Kickoff for Changing Cancer Care University of Lübeck, September 11 th 2019
Welcome by Prof. Dr. Alexander Katalinic , Research director at the Institute for Cancer Epidemiology, University of Lübeck
Interreg’s support of Changing Cancer Care by Freddy Blak , member of the regional Council of Region Zealand, Denmark
B lood test in the patient’s home by Program manager, Søren Stig Tvilsted , Research Projects and Clinical Optimization, Zealand University Hospital, Denmark
Why Point of Care (POC)? • Patients : less transportation time, less waiting time, more knowledge, less insecurity • Relatives: less unnecessary involvement (e.g. help with transport), less insecurity • Financial gain for the hospitals • Device could be used by other patient groups • Device could be developed to measure other elements / parameters, reaching yet other patient groups
Devices
Possible devices
Büsum
Changing Cancer Care; new perspective on diagnosis and treatment by Prof., Chief Phys. Julie Gehl , Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital
WP5 - Innovative diagnosis and treatment of cancer • Wp5.1 – Liquid Biopsy - Diagnosis (Dr. Malene Støchkel Frank) • Wp5.2 Calcium Electroporation - Treatment (Prof. Julie Gehl) • Wp5.3 Spinal cord compression radiotherapy - Treatment (Prof. Dirk Rades)
The overall goal: Benefit for the patient, benefit for society • If liquid biopsy works, treatment that will not work may be avoided. Benefit for the patient, benefit for society. • If calcium electroporation, single, low-cost, once-only treatment for cancer may become reality. • Benefit for the patient, benefit for society. • If radiotherapy for spinal cord compression can be refined, patients may remain ambulatory longer. • Benefit for the patients, benefit for society.
WP5 - Innovative diagnosis and treatment of cancer • Wp5.1 – Liquid Biopsy - Diagnosis • (Dr. Malene Støchkel Frank) • Wp5.2 Calcium Electroporation - Treatment • (Prof. Julie Gehl) • Wp5.3 Spinal cord compression radiotherapy - Treatment • (Prof. Dirk Rades)
Liquid biopsy
Collaboration • Universitätsklinikum Schleswig-Holstein, Campus Kiel, Institut für Klinische Molekularbiologie (IKMB) – Molecular Biologist, Michael Forster • Performing analyses of a variety of mutations in a subgroup of 10 patients to explore potential resistance-mechanisms during treatment • Collaboration meeting at IKMB, May 2019
Perspectives • A dynamic measurement of treatment-response through ctDNA • An early registration of treatment failure – To avoid long-lasting ineffective costly treatments – To avoid unneccesary side-effects
WP5 - Innovative diagnosis and treatment of cancer • Wp5.1 – Liquid Biopsy - Diagnosis • (Dr. Malene Støchkel Frank) • Wp5.2 Calcium Electroporation - Treatment • (Prof. Julie Gehl) • Wp5.3 Spinal cord compression radiotherapy - Treatment • (Prof. Dirk Rades)
Calcium electroporation study Protocol and patients • 3 centers will treat each 10 patients = 30 patients. • Patients will have cutaneous metastases from any cancer • Primary endpoint will be clinical response at two month follow-up • We will discuss secondary endpoints between the partners
5.2 Calcium electroporation collaborators • SUH, Zealand ( Julie Gehl ) Write and submit multi-center protocol Training Treat 10 patients with follow-up of a minimum of 2 months. Secondary endpoints TBA • Vejle Sygehus ( Lars Henrik Jensen ) • Facilitate protocol start • Treat 10 patients with follow-up of at least 2 months. • Secondary endpoints TBA • Lübeck University Clinic ( Mascha Pervan and Achim Rody ) • Facilitate protocol start • Treat 10 patients with follow-up of at least 2 months. • Secondary endpoints TBA
WP5 - Innovative diagnosis and treatment of cancer • Wp5.1 – Liquid Biopsy - Diagnosis • (Dr. Malene Støchkel Frank) • Wp5.2 Calcium Electroporation - Treatment • (Prof. Julie Gehl) • Wp5.3 Spinal cord compression radiotherapy - Treatment • (Prof. Dirk Rades)
RAdiotherapy for Metastatic Spinal cord compression with increased radiation dosES (RAMSES-01) • Aim is to show if high-precision radiotherapy with 18x2.33 Gy should be recommended for patients with favorable survival prognoses • Study leader: Prof. Dr. Dirk Rades, Department of Radiation Oncology, University of Lübeck • Participating study centers: – Odense Universitetshospital, Onkologisk Afdeling, Denmark – Clinic for Radiation Oncology, Hannover, Germany – Other interested centers in Spain, Slovenia, Canada and Georgia
RAMSES-01: Patient selection and treatment • 65 Patients with motor deficits of the lower extremities resulting from MSCC and a favorable survival prognosis • Treatment with 2.33 Gy per fraction on 5 days per week = EQD2 of 43.1 Gy = dose escalation by 33% • Comparison to a historical control group treated with 10x3 Gy of conventional radiotherapy (ca. 235 patients, previous study data documented in the EU)
Interventions led or delivered by general or specialized cancer nurses by Prof. Dr. Sascha Köpke , Head of the Nursing Research Unit at the Institute for Social Medicine and Epidemiology, University of Lübeck 22
Sascha Köpke Nursing Research Unit Insitute of Social Medicine and Epidemiology Interventions led or delivered by general or specialized cancer nurses Kick-off Meeting, Lübeck, September 11, 2019
Agenda • ANP, APN, CNS… • International view (substitution of roles, task shifting) • National view (delegation of roles) • Possibly future roles • Relevance for CCC 2 4
ANP, APN, CNS… Definition by the International Council of Nurses (ICN) (2008) „ A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision- making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master's degree is recommended for entry level. “ https://international.aanp.org/Practice/APNRoles 2 5
Professional motivation Nurses in countries with major skill-mix reforms are • more frequently motivated to new roles (67 vs. 39%) • more frequently able to do so (52 vs. 25%) Physicians’ and nurses’ motivation are influenced • more by intrinsic factors (personal satisfaction, use of qualifications) and • less by extrinsic factors (salary, career opportunities) Barrier • workforce shortages Facilitator • professional and management support 2 6
Professional motivation Managers’ recruitment decisions on choice of staff were mainly influenced by • skills, • competences and • experience of staff 2 7
2 8
Task Shifting 2 9
Intervention in cancer nursing Intervention categories (OMAHA nursing intervention classification) • Case management (n=38 studies) • Surveillance (n=27) • Teaching, counselling and guidance (n=131) • Treatment and procedures (n=18) 3 0
Intervention in cancer nursing Intervention categories (OMAHA nursing intervention classification) • Case management (n=38 studies) • Surveillance (n=27) • Teaching, counselling and guidance (n=131) • Treatment and procedures (n=18) 3 1
Workpackage 3 Aims • To systematically review published research and generate new knowledge on re-organizing and changing tasks from doctors to nurses, related to cancer care • To distribute healthcare resources more equally concerning patients' needs in cancer care by involving health care technologies • To develop two prototype curricula for nurses aiming to develop nurses’ clinical competencies in cancer care, to handle processes of new tasks and methods in cancer care, and to acquire new knowledge about health care technology in the work with cancer patients in primary care 3 2
Thank you very much! 3 3
The cancer patient’s perspective by Prof. Dr. med. Frank Gieseler , Chairman of the Cancer Society Schleswig-Holstein, Head of Department for Experimental Oncology, Palliative Medicine and Ethics in Oncology, University Hospital Schleswig-Holstein, Lübeck 34
UK UNIVERSITÄTSKLINIKUM SH Schleswig-Holstein "The Cancer Patient's Perspective" Frank Gieseler, MD Professor for Internal Medicine Cancer Society Schleswig-Holstein
what is "quality" in cancer care? "quality parameters" "quality indicators" o adequate equipment o patients treated according guide lines o enough workforce, personnel o complications o localized guidelines o hospital stay durations o interdisciplinary tumor boards o survival times o reports to tumor registry o certifications "public reputation" o referring medical colleagues and hospitals o confidants, care keeper o treated patients public relations, PR work
what is "quality" in cancer care? "public reputation" o referring medical colleagues and hospitals o confidants, care keeper o public relations, PR work o treated patients referring patient collegue cancer registry cancer center
Recommend
More recommend
