Bratislava Statement: consensus recommendations for improving pancreatic cancer care

Abstract

Pancreatic cancer is one of the most lethal tumours, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care. This alarming situation is emblematic of a larger group of cancer diseases, known as neglected cancers. To address the impact of these diseases, the European Commission-supported Innovative Partnership for Action Against Cancer launched a multi-stakeholder initiative to determine key steps that healthcare systems can rapidly implement to improve their response. A working group comprising 20 representatives from European medical societies, patient associations, cancer plan organisations and other relevant European healthcare stakeholders was organised. A consensus process based on the results of different studies, discussion of research outcomes, and development and endorsement of draft statements resulted in 22 consensus recommendations (the Bratislava Statement). The statement argues that substantial improvements can be achieved in patient outcomes by centralising pancreatic cancer care around state-of-the-art reference centres, staffed by expert multidisciplinary teams capable of providing high-quality care. This organisational model requires a specific care framework encompassing primary, palliative and survivorship care, and a policy environment prioritising the use of quality criteria and performance assessments as well as research investments dedicated to prevention, risk prediction, early detection and diagnosis. In order to address the challenges posed by neglected cancers in general and pancreatic cancer in particular, a specific control strategy tailored to this reality is required.

Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)

“…First, these pathologies present very different degrees of centralization, with a reduction from 20 to 12 centers for pancreatic cancer and from 51 to 27 centers for rectal cancer. Secondly, surgery for pancreatic cancer is one of the most technically complex and risky surgical interventions performed, while surgery for rectal cancer is a common practice but is considered at the lower limit of a “high complexity” procedure in oncology [ 9 ].…”

“…Such policies aim to reduce clinical practice variability and differences in quality that are not justified by the clinical situation or tumor subtype [ 8 ]. Numerous European strategies indicate the need for a limited number of specialized, multidisciplinary teams to take on cases of pathologies such as pancreatic cancer [ 9 ] or sarcoma [ 10 ], as well as other more common ones, such as breast cancer or other tumours with extensive care and resource requirements [ 11 ]. Such care scenarios increase the distance that many patients have to travel to reach reference centers and units, so the sought-after improvement in effectiveness may be countered by a negative impact on equity of access.…”

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Pancreatic Cancer

“…iPAAC has also issued the Bratislava Statement on recommendations for improving pancreatic cancer care [6], which includes implementing policies that promote specialisation and put expert MDTs at the centre of the decision-making process, and identifying reference centres and building on efficient models of centralised care. Following the statement, a report that describes the advantages of multidisciplinary reference centres has been published [7].…”

UEG position paper on pancreatic cancer. Bringing pancreatic cancer to the 21st century: Prevent, detect, and treat the disease earlier and better

“…The U.S. Congress has defined PDAC as a “recalcitrant cancer,” leading to the implementation of a 5‐year effective “Pancreatic Cancer Research and Education Act” involving research for biomarkers of early detection. Similarly, the European Commission‐supported “Innovative Partnership for Action Against Cancer” called PDAC a “neglected cancer” due to its biological aggressiveness, late diagnosis, and lack of effective treatments and therefore prioritized all actions to control this disease 1 . Remarkably, public and private funding for PDAC research over time has been significantly less than for other cancers for which a large impact in their survival has been achieved 2 …”

“…Similarly, the European Commissionsupported "Innovative Partnership for Action Against Cancer" called PDAC a "neglected cancer" due to its biological aggressiveness, late diagnosis, and lack of effective treatments and therefore prioritized all actions to control this disease. 1 Remarkably, public and private funding for PDAC research over time has been significantly less than for other cancers for which a large impact in their survival has been achieved. 2 Facing this situation, the following position paper initiated by members of the UEG Public Affairs and Research committees and coauthored by scientists from six European countries aims to increase awareness for pancreatic cancer among European stakeholders from politics, industry, and academia by identifying areas with immediate need for joint actions.…”