Summary

In Europe, survival rates for several types of cancer vary considerably between countries.1 This may be due to differences in lifestyle factors and care-seeking behaviours, but it may also result from unwanted variation in the provision and quality of cancer care.2 In 2002, the Organisation of European Cancer Institutes (OECI) launched the Accreditation and Designation (A&D) Programme to improve and standardise care and research in European cancer centres.3 4 To receive OECI accreditation, centres must undergo a rigorous process of self-assessment and independent audits.3 Since its launch, the A&D Programme has certified 40 centres,5 with an additional 10 currently undergoing accreditation.6 It has contributed to improvements in a number of areas: governance, multidisciplinary care, data collection and analysis, quality and risk management, staff education and training, and cancer research.7

Challenge

Survival rates for cancer have improved across Europe, but they continue to differ between countries.1 For example, the survival rate for stomach cancer is around 32% in Portugal and Italy, but only 17% in the United Kingdom and Ireland. This may be due to differences in lifestyle factors and care-seeking behaviours, but it may also be caused by variation in how cancer care is delivered, as well as its quality.2

In Europe, some people with cancer still face diagnostic delays and/or limited access to specialists and effective treatment,1 potentially compromising outcomes. The provision and quality of cancer care can vary between countries due to differences in the structure of healthcare systems, the amount of resources allocated to cancer care and research, the links between research and clinical practice, the implementation of screening programmes and the cancer workforce.2

Solution

In 2002, the Organisation of European Cancer Institutes (OECI) launched its Accreditation and Designation (A&D) Programme to improve standards and reduce unwanted variation in the organisation and quality of cancer care.3 It is a voluntary accreditation scheme that reviews and certifies cancer centres based on a comprehensive list of standards.4 The aims of the programme are to:

  • support equal access to high-quality cancer care across Europe
  • implement a European quality system for cancer care
  • foster and accelerate improvements in cancer research.

When a centre applies to the A&D Programme, it receives a preliminary designation as a Cancer Centre (CC) or a Comprehensive Cancer Centre (CCC).3 Next, it uploads relevant information to the A&D Programme e-tool, which is a virtual platform for self-assessment. This information is paired with independent auditing visits, and eventually results in an OECI report with recommendations for improvement before final designation and accreditation.8 Centres have a maximum of two years to complete the process.9

Accreditation is based on a list of standards developed by OECI members, European oncology societies and patient organisations.4 The standards are certified by the International Society for Quality in Healthcare,4 and consider:

  • annual budgets and resources for cancer care and research
  • the composition and processes for multidisciplinary teams
  • inpatient and outpatient capacity and processes
  • patient involvement at the centre
  • number of active research studies and proportion of people with cancer included in clinical trials (at least 10%)
  • national and international peer-reviewed publications linked to the centre (first, second or last author employed by the centre)
  • treatment offered at the centre, including radiotherapy, surgery and medical oncology.10

A CC is required to have clear organisational governance, an extensive range of cancer diagnostics and person-centred care, and a culture of continuous learning and improvement.10 To achieve a CCC status, centres must demonstrate expertise and innovation in cancer research, strong university and research institute links, and an international network of collaboration. Centres must apply for reaccreditation every five years.7

What has been achieved

Since the launch of the A&D Programme, 40 centres have been certified5 and a further 10 centres are currently in the process of achieving accreditation.6 They are spread across 16 European countries, with an equal proportion of CCs and CCCs.11

Based on the reports generated during the accreditation process, the A&D Programme is contributing to improvements in:

  • governance and organisation, namely the integration of cancer research and clinical care, and efficient use of existing resources
  • multidisciplinary care, specifically the development of consistent procedures across cancer types for multidisciplinary teams
  • data collection and analysis of types of cancer, treatment and outcomes
  • quality and risk management focused on cancer care and new technologies
  • patient empowerment, including education for people with cancer and their involvement in designing new services and research studies
  • education and training for oncology nurses
  • cancer research, including clinical trials and the proportion of people with cancer enrolled into these studies
  • scientific oversight through the creation of international Scientific Advisory Boards.7

Next steps

Within the context of the European Union’s Mission on Cancer and Beating Cancer Plan, the next steps for the OECI A&D Programme are to extend its European quality network supporting cancer centres in sharing best practices in care and research.11 Specific goals include:

  • expanding the network in Spain, the Netherlands, the UK, Denmark, Poland and central and eastern European nations11
  • setting up a comprehensive data system to collect and benchmark data across accredited centres11
  • refining the quality standards and accreditation process for cancer networks.9

The A&D Programme’s e-tool was used during the COVID-19 pandemic to virtually reaccredit centres.9

Further information

Contact

Kelly O’Reilly (Secretary, OECI A&D Programme): Kelly.OReilly@cruk.cam.ac.uk

References:

  1. De Angelis R, Sant M, Coleman MP, et al. 2014. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncology 15(1): 23-34
  2. Sant M, Minicozzi P, Primic-Žakelj M, et al. 2015. Cancer survival in Europe, 1999-2007: Doing better, feeling worse? European journal of cancer (Oxford, England : 1990) 51(15): 2101-03
  3. Saghatchian M, Thonon F, Boomsma F, et al. 2014. Pioneering quality assessment in European cancer centers: a data analysis of the organization for European cancer institutes accreditation and designation program. J Oncol Pract 10(5): e342-9
  4. Organisation of European Cancer Institutes. Background of the OECI Accreditation Programme. Available here: https://www.oeci.eu/accreditation/Page.aspx?name=BACKGROUND [accessed: November 2020]
  5. Organisation of European Cancer Institutes. Certified centres. Available here: https://www.oeci.eu/Accreditation/Centres.aspx?type=CERTIFIED [accessed: November 2020]
  6. Organisation of European Cancer Institutes. Centres in the A&D process. Available here: https://www.oeci.eu/Accreditation/Centres.aspx?type=PROGRESS [accessed: November 2020]
  7. Westerhuis W, Blaauwgeers H, Oberst S. 2020. Catalysing quality improvement in OECI A&D Centres: recent findings.
  8. Organisation of European Cancer Institutes. 2019. Accreditation and designation: User manual 3.0. Available here: https://www.oeci.eu/Accreditation/Attachments/OECI_AD_MANUAL_3_2019.pdf [accessed: November 2020]
  9. Blaauwgeers H. 2020. Interview with Marissa Mes and Catherine Hodge at The Health Policy Partnership [videoconference]. 19/12/20
  10. Organisation of European Cancer Institutes. Designation types. Available here: https://www.oeci.eu/Accreditation/Page.aspx?name=DES_TYPES [accessed: November 2020]
  11. Oberst S. 2020. 50 Centres are now in the OECI Accreditation and Designation Progamme: a significant milestone. Available here: https://www.oeci.eu/Attachments/OECI_Magazine_1_2020.pdf [accessed: November 2020]