Analysing the attributes of Comprehensive Cancer Centres and Cancer Centres across Europe to identify key hallmarks

Abstract

There is a persistent variation in cancer outcomes among and within European countries suggesting (among other causes) inequalities in access to or delivery of high-quality cancer care. European policy (EU Cancer Mission and Europe's Beating Cancer Plan) is currently moving towards a mission-oriented approach addressing these inequalities. In this study, we used the quantitative and qualitative data of the Organisation of European Cancer Institutes' Accreditation and Designation Programme, relating to 40 large European cancer centres, to describe their current compliance with quality standards, to identify the hallmarks common to all centres and to show the distinctive features of Comprehensive Cancer Centres. All Comprehensive Cancer Centres and Cancer Centres accredited by the Organisation of European Cancer Institutes show good compliance with quality standards related to care, multidisciplinarity and patient centredness. However, Comprehensive Cancer Centres on average showed significantly better scores on indicators related to the volume, quality and integration of translational research, such as high-impact publications, clinical trial activity (especially in phase I and phase IIa trials) and filing more patents as early indicators of innovation. However, irrespective of their size, centres show significant variability regarding effective governance when functioning as entities within larger hospitals.

Keywords: accreditation; clinical trials; comprehensive cancer center; multidisciplinarity; quality standard; translational research.

Fig. 1

Size of OECI Comprehensive Cancer Centres (CCC) and OECI Cancer Centres (CC) in terms of patient numbers and financial budgets. (A) Number of patients newly managed (CCC n = 22, CC n = 18). All numbers reported for individual centres correspond to the index year of the accreditation process. (B) Oncology budget (CCC n = 22, CC n = 17) for cancer care. (C) Research budget (CCC n = 22, CC n = 17). Budget values have been converted to Euros and corrected for purchasing power parity. OECI thresholds for preliminary designation status for CCCs according to A&D Manual 2.0 are indicated with dashed lines. Middle horizontal lines represent the median, and bars represent interquartile ranges, ** P < 0.01, *** P < 0.001 (Mann–Whitney test).

Fig. 2

Centre compliance with OECI qualitative standards. Compliance has been compared between the two designation types across the six main chapters of the OECI qualitative questionnaire (A). Centres have been compared on overall compliance (B) and compliance with the individual chapters (C) (CCC n = 22, CC n = 18). A heat map of individual centre compliance and its designation status is shown in (D). Centres are ordered by rank of total compliance from left to right. Middle horizontal lines represent the mean, and error bars represent the standard deviation, * P < 0.05, ** P < 0.01 (Welch’s t‐test using the Bonferroni adjusted P‐values for multiple comparisons).

Fig. 3

Research output in form of scientific publications and successful patent applications as early indicators of innovation. (A) Sum of all national and international publications in the index year (CCC n = 22, CC n = 18). OECI threshold of 125 publications for preliminary designation status for CCCs according to A&D Manual 2.0 is indicated with a dashed line. (B) Number of high‐impact publications (IF > 10) with the first or last author being a centre member in the index year (CCC n = 21, CC n = 17). (C) Number of high‐impact publications shown in (B) as a percentage of the total publication output shown in (A). (D) Number of filed or granted patents within the last 5 years. Middle horizontal lines represent the median, and bars represent interquartile ranges, ** P < 0.01, *** P < 0.001 (Mann–Whitney test).

Fig. 4

Clinical trial activity in OECI centres. (A) Total number of open clinical trials (interventional studies) (CCC n = 22 CC n = 17). (B) Total number of patients recruited to prospective interventional clinical trials within the index year (CCC n = 21, CC n = 15). (C) Patients recruited as a percentage of all newly managed patients (CCC n = 21, CC n = 15). (D) The number of open phase I and phase I/IIa trials is used as an indicator of centre initiated early clinical development (CCC n = 15, CC n = 11, data not available for A&D Manual v1.0). Dashed lines indicate OECI designation thresholds for CCCs: 75 open trials (A) and 10% of newly managed patients enrolled in prospective interventional trials (C). Middle horizontal lines represent the median, and bars represent the interquartile ranges, *** P < 0.001 (Mann–Whitney test)