES
Area 2 – INNOVATIVE TECHNICAL AND LABORATORY
APPROACHES
Area 3 – NEW MULTIDISCIPLINARY/MININVASIVE
THERAPEUTIC APPROACHES
Area 4 – SUPPORTIVE CARE
Area 5 – NEW MANAGEMENT AND ORGANIZATION
MODELS
 NCC
Bari, Italy
Genetic Risk factors
HEREDITARY BREAST CANCER:A CHARACTERISTIC GENEAOGIC
TREE
 NCC
Laboratory Innovation Bari, Italy

Institutional Biobank-NCC Bari

Duval n. 10 Freezer -80C n.12 Samples Stored > 20.000

 NCC
Bari, Italy

YEARLY MANAGEMENT COSTS FOR AN INSTITUTIONAL BIOBANK:

A survey on 15 Italian Biobanks coordinated by NCC-Bari

costi/spese (analisi delle mediane)

Mean costs
800000

700000

600000

500000
costo (€)

400000

300000

200000

100000

0
personale locali corsi formazione
0 1 2
strumentazione 3 4
materiali 5 6
altro 7

Mean costs: 115.000 Euros (range 24.000-230.000)

 NCC
Bari, Italy

Colospheres from different sites

Normal Tumour Metastasis

human breast tumors initiating

cells CD44+/CD24-
A

B
Circulating tumor cells:
 NCC
Bari, Italy

Activated Multidisciplinary Teams in NCC Bari, Italy

• Gastrointestinal Cancer
• Women Cancer
• Head and Neck Cancer
• Skin Cancer

Teams meet every week with:

Biologist, Pathologist,
Radiologist, Surgeon,
Radiotherapist Medical Oncologist,
Nurse, Psychologist,
General Practitioner Volunteers

Sidhom, Lancet Oncol, 2006

 NCC
Bari, Italy

Single- Step transarterial chemoembolization and

radiofrequency ablation for Liver and Lung Cancer

Gadaleta, In Vivo, 2009

 NCC
Bari, Italy

Continuous Education in Oncology:

Activities in Progress in NCC-Bari, Italy

•E-learning sessions (in collaboration with ESO)

•Cancer Research Nurse Courses

-Cohoperation to Clinical Trials

-Palliative Care Nursing

-Treatment Toxicity Management

 NCC
Bari, Italy

Characteristics of the NCC of Bari, Italy

Management and Medical Summary
• 45 clinical trials ongoing n.45
• Annual IF for scientific publications(2007) n.280

• Annual budget $ 61.5 M

• Annual budget for research activities $ 7.3 M

• Funding Agencies
Regional Health System (pay/perform) 75%
National HS (Quality of Care/Research) 10%
Private/others (Special Projects) 15%
Eckhouse, Mol Onc,2008
 NCC
Bari, Italy

National Cancer Center

Conclusion (1)
• Complexity >> full range of facilities
• Integration >> multidisciplinary approach
• Innovation >> funds for new technologies
• Education >> funds for personnel
 NCC
Bari, Italy

Regional Cancer
Network-Puglia
Take in charge of the patient along all the
diagnostic-therapeutic-palliative pathway
to guarantie updated and optimal care

NCC-BARI within the Regional Cancer Network-Puglia

Production of Guide Lines
Production of Health Technology Assessments
Cancer Education Provider
Coordinator
Regional Biobanks
Clinical research
Translational Research
 The National Network
ALLEANZA CONTRO IL CANCRO
Board Members

Istituto Nazionale per lo Studio e la

Cura dei Tumori, Milano;
Centro di Riferimento Oncologico,
Aviano
Istituto Europeo di Oncologia, Milano;
Istituto Nazionale per la Ricerca sul
Cancro, Genova;
Istituto Nazionale per lo Studio e la
Cura dei Tumori - Fondazione Giovanni
Pascale, Napoli;
Istituto Regina Elena per lo Studio e
la Cura dei Tumori, Roma;
Istituto Oncologico, Bari;
 NCC
Bari, Italy

National Cancer Center

Conclusion (2)
• Complexity >> full range of facilities
• Integration >> multidisciplinary approach
• Innovation >> funds for new technologies
• Education >> funds for people

• Referent for a Territory

 Italian National Network NCC EUROPE
ALLEANZA CONTRO IL CANCRO European Community

The Italian Networks of ACC T European Infrastructures

Cancer Registries
Biobanks
& Biomolecular Resources
National Network for Clinical
Studies and GMP facilities
National Network
Guidelines Production-START
R and Networks
A
Eranet European Cancer Reg.
I
N BBMRI -Networking major
biobanking across Europe
I
N ECRIN-Infrastructure for
G Clinical Trials and Biotherapy
CoCanCPG: Production of
P European Cancer Guidelines

Bioinformatics E INSTRUCT (Int. Structural

O Biology Infrastructure)
Pre-clinical models
P
and “animal facilities” EATRIS –Translational
L
Hereditary Tumors Research Infrastructure
E
Telepathology TESEO Accreditation

PREPARING THE MODEL FOR A NATIONAL TRASLATIONAL RESEARCH INFRASTRUCTURE

Organisation of European Cancer Institutes
 European Organization of Cancer Institutes
Activities

• Project of Accreditation of Cancer Centers

(M.Sagatchian, IGR, Paris)
• Project of Education/Training
(A.Paradiso, NCC, Bari)
• Project of Guidelines Production
(B Fervers, L Berard, Lyon)
• Project of Pathobiology
(P Riegman, Erasmus-Rotterdam,NL)
 NCC
Bari, Italy

National Cancer Center

Conclusion (3)
• Complexity >> full range of facilities
• Integration >> multidisciplinary approach
• Innovation >> funds for new technologies
• Education >> funds for people

• Referent for a Territory

• Living within International Scientific World

 NCC
Bari, Italy

The Triangle of Comprehensive Cancer Center Life

Comprehensive Cancer Center

Innovation

Territory International Scientific World

Epidemiology Research
 The Cancer World

Patients Health
The Cancer Authorities
Centre/institute

Cancer (Research)
Care/research Funders
Professionals (Industry)
and Organisations
Thank you