Anna Wagstaff

with Alberto Costa

Learning to Care ESO at 30

Anna Wagstaff

with Alberto Costa Authors’ note This book is about how the European School of Oncology was born and the unique contribution it has made to helping improve cancer care over the past 30 years.

It draws heavily on the recollections of key players, many of whom are quoted. We have taken pains to check that our account is accurate, but it is certainly not complete. These last 30 years have seen momentous changes in the field of cancer, and countless doctors, researchers, patients, policy makers and others have played their part. This book focusses on ESO’s role in these events; it is not our intention to detract in any way from the contribution made by others.

ESO has no more than 15 full-time staff members, all of whom do a wonderful job. It has always depended heavily on the time, commitment and enthusiasm freely given by hundreds of people from all walks of the world of cancer. While it is not possible to name them all, this book is a tribute to them and to everyone who contributes to turning progress in science and medicine into a better life for patients.

PREFACE 5

1 A EUROPEAN SCHOOL OF ONCOLOGY 7

2 ESO PEOPLE & PLACES 13

3 LEARNING TO CARE 21

4 SPEARHEADING CME IN EUROPE 25

5 PARTNERS IN CARE 31

6 MANY DISCIPLINES, ONE TEAM 37

7 EUROPE AGAINST CANCER 43

8 A TRANSATLANTIC ALLIANCE 49

9 PROMOTING PATIENT POWER 55

10 ESO AND THE MEDIA 61

11 AN INTERNATIONAL AGENDA 67

12 ESO IN THE DIGITAL ERA 73

APPENDIX 78 Who’s who at ESO 2012 ESO faculty 30 years of ESO courses 4 PREFACE

DEFINED BY INDEPENDENCE

Being in the right place at the right time can change your life. When Umberto Veronesi asked me to go with him to see that special patient, I could not have imagined that I would come home that evening as director of the European School of Oncology. The special patient was one of the wealthiest Italian industrialists, living with his wife and her sister in one of the most magnificent Milanese mansions.

“Everybody wants to give money to research,” he said to us quite bluntly “but I want to fund education, because my problem was misdiagnosis and late treatment.” Alberto Costa ESO scientific director For years we had been thinking about a school to improve the knowledge and skills of cancer doctors, and to do it by drawing on the multicultural and multilingual European tradition.

It was soon a done deal. Our generous donors immediately liked the idea and we left the unforgettable villa with the promise of an endowment that would guarantee the life and activity of a European school of oncology for as long as it was needed.

Thirty years on, I can say that the most fascinating experience in my professional life had just started. Since October 1982 I have had the special privilege of working as a surgeon but also as a manager, teacher, organiser, coordinator and project developer.

Our official language was ‘bad English’, our currency the ECU (the European Currency Unit, long before the euro), my office was a suitcase that travelled all over Europe with me.

For 30 years our financial independence has given us the great privilege of being able to think freely and act freely in a world full of constraints and boundaries. This has been, and still is, the defining characteristic of ESO, which I do hope we will be able to pass on to the next generation

CHAPTER 1

A EUROPEAN SCHOOL OF ONCOLOGY

If the concept seems an obvious one now, it certainly didn’t in 1982 when the European School of Oncology was founded. “It sounds like a crazy idea,” is how Vince DeVita, then head of the US National Cancer Institute, and a strong supporter of the school, described the way his colleagues responded to the proposition. Sir Michael Peckham, who pioneered the mantle technique for irradiating Hodgkin’s lymphoma, and went on to become one of the school’s founding fathers, remembers his first reaction was: “My goodness! Have they a hope in hell of pulling this thing off?” They had a point.

To begin with, ‘Europe’ in those days was where in Europe. Oncologists were under essentially an economic entity – any sense no obligation to take time out to deepen of a European cultural or social identity and update their knowledge, and atten - was more aspiration than reality. Could an dance at an ESO course conferred no for - organisation centred around healthcare mal qualification that would be recognised and education be made to work at a Euro - and valued in their own health system. pean level? Attracting students would therefore rely on appealing to those who were driven by a As for the concept of a ‘school’, the very idea desire to be the best doctors they could, and that qualified doctors need to continue to help play a role in moving the practice of their education was barely recognised any - oncology forward.

7 A Z N A E L O I N N E

Most important of all, perhaps, the very concept of ‘oncology’ as a branch of medi - cine that needed to be understood, taught and practised in an integrated way, was still in its infancy. Trainee doctors learned about lung cancer alongside other diseases of the lung, breast cancer was classed as a gynae - cological disorder and colon cancer was taught as part of the gastroenterology cur - riculum. An integrated approach was equally lacking in clinical practice, where departments of surgery, radiotherapy and internal medicine tended to do their own thing in isolation from one another. ESO would need to convince people who had been taught, and were practising cancer medicine, in such a fragmented way that it was important to develop a deeper and more integrated understanding, both of the biology of cancer and of the broader princi - ples of disease management and care.

But if the challenges of developing a European School of Oncology were great, the need for such a school was greater.

8 CHAPTER 1

Session at the masterclass in clinical oncology, Ermatingen 2011. Over the past 30 years ESO has taught many of Europe’s brightest and most committed young oncologists at almost 750 courses, symposiums and conferences

Back in the early 1980s, oncology was patients, who were not treated at elite rapidly becoming one of the fastest devel - institutions. Most people would continue to oping areas of medicine. It was also be - be treated using outdated paradigms unti l coming increasingly complex, demanding these new ways of working were dissemi - close cooperation between different disci - nated to, and adopted by, the hospitals and plines that had traditionally neither doctors in charge of their care. trained nor worked together. Medical on - cology was breaking away from internal This is the task that a small group of medicine as a speciality in its own right; European oncologists took responsibility surgical oncology was emerging as a new for when they launched the European speciality, with its own subspecialities; School of Oncology with the mission: “To and even radiation oncology was going contribute to the reduction in preventa - through a period of rapid change. ble deaths from cancer that resulted from late diagnosis or inadequate treatment, Under pressure from the public and the due to failures in the training of those growing patient advocacy movement, responsible for their care”. This was mod - quality of life was becoming a bigger issue ified many years later to its current form: both during and after treatment, and more “To contribute through education to redu- attention was being paid to limiting the cing the number of cancer deaths and to damage from cancer treatment. ensuring early diagnosis, optimal treat - ment and holistic patient care”. Taken together, these changes were trans - forming the way oncology was practised in ESO soon found it had many dedicated Europe’s top cancer centres. However, they supporters and allies among leading inter - were of scant benefit to the vast majority of national experts who were happy to offer

9 their services for free. Over the ESO faculty member Razvan Popescu past 30 years, using the School’s with Annemiek Walenkamp from official language of ‘bad English’, Groningen University Hospital, holding top oncologists from every disci - her certificate for participating in the pline and specialism have taught masterclass in clinical oncology almost 750 ESO courses to some of Europe’s brightest and most motivated students − all chosen ists from different disciplines on merit. They have guided them and professions to address the through topics varying from particular needs and priorities week-long ‘full immersion’ mas - of each patient. terclasses in clinical oncology and shorter courses focusing on Thousands of ESO alumni now particular types of cancer, to hold senior positions in treatment more general topics covering centres the length and breadth of cancer biology and the concepts Europe, where they can put into behind new types, techniques practice what they have learned and strategies of treatment, can - and disseminate it to others. cer nursing, psycho-oncology, end-of-life interaction with the teachers, to help Many stay in touch with the tutors and care, reconstructive surgery and the prin - students develop a critical approach to mentors they met through ESO; most keep ciples and practice of clinical and transla - their practice and an awareness of the in touch with ESO through its alumni club; tional research. need for continual improvement that some are now returning to ESO courses in they will take back with them to their the role of tutor. Following ESO’s educational philosophy own institutions. And no matter what the of ‘learning to care’, every course is de - topic, every course is taught from the ESO knew from the start, however, that signed to promote a close and personal perspective of bringing together special - educating frontline carers was never

10 CHAPTER 1

ESO’s Mission going to be enough to ensure all ments and health authorities are patients had access to timely To contribute through still failing to take responsibility diagnosis and high-quality care. for ending substandard care by Policy makers, administrators, education to reducing the setting standards and implement - general practitioners, nurses, ing quality control systems. psychologists, palliative care number of cancer deaths, specialists, patient advocacy Huge progress has been made in groups, public health workers and to ensuring early understanding cancer biology, and the media all had a role to which is gradually translating play. Over the years, ESO has diagnosis, optimal treatment into promising new therapies, developed initiatives to work including biologically targeted with all these groups, some of and holistic patient care personalised therapies, immuno- which are described in the fol - therapies, and also new surgical lowing chapters. and radiotherapy strategies and techniques. However, many pa - Thirty years on, the picture of can - tients are still treated according cer care in Europe has been transformed in students understand what new research to the judgement of the first doctor who many ways. The internet, together with the findings mean for our understanding of the sees them. Patients will not reap the po - burgeoning number of cancer congresses disease and how to treat it. tential benefits of new therapies unless and conferences, offers new ways to learn their diagnosis, treatment and care are in about the latest developments that hardly The differences in cancer survival rates be - the hands of multidisciplinary teams who existed in Europe in the early 1980s. tween northern and central Europe and understand all the options and know how However, ESO remains almost alone in eastern and southern Europe have nar - to choose the right one for the patient in offering education that is independent of rowed considerably. However, the quality front of them. commercial sponsorship and goes beyond of care continues to vary significantly both reports of breaking research results to help between and within countries, and govern - ESO’s work is not yet done.

CHAPTER 2

ESO PEOPLE & PLACES

The man with the vision to develop the concept of a European School of Oncology, and the determination and clout to pull it off, was Umberto Veronesi. At the time, he was helping to drive oncology towards a multidisciplinary future by playing a key role in innovations that were breaking down boundaries between surgery, medical oncology and radiotherapy.

As scientific director of the Istituto evidence to show a large proportion of Nazionale dei Tumori in Milan, it was breast cancer patients could be safely Veronesi who, in 1972, enthusiastically treated with quadrantectomy together agreed to play host to the first trials with adjuvant radiotherapy. of adjuvant chemotherapy, which were being boycotted by surgical departments Veronesi could see the direction cancer care in the US. Those trials, led by his head of was going – but he could also see how diffi - medical oncology, Gianni Bonadonna, cult it was to get cancer doctors outside the marked a milestone in the rise of the im - main centres to adopt the new practices. portance of medical therapies in treating solid tumours. As the chair of the education committee of the UICC (now the Union for International Then a year before ESO was founded, Cancer Control), Veronesi had already been Veronesi published his landmark paper on involved in drawing up recommendations breast conservation, which presented the to improve the fragmented way that

13 oncology was taught at medical school. But the idea for a European School of Oncology, aimed at qualified doctors, came about al - most by chance.

“It was not a rational plan,” he recalls. “I was at dinner with Alberto Cavallari, the editor of Corriere della Sera , and I told him I was keen to be part of building Europe. I am Eu - ropean by culture and I am totally convinced now, as I was then, that Europe is our future, but at that time the European project was still very vague. I suggested something could be done to develop a European type of edu - cation for young doctors of any kind in can - cer, because cancer had made tremendous leaps forward in the last 10 years, with a number of achievements of great impor - Umberto Veronesi, founder tance. But it was difficult to disseminate this of the European School information on a large scale. It remained of Oncology (right) with limited to a few important cancer centres. Alberto Costa, who has This was a sort of obsession of mine.” been director of the School throughout its 30 years This was Italy, so Cavallari advised Veronesi to seek the backing of an influential public

14 CHAPTER 2

figure, and suggested the Principessa Lau - it turned out, had travelled to the UK for cal challenge. Veronesi returned to Milan to domia Del Drago, an Italian fashion icon treatment, and had been very relieved make plans. “Together with a group of who had married into Roman royalty and when her surgeon mentioned a novel pro - friends and collaborators, we decided to have had recently been treated for breast cancer. cedure that would avoid having her entire a centre around Milan where people from all Veronesi took his advice, sought a hearing, breast removed. She was surprised to learn over Europe could come for a full-immer - and found a ready listener. The principessa, that this procedure came not from the US sion course in specific types of tumours. We as she had assumed, but from Umberto decided to address our education to the sec - Veronesi in her own native Italy. So when ond level in the hospital hierarchies. You Veronesi came knocking at her door ask - have the boss, the head of department, but it ing for backing to launch a European is hard to change his mind. Then you have school that would give a profile to the im - the assistants, who are more receptive, but portant work being done in Europe and there are too many – thousands and thou - help ensure all patients could of benefit sands. So we decided to aim for the middle from the latest knowledge and techniques layer, the number twos – because this group wherever they were treated, she was only is young enough to be open to new ideas, but too happy to oblige. not so numerous as to be unmanageable. À

T This is the idea we started with.” I R

E Laudomia Del Drago become ESO’s found - V E

T ing president, donated the start-up funds Chief among those collaborators was Alberto N O that allowed them to organise the first Costa, a young breast surgeon who had col - M E

N courses, and remains honorary president to laborated with Veronesi in many areas, in - O I Z this day. cluding a chemoprevention project, which A D

N gave him foothold in research and cancer bi - O F Organising something on that scale in the ology, and had also led to a spell working in Monte Verità, Ascona days before the internet was a major logisti - the US at the National Cancer Institute

15 (NCI). Costa was tasked with knocking on bers is the great enthusiasm he encoun - G Bob Pinedo, who co-edited with Bruce the doors of leading European oncologists to tered among these leading figures for the Chabner, then deputy director of the NCI, drum up support for the venture. idea of spreading knowledge about the new annual editions of Cancer Chemother - techniques and practices that they were de - apy , the medical oncologist’s ‘bible’, and It was an intimidating task for a man just veloping. The team of collaborators he put was practising translational research at starting his career, but what Costa remem - together represented some of the most ded - his Utrecht base in the Netherlands, long icated innovators from all walks of Euro - before there was a word for it. pean oncology at that time: G Franco Cavalli, a Swiss haematologist who G Michael Peckham, the UK-based inter - was leading efforts to develop medical on - national leader in radiotherapy, who was cology as a recognised discipline in Europe best known for pioneering the technique – a founder member of the European So - of mantle field radiation, and had him - ciety for Medical Oncology (ESMO), who self written a piece in the Lancet pro - would go on to be the founding editor of moting the idea of a body in the UK that the Annals of Oncology . would bring the different disciplines and specialities together. Costa remembers vividly the founding ‘con - ference’ of ESO: Peckham, Pinedo, Denis, G Louis Denis, a urologist from Antwerp Cavalli, Veronesi and himself deliberating who had been instrumental in setting up over how to shape the educational pro - the European Organisation for Research gramme that the school would offer, seated and Treatment of Cancer, and continued on the grass of Monte Verità – a hill in the throughout his career to lead progress Swiss canton of Ticino that had hosted the ESO’s Honorary President, Principessa in patient-centred care, particularly in birth of many humanistic projects over the Laudomia Del Drago prostate cancer. course of the 20th century.

16 CHAPTER 2

Umberto Veronesi preparing his speech at ECCO 2 about the aims and ambitions of the newly founded European School of Oncology, Amsterdam 1983. Also pictured are Michael Peckham (right), Alberto Costa (standing) and Sheila MacGrath

that they feel happy and represented by what we are doing for everybody.”

Over the last 30 years there have been countless others whose enthusiasm and goodwill has made ESO what it is, serving on the board of directors, directing its sci - entific and educational work, coordinating They were not the first European multidis - into ESO’s genes. At that time it was very its programmes. Hundreds of faculty mem - ciplinary gathering – that had happened the innovative to teach medical oncology and bers have given their time for free – among year before with the founding of the Feder - conservative surgery of various types of them Nicolas Pavlidis, who attended ESO’s ation of European Cancer Societies (which cancer. Twenty years later we were the first first medical oncology course as a student, later morphed into ECCO). They were, how - to help launch patient advocacy, and two and is now chair of the faculty for the flag - ever, unique in that everyone was facing years ago we were the ones who began ship Masterclass in Clinical Oncology. outward and focused on initiating change teaching doctors about molecular biology on a large scale; they weren’t in any way laboratory work and introducing surgeons Sheila MacGrath was ESO’s office adminis - there to ‘represent’ their discipline or fight to gene profiling. ESO can work this way trator and point of contact for the first 10 their corner. because we have no barriers. years. Between 1992 and 2002 the growing team of ESO staff was led by Vlatka Majs - “It was very laid back – there were no power “I think this is why we still have only one torovic. Her role was later taken on by or hegemony issues, and nobody was ask - ESO and not a European School of Surgical Marina Fregonese. Today, the ESO staff ing for anything,” says Costa, who took on Oncology, or a European School of Medical has grown to a team of around 15, based the post of ESO director without relin - Oncology or Radiotherapy. The other soci - mainly in Milan and Bellinzona (Switzer - quishing his clinical work. “We were driven eties and specialities never thought of es - land), with small outposts in St Petersburg, by the need for change, and that was built tablishing their own school. I like to think for their Russian-language website, and

17 San Servolo, Venice

Cairo, to service the work of their Euro- found out that he had prostate cancer, a dents from many different countries, and a Arab School of Oncology. Supervising it all full year after his bone metastases had been holistic, patient-centred approach to care. is Chatrina Melcher, who joined ESO in wrongly diagnosed and treated as arthritis. Just as much care was exercised in selecting 2003, to organise the Masterclass, and was Campiglio decided that he would like to do the right locations to hold the courses. appointed to a new position of chief oper - something to help ensure that doctors ating officer in 2010. were properly educated about how to diag - ESO wanted to take a stand against ‘onco- nose and treat cancer. So when Veronesi tourism’ – the use of attractive locations to One family in particular deserves a men - explained his plan to start a European entice people to attend a course or confer - tion for the gift they gave to ESO of finan - school, Campiglio arranged for the entire ence. It did use, and still does use, some cial independence, which has allowed the family inheritance to go to ESO after the stunning locations, but each was selected for school to set its own agenda and given stu - death of the two sisters. This substantial a good reason. ESO looked for places that dents confidence in the integrity of its fortune continues to pay for the (still min - had the sense of quiet and contemplation teaching. This is the Campiglio-Necchi imal) running costs of the School as well that was associated, for instance, with its family. The Necchis had made a fortune as all its core teaching activities. founding spot on the Monte Verità – places from their family business selling stylish that would help students and faculty mem - sewing machines the world over, but by the From the start, ESO chose the faculty bers connect and learn from one another early 1980s, sisters Gigina and Nedda were members for its courses with great care – during the two or three days that most the sole survivors. Gigina’s husband, An - expertise was essential, but so was an abil - courses lasted. For a long time they used a gelo Campiglio, was a wealthy industrialist ity to teach, sufficiently clear English place on one of the Italian lakes, Lago d’Orta, who consulted Umberto Veronesi when he language skills to be understood by stu - that overlooked an ancient monastery on the

18 CHAPTER 2

Isola di San Giulio on Lake Orta (left) and the cloister of Palazzo delle Stelline, Milan (below) K C A P O L L O R

island of San Giulio. Another frequent loca - This gave rise to the so-called E N I tion was the Palazzo delle Stelline in Milan, Red Square Seminars, a series of L L E T built originally as a cloistered Benedictine ESO courses located in Moscow S E L

monastery – ESO referred to its sessions that were open to students from L E here as the ‘cloister seminars’. all over Europe as well as D O Z Z

Russia, organised in collabora - A L A

One of the best known ESO locations, tion with oncologists at the P which it used for many years, was another NN Blokhin Russian Cancer Re - former Benedictine monastery, this one on search Centre. By the same token, the build bridges in places of conflict. In 2001 it the island of San Servolo in Venice. In re - School has chosen Cairo as a location for its chose Sarajevo, the multi-ethnic capital of cent times it had been home to a psychi - courses on many occasions, as part of the Bosnia-Herzegovina that had been battered atric hospital, but when that closed due to collaboration it has built up over the years by three years of siege and bombardment the reorganisation of Italy’s psychiatric with the Egyptian National Cancer Institute during the Balkan conflict, for the location services, ESO was offered the use of its – which is now a partner with ESO in the of a series of international workshops on premises. For many people this is the site Euro-Arab School of Oncology. breast cancer, starting in 2001. This later de - most closely associated with ESO, but it had veloped into the International Interconfer - no accommodation facilities, it was acces - When choosing its locations, ESO has also ence Breast Cancer Meeting, which is held sible only by boat, and Venice was an ex - on occasion taken into consideration bene - in Sarajevo every two years, and involves pensive city, so eventually ESO moved its fits that go beyond the immediate learning ECCO, Europa Donna and other organisa - courses and seminars to other locations. environment, or building relations with on - tions, alongside the University of Sarajevo cologists working outside the main western Clinical Centre, the Association of Oncolo - The School was also keen to push the fron - arena. Mindful of the unifying power of its gists of Bosnia and Herzegovina and ESO, tiers of collaboration to include areas be - mission to save lives and ensure patients get with the aim of bringing the latest in breast yond the borders of Europe that were the best possible outcomes, ESO has on oc - cancer research, treatment and care to the ignored by most oncology organisations. casion sought to use its activities to help Balkan area and central and eastern Europe.

CHAPTER 3

LEARNING TO CARE

ESO’s motto “Learning to care” was not formally adopted until the early 1990s. From the outset, however, the School was determined to go beyond traditional medical teaching of new knowledge, techniques, methodologies and management strategies. No matter what the topic, ESO courses were designed to help students assimilate an approach to their work that involved caring for the whole patient, not just treating their disease.

The impact of the work being done by the Meanwhile, the single-minded focus on find - Milan group on conservative breast surgery ing a cure, which had dominated oncology in may well have played a role here. The psy - the 1970s, was also being questioned, particu - chological and emotional trauma involved in larly after treatments such as high-dose removing a woman’s entire breast received chemotherapy with bone marrow transplan - more attention now that many women had a tation and early attempts at immunotherapy choice of opting for much less radical sur - using interferon failed to live up to high hopes. gery. That same choice highlighted the role of patients in making treatment decisions, With the possibility that cancer might be and the need for effective communication turned into a chronic disease came the chal - and good-quality information. It also stimu - lenge of maximising patients’ quality of life lated the search for more conservative treat - so they could make use of the added survival ment options in other cancers. they gained through new treatments.

21 ESO founding member Bob Pinedo (left) with Frits Parc (centre), one of three patients Pinedo invited to a masterclass to ESO embraced this new holistic approach to talk about how care from the start. It was the first oncology patients feel organisation in Europe to run courses for about discussing (and later with) cancer nurses and to cham - their disease, pion their role, almost before the concept of Tenerife 2003 ‘cancer nurse’ was recognised in Europe. It was the first to incorporate emotional, psy - themselves poorly served by mainstream More recently, ESO has taken a lead on chological and communications aspects into oncology. One of the early monographs pub - focusing clinical and research attention its teaching, and it supported the newly lished by the School provided a unique over- on the needs of women with advanced formed International Psycho-oncology view of the available evidence on treating breast cancer, under the leadership of Fa - Society (IPOS, founded 1984) in designing, cancer in pregnant women, offering helpful tima Cardoso, head of the Breast Unit at translating and disseminating its core cur - advice on how to approach decision-making Lisbon’s Champalimaud Cancer Centre, riculum on psycho-oncology. It ran specific in this difficult situation, where what is best who is in charge of the School’s breast courses on palliative care, psycho-oncology, for the mother may pose a threat to the cancer programme. and how to discuss end-of-life issues with pa - child. ESO championed the cause of elderly tients. And in its treatment-oriented courses, cancer patients, teaching its students that “The motto of ‘learning to care’ combines faculty members would talk about how to not all elderly patients are frail, and that the two most important words for a doc - communicate with patients to involve them many could derive as much benefit from re - tor, and what we try to teach the younger in decisions regarding their care, sometimes ceiving the full recommended treatment as generation is exactly that,” says Cardoso. even inviting patient advocates along to the younger patients, so deserved to be given “You cannot be a good doctor if you don’t sessions to show them how it is possible to that opportunity. The School has also played continue to learn for the rest of your life. talk about even difficult subjects. a very active role in supporting efforts to dis - But you cannot just learn the science and seminate knowledge, and promote research then forget about everything else – the ESO also looked to take up the cause of pa - and access to specialist care for patients with humane and humanistic part of taking tients who face special problems or find rare cancers. care of the patient.

22 CHAPTER 3

“We try to teach people how to take care of “Learning a multidisciplinary approach is patients, but also how to care. How can we essential in caring for patients with all change what is not working well? How can advanced cancers. It’s much easier to do in we improve the way oncology care is deliv - ESO because there is not that pressure Fatima Cardoso ered all over the world? How can we change of belonging to a society and having to the difference between rich and poor inside ‘defend’ your speciality. We are all in the each country and between countries?” difficult to take care of a situation that will same school and we are all there to help inevitably end in death. Death is never far each other and to learn with each other. It’s A medical oncologist specialising in breast away. It is difficult for the physicians, the much easier to really make multidiscipli - cancer, Cardoso had long felt that some - nurses, for everyone involved. And even narity a practical thing and to apply it.” thing was not well with the way the needs more difficult for the patient.” of people with advanced breast cancer were In 2013 ESO will be opening a new chapter being addressed. Surveys of this group of Advanced disease is also much more com - in helping its students learn to care. For patients carried out in 2005 and 2009 plicated to deal with, says Cardoso, which the first time it will address many issues showed that they felt the same shame, is the second reason why ESO, with its that are important to the rapidly expand - stigma and isolation that were common emphasis on learning, is so well placed to ing group of people who are living many among all breast cancer patients back in take a lead on this topic. “There are fewer years with cancer or with long-term effects the 1960s. “They feel it is their fault. They data available, and not all coming from of the disease and its treatment. The School are alone and have to fight alone. This is phase III randomised trials, so the knowl - will be working with experts to put together something I wanted to change.” edge is not so deep as in early breast can - a programme on issues in cancer survivor - cer. You have bits and pieces, and you ship, from the physical and functional, to ESO was the perfect group to take on this need expert help to make sense of it and psychological and sexual, different aspects challenge, she says. Firstly, because of the to take good decisions. This can only be of rehabilitation, and issues surrounding emphasis on caring. “It is always extremely done through education. return to work.

CHAPTER 4

SPEARHEADING CME IN EUROPE

ESO sought to attract students by appealing to their desire to be the best cancer doctors they could be. There was never any grand vision of challenging traditional systems of medical training and education, by obliging doctors to regularly update their knowledge, nor did ESO’s ambitions stretch beyond the field of oncology. But as it built up experience doing its own thing, the logic of having a recognised system for accrediting courses and giving doctors recognition for attending those courses became apparent.

ESO took on the challenge. In a report to important areas of activity for the UEMS. the European Commission it put contin - The immediate stimulus for this work uing medical education (CME) onto the came from the US – not from doctors, but European political agenda, and in part - from the students. In contrast to Europe, nership with the Union of European American doctors were already obliged to Medical Specialists (UEMS), it laid the refresh and update their knowledge as a groundwork for a formal European CME condition of their licence to practice – and system that went on to expand into many offered tax breaks to help cover costs. It other fields of medicine. Oversight of was young American oncologists, at - CME is now listed as one of the three most tracted by the prospect of clocking up

25 some CME credits in a historic setting on Having embraced the concept of continu - erously of his advice and assistance, even the Italian lakes, who first introduced ing medical education, for the next seven though he had neither obligation to nor ESO to the concept of formal accredita - years ESO worked towards establishing responsibility for this Milan-based School. tion for its courses. something similar in Europe. Throughout that time it relied heavily on Charles Sher - ESO needed to find a body to take overall At that time there was no accrediting body in man Jr, then head of the accreditation responsibility for accreditation of continu - Europe, which is how ESO ended up ap - committee of the American Medical Associ - ing medical education activities in Europe – proaching the American Medical Association ation’s Educational Council, who gave gen - much as the American Medical Association to seek US accreditation for its courses, and does in the US. It approached the Union of how, for its first 10 years, graduates from European Medical Specialists, which agreed ESO courses came away to take on the role. It then approached the with US CME credits even Federation of European Cancer Societies though those credits had no (FECS, now rebranded as ECCO), with a formal status anywhere in request that they take responsibility for Europe. It is also how ESO accrediting CME courses in oncology. FECS began a highly fruitful and agreed, and set up the Accreditation Coun - constructive relationship with the Memorial cil of Oncology in Europe (ACOE). Sloan-Kettering in New York, which agreed to act as the formal ‘tutor’ for ESO courses, As a result of these efforts, finally, ESO had checking the content of the courses and the a European body that could give independ - credentials of the speakers, as required by the ent accreditation to the courses it had American Medical Association. already been teaching for a decade. And Europe had a system, enthusiastically em - Charles D Sherman Jr, chair of the accreditation braced by the UEMS, that could be used to committee of the AMA’s Educational Council develop CME across all fields of medicine.

26 CHAPTER 4

But for CME to take root within Europe’s munity where health needs are greatest, about treatment or diagnosis. They made the health systems required a radical change to rather than in the university hospital.” link with how quickly “fully trained physi - the whole approach to delivering medical cians” renew their knowledge and expertise. education, which was unlikely to happen They pointed to a huge gap in survival rates without pressure from outside the aca - between patients treated for testicular can - The report criticised existing post-graduate demic hierarchy. ESO went to the Euro - cer, depending on where they lived, ranging education provision as “confused” and “self- pean Commission, which had been given a from 80% to only 30%, and they cited an es - directed by physicians according to their role in education policy, to argue its case. timate of one in five patients in Europe losing own interests, practice and perceived needs,” In a landmark advisory report on continu - their chance to be cured due to ignorance and it argued that governments have to step ing medical education in oncology in Eu - in and take some responsibility for ensuring rope, published in the European Journal of doctors regularly refresh and update their Cancer , Jean-Pierre Armand (head of med - knowledge or patients will suffer – and there ical oncology at the Institut Gustave would be a price to pay. Traditional deferen - Roussy), Alberto Costa (director of ESO tial attitudes were dying out and patients and specialist breast surgeon), Jens Over - were demanding greater accountability of gaard (head of the Experimental Oncology those charged with their healthcare. “The Department at the Radiotherapy School in implementation of CME programmes,” they Aarhus, Denmark), Charles Sherman Jr argued, “will help to curb the explosion of (Department of Surgical Oncology at the malpractice issues which has had a noxious Highland hospital, New York, and Ameri - effect on the patient/doctor relationship in can Medical Association Education Coun - North America.” cil) and others set out the need for “continuing medical education, based on ACOE was set up in response to ESO’s request The authors also put their finger on an issue new concepts and new teaching methods, for FECS (now ECCO) to provide independent that was only just becoming apparent. Drugs which are developed in the medical com - accreditation of ESO courses were becoming increasingly important in

27 treatment of cancer, and doctors were heav - velopment of national CME systems, and ily reliant on the companies that manufac - played a key role in the huge progress tured them for information about what that has been made in this field over the benefit they could offer, and to whom. past decades. Patients, meanwhile, were becoming very adept at finding out what was available, and For ESO, which was highly focused on were pressuring doctors to give them access. improving practice everywhere that cancer If doctors could not turn to independent patients were being treated, reshaping med - providers to learn about the most appropri - ical education was essential. It was some - Jean-Pierre Armand ate use of these and other technologies, what more controversial among leading healthcare costs could soar without seeing medical oncologists, who were highly an equivalent benefit for patients. Drawing some misgivings, that “funding should be focused on convincing more hospitals to get on the wisdom of Groucho Marx, the paper accepted from different bodies, including involved in research rather than putting argued: “If you think education is costly, try private sources,” with the qualification that efforts into teaching current protocols they paying for ignorance.” the funding be always channeled through felt were highly unsatisfactory. independent bodies. It opted for a voluntary The advisory report recommended a change system “governed by incentives and con - Jean-Pierre Armand was president of the in the principles and methods of education trols”. And it proposed that oncology would European Society for Medical Oncology towards something not unlike what ESO be the ideal field to test CME, on account of when he signed off that report, and says he had itself been following for many years: its complex all-embracing nature, which had certain reservations. “Testicular cancer self-directed, non-bureaucratic, and “above crosses the boundaries of organ specialities is an exception – it has been curable now for all, oriented around patient needs.” Given as well as different medical disciplines. 20 years. But in lung and breast cancer our the reality that no public or independent results were very poor. For me research was money was being put into oncology CME That document provided a template for much more important than continuous outside of the UK, it recommended, with people all over Europe arguing for the de - medical education, and I wanted oncologists

28 CHAPTER 4

to do research with patients in the companies, meanwhile, has trials and not learn to use proto - increased in a way that had not cols that gave very poor results. been envisaged by the authors of the report. “At the time very few “At that time, ESMO was a club of companies were interested in people like me who were not satis - oncology, but now a big part of fied with the poor results we were pharma money goes into cancer, getting, we were managing failure and the competition between – ‘la géstion de l’echec’. So we them is very strong. And of course wanted all patients to be in trials, while when you have strong competition ESO was taking account of the reality that you have a big fight for selling not all patients could enter trials, so we had their drugs. This is something that to do our best for patients and doctors even took the protocol for the has changed,” says Armand. with the poor results that we had.” control arm to apply to their patients. That was the way people were updating their The report’s recommendation that “If I had to write it again, I would totally education in oncology.” money from many sources can be pooled agree with it,” he adds. “Results in oncology and channelled through not-for-profit CME were obsolete every six months, so we did The issue of accepting commercial sources providers under their control, he says, is not need to update things.” He remembers a of funding, however, remains a concern, says an accurate description of what happens constant stream of self-motivated doctors Armand. There are too few organisations like today in Europe. “When you have a new drug making the trip to his department at the ESO with significant resources of their own on the market they put a lot of money into Gustave Roussy, to keep up with the latest that they can use to fund core educational CME just to publicise the new drug they treatments. “The doctors would take all our activities and give them greater power to ne - have registered. That is a weak point, but we research protocols, which would have a con - gotiate terms on which they accept funding need this money, because it is hard to im - trol arm and an experimental arm, and they from commercial companies. The power of prove CME without it.”

CHAPTER 5

PARTNERS IN CARE

By the early 1980s, relations between doctors and patients in the US were changing rapidly. Thanks to a strong advocacy movement, boosted by the HIV/AIDS activism, and to a system that cast patients in the empowering role of ‘consumer’, doctors were starting to focus more on meeting the needs and demands of their patients rather than just treating the disease.

What patients were demanding was a their training was all about the disease and greater effort to help them cope with their not the patient. The concept of having al - disease and live their lives as well as possi - lied professionals, such as nurses and psy - ble: better treatment of problems such as chologists, who were specialised in cancer pain, fatigue and nausea as well as stress, and worked alongside medical teams, was depression and other emotional and psy - simply unheard of among European oncol - chological needs; greater efforts to min - ogists. ESO’s founders were no exception. imise any damage done to their appearance or loss of function, and in general more in - But when the idea of incorporating these formation, advice and support. aspects of care into ESO’s curriculum was suggested, ESO was quick to embrace it and Europe’s health systems, meanwhile, re - to seek collaboration with groups of allied mained oblivious to all of this. While indi - professionals and promote their role in vidual cancer doctors often did their best, mainstream oncology practice.

31 It was Jimmie Holland who first suggested isolated individuals, however, the need for ESO to formally incorporate who were developing expert - communication skills and the psychologi - ise in this area. Among them cal aspects of care into their teaching. This was Robert Zittoun, a French was a fast-developing area of oncology in haematologist who cared for the US at the time, and Holland was the real some of the first generation pioneer. She got involved with ESO purely of patients to be treated with because she was based at Memorial Sloan- a bone marrow transplant, Kettering in New York, and Memorial had including helping them agreed to oversee the quality of ESO’s come to terms with the very courses so that the courses could be ac - novel idea of their blood credited by the US system for continuing being generated by another medical education. Commenting on the person’s bone marrow. He content of an early breast cancer course, understood the value of good she noted that no attention had been paid communication and psychological support Together, Zittoun, Razavi and Holland to psychological aspects, and cautiously for cancer patients, and he approached ESO formed ESO’s psycho-oncology task force, asked whether ESO might like to address with the request that the school should publishing a monograph, overseeing the this. A correspondence sprang up between address this need in its teaching. psycho-oncology aspects of ESO courses, ESO and Holland and she gave ESO invalu - and developing and teaching numerous able guidance and assistance in developing Zittoun brought with him Darius Razavi, ESO courses, from 1989 onwards, cover - this work, including acting as a teacher. a friend and colleague from Belgium who ing topics such as ‘Psychosocial Oncology was opening up discussion about end-of- and Palliative Care’, ‘Sexuality and Can - The concept of psycho-oncology as a spe - life care and even euthanasia − but in fo - cer’ and ‘Psycho-oncology, Information cialist area of psychology was almost non-ex - rums and journals that were never visited and Communication’. Their involvement istent in Europe at the time. There were by oncologists. was significant in shaping the ‘learning to

32 CHAPTER 5

care’ approach to teaching oncology. The where outside of the UK, and in many core group of cancer nurses at the Royal ESO courses, in turn, helped a small countries nursing was seen as a vocation Marsden cancer hospital in London, who group of psychologists to develop special - rather than a profession. Surprisingly, were taking the first steps to define the ist skills in working with cancer patients, perhaps, it was Bruce Chabner − at that time skills and competencies of specialist cancer giving a significant boost to the develop - the undisputed leader of the fast developing nurses and develop courses for their educa - ment of psycho-oncology in Europe. discipline of medical on - tion and training. They cology − who first flagged were looking to reposi - There was another group of health workers up the crucial role of tion the role of cancer that ESO believed should become involved specialist cancer nurses. nurses on the grounds in much closer collaboration as core mem - “Don’t go ahead without that nurses have the bers of a team of carers – this was the nurses. the nurses,” was the one most sustained involve - Unlike with the psychologists, this was not a piece of advice he gave ment with the care of case of bringing professional skills in from ESO’s future director patients − they carry a the outside. It was a question of recognising when Alberto Costa, then heavy responsibility, so the value of the contribution they were al - researching chemopre - they should have equal S ready making − or had the potential to make vention at the US NCI, A status as part of a multi - M

− to the care of cancer patients, and pro - finally plucked up the O professional team. It was H T moting a new way of working together as courage to seek a meeting K this group, led by Bob R A

equal members of a multiprofessional team. with Chabner to seek his M Tiffany, that in 1984 went support for the idea of a on to launch the Euro - Here again the US was far ahead of Europe. European school of oncology. “Oncology pean Oncology Nursing Society (EONS). American cancer nurses were already organ - nursing will grow dramatically,” he predicted. ised as a professional group in the Oncology ESO was therefore in dialogue with Eu - Nursing Society. In Europe, the concept of a ESO took his advice to heart. Searching for rope’s cancer nurses almost from the time specialist cancer nurse existed hardly any - a partner in Europe, they came across a they started emerging as an organised

33 Kathy Redmond (centre left) and Nora Kearney, president and president-elect of EONS respectively, signing the agreement with ESO, Milan 1996

was needed on both sides. But by 1996 president-elect of EONS. “It was important ESO and EONS had reached a formal for a number of reasons. One was about agreement on the terms of their coopera - positioning EONS as an equal partner in group of professionals. tion: ESO and EONS would jointly design that relationship. But more important was It began to address the role and and offer multiprofessional training the ability to formally run joint courses, to contribution of specialist cancer nurses in courses, and ESO would not run any can - develop them together from a multipro - the courses it taught. And by 1986 ESO was cer nursing courses without the prior fessional point of view. What was very clear running its first courses on cancer nursing. agreement of EONS. The nursing society from the start, and was enhanced by the would be offered an ‘ex officio’ seat at formal agreement, was that if ESO was For the medical specialists who led ESO’s ESO’s Scientific Committee and Pro - going to do something, in general it would work and formed its faculty, the idea of gramme Committee meetings to facilitate be done jointly in a multiprofessional way, working alongside nurses on an equal this joint work. The agreement ran for two with nurses involved as equal partners.” basis proved somewhat more challenging years, and has been renewed every two than collaborating with other medical spe - years since that date. Kearney recollects that most people on the cialists such as psychologists. It required ESO side saw the newly-defined relation - a major cultural shift, particularly in That agreement marked an important ship with the nurses as positive and ac - countries where nursing had no profes - milestone in the long battle to get recog - ceptable. “But for some areas and some sional status. The path was not always nition for the role cancer nurses play, says countries that was really challenging, be - entirely smooth, and a certain amount of Nora Kearney, who played a key role in the cause nurses were seen as subservient to, patience, determination and leadership negotiations in her capacity as the then and much less important than, medical

34 CHAPTER 5

colleagues.” She recalls attending a meet - different disciplines to make sure you get ing in one eastern European country to the best possible outcomes. That is part of plan an educational initiative. At the meet - the message of the masterclass: you need ing, she made the point that nurses would those different perspectives.” have to participate, including leading and Nora Kearney presenting some of the sessions. “They Kearney, who is now professor of cancer said no, that is not acceptable in their care at the University of Dundee in Scot - country. ESO was pushing the boundaries care. But a lot of work is shared with the land, believes ESO’s multiprofessional ap - of multidisciplinary practice, particularly oncologists, so the networking potential proach means it is uniquely placed to help in education and the position of nurses.” for nurses as well as the educational drive good clinical practice, and she would potential is really exciting.” like to see the goals of the partnership ex - ESO’s flagship week-long masterclass in pand beyond education to promoting inte - clinical oncology is where this educational The joint masterclass also offers an oppor - grated multiprofessional clinical research. partnership has shown its real potential, tunity to raise awareness of the untapped She has spent many years leading research says Kearney. “When we started to collab - potential of cancer nursing among oncol - into how technology, such as mobile orate, it became a joint masterclass, we de - ogists from countries where the profession phone apps, can help health professionals veloped a joint programme together. We is poorly developed. “It’s an opportunity to deliver care in a more patient-friendly and are bringing the brightest young oncolo - show we are different but complementary cost-effective way. “If we don’t continue to gists together in a very good location with − if you look at focused patient outcomes, build the cancer care research portfolio we some of the best speakers across Europe, no one discipline can do it on their own. are not going improve outcomes for pa - and updating them on tumour-specific It’s not a tokenistic approach – ‘Here’s a tients as much as we could. At the moment topics and chemo-specific topics and so whole day on gastrointestinal cancers and collaborative multidisciplinary research on. From the nursing side we share some at the end of the last session we will talk doesn’t happen very well, at least at a Eu - of those sessions and we also have some about the nursing input’. It’s about how ropean level. There is a huge opportunity nursing-specific sessions on supportive you integrate the skills and experience of for ESO to take that work forward.”

CHAPTER 6

MANY DISCIPLINES, ONE TEAM

Multimodality treatment strategies were in their infancy when ESO was first established. The introduction of adjuvant chemotherapy was reducing rates of breast cancer spread and recurrence; adjuvant radiotherapy was mandated for women opting for new breast- conserving surgery. ESO taught these multidisciplinary strategies with great enthusiasm. But when its students returned to the hospitals they came from, they would usually find it was impossible to replicate the sense of interaction they had learned.

Departments of surgery, radiotherapy and for adjuvant treatment. The interaction be - internal medicine operated independently, tween experts from different disciplines with very little opportunity for interaction that the students had seen when discussing between them. Patients, and their medical how to plan the treatment of different cases notes, would be passed from one to the at ESO courses simply did not happen with next, as their treatment journey progressed. real patients in real hospital settings. Whichever department saw them first would be the one to determine what treat - ESO began to realise that it was not enough ment they would get, and in what order. It to teach younger, second-level doctors about was often the surgeons who decided multidisciplinary approaches to treatment; whether or not to refer ‘their’ patients on to make these approaches work required

37 Y G O L O restructuring the environment in which they C N O worked. So began a process that would even - F O E

tually lead to the development and formali - T U T sation of the concept of a ‘multidisciplinary I T S N

team’ – a team whose structure was defined I N as being drawn from many disciplines and A E P health professions, all specialised in the same O R U cancer, or group of cancers, and whose func - E tion was not only to work interactively to plan and deliver patient-centred care, but also papers in its own name. In 1998 it started control to alternative structures. Vested in - to review the quality of their work, to learn organising a series of multidisciplinary terests were tied up in status and budgets, and introduce changes as necessary, to con - workshops which drew up clinical guide - and anyway not everyone was convinced that duct specialist training, and preferably to par - lines that were published in the European they really needed the input of any other dis - ticipate in research networks. Journal of Cancer . In 2000 it published a cipline to tell them how to do their job. Driv - landmark position paper, “The Require - ing through change would require some The first step came with the founding of the ments of a Breast Unit”. This was the first determined pressure from people who were first multidisciplinary professional body for time that the concept of a multidisciplinary publicly accountable. And getting the people cancer specialists. This was EUSOMA – the team, and a multidisciplinary team meeting, with the power to exert that pressure would European Society of Mastology (now the was published in the academic literature. require pressure on them from health serv - European Society of Breast Cancer Special - ice users. What was needed was an alliance ists). Set up in 1986, on the initiative of Winning the argument on paper, however, between doctors and patients around the Veronesi, funded and serviced for very many was never going to be enough to change the agenda of delivering the best-quality care. years by ESO, it operated as an informal net - traditional, department-led, status quo. work for some years before establishing a Heads of departments rarely welcomed sug - So the second step came with the establish - formal structure and beginning to publish gestions that would result in them ceding ment of Europa Donna, the European

38 CHAPTER 6

Breast Cancer Coalition, in 1994. Estab - was in fact already being practised in many lished on the initiative of Veronesi, and sup - parts of the UK, but had not been formalised ported by ESO in its early years, the or defined. Roger Blamey, a surgeon from organisation developed rapidly under the Nottingham City Hospital, made the case for leadership of determined and highly capa - EUSOMA to promote the idea more widely. Luigi Cataliotti ble patient advocates from across Europe. It took up the call for all breast cancer patients “The UK was a good example for us to try to be treated in specialist breast units or (Europa Donna) and the researchers to develop and write up minimal require - breast centres, and by 2003 this was adopted (EORTC). This broad-based conference re - ments for breast units in a way that could as the policy of the European Parliament. placed the biennial conferences that EORTC apply to the whole of Europe – not just one This policy provided ammunition for Eu - had previously been organising on breast country but all European countries,” says ropa Donna member groups across Europe cancer. Luigi Cataliotti, who was about to Cataliotti. “We organised a consensus con - to campaign for the reorganisation of breast take over the presidency of EUSOMA at the ference in Leuven and wrote the first paper, cancer services in their own countries. Eu - time, remembers the EBCC founding con - published in 2000 in the EJC on the mini - ropa Donna has since worked with EUSOMA ference as a very influential event. mal requirements for breast units. Europa and the European Commission to establish Donna then brought this paper to the at - an independent accreditation process, so “There were 3000 people in attendance, tention of the European Commission. I was patients can tell which centres truly con - compared with 800 who had attended the twice invited to the European Parliament to form to the minimum standards required to previous conference organised by the explain what a multidisciplinary approach be considered a specialist breast unit. EORTC. We decided to hold a consensus means, and how important it is for breast meeting at the end of the conference, which cancer patients to have a team of doctors An important step along the way was the was attended by more than 1000 people.” It who can follow them throughout their care. launch of the European Breast Cancer Con - was during the consensus conference that This was the beginning of our campaign on ference (EBCC), in 1998, which brought to - EUSOMA proposed the idea of promoting the breast units, and the European Parliament gether the doctors (EUSOMA), the patients concept of breast units. The team approach accepted this completely.”

39 This was more than a paper providing information to help patients and victory, says Cataliotti. “If you their caregivers to identify high-quality go around Europe and ask breast units throughout the world. people who are involved in treating breast cancer, you’ll find that everyone knows The School is now looking to spread the about breast units. Consider Italy – not the model of specialist units to other types of can - best country when it comes to bureaucracy. cer, starting with prostate cancer – a disease Here we have at least three statutes that have to learn, because you can teach where patients could benefit from increas - been promulgated by our government. In and train different roles, and they are the ingly sophisticated personalised management two regions, Tuscany and Campania, it is al - right place to organise clinical trials or trans - by a team of specialists, but where the reality ready law that breast cancer should be treated lational studies.” is that too often they are being shunted in breast units, and now there is a strong towards one treatment modality or another. movement in favour of establishing breast ESO is now working with EUSOMA to sup - units across the whole country. In Germany, port the work of breast centres, and help new In 2011 ESO published a discussion paper in the concept is very well diffused, as it is in groups set themselves up as specialist breast the European Journal of Cancer on the Austria, Switzerland and the Netherlands. The centres, through the International Breast Requirements of a Specialist Prostate Can - Belgian government is now considering fol - Cancer Centres Network, which has almost cer Unit, with Riccardo Valdagni, ESO’s lowing the EUSOMA guidelines for organis - 175 member members in 41 countries. All prostate programme coordinator, as lead au - ing breast cancer centres. Good ideas at the members commit themselves to playing an thor. The School is working closely with the end of the day have success.” active role in the proposal and validation of patient advocacy group Europa Uomo to pro - breast cancer care guidelines, fostering train - mote the idea of restructuring prostate care Throughout the last 20 –30 years, ESO has ing activities and academic exchange among around multidisciplinary specialist units, been very close to all these good ideas, says breast units, contributing to the process of and it is working with the Organisation of Cataliotti. “ESO understood immediately standardising breast cancer care among these European Cancer Institutes (OECI) on an that specialist breast units are the ideal place units according to European guidelines, and accreditation procedure.

40 41

CHAPTER 7

EUROPE AGAINST CANCER

Very early in the morning, mid-June 1985, ESO’s director mounted his velosolex to go and send an urgent telex to the office of Prime Minister Bettino Craxi. It contained a one-page proposal for an ambitious plan to tackle cancer in Europe, setting a target of a 15% reduction in the number of deaths by the year 2000. The European Council of Ministers would be meeting that day in Milan, and Craxi – who held the presidency of the Council – had promised to put the proposal on the agenda.

Having been notified of Craxi’s intentions ble for industrial carcinogens) to Social Af - less than a day before the Council meeting, fairs (health and safety), Internal Market Veronesi and Costa had been up all night, (training and cross-border movement of drafting the document, and faxing back and healthcare workers), Information and Au - forth with Maurice Tubiana at the Institut diovisual (public awareness campaigns and Gustave Roussy, distilling their long wish- the Eurobarometer polls), and Research. list down to a single page of 200 words. Those 200 words gave birth to Europe The Commission established a ‘high-level Against Cancer, a programme that would group’ from the health ministries of the 15 mobilise almost every directorate of the Eu - member states, which met six times in three ropean Commission in one way or another, years, with the brief to roll out the pro - from the Industry Commission (responsi - gramme in each country. It mobilised

43 More than 25 years after it was first written, ESO’s 10-point Cancer Code is still used to promote cancer awareness cancer leagues, anti-tobacco cam - of the Cancer Code increased from paigners, and even public service broad - 16% in 1988 to 25% in 1990, and 38% casters, behind the campaign. To of Europeans had heard of Europe provide medical and scientific guidance, Against Cancer. it set up a Committee of Cancer Experts drawn from all 15 countries and led by Europe Against Cancer had many France’s Maurice Tubiana, head of the Gus - other, less visible, arms. ESO played tave Roussy, and Italy’s Umberto Veronesi. a key role in delivering some of The programme was given an initial budget these. They organised training pro - of 18 million euros (in those days ECUs). grammes in primary prevention and early detection for GPs and nurses (together with Among its most visible lasting legacies is the in a 2003 update to the code, which gave rise EONS, the cancer nurses group). This in - 10-point Cancer Code – the ‘ten command - to the ‘five a day’ slogan. volved using a variety of manuals and audio - ments’ – drawn up by an ESO task force visual materials in a number of languages for chaired by the epidemiologist Peter Boyle. The impact of the Code was amplified when training of trainers, as well as television and The Code, which is still in widespread use, the UK, which took over the presidency of radio broadcasts. They also drew up the rec - scored a number of firsts. It was the first the European Council in June 1986, desig - ommendations that introduced a compul - time cancer was presented to the public as a nated 1989 the Year of Information about sory minimum of 98 hours of integrated disease that they could – and should – pro - Cancer. Public health campaigns were re- oncology teaching at medical school for tect themselves against. It sparked a lasting inforced by some high-profile radio and tel - undergraduates. change in the approach to sun exposure, not evision programmes. One of these, Lifestyle least among the sun-loving Scandinavians. and Cancer in Europe, was broadcast on 11 Guidelines on screening programmes, sup - And it was the first time the role of weight channels and reached an audience of 6 mil - port for collaboration among cancer reg - and diet were publicly highlighted as risk lion in Germany alone. A poll taken by the istries, epidemiological studies and other factors. These aspects were spelt out further EU’s Eurobarometer showed that awareness research work all featured in the programme

44 CHAPTER 7

When the UK took over presidency of the European Council, Prime Minister Margaret Thatcher gave a boost to Europe Against Cancer by designating 1989 the European Year of Information About Cancer, with a budget of of Europe Against Cancer. It even 10 million ECUs. She is pictured here mustered the considerable political after a meeting to discuss the initiative, will needed to begin taking meas - London 1986. Also pictured are Michel ures against tobacco, facing down Richonnier (back right) and Umberto heavy lobbying from industry and Veronesi (back second from left) agriculture. The compulsory warn - ing signs displayed on every cigarette packet plan to propel Europe from being an eco - of the Gustave Roussy, for support. Know - originate from this era; Veronesi and Costa nomic entity defined by disputes over mon - ing the Italians were shortly to take over took part in delegations that visited every etary union, farming subsidies and fishing the presidency of the European Council, one of the 15 prime ministers or heads of rights, to becoming a People’s Europe, Tubiana in turn approached Veronesi, who state to seek their support for the measure. united around universal issues such as was then able to use his own good rela - health and education. tionship with Italy’s socialist prime min - More generally, the Europe Against Cancer ister to convince Craxi to support the idea. programme created an environment in A key figure behind this grand plan was member states and beyond where anti-can - the French socialist President François ESO was nonetheless an important catalyst, cer policies, initiatives, and campaigns began Mitterand, who in 1984 held the presi - and played a big role in making the pro - to flourish, providing the sort of leadership – dency of the European Council. It was gramme work. Michel Richonnier, who was if not the money and the institutions – that he who coined the term ‘Europe des given the task of getting the different parts Nixon’s Cancer Act had done in the US. Citoyens’, and who – influenced perhaps of the Commission to work together to by his own, unreported, diagnosis of progress the Europe Against Cancer pro - None of this, of course, could have been set prostate cancer three years previously – gramme, points out that fragmentation in motion purely from a one-page document selected fighting cancer as an issue that among the key players in cancer made a Eu - drawn up by ESO. At its inception, the idea would command widespread support ropean initiative like this one significantly for Europe Against Cancer was not really across the populations of Europe. Mit - more challenging than, for instance, the about cancer at all. It was part of the grand terand approached Maurice Tubiana, head Erasmus and Comett (later rebranded as

45 Leonardo da Vinci) initiatives being recommendations issued by the European launched at the same time in the field of Commission. That was very useful. It was training and education. produced and adopted by 1988, which was very fast.” At the same time, because all health issues could be decided only by majority vote, get - Michel Richonnier When Europe Against Cancer came to an ting new policies accepted would require end, in the year 2000, the highly focused significant political will, particularly for any programme was replaced by a more diluted measures that might not please the highly available.” Accustomed to lengthy European strategy that aimed to tackle problems such organised industry and agriculture lobbies. consultations seeking approval for a single as smoking, diet and exercise that were It is no accident therefore, that the body policy from multiple stakeholders across all common across chronic diseases. Thanks in which ended up drafting the basis for Eu - member states, Richonnier was particularly particular to the efforts of Europa Donna, rope Against Cancer, and helped mobilise impressed by the speed at which ESO could MEPs Against Cancer and the European experts from many parts of the world of bring different groups of people together and Cancer Patient Coalition, however, the Eu - cancer to participate in carrying out the get the job done. ropean Parliament and Commission did work of the programme, was the one Euro - continue to take up the cause of cancer. pean body that embraced all cancer disci - Being able to offer beautiful locations again plines and that was driven by a European proved helpful. “They were quick, reactive In 2003 the European Council issued a rec - outlook and a thirst for change. and active. ESO organised many seminars in ommendation on screening for breast, cer - San Servolo [Venice]. One was a symposium vical and colorectal cancer. In 2008 the Richonnier remembers ESO as a very en - on the issue of training medical doctors and European Parliament passed a resolution on thusiastic partner in Europe Against Cancer. nurses in cancer. This involved all medical combating cancer in the enlarged European “Alberto Costa spent a lot of time building associations throughout Europe who were Union, which addressed many issues, in - this programme up with us. Both he and involved in training medical personnel, cluding statutory cancer registration, pre - Umberto Veronesi really made themselves and formed the basis of the formal policy vention campaigns, implementation of the

46 CHAPTER 7

Council’s recommendations on cancer Policy and management issues are likely The Europe Against Cancer programme screening, recommendations on manage - to become increasingly important to the played a key role in mobilising the political ment through multidisciplinary oncology delivery of high-quality cancer care in the will needed for Europe to face down the teams, psycho-social care, palliative care, pa - coming decades, as governments seek to powerful tobacco lobby and introduce tients’ rights and more. It also sought to pro - square the circle of shrinking health bud- measures such as the compulsory warning vide the focus and drive that had been lost gets, rising costs and increasing demand. notices on packets of cigarettes and tobacco when Europe Against Cancer came to an Progress towards narrowing the gaps in end, by calling on the Commission to “set up cancer survival between northern and cen - an interinstitutional EU Task Force com - tral Europe and eastern and southern Eu - ESO will be looking to work closely with posed of Members from the Commission, the rope may become threatened by the ECCO and partnerships like EPAAC to Council and the European Parliament, impact of austerity measures in some help clinicians, nurses, patient advocates, which shall meet on a regular basis”. The re - countries. European health systems have researchers and policy makers work effec - sponse to this call was to set up the Euro - barely begun to define minimum stan - tively together to find sustainable ways of pean Partnership for Action Against Cancer dards and put in place procedures for delivering high-quality patient-centred (EPAAC), where ESO is actively involved, auditing and reporting on the quality of care to cancer patients whoever, and particularly in media training. care delivered to cancer patients. wherever, they may be.

CHAPTER 8

A TRANSATLANTIC ALLIANCE

By the time ESO was founded in 1982, American cancer professionals had been organised for decades, starting with the oncology surgeons, who founded their society in 1940, followed by the radiotherapists in 1958, the medical oncologists in 1964 with ASCO, and the cancer nurses in 1975. Spurred on by 1960s successes in treating leukaemia and then Hodgkin lymphoma, backed by the huge war chest of the War Against Cancer and led by the mighty NCI and the first cooperative clinical research groups, the US was the unchallenged leader in the world of cancer, and a magnet for young European oncologists who were serious about research.

But Europe was by no means absent from Anticancéreuse (GECA). The European the world stage. Europe had started Molecular Biology Organisation (EMBO) building its own cancer research infra - was founded in Heidelberg two years structure in the early 1960s. Henri later. By 1965 Europe was ready to launch Tagnon, who started medical oncology at its own oncology journal, the European the Jules Bordet in Brussels, set up the Journal of Cancer . European Organisation for the Research and Treatment of Cancer (EORTC) in All of this was happening in response to a 1962 – under the initial name of the huge upsurge in research and innovation Groupe Européen de Chimiothérapie on the ground at centres across Europe,

49 with people like Peckham at London’s In particular, there was a sense that, in States had a much more aggressive ap - Royal Marsden and Tubiana at the Gustave rejecting the traditional paternalistic proach, sometimes treating patients with Roussy in Paris leading developments in ‘doctor knows best’ approach in favour chemotherapy when they were terminally radiotherapy, Bonadonna at the Istituto of empowering the patient to take their ill,” explains Peckham. “They had a dif - Tumori in Milan, Gordon Hamilton-Fair - own decisions, American cancer doctors ferent concept of palliation and of care at ley at London’s St Bartholomew’s, and had adopted too rigid an approach to the end of life. Ours tended to be a far Bob Pinedo at the University Hospital in ‘truth telling’, which came over as lacking more gentle approach.” Utrecht pushing the frontiers of medical in compassion. oncology, and people like Veronesi in But if Europe felt it had something to Milan challenging traditional approaches Granted, Europe was not getting it en - teach the US, the US also had a lot to to cancer surgery. tirely right either – it was still the norm in teach Europe. There were many impor - many countries not to tell patients they tant figures in American oncology who So although cancer surgeons and radio - had cancer, which became a sticking contributed enormously to ESO, particu - therapists only started organising at a point, for instance, in the Milan CMF tri - larly in its early days. Charles Sherman, European level a couple of years before als, as the US NCI who sponsored the trial the chair of the accreditation committee ESO was established (a decade after the insisted on informed consent. of the American Medical Association’s Ed - medical oncologists, who started ESMO, ucation Council, gave generously of his the European Society for Medical Oncol - ESO was not going to teach doctors to time and enthusiasm, first helping ESO ogy, in 1975), the School’s founders had keep patients in the dark, but it did want get US accreditation for its courses, and a clear sense of a European approach to to preserve some of the good points of the then helping them advocate for a CME practising cancer medicine that differed European approach, to teach compassion system in Europe and develop CME in from the US approach in a number of and a responsibility for caring for the cancer education. ways. Some of these differences they whole patient, which had implications valued and were very keen for ESO to not just for delivering the diagnosis, but The team at Memorial Sloan-Kettering explicitly promote. the whole approach to treatment. “The acted as the formal ‘tutor’ for ESO

50 CHAPTER 8

courses. They checked the credentials of a school of oncology for Europe when the teachers and the content of the Europe was just a vague idea. They courses, as required by the AMA, and even thought it was a joke,” he says. “But ran joint courses with ESO at Memorial Veronesi was often ahead of his time. He in New York. It was Jimmie Holland, the saw a need for it.” Unlike many of his col - mother of psycho-oncology, who first in - leagues, DeVita also appreciated that troduced ESO to this rising discipline, countries other than the US might also and then went on to help design their have something to offer in the fight courses and participate on the faculty. against cancer, and he welcomed the Vince DeVita prospect of an organisation that might Support from some of the big hitters in help overcome the curse of fragmentation the US was also very important at the start that afflicted the European cancer effort. in building the credibility of the school, number of countries, it had funded and which was vital to attracting top-level fac - helped the EORTC set up a data manage - Under his leadership, the NCI had started ulty. Among them was the then head of ment programme, and it had also funded to organise big cooperative clinical trials the NCI, Vince DeVita, who backed the and helped to set up the clinical trials groups such as the CALGB (Cancer and School from the word go., He has re - office at the Istituto Tumori in Milan. Leukemia Group B). But when he trav - mained a consistent ally ever since, join - DeVita knew Veronesi very well. So when elled to Europe, cooperation was sadly ing ESO’s Scientific Committee in 1989, the proposal to start a European School lacking. “The conflicts between countries and later joining the editorial advisory of Oncology became a talking point in the were obvious – even within countries. board for ESO’s magazine, Cancer World . US, while many of his colleagues scoffed Once I went to Paris and they kept us at the idea, DeVita did not. waiting in the hall. When they finally DeVita knew the European cancer scene came out they said, ‘Would you chair the quite well by the time ESO was launched. “The people in this country thought meeting?’ I asked, ‘Why me?’ They said, The NCI had bilateral agreements with a it was a crazy idea, putting together ‘We can’t agree among ourselves who

51 should do it.’ So I chaired a meeting in met. “One of the major weaknesses of France!” The idea of a European School bureaucracies is not looking at what they of Oncology, says DeVita, seemed like a are doing, and deciding they don’t need to good way to bring down these barriers. do it anymore. To me, one of the things you do when you set up a programme is to have DeVita’s backing for the fledgling organi - some sort of sunset rule.” sation counted for a great deal. “Being director of the NCI, when you said some - ESO’s recent focus on organising weekly thing, people would listen. We called it a e-grandrounds, broadcast live and inter - bully pulpit. A lot of people would like actively on the web, is a good example of you to get up and say, ‘I think this organ - keeping up with current needs and possi - isation is really great’. I supported ESO.” bilities, says DeVita, and he feels it is He also helped find people who could as - working well. “When they started I lis - sist ESO in various capacities and backed tened to every one for the first year. I the fundraising initiatives of the Ameri - thought it was a great idea. You have an can –Italian Cancer Foundation, which audience scattered around the world, so was an important source of funding for the hardest part is finding the best time ESO, particularly in its early days. to reach the most people. I think they’ve done a great job with that.” advanced disease. ESO saw this as strate - DeVita says he is not at all surprised that gically important, because it answered an ESO is still strong and active 30 years on. In 2011 an important new chapter was urgent unmet need for developing a con - He attributes its success, in part, to its abil - opened in the transatlantic alliance when sensus on evidence-based guidelines for ity to respond quickly to new challenges as ESO launched ABC1, the first breast can - treating breast cancer in the advanced they arise – and to close down areas of cer conference to focus entirely on the setting. It was, however, a gamble, done activity once their goals have largely been treatment and care of patients with with no commercial sponsorship and

52 CHAPTER 8

ESO’s newly launched ABC conference on advanced breast cancer is a transatlantic project. Eric Winer from Dana-Farber (above left) and Larry Norton from Memorial Sloan-Kettering (above right) were co-chairs alongside ESO’s Fatima Cardoso and Alberto Costa little idea of how many people would be in chief of the Memorial Sloan-Kettering ference proved a huge success in both likely to attend. breast cancer programme and Eric attendance and in the consensus-based Winer, director of the Breast Oncology guidelines that came out of it. The The backing and active involvement of Center at the Dana-Farber Cancer Insti - transatlantic alliance is set to continue two high-profile American breast cancer tute, acted as co-chairs of the conference, with ABC2, scheduled for November specialists was therefore particularly and helped plan it and assemble an expert 2013, followed by further conferences valuable. Larry Norton, deputy physician and varied faculty. In the event, the con - every two years.

CHAPTER 9

PROMOTING PATIENT POWER

Patient support groups have been going for many decades, providing opportunities for patients to give and get solidarity and advice from people who have been there, or are still in a similar situation. But when ESO was founded at the start of the 1980s, the idea of advocacy groups that could give patients a collective voice, and help them play an informed role in decisions about their treatment, did not exist. ESO played an important role in seeding the idea, and making it happen for cancer patients in Europe.

The US, as usual, was ahead of the game. though not exclusive, patient base. In In the mid 1980s, frustration at the slow 1992, the NBCC demonstrated its lobby - pace of action to stem the disastrous death ing power by convincing the United States toll from AIDS prompted patients to or - Congress to direct a sizeable chunk of ganise to get their concerns addressed, money from the Department of Defense to with remarkable results. Fuelled, no fund breast cancer research – a practice doubt, by their success, in 1991 a group that has continued ever since, totalling of breast cancer survivors in the US $7 billion by 2012. The NBCC also began launched the National Breast Cancer lobbying for changes to policies in the Coalition – a group with a very strong ad - areas of screening, prevention, quality of vocacy mission, which has a significant, care and more.

55 In the absence of the internet, and with very launched by women at this point, and I cer - little global activity at a patient level, little tainly would not accept the presidency, as I of what was happening in the US was feed - hadn’t been elected. It is something that we ing into patient groups in Europe. Umberto would work towards.” Veronesi, however, was well aware of this growing advocacy power of American pa - But Veronesi’s plan did pay off. The women tients. He could see the potential they had whom he had invited to the conference to educate patients and drive change, and gathered around Freilich after the press he decided to try to organise something conference and agreed to form a commit - Gloria Freilich similar in Europe. tee to look at whether such a pan-Euro - pean patient advocacy organisation would Veronesi enlisted the help of Reach to Re - European patients’ organisation. At a press be feasible, and if so, how best to set it up. covery, a programme for breast cancer pa - conference held at the closing of EUSOMA’s A year later, Europa Donna held its first tients run by the American Cancer Society, conference, Veronesi called Freilich up to pan-European conference, hosted in Milan; which had been quietly developing contacts the platform and announced the launch of the year after, it held elections to the board, across Europe for a number of years. In Europa Donna, Europe’s first cancer patient and Freilich was elected founding presi - 1993, Veronesi invited some of these con - advocacy group, with Gloria Freilich as its dent; and one year later, in 1996, Europa tacts to attend one of the first international first president! Donna adopted its constitution, which conferences organised by EUSOMA (the spelt out the 10 goals that remain at the organisation for breast cancer specialists) It was, perhaps, not the most auspicious heart of its mission. in Paris. Among them was Gloria Freilich, start, but it did offer Freilich her first prac - who ran a patient organisation, Cancerkin, tice in standing up for the independent And as Veronesi rightly foresaw, Europa based at the Royal Free in London, and had voice of patient advocates. “I had to save Donna became a very effective lobbying been corresponding with Veronesi for the myself,” Freilich recalls. “I said sorry but group, pushing breast cancer up the politi - past year about his interest in setting up a Europa Donna has not been planned or cal agenda at a European level and in the 46

56 CHAPTER 9 A

N Europa Donna’s N

O annual advocacy D A

P training course, O R

U Milan 2011 E

countries where it has member novation we were never left out groups. It got the European Par - of the picture. Europa Donna liament to pass a breast cancer was always consulted and always resolution in 2003, supporting brought into it. It is very inclu - the right of women to be treated sive and that is the great secret by multidisciplinary teams in spe - of ESO’s success.” cialist breast units. And, together with tional work. It helped Europa Donna set EUSOMA, ESO and others, it has helped up its own headquarters, in Milan, con - One of these projects was a series of fairly drive this policy forward in many European tributing also to its funding. But it was small courses on breast cancer in young countries, including establishing an inde - the working relationship that was estab - women, which has now developed into a far pendent European accreditation process to lished between the two organisations that more ambitious programme of regular con - ensure that patients know which breast Freilich values most. “All the way along ferences, which will launch in Dublin at the centres can be trusted to provide high-qual - ESO has been a great supporter and a end of 2012. “I had contact with a lot of ity treatment. It has also helped transform mentor to lay breast cancer advocates, and young women [at Cancerkin] and I knew the the knowledge and understanding patients I for one really cherish Europa Donna’s kinds of problems they faced, and it grew have of their disease and treatment options, relationship with ESO. Alberto Costa has from that. I was in touch with Alberto helping breast cancer patients get the care always been very close to us, and a very through Europa Donna at that point, and I they need, and often forcing doctors and sound advisor,” says Freilich. “I don’t talked to him about what I wanted to do, and treatment centres to raise their game. think he ever embarked on anything sig - we decided to do the first one together. His nificant without considering where the office worked with mine and it was very suc - ESO played an important support role in advocates could be involved. He would cessful. It has gone on and developed from the early days. Europa Donna’s first legal often put suggestions about projects we those small courses. This is the way we’ve status was as an educational arm of ESO, might do together or invite representa - seen ESO work. It doesn’t just stop there and ESO dedicated someone on its staff to tives from Europa Donna to speak at ESO with the success of a course. If it’s been suc - help with administrative and organisa - conferences. Every time there was an in - cessful, it is developed and enlarged.”

57 Over the years, ESO has looked for oppor - But ESO was also aware of the problem that years, and shouldered much of the admin - tunities to support patient advocacy in other key messages about the rights of cancer pa - istrative burden in those early days. Today types of cancer. Patients with prostate can - tients and the need for high-quality cancer the Coalition has more than 300 member cer were seen as an important group. They services would get lost unless different pa - organisations from 45 countries, with its needed a voice because overtreatment and tient groups could speak with a single voice. own secretariat in Brussels and a strong ad - poor quality treatment were leading to un - So in 2003, ESO was instrumental in es - vocacy programme, particularly at the level acceptable rates of incontinence and impo - tablishing ECPC, the European Cancer Pa - of the European Parliament. tence. They also needed particular support tient Coalition – an umbrella group that because men tend to be less comfortable could speak at a European level for patients More recently, ESO has given a lot of sup - than women when it comes to talking about with any type of cancer, and could help sup - port to the work of groups of patients with their personal health issues. port member organisations with their ad - rare cancers, who are campaigning for or - vocacy activities. ganisational changes that will ensure that So in 2002, ESO helped a core of prostate where a rare cancer is suspected, the pa - cancer groups from around Europe join to - The founding conference, held at the Euro - tient is quickly referred to a specialist cen - gether to form Europa Uomo the European pean Institute of Oncology in Milan, under tre that can make the correct diagnosis and Prostate Cancer Coalition, and supported the ECPC motto “Nothing about us without advise on appropriate treatment options. their activities for many years. Today Europa us”, was attended by one hundred different Uomo has member organisations in 23 coun - cancer patient organisations, from 33 coun - Looking ahead, ESO is supporting propos - tries across Europe and is leading efforts to tries. It was the first opportunity for pa - als to establish a Europe-wide group for raise awareness about the importance of tients with different types of cancers and lung cancer patients – a group where en - being cared for by a multidisciplinary team from different countries to start to identify suring treatment is carried out by specialist specialised in prostate cancer, and the right of the issues they had in common, and the units working in networks will be very im - patients to be fully informed about the many shared issues they wanted to campaign on. portant to make sure patients benefit as different treatment options, and play a role ESO supported ECPC masterclasses to the quickly as possible from rapidly growing in - in decisions about their care. tune of €90,000 per year for the first three sight into the biology of lung tumours.

58 59

CHAPTER 10

ESO AND THE MEDIA

Information overload caused by too many articles in too many peer reviewed journals was one of the reasons ESO was started. Doctors were finding it hard to keep up with all the latest research while having time for their patients and possibly also participating in their own research work. ESO wanted to offer them the chance to learn about important developments, and their implications, from experts who had already digested the literature, and could talk to them, face to face. The last thing ESO wanted was to give busy young cancer doctors yet more material to read.

But it soon became apparent that students zine was launched October 2001 with a valued what they learned outside of the for - cover story on the founder of BIG, the mal sessions, chatting to faculty members Breast International Group, which ran in coffee breaks, at meals, in the evenings, under the title “Martine Piccart: medic and almost as much as the formal teaching. It musician”. Published by Springer, under gave them fascinating insights into the the tag line “Education and knowledge world of oncology, and the people who in - through people and facts,” and with Mau - habit it, that they could not have got else - rice Schneider, co-founder of ESMO, in the where, and they wanted to hear more. This editor’s chair, the magazine was designed as is where the idea for Cancer Futures origi - an ‘easy read’ – to be picked up and read nated. ESO’s first full-colour glossy maga - when off duty, or on the train journey home.

61 were more used to writing academic arti - cles and were often poor at delivering their With its emphasis on learning from people, copy on time. The operation was also costly. rather than only data and graphs, Cancer ESO decided to take the leap and bring pub - Futures always led with a personal profile as lication of its magazine in-house. In 2004 its cover story, and the magazine was in - it relaunched as Cancer World , with the It did have a CME section, which in the stantly recognisable from its front cover, same signature cover and cover story, but launch issue focused on adjuvant therapy which always featured a head-and-shoulders with a new editor, recruited from outside for breast cancer; there were five articles picture of the person being profiled. the ranks of oncology doctors. covering various aspects, preceded by a general overview written by Maurice It avoided focusing on big names who head Kathy Redmond was a cancer nurse by pro - Schneider. But it also had a section about societies and chair conferences. Not only did fession, who brought to the job more than a other professions involved in cancer care every discipline get a fair share of the lime - decade of experience in cancer politics and – cancer nurses in the case of the launch light, but leading people from cancer nurs - policies. As president of the European issue – one on advocacy, information ing, advocacy, research and non-commercial Oncology Nursing Society she had helped about careers and opportunities, and a drug development were all included, chosen establish cancer nursing on an equal footing Spotlight feature that could be used to from every corner of Europe, and with an with other professional societies. She had take a detailed look at a particular issue, equal representation of men and women. served on the board FECS (now ECCO) – the event, or institution. There was also Drug umbrella body that brought the three Watch, which was a news section looking This was something very new, and it was cancer disciplines together with basic re - at new drug approvals and developments very well received. But the content came searchers, nurses and paediatric oncologists; in regulatory procedures. mainly from busy cancer professionals, who she had been involved in Europe Against

62 CHAPTER 10

Cancer – winning observer status for nurses Over the years, Cancer World has been able on the board of experts; she had experience to cover a variety of issues that are under the working with patient advocacy groups – she radar of many oncologists, including: inno - was instrumental in launching the European vative uses of IT to keep a close eye on Kathy Redmond Cancer Patient Coalition, which was covered potentially serious symptoms; how to help in the first issue of Cancer World ; and she patients weigh up risks and benefits of dif - had been news editor for Cancer Futures . journalists was brought in. The extra cost ferent treatment options; thinking ahead was covered from the money saved by bring - about fertility problems; addressing side- Redmond took the magazine in a new direc - ing the publication in-house, together with effects and long-term effects, physical, psy - tion. “Because my background is not a doctor additional funding raised through a collabo - chological, sexual. But it has also been able I was able to stand back and look at a spec - rative programme with a group of commer - to tackle more complex and sensitive issues trum of things that were influencing the can - cial companies, Sharing Progress in Cancer such as access to experimental therapies, and cer scene,” she says. “No publication at that Care, coordinated by ESO’s Matti Aapro. the frictions, power struggles and political time was proactively covering policy issues, tensions that accompany efforts to restruc - and issues that have an impact on cancer out - “What we’ve done is to educate about issues ture cancer services. comes. Too many people just focus on the nobody was ever focusing on before,” says clinical issues a patient may face – what Redmond. “This was before the word ‘on - “Very rarely do we have single-interview drugs, what combination of drugs, what mul - copolicy’ was ever used. It’s only in recent articles,” says Redmond. “That is part of timodality treatment – without looking at the years people have started to understand what our philosophy, to acknowledge that there bigger picture. There was a clear gap that oncopolicy is, and that there is a need to in - is a spectrum of opinions and they are all Cancer World could fill.” fluence, to understand and to educate the valid, and by asking for different opinions community about these issues. People still we get a better understanding of the situa - Looking at the bigger picture, however, don’t understand how important policy is to tion. We’ve had very few people who’ve required covering issues from a variety of getting patients diagnosed on time, and seen refused to be interviewed, because we are viewpoints and perspectives, so a team of by the right people.” careful to give that balance.”

63 S I R R A H N O S A J

As ESO marks its 30th Axel Ullrich, the molecular biologist behind Herceptin and Sutent, talking about the anniversary, Cancer pressures on researchers to exaggerate the implications of their work, at a session World marked its 50th organised by ESO at the World Conference of Science Journalists, London 2009 issue with a redesign and a subtle change of empha - opportunity to talk about ference of Science Journalists, and in par - sis. A new Cross Talk section what their work means to them. allel with the Open Forum of the European looks at issues arising at the border Partnership for Action Against Cancer. between one discipline or profession and ESO also started to turn its attention to the another, by bringing people from either side role of the wider media – broadcast, print “Journalists are important because they of that border into a dialogue. A new My and online health and science journalists. shape expectations about new treatments,” World section gives cancer professionals of It launched its Best Cancer Reporter Award says Redmond. “They can inform people all descriptions, who are bringing commit - to encourage journalists to cover cancer about preventive strategies, and they can ment and creativity to their job, the stories using an investigative approach that raise awareness about the importance of is sensitive to cancer patients and their early detection. And politicians take notice families and stimulates awareness about of what the media says, so it is important advances in the cancer arena. And it devel - that journalists understand the issues they oped courses to help journalists improve are covering.” their knowledge and skills in covering dif - ferent aspects of cancer, which it delivered More recently, ESO’s media team has also at events such as the biennial World Con - started working with cancer professionals to help them get their own points across E R Y

T Dana Coza, epidemiologist at the I Chiricuta more effectively in media interviews. There N I c Oncology Institute in Cluj, Romania, doing a is a clear unmet need for this sort of media M R

E practice interview about cervical cancer screening, training, and this is an area ESO may T E P at a media training session run by ESO, Cluj 2011 expand in the coming years.

64 65

CHAPTER 11

AN INTERNATIONAL AGENDA

Cancer is a disease of rich countries, and emerging countries have neither the money nor the sophisticated health services that are required to tackle it. Neither of these statements has ever been entirely true, yet when ESO was founded, it was certainly the prevailing perception among the global health community. In reality, by the early 1980s more people were dying from cancer in emerging countries than in the developed world, and the numbers were starting to escalate at an alarming speed.

The reasons for this upsurge in new cancer of the populations of emerging countries. cases were not difficult to understand. The Governments, health services and interna - success of programmes to reduce deaths tional health and aid agencies that had from infectious diseases, combined with ris - traditionally been focused on tackling infec - ing living standards for some, meant more tious diseases needed to respond quickly to people were living longer – enough by itself stave off the worst of the rising tide of cancer. to push up the rates of new cancers. To make Few of them had any idea of how many new matters worse, many facets of the ‘western’ cases of different types of cancer were lifestyle that are linked to cancer – poor diet, occurring, or where. Almost none had any smoking, and starting families at a later age plans that addressed prevention, early detec - – were now being adopted by large sections tion, treatment or palliative care.

67 The year 2000 offered a major opportunity In 2003 the World Health Assembly – the at the highest international level, and the to turn things around, when the interna - global parliament of the World Health principles behind many – though by no tional development community drew up the Organization – took the first major global ac - means all – of the action points in the World Millenium Development Goals, which were tion against tobacco, with the WHO Frame - Cancer Declaration were endorsed. to set priorities for international aid until work Convention on Tobacco Control. In 2015. Sadly, however, such was the gap be - 2005 a gathering of the same Assembly As a small educational outfit with a remit tween perception and reality that cancer was passed the first ever international resolution focused on Europe, a target audience of can - not given a mention. on prevention and control of cancer, calling cer doctors, and an office with no more than for every country to develop and implement 15 staff, ESO had neither the mission nor the The new millennium saw a concerted attempt comprehensive cancer plans. In 2008 the ability to effect major change at a global to retrieve this disastrous situation. In 2000 a UICC (now known as the Union for Interna - level. However, its commitment to the prin - World Summit Against Cancer for the New tional Cancer Control) adopted the World ciple of equal access to high-quality care Millenium was convened in Paris. It con - Cancer Declaration – a concise roadmap of meant it kept an eye out for opportunities cluded with the signing of the Charter of practical actions, under the headings of where it could make a difference, and the Paris by President Jaques Chirac and K ōichir ō ‘health policy’, ‘prevention and detection’ and School deserves some credit for the contri - Matsuura, director of UNESCO, among oth - ‘treatment’, that could be implemented with bution it made to getting cancer on the ers. This Charter recognised the “rapidly ris - speed in any country. In 2009 the UICC international development agenda. ing tide of cancer incidence throughout the teamed up with international groups on globe, in developed and developing nations heart disease, diabetes, and tuberculosis and The first time the looming crisis in emerging alike,” and pledged to develop “unprece - lung disease, to call for a UN Summit on non- countries was flagged up in the mainstream dented global cancer networks and alliances” communicable diseases. In 2011 the summit cancer community was in the Djerba State - and create global research organisations to was convened, resulting in a political decla - ment, which was the result of an ESO initia - further the goal of preventing and curing can - ration, in which the huge problems cancer tive. Published in the Annals of Oncology in cer, and maintaining the highest quality of life and other ‘non-communicable diseases’ pose 1995 – five years before the Charter of Paris for those living and dying from the disease. for emerging countries were finally addressed – this admirably short statement called for

68 CHAPTER 11

Specially trained doctors explain the breast screening process to women at a Cairo clinic, 2000. This was part of a successful pilot, supported by ESO, that used clinical breast examination as an alternative to mammography for population-based screening the international community to wake up to showed that low-tech methods were a fea - tritional and health status than the average what was happening, and to recognise that sible alternative to mammography. Despite western patients, and could be administered most western strategies for controlling can - its success, the government opted instead within the logistical and economic realities cer were not appropriate to the developing for a high-profile mammography programme of the region. world. It called for support for efforts already that had a limited reach. Interestingly, in being made in many emerging countries to 2010, 10 years after the start of the Cairo As ESO readily admitted in Challenge conduct original research into the particu - pilot, a group of oncologists from the newsletters at the time, all of this was a lar problems they faced and how to address Egyptian University of Mansoura published mere drop in the ocean. The real challenge them using the resources they had available. results from the first screening project to would be to find ways of moving from a use clinical breast assessment that was smattering of small pilot projects to con - The signatories included many of the key based in an entirely rural community. It vincing governments and NGOs the world people who were pioneering efforts to de - used a strategy similar to the Challenge over to formulate and implement cancer velop oncology on the ground, in India, project, and confirmed that it was effective plans that would deliver prevention, Tunisia, Nigeria, Iran, Egypt and Albania. and improved outcomes. detection, treatment and care across their The statement had been agreed at a meeting entire populations. This would need inter- in the Tunisian island of Djerba, organised The Challenge Fund was also able to support national resources and advocacy on the by ESO as part of its Challenge initiative to the capacity building work done by organi - scale that had been mobilised throughout help people like them communicate with sations like the International Network for the 1990s in response to HIV/AIDS. The one another and disseminate information Cancer Treatment and Research (INCTR), trouble was that cancer control is so com - about the important work they were doing. whose projects included helping health pro - plex, requiring so many different activities fessionals in equatorial Africa to improve to be carried out by different players work - Challenge went on to launch a fund which their management of Burkitt lymphoma – a ing together, that it was hard to put to - financed some early pilot studies, including particular problem in this region. The gether a strategy that busy politicians, a palpation-based early-detection pro - INCTR helped them develop and trial proto - policy makers and international opinion gramme for breast cancer in Cairo, which cols that worked for patients with poorer nu - leaders could grasp and sign up to.

69 This, then, was the idea behind the World ting down the priority actions still further, Cancer Declaration – another initiative that and renaming it the Tianjin Declaration. owes a lot to ESO. Having seen how suc - The UICC used it to great effect in an im - cessful the ‘ten commandments’ of the pressive global advocacy campaign, lobby - Franco Cavalli European Cancer Code had been at raising ing world leaders in the run up to the 2011 public awareness of prevention and early UN Summit on Non-Communicable Dis - detection, ESO wanted to try a similar from 250 experts worldwide, and stretched eases, and it continues to be a backbone of approach at a global level. An opportunity to 20 pages. A review process by major UICC advocacy work, with more than half a arose when Franco Cavalli, a founding mem - global bodies including the WHO and IARC million people adding their signatures to ber of ESO, and co-chair of its Scientific gave birth to the second draft, which was the declaration so far. Committee, was elected president of the even longer. Remembering the lessons of UICC in 2006, with the intention to concen - the Code, Cavalli and Redmond distilled it In 2012 the World Assembly of the WHO trate the efforts of the organisation far more all to the current text, which fits on two agreed to establish a research and develop - on working with emerging countries. sides of A4 paper, and presents 11 targets ment fund devoted specifically to topics of together with key action points that can be relevance to emerging countries – a need “At the time, the UICC was still largely a acted on quickly in any circumstances with that had first been flagged up 17 years previ - Euro-American undertaking, centred on measurable results. ously in the Djerba Statement. developed countries,” Cavalli remembers. “With the help of ESO I was able to change The World Cancer Declaration was wel - It all adds up to a major shift in awareness at the focus. The result was the World Cancer comed by NGOs all over the world, which national and international levels of the prob - Declaration of 2008, which was not just are using it to back up their demands lem of cancer in emerging countries, and a financed by ESO, but was drafted by Kathy for more action on controlling cancer. It growing political will to find solutions. Redmond and myself.” That drafting became a topic of debate in regional and Cavalli believes that ESO has a role to play process was in fact a labour of many national conferences in many areas of the in making sure this now gets transformed months. The first draft incorporated input world; the Chinese made it their own, cut - into effective action.

70 CHAPTER 11

but never yet in an interna - radiologists and pathologists – in this case tional one: Are we winning the training in breast was done in Italy, and the war on cancer? The in - for colorectal cancer in the Netherlands. tention is to tease out the When we have trained people in early detec - nature of the biggest obsta - tion, we move on to improving their han - cles to controlling cancer, to dling of surgery and other treatments. We help better focus efforts on are currently training endoscopists and are how to overcome them. planning to bring some to the Netherlands to train for two or three months. Next year ESO is also keen to use its we will do the same for surgeons.” experience in educating and training to help people on To avoid a replay of the fate of the Cairo pilot, the ground set up high- ESO is working with the Kazakh govern - “ESO has two great advantages: it is eco - quality services. In 2010 it started its ment to ensure that the programme they are nomically independent, and it is a multidis - Caspian Sea programme, which is currently helping to develop is sustained and rolled out ciplinary society,” says Cavalli. This, he focusing mainly on developing the screen - to other parts of the country. “We are start - argues, makes it particularly well placed to ing services for breast and colorectal can - ing in one region and will take it from there bring together key players from across the cer in one region of Kazakhstan – a country to other parts of the country. We are now dis - world to develop a shared understanding of the size of western Europe with a popula - cussing a framework with Kazakh govern - the challenges and ways of meeting them. tion of 15 million. ment to carry this work forward on a Indeed ESO will mark its 30th anniversary long-term basis,” says Cavalli, who hopes the by doing exactly that: it will host 100 experts Cavalli explains the strategy. “We send project can become a template that can be from every corner of the world to spend two experts to evaluate the situation. They then applied in other countries, and is looking in days considering a question that has been work with local people to put together a the medium term to extend it to neighbour - posed many times in a western context, project. We start by training a couple of ing countries Azerbaijan and Uzbekistan.

CHAPTER 12

ESO IN THE DIGITAL ERA

Worldwide access to computers, mobile devices and the internet has opened up possibilities for delivering education that were almost undreamed of 30 years ago. It has also radically changed the way new generations communicate and seek information and knowledge.

For ESO, the question of how these new packs for general practitioners, nurses and opportunities could be put to best use to primary care workers, developed as part of further their mission posed a bit of a chal - the Europe Against Cancer programme. In lenge. The School had been pushing the the mid-1990s it participated in the Euro - frontiers of emerging communication tech - TransMed project, which pioneered deliver - nologies from its very start. In the early ing CME through live satellite television 1980s it used new video technologies to dis - broadcasts. With the rise of the internet, it seminate information about novel proce - had the chance to reach doctors at home or dures and best practice in cancer surgery. at work, at a time of their choosing, any - It employed a team to film in operating the - where in the world. atres across Europe as far as Moscow, where Nikolai Trapeznikov was pioneering limb- On the other hand, this isolated and rather sparing surgery for sarcoma. The record - passive way of receiving information did not ings were then disseminated on VHS work well with ESO’s educational style. The cassettes. In the mid-1980s it used a mix of ‘learning to care’ approach was all about audio and written materials in the training fostering an understanding of how different

73 Doctors can participate in live sessions of e-grandrounds or they can watch recorded sessions at a time of their own choosing bits of information fit into a broader picture of the disease and therapeutic options, and exploring how to work with others to apply this understanding to the complex realities of the patient in front of you. It was a style ideally suited to ESO courses, where 30-40 students are ‘cloistered’ away with one an - other, and with the faculty, for two or three days at a time, and can go into subjects in depth and take time to discuss and interact.

The solution the School came up with was they can pose their questions to the sessions on the scientific principles behind a programme of weekly e-grandrounds, presenter during the live session, via new therapeutic approaches, or questions every Thursday at 18.15 CET, that tackle the discussant. All the courses are CME of rehabilitation, survivorship, communi - both scientific/medical issues and issues accredited, and participants are invited to cation, accreditation and quality control, focused more on patient care. Each ses - complete a multiple choice exercise at the delivering cancer care in emerging coun - sion is presented by an international end to test their learning. CME points are tries and more. expert and is broadcast live over the awarded on the basis of their responses. internet, moderated by a ‘discussant’ – All sessions are recorded and can be ac - As its name suggests, the concept behind also a specialist in the field – who can cessed from the e-eso.net site at any time. e-grandrounds was based on the weekly ed - comment or ask questions to help clarify ucational gatherings that many hospitals points or elicit further detail. Anyone can Though each session is quite specific, as still organise around specific topics or clin - register to participate from anywhere in they happen weekly they cover a lot of ter - ical cases, often taking the format of a the world, and once registered they can ritory, from cutting-edge clinical issues re - Socratic dialogue between a senior doctor send questions in advance by email or lated to different cancers and settings, to and trainee. The idea for transferring this

74 CHAPTER 12

concept to the internet, where experts from make the most of the available technol - around the world can present sessions to ogy. People like Daniel Helbling. participants from around the world, origi - nated with ESO director Alberto Costa, and Helbling was completing his training at the stemmed from his appreciation of an edu - Inselspital in Bern, Switzerland, when he was cational format that decades previously he first approached to help with this project. A had imported from the UK to the hospital medical oncologist specialising in gastro- where he worked in Milan. intestinal cancers, he had already attended a number of ESO courses, and was very en - Daniel Helbling “I’ve always been very fond of the thusiastic about the potential for delivering grandround,” says Costa. “I learned about that sort of education over the internet. it when I was training in London. When I global grandround in which everybody started working at the European Institute could participate by simply logging in. The internet was coming into its own as a of Oncology [in Milan], I introduced the We then developed the concept of the teaching resource at that time, and Hel - grandround, because it was not part of the e-grandround, which was very well received bling could see its potential, but he had not Southern European mentality.” by the ESO board.” been able to use it much for his own oncol - ogy training because it was not yet widely Costa organised a grandround every Turning this idea into a workable proposal used in medicine. “That’s why I liked the Wednesday morning for the seven years he required involving people from a younger ESO proposal so much,” he says. spent at the EIO. While it was a very novel generation – people who shared ESO’s concept for Italy, the doctors welcomed it, philosophy of learning to care, but who Helbling helped develop the interactive he says, and always made an effort to attend. had grown up with the internet, were used style of the e-grandround, and believes to social networking and interactive that the chance to participate in live “When I saw what could be done with applications, relied on the web for a lot of sessions is an important feature. However, the internet, I had this vision of a their information and understood how to the quality of the content, and the

75 Participation in e-grandrounds is steadily increasing, but there is a lot of scope to further extend the reach of these cutting- edge educational webcasts

independence from any com - one tool among many, and it will mercial bias, are what he feels eventually become much better, make ESO e-grandrounds such a with advances in videoconferenc - valuable resource. ing. People will be able to connect by video using mobile devices, and “You have to look for high-qual - the connection will go faster, so ity content. You need this to be you will have more of a feeling of your principal goal. It doesn’t just being together.” happen. Quality speakers, good topics, cur - So far, he says, his requests have always met rent topics that are being discussed and are with an enthusiastic response. “I’m amazed, And while the sessions themselves have interesting now for those who learn.” because people are quite busy. But they like proved an enormous success, with almost to do it, because they know it is a big com - 20,000 viewings in 2012 and more than Helbling, who now heads a group of oncolo - munity which is not sponsor-driven, and 4300 registered users, only a small minor - gists in Zurich specialising in gastro-intesti - where unbiased knowledge is the prime pur - ity of these users participate in the live ses - nal cancers, has taken responsibility for pose. You just have to fit into their schedule.” sions and ask questions. It is a problem finding such speakers in his specialist field. that many interactive internet learning ac - “I go to conferences and I hear brilliant This is no substitute for face-to-face learn - tivities are struggling with, says Helbling. speakers on topics that are very current, ing, as Helbling readily admits, but he can “Nowadays young doctors are more used really something we are on right now, and I also see a time when improvements in tech - to short messaging and text messaging just ask them or email them to say we would nology will offer participants in the live and chatting, which helps them send in be interested to have them as speakers. That sessions a real sense of being part of a questions. But it is still difficult, and be - is how I like to do it. I’m not so much in group. “The limitations are that you cannot cause we are still at an early stage with favour of doing it from reading an article and make an emotional bond between teacher this, we always have to think about how asking the first author, because I don’t know and student, you cannot get the personal we can increase interactivity. It’s also a whether they will be a good speaker.” relationship over the internet. But it’s just cultural issue. Americans tend to interact

76 CHAPTER 12

The weekly e-grandrounds are viewed the world over, as this map indicates. European countries account for the highest numbers of participants, but India and Egypt both have a place in the top ten more; some more shy doctors from other that does not stop people watching the Helbling is delighted by the growing global cultures where normally they would not broadcasts after the event. Broadband con - interest in the e-grandrounds, which are ask questions would never join in.” nections remain a limiting factor, however, now giving ESO by far the greatest global in some parts of the world. Doctors from reach of any oncology body. “It’s amazing Global time differences being as they are, the Nigeria, for instance, report that they often to see that participants from North Africa timing of the sessions largely rules out live have to choose between hearing the speaker and countries where the healthcare is still participation from many parts of the world and seeing the slides, which may indicate the quite basic join so regularly. It shows that anyway – principally Asia, and Australia, as need to use a webcasting system that is they are reaching out to a good education. well as the west coast of North America. But geared to slower connections. It’s a great big community.”

77 WHO’S WHO AT ESO 2012

FOUNDERS DEPARTMENT COORDINATORS Laudomia Del Drago, Rome Sharing Progress in Cancer Care Matti Aapro, Geneva Umberto Veronesi, Milan Masterclasses Wolfgang Gatzemeier, Milan e-ESO Daniel Helbling, Zurich Cancer World magazine Kathy Redmond, Lugano BOARD OF DIRECTORS President Ugo Rock, Milan Members Alberto Azario, Milan PROGRAMME COORDINATORS Piergiuseppe Biandrino, Milan Breast Cancer Fatima Cardoso, Lisbon Alberto Costa, Milan (CEO) Breast Centres Network Carlos A Garcia-Etienne, Milan Vincenzo Finizzola, Milan Euro-Arab School of Oncology Omar Z Youssef, Cairo Thomas Galdy, Florence Balkan Region Razvan Popescu, Aarau Fedele Gubitosi, Milan Caspian Region M. Rosselli del Turco, Florence Pierandrea Maestro, Milan Prostate Cancer Riccardo Valdagni, Milan Laura Pellegrini, Rome Lymphoma Emanuele Zucca, Bellinzona Gualtiero Ventura, Milan Luigi Vita Samory, Milan Auditors Marco B Lovati, Milan (Chairman) TEAM Barbara Negri, Milan Chief Operating Officer Chatrina Melcher Stefano Sarubbi, Milan SPCC, EASO and Caspian Programmes Daniela Mengato Balkan Region and Teaching Activities Roberta Ventura Breast Programme, E-Learning, Masterclass SCIENTIFIC COMMITTEE and Teaching Activities Francesca Marangoni Chairman Franco Cavalli, Bellinzona Prostate Programme and Teaching Activities Rita De Martini Scientific Director Alberto Costa, Milan and Lugano Lymphoma Programme and Teaching Activities Dolores Knupfer Members Jean-Pierre Armand, Ville-Juif Teaching Activities Laura Richetti Mariano Barbacid, Madrid Editorial and Media Programme Marina Fregonese Lev Demidov, Moscow Alexandra Zampetti Louis Denis, Antwerp Corinne Hall Vince T DeVita, New Haven Communication Gabriele Maggini Mario Dicato, Luxembourg Administration Lorena Camarini Lex Eggermont, Paris Emanuela Garlaschelli Sara Faithfull, Brussels (EONS) Margherita Spreafico Ian Magrath, Brussels (INCTR) Bibliography Samuel William Russell-Edu Larry Norton, New York Nicolas Pavlidis, Ioannina Piergiuseppe Pelicci, Milan ESO is supported by Bob Pinedo, Amsterdam Fondazione per la Formazione Oncologica, President: Susy Gandini, Milan Michael Stevens, Bristol ESO Foundation, President: Carlo Maggini, Bellinzona

78 ESO FACULTY

ESO FACULTY

ESO faculty members are all international experts in their own field who give up their time to pass on their knowledge and experience to new generations of oncologists, asking nothing in return. Thousands of specialists have contributed to ESO courses over the past 30 years.

A J. Alamanos Gerald L. Andriole Ahmad Awada Jan G. Aalders Juan Albanell Mestres Guy Andry Baffour Awuah Lauri A. Aaltonen Peter Albers Simona Anelli Hatem A. Azim Jr. Matti Aapro Adriana Albini Andrea Anichini Neil Aaronson Christopher Alcock Mauro Antimi B Vera Abeler Judith Alder Antonis Antoniou Paul Baas Giancarlo Abelli Fiona Alderdice Ahti Anttila Gunnar Baatrup Lynne Abraham Jérôme Alexandre Lionel Jerome Apetoh Rajendra Badwe Per-Anders Abrahamsson Mamed G. Aliev Carlo Aprile Gaby Baerlocher Martino Abrate Malcolm R. Alison Carmen Ara Lea Baider Omalkhair Abulkhair Kari K. Alitalo Anne Arber Liliana Baila Sheila Adam Riyadh Lafta Al-Juboori Paolo Giorgio Arcidiacono Andrew David Baildam K. Adamos Adamou David J. Allison Andrea Ardizzoni Walter Baile Sven Adamsen Craig D. Allred Maurizio Aricó John Baillie Peter C. Adamson Elisabeth Alluard Jean Pierre Armand George Baitchev Adedoyin Adesanya Francesco Aloisi Luciano Armaroli Emilio Bajetta Suresh Hariram Advani Jonathan Alter James O. Armitage Maurizia Baldi Stefan Aebi Saverio Altieri John Armstrong Bettina Ballardini Reuven Agami Lucia Altucci Zoran Arnez Judith Balmaña Shyam Aggarwal Dino Amadori Angela Arnold Luca Balzarini Alija Agincic Sergio Amadori Daniel Aronson Shripad Banavali Niki Agnantis Ugo Amaldi Rodrigo Arriagada Roberto Bandelloni M. B. Agrawal Frédéric Amant Alan Ashworth Susana Banerjee Uros Ahcan Claudio Amanti George Assimakopoulos Chris H. Bangma David Ahlquist Hassan Amir Alli Jaromir Astl Mariano Barbacid Saleem Ahmedzai Carey Anders Philippe Astoul Tiziano Barbui Paola Aita Susan Anderson Lale Ibtisam Atahan Bart Barlogie Alessandro Aiuti Fabrice André Wendy Atkin Giuseppe Baroni Jaffe Ajani Claudio Andreoli Riccardo A. Audisio Guido Baroni Amin Hussain Al Amiri Bruno Andreoni Werner P. Audretsch Giovanni Barosi K. Al Jader Paul Andrews Philippe Autier Bruce H. Barraclough

79 Sally Barrington Marco Benasso Mariusz Bidzinski Michel Bolla Yuri Barsukov Marco Benazzo Stefan Bielack Werner Bollag Harry Bartelink Simone Beninati Philip Bieman Emilio Bombardieri Marc Barthet Javier Benitez Roberto Biffi Bernardo Bonanni Carlo Bartolozzi Paul Benkimoun Laura Biganzoli Italia Bongarzone Rupert Bartsch Osnat Benshoshan Nurija Bilalovic Corrado Boni Luisa Barzon Soeren M. Bentzen Jacques Bille Adriana Bonifacino Ethan M. Basch Giordano Beretta Andrea Biondi Herve Bonnefoi José Baselga Stacey Berg Lorcan Birthistle Aldo Vittorio Bono Hiba Basic Christophe Bergeron Timothy Bishop Marc Boogaerts Maria Basile Jonas Bergh Henri Bismuth Joachim Boos Assia Bassarova Manuela A. Bergmann Marie Christine Bissery Andrew Booth Pier Francesco Bassi P. Leif Bergsagel Debbie Bissett Peter Borchmann Amelia Bastagli Photis Beris Giorgio Bissoni Claudio Bordignon Filipe Basto Philip Berman Giampaolo Biti Patrick J. Borgen Jan J. Battermann Giovanni Bernardo Johannes Bitzer Bettina Borisch Eric Baudin Mario R. Bernardo Anders Bjartell Sussanne E. Börjeson Michael Baum Carlo Bernasconi Fiona Blackhall Neil Borley Michael Baumann Jürg Bernhard William A. Blackstock Erminio Borloni Amanda Baxter Jacques Bernier Didier Blaise Nenad Borojevic Louise Bayne Mark Bernstein Roger W. Blamey Josep Borras Martine Bayssas Adriana Berreta Ignacio Blanco Maria Grazia Borrello Massimo Bazzocchi Franco Berrino Susan Blaney Else Borst-Eilers Heinz Becker Pietro Berrino Maria Blasco A. Bosch Paolo Beck-Peccoz Alfredo Berruti Jean-Yves Blay Sarah Boseley Geerard Beets Oscar Bertetto Harry Bleiberg Cristina Bosetti Regina Beets-Tan Dominik Berthold Oleg Bliznyukov Snezana Bosnjak Adrian Begg Giulia Bertino Henric Blomgren Petar Bosnjakovic Yves Beguin Francesco Bertolini Diane Blum Jean-François Bosset Jose S.A. Belderbos Filippo Bertoni Mario Boccadoro Alberto Bossi Leonor Beleza Francesco Bertoni Francesco Boccardo John Bostwick Antonino Belfiore William Bertrand Lisa Bodei Peter Bösze Carol Bell Sefic Beslic Werner Boecker Andrew Bottomley Marco Bellani Semir Beslija Andreas Boehle Alan Boyd Lara Bellardita Jan Betka Paolo Boffetta Peter Boyle Filiberto Belli Daniel Betticher U. Bogdahn Deborah Boyle Mauro Belli Alex Bex Dragana Bogdanovic Federico Bozzetti Joaquim Bellmunt Raimundo Bezares Julia Bohlius Sergio Bracarda Massimo Bellomi Abhay Bhave Catherine Boisante Michael Brada Andreas Bembenek Gabriella Bianchi Micheli Hans Bojar Andres Brahme Farhat Ben Ayed Giampaolo Bianchini Carsten Bokemeyer Elizabeth Brambilla Rachel Benamore Angelo Raffaele Bianco Leslie Bokey Maria Luisa Brandi

80 ESO FACULTY

Lawrence Brandt C Gianni Casanova Roberta Chersevani Susan Branford Natercia Cabral Natale Cascinelli Roberto Cherubini Susan Braun Claudio Calabrese Stefano Cascinu Bruce D. Cheson Freddie Bray Luca Calabrese Alberto Cascon Teresa Chiaravallotti Anne Bredart Carlos Caldas Enrico Cassano Fausto Chiesa James Brennan Trinidad Caldes Ignazio Cassis J. Anthony Child Ricardo Renzo Brentani Giancarlo Caletti Maria Rita Castellani Lau Ching Brigitte Bressac-de Paillerets Federico Caligaris-Cappio Manuel A. Castello David Chinitz Cinzia Bressi Luciano Callegaro Antoni Castells Giovanna Chiorino Alberto Briganti Angelica Calleri Monica Castiglione-Gertsch Luca Chiovato Stephen Brincat Hilary Alan Calvert Carlos Jose Castro Jiri Chod Nancy G. Brinker Felipe A. Calvo Gianpiero Catalano Rakesh Chopra Thomas Brodowicz Tiziana Camerini Luigi Cataliotti Elie Chouillard Massimo Broggini David A. Cameron Gianluca Catania Stefano Ciatto Jacqueline F. Bromberg Alan J. Cameron Carlo V. Catapano Slobodan Cikaric Dominique Bron Salvatore Campo Federica Cattani Saverio Cinieri Miguel Bronchud Hernandez Cristina Camponovo Elena Cauzza Livio Cipolletta Vincenzo Bronte Vukasin Canak Guido Cavaletti Fabrizio Ciprani Giorgio Bronz George P. Canellos Ugo Cavallaro Roberto Cirio Lucio Bronz Giulio Cantù Franco Cavalli Saskia Claassen Stuart Brown Rodolfo Capanna Luigi Cavazzini Orlo H. Clark Gina Brown Jaume Capdevila Simon Cawthorn Mike Clarke Marvelle Brown Renaud Capdeville Giovanni Cecchetto Noel Clarke Robert Brown Gabriel Capellá Graziella Cefalo Helen Clayson K. Brunnert Francesco Caponigro Aleksandar Celebic Mario Clerico Roberto Bruschini Vera Cappelletti Carlos Centeno Gary Clifford Paolo Bruzzi A.T. Caraceni Giovanni Luca Ceresoli Krishna B. Clough Jane Bryce Corrado Caracò Luca Ceriani Anna Cluxton Claudio Buccelli Fatima Cardoso Timur Ceric Alan Coates Gordon Buchanan Angelo Michele Carella Thomas Cerny Jan Willem W. Coebergh Vittoria Buffa Lisa A. Carey Enzo Cerundolo Ronald Coggins Roland Bugat Paolo Carli Andrés Cervantes Francesco Cognetti Steffen Bulow Carmelo Carlo-Stella Amitabh Chak Gaetana Cognetti Paul Bunn James Carmichael Mammen Chandy Alfred Cohen Alex Burdorf Giorgio Carmignani Guillermo Chantada Odile Cohen-Hauenauer John Burn Desmond N. Carney David J. Chaplin Elena Colajori Harold Burstein Angelo Caroggio Tengiz Charkviani Slobodanka Colakovic Jane Busev Huib N. Caron Carole Charley Robert E. Coleman Federico Bussolino Cinzia Caroti Martin Charvat Marco Colleoni Johanna Augusta Bützer Peter R. Carroll Pierre Chauvel Paola Collini Marc Buyse Chiara Casadio Mark Cheetham V.Peter Collins Roberto Buzzoni Paolo Giovanni Casali Ivan Chernozemski Maria Ines Colnaghi

81 Alessandro Colombo Francoise Crokaert Ara Darzi Juergen Debus Nicoletta Colombo Daan J.A. Crommelin Amar Dasgupta H. Joachim Deeg Renzo Colombo Cristiano Crosta Iskra Daskalova Angelo Paolo Dei Tos Pamela Colombo Nadia Crotti Timothy Davidson Elisabetta Dejana Ramon Colomer John Crown Nancy Davidson Suzette Delaloge Cesare Colosimo Siobhan Crowther Andrew Davies Richard Delarue Giuseppe Colucci Neil Cruickshank Elisabeth Davies Jean Yves Delattre Giuseppe Comella Ofelia Cruz Robert Davies Emmanuel Delay Pasquale Comella Juan Cruz Cigudosa Richard Davies Domenico Delia Alain Cometta Juan A. Cruzado Mikhail Davydov Mario Dell 'Oca R.L. Comis Gabor Cserni Claudio De Angelis Matteo G. Della Porta Massimo Conio Tanja Cufer Robrecht De Bock Chiara Dell'Agnola Marianna Connola Zoran Culig Johann S. de Bono Daniela Dell'Anna Elizabeth Connolly Stephane Culine Filippo De Braud Angelo Delmonte Joseph M. Connors Michael Cullen Andrea De Censi Florence Demenais Pier Franco Conte Francesco Cupella Concetta De Cicco Lev Demidov Giario Natale Conti Walter Curati Alasonatti Ottavio de Cobelli Louis J. Denis Stefano Corcione Razvan Ovidiu Curca Franco De Conno Alain Depierre Carlos Cordon Cardo Giuseppe Curigliano Francesco De Falco Rika Deraemaecker Claudia Corrado Gregory A. Curt Elvio De Fiori Marco C. DeRuiter Pelayo Correa Giacomo Maurizio Cuttone Hanneke De Haes Omer Devaja Chiara Corsini Jack Cuzick Maja de Jonge Peter Devilee Hernan Cortés Funes Esteban Cvitkovic Jean-Pierre De Landtsheer Bernadette Celine Devine Umberto Cortinovis Dorota Czudowska Nicolò de Manzini Santiago Dexeus Renzo Corvò Filippo De Marinis Sven Dhaese Y. Coscas D Damir De Monaco Frederic Dhermain Sergio Cosciani Cunico Gian Antonio Da Prada Giuseppe De Palo Serena Di Cosimo Vincenzo Cosentino Maria Grazia Daidone Tommaso De Pas Franco Di Filippo D. Cosgrove Giuseppe D'Aiuto Bernard De Pauw Pier Paolo Di Fiore Alberto Costa Mariangela Dal Prà S. De Placido Simona Di Giovanni Josè Costa Faruk Dalagija Theo de Reijke Giuseppe Di Giulio Guido Costamagna David C. Dale J. Marjan de Rijke Paola Di Giulio Anna Costantini Riccardo Dalla Favera Marisa De Rosa Angelo Di Leo Richard James Cote Ernesto D'Aloja Dirk De Ruysscher Massimo Di Maio Finbarr E. Cotter Gaetano D'Ambrosio Maria De Santis Concezio Di Rocco Bruna Cotza Giovanna Damia Vincent T. De Vita Eduardo Diaz Rubio Etienne Coussens Lucia Danesi Manganiello Elisabeth G.E. de Vries Kay Dickersin Peter Covitz Montserrat Daniels Maruscha de Vries Volker Diehl Brett Cox Luigi Maria D'Anna Paul De Vuyst Ingo Diel Lucio Crinò Françoise Dantzer Ronald De Wit Holger Dieterich Flavio Crippa Gwen Darien Theo De Witte P.Y. Dietrich Stefano Crippa Sandra Darkins David Dearnaley Andreas Dietz

82 ESO FACULTY

Raghunadharao Digumarti Robert Edwards Sara Faithfull Thomas Fischer Maurizio D'Incalci Rosalind Eeles Jean Faivre Uwe Fischer Mario Dinis Ribeiro Fabio Efficace Corinne Faivre-Finn Deborah Fisher Stephan Dirnhofer S. Efremidis Alessandro Faldini Richard I. Fisher Jennie Dix Rudolph Maarten Egeler Lesley Fallowfield Alfred Fitoussi J.Michael Dixon Alexander M.M. Eggermont Valeria Fantin John M. Fitzpatrick Jadranka Dizdarevic Angelika Eggert Naim Bakr Farah Karim Fizazi Benjamin Djulbegovic Manuela Eicher Guenter Farin Michael Flentje Srdjan Djurdjevic Wolfgang Eiermann Francis Farrell Carlo Aurelio Floris Roberto Doci Timothy Eisen Antonio Farris Riccardo Fodde Radan Dodic Elisabeth Eisenhauer B. Farsides Judah Folkman Shelley Dolan Christine Eiser Giuseppe Favalli Secondo Folli Sylvie Dolbeault Francois Eisinger Nicola Fazio Sharon Fonn Alberto Donfrancesco Rossella Elisei Paul A. Fearn Vinjar Fonnebo John H. Donohue John E. Ellershaw Philip Febbo Alastair Forbes Michael Donovan Ian Ellis Massimo Federico Bruno D. Fornage Jean Francois Doré Mark Emberton Enriqueta Felip Guido Forni Massimo Eugenio Dottorini Andreas Engert A. M. Feller Graziano Fortuna Mitchell Dowsett Alexandru Eniu Dean Fennell Sophie Dorothea Fosså François Doz A. Epenetos Tom Ferguson Piero Fossati Martin Dreyling Jonathan I. Epstein Jayme Fernandes Franca Fossati Bellani Christoph Driessen Paola Erba Isolda Fernandez Christopher Stuart Foster Carol Dumelow Melek Erkisi José Fernández-Piqueras Jan Foubert Ian D. Duncan Mustafa Erman Irene Feroce Harold Fox Malcolm Dunlop Edzard Ernst Andrea Ferrari Jesme Fox Jürgen Dunst Gerd Ersdal Carlo Ferrari Silvia Franzetti Enzo Durante Bente Appel Esbensen Stefano Ferrari Andrea Frasoldati Marco Durante Jordi Estape Andrés J.M. Ferreri Francesco Frassoni Erol Duren Emilio Esteban Frank D. Ferris Milo Frattini Osman Duric Manel Esteller Pier Francesco Ferrucci Thierry Frebourg Harold F. Dvorak Andrew Evans Martin F. Fey Vittorio Fregoni Martin Dyer Gareth Evans Willem V. Fibbe Stefan Frei Esther Dyer Gunther Eysenbach Vincenzo Ficarra Gloria Freilich Aslan Dzampaev Isaiah J. Fidler Jane French Joan Dzenowagis F John Field Gisela Fridstedt Alma Dzubur-Kulenovic Alessandra Fabi Rosa Filiberti Gilles Frydman Angelica Facoetti Sladjana Filipovic Li Fu E Thierry Facon Aleksandra Filipovic Laura Fugazzola James East Jan Fagerberg Stephan Finical Zvi Fuks James A. Eastham Francesco Fagnoni Ilora Finlay Daniela Furlan Wilfried Eberhardt Tom J. Fahey Roberto Fiocca Eileen Furlong Diana Eccles R. Fahlbusch Claudio Fiorino Hansjakob Furrer

83 Carl Johan Fürst Roberto Gennari Roger Gomis Lin Gu Oreste Davide Gentilini Vera Gorbunova Giacomo Gucciardo G Birgit Geoerger Michael Gordon Carmen Guerra Pietro Gabriele James Geraghty Norbert C. Gorin Angela Guerrieri Dmitry Gabrilovich Jean Pierre Gerard Georg Gosheger Gianluca Guffanti Tanja Gagliardi Franco Gerardi Margot Gosney Aymeric Guibal Gianluca Gaidano Bernd Gerber Mary Gospodarowicz Guido Guidi Dorothea Galié -Wunder Paula Ghaneh Christopher Gostout Pierre Guillou Viviana Galimberti Michele Ghielmini Takuji Gotoda Sumeet Gujral Andrea Gallina Michael Ghilezan Amit Goyal Bahadir M. Gulluoglu Michele Gallucci Giuseppe Giaccone Richard Gralla Leonard Gunderson Lorenza Gandola Felice Giangaspero Luigi Grassi David H. Gustafson Arnold Ganser Jocelyne Gianini Alois Gratwohl Eva Gustafsson Marina Chiara Garassino Alessandro Gianni F. Graus Barry Austin Gusterson Silvio Garattini Luca Gianni Richard Gray Rema Gvamichava Guido Garavaglia Raffaella Giavazzi Alessandra Graziottin Thomas Gyr Claudio Garbelli Bianca Gibelli Carlo Greco Judy Garber Francisco Gil Andrew Green H María J. García Robert J. Ginsberg Philip Greenberg Rainer J. Haas Guillermo Garcia-Manero Massimo Gion Stefano Greggi H.A. Haaxma Reiche Giorgio Gardini Francesco Giovagnorio Vincent Gregoire Herbert Habets Michelle D. Garrett Luca Giovanella Anna Gregor Nagy Habib Sebastien Garson Marc Giovannini Vanesa Gregorc Neville Hacker Cristina Garusi Raffaele Giubbini Manuela Gregori George Hadjidekov Pere Gascón Gioacchino Giugliano John Gribben Tatiana Hadjieva Randy D. Gascoyne Jean Claude Givel Cesare Gridelli Anne Hagemeijer Hausman Gemma Gatta Julie Glanville Vincent Griesser Christine Haie Meder Giovanna Gatti Axel Glasmacher Arjan W. Griffioen Michael Halaska Wolfgang Gatzemeier John A. Glaspy Gillian Griffith Jacqueline Hall Philippe Gaulard Agnes Glaus Keith Griffiths Nigel Hall Oliver Gautschi Michel Glauser Alexandru-Calin Grigorescu Michael Hallek Javier Gavilan Fergus V. Gleeson Jacques Grill Daniel Haller Anna Gavin Joseph Gligorov Filippo Grillo Ruggieri Stephen Halligan Valeria Gavrikova Bengt Glimelius Robert Grimer Freddie C. Hamdy Harold Gaya Robert Glynne-Jones Andrea Grisotti Axel-R. Hanauske Simon Gayther F. Gogolin Paolo Gritti Bojar Hans Mark Gaze David Goldgar Alessandro Gronchi Heine H. Hansen Fady B. Geara Aron Goldhirsch Samuel Gross Thomas Hany Jan Geissler John M. Goldman Enzo Grossi Xishan Hao Richard Gelber I. Goldschmidt Daniela Grosso Nadia Harbeck Shari Gelber Peter Goldstraw Birgitte Grube Felix Harder Maryline Genero Henry Gomez Moreno Nekelle Gruis Jendrik Hardes

84 ESO FACULTY

Darren Hargrave Harald Hoekstra Nicole Iborra Christopher Johansen Peter Harper Dieter Hoelzer Majilinda Ikonomi Peter W.M. Johnson Adrian L. Harris Francesco Hofmann Ermina Iljazovic Patrick G. Johnston Claire Harrison Pancras C.W. Hogendoorn Mohammad Ilyas Stephen Johnston K. A. Hartmann Emily Holbrook Treen Marcello Imbriani Walter Jonat Michelle Harvie David Hole Axel Imhof Eric Jonckheere Adnan A. Hassan Roland Holland Luca Incrocci Xavier Jonckheere Gerard Hastings Kaija Holli Mattia Intra Alison Jones Karin Haustermans Brian Holloway John Ioannidis Glyn Jones Klaas Havenga Torbjorn Holm Loretta Itri Virgil Craig Jordan Bob Haward Katarina Holmberg Andreas Josting Ernest Hawk E. Carmack Holmes J Dragana Jovanovic Andrew Hayes Jerzy Holowiecky Fatteneh Tavassoli A. Jabbari Albert J. Jovell Anita Hayes Arnulf Holscher Annie Jackson Ana Jovicevic Daniel F. Hayes Zdenek Holub Andrew Jackson Ian Judson William Heald Sally Hopewell Ian Jacobs Peter Jüni Rüdiger Hehlmann Jean-Claude Horiot Alex Jadad Sara Junius Axel Heidenreich Markus Horneber Elke Jaeger Herbert Jurgens Dominik Heim Josipa Horvatin Dirk Jäger Edmund Juszczak Volker Heinemann Alan Horwich Raimund Jakesz Paul Held Peter Hoskin Michael T. Jaklitsch K Emma Helm Dieter K. Hossfeld Radoslav Jakovic Stein Kaasa Lee J. Helman Claude Houdayer Gerhard Jakse Vesna Kacar-Kukric Kari Hemminki Peter Houghton Nicholas James Zaira Kadagidze Michael Henk Nehmat Houssami Momcilo Jancovic Sasa Kadija Michael Henke Anthony Howell Przemyslaw Janik Yoshiyuki Kakehi Guenter Henze Sacha Howell Momcilo Jankovic Chantal Kalifa Paul Hermanek Andrew Hoy Maryska Janssen-Heijnen Ioannis Kalomenidis Niels Hermann Iztok Hozo Nickolay C. Jaramov Hossam Kamel Miguel Hernandez-Bronchud Hedvig Hricak Janusz Jaskiewicz Willem A. Kamps Roberto Herrera-Goepfert Robert Huddart Tim Jaspan Guy Kantor H. Herrmann Clifford A. Hudis Jeremy Jass Ingvar Karlberg Richard Herrmann Tom Hudson Jacek Jassem Vesa Kataja Christian W. Hess William Avery Hudson Svetislav Jelic Nikolay Katev Urs Hess M. Huenerbein Claude Jemelin Michael Kattan Johannes Heverhagen Maureen Hunter Meriel E.M. Jenney Nikolay Katzarov Joan Higgins Rodolfo Hurle Guido Jenster Hans-Ulrich Kauczor J.G Hildebrand Christof Hurny Barbara Jereczek Bella Kaufman Kle Hoang Xuan Maha Hadi Hussain James Jett Manfred Kaufmann Shirley Hodgson Zefei Jiang Andrzej Kawecki Michael Hoeckel I Farah F. Jijna Nora Kearney Caroline Hoeks A. Iannella Steven Joffe Armand Keating

85 Gordana Kecman - Malcic Andrzej Komorowski Ruth Ladenstein Mark Levine Sean Kehoe Daniel B. Kopans Fiona Lalloo Yexiong Li Ulrich Keilholz Thomas Koperna Bernhard Lämmle Alberto Liboni Malcolm Kell Smruti Koppikar Fabio Landoni Mikhail Lichinitser Pirkko-Liisa Kellokumpu-Lehtinen Ida Korfage Athene Lane Danuta Lichosik Daniel Kelly Dieter Körholz John D. Langdon Lisa Licitra Lorraine Kelly Stine Sofia Korreman Francesco Lanza Nicky Liebermann Karen Kelly Paris Kosmidis Antonio Lanzavecchia Justin Lindemann Catherine M. Kelly Ingrid Kössler Pablo Lapunzina Barbro Linderholm Robert Kerbel Zsofia Kote-Jarai Catharina Larsson Per-Gote Lindgren Winfried Kern Vilijem Kovac Eric Lartigau Clifton Ling Izidor Kern Gyula Kovacs Catherine Lassale Scott Lippman David Kerr Gabor Kovacs Jean Michel Lassauniere Sarah Liptrott Keith Kerr Krassimir Koynov Mercedes Lassus Michael Lishner Eli Keshet David Nielsen Krag Conxi Lazaro Florigio Lista Mohammed Keshtgar Neika Krasteva Axel Le Cesne T. Andrew Lister Vesna Kesic Malgosia E. Krasuska Thierry Le Chevalier J.W. Little Ann Kessinger Mecththild Krause Clifton Leaf Mark S. Litwin Sami Khatib Thomas Krause Gary Y.C. Lee Lorenzo Livi Samir Khleif Kurt Krejcy Jack Lee Antonio Llombart Cussac Christopher Khoo Leontine C. Kremer William Lees Francesco Lo Coco Wenny Kiebert Marco Krengli Jean Louis Lefèbvre Bernard Lobel Judy King Gary Kreps Thomas Lehrnbecher Franco Locatelli Roger King Maciej Krzakowski Marjut Leidenius Imogen Locke Mary-Claire King Rahel Kubik-Huch Stéphane Lejeune Mark Lodge David W. Kinne Roger Kuffer Madelaine Lejour Marian Loertscher Ziya Kirkali Christiane K. Kuhl Giorgio Lelli Sherene Loi Krassimir Kirov Rajat Kumar Nicholas Lemoine Sibylle Loibl Alexander Kiss Harpal Kumar Roberto Massimo Lemoli Hugues Loiseau Monica Kjeldstrøm R. Kuner Marko Lens Louis A. Loizou Melika Klancevic Arun P. Kurkure Raul Léon Barua Lee Lokey Gunther Klautke Purna Kurkure Jorge Leon Chong Claudio Lombardo Jos Kleijnen Bernhard Kurtz Kay Leonard Walter Longo Eric Klein John Kurtz R.C.F. Leonard Michel Longy Jan G.M. Klijn Stella Kyriakides M. Cristina Leonardi Paul Lorigan Marianne Kloke Leda Leoncini-Franscini Reuben Lotan Laurence Klotz L Antoon E.M.R. Lerut Susan Love Jan Klozar Nicholas B. La Thangue Viktor Letyagin Bob Lowenberg Susan Knox Carlo La Vecchia Ragnar Levi Laura Lozza Claus-Henning Köhne Roberto Labianca Fabio Levi Jan Lubinski Hans Jochem Kolb Denis Lacombe Bernard Levin Giovanni Lucignani George Komatsoulis Ludovic Lacroix Theo Levin Heinz Ludwig

86 ESO FACULTY

Michael Luebbert Per Uno Malmstrom Tamas Masszi Stefan Michiels Josef Luetzeler Marcos Malumbres Renato Mastrangelo Jean Marie Michon Alberto Luini Anna Mancuso Sabrina Mastrovito Rachel Midgley Peter Lukas Dragan Mandaric Victor Matei Silvia Migliazzo Alexander Lukianchenko Giovanni Manfredi Maria Victoria Mateos Martin Mihm Roberto Luksch Paul Manley Christopher Mathew Franco Milani Urska Lunder Robert E. Mansel Erika Matos Gerard Milano Staffan Lundström Behrouz Mansouri Takahisa Matsuda Vera Milenkovic Way Lup Wong Paola Mantellini Alex Matter Angel Milev Dieter Lutz Alberto Mantovani Andrea Mattiussi Natasa Milicevic David C. Lyden Markus Manz Tim Maughan Koen Milisen Frank Lyko Pasquale Marano Michela Maur Anthony B. Miller Gary H. Lyman Michael Marberger Deborah Mayer Kurt Miller Elizabeth Lynne Oscar Marchetti Giovanni Mazzarol C. Miller Alessandra Marchi Luca Mazzucchelli WR Miller M Marko Margaritoni Dennis McCance Ken Mills Hubert Maas Anita Margulies Stephen McCulley Roger Milne James Mackay Giuliano Mariani Enda William McDermott Gustavo Milone Douglas Macmillan Luigi Mariani Kieran McHugh Zorica Milosevic Fiona MacNeill Ann Marinus Gillies McKenna Lea Minnen Faik Madanat Janina Markowska John A. McLachlan Bruce Minsky Massimo Maffezzini Jean Alfred Maroun Anne McTiernan Saverio Minucci G. Maggi Victor E. Marquez J. Gordon Mcvie Michele Minuto Angelo Maggioni Giancarlo Marra Jukka - Pekka Mecklin Raymond Mirabell Massimo Magnani Michelle Marshall Bakir Mehic Deepak K. Mishra Karin Magnusson Hugo Raul Marsiglia Laurent Meijer Moshe Mittelman Ian Magrath Silvia Marsoni Dror Meirow Milos Mlyncek Miriam Magri Hendrik Martijn G.S. Mela Edgar Mocanu Stefano Maria Magrini Lesley-ann Martin Sylvie Menard Victoria Mock Roma Maguire Giovanni Martinelli Ilario Menchi Giulio Modorati Eamonn Richard Maher Alvaro Martinez Fred H. Menko Kathy Moebus Jane Maher Maria Elena Martinez Georgi Mentkevich Gabriela Moeslein Charles Mahler Gemma Martino Francesco Mercuriali Alejandro Mohar Madeha Awad Mahmoud Pietro Martino Giampaolo Merlini Eleonora Molinaro Antonello Mai Giuseppe Martorana Roland Mertelsmann Annamaria Molino Elena Maiolo Michel Marty Francesca Merzagora Burkhard Möller Eugenio Maiorano Dorjan Marusic Maria Cristina Messa Michael Molls Patrick Maisonneuve Riccardo Masetti Helmut Messmann S. Monfardini Galina Maistruk Nick Maskell Stephan Metzelder Simonetta Monti Vassiliki Malamou-Mitsi Federico Maspes Paolo Miccoli Rodolfo Montironi Hemant Malhotra Joan Massagué Joelle Michel Francesco Montorsi Raffaele Malinverni Maura Massimino Olivier Michielin Silvia Montoto

87 Emili Montserrat N Christine Norton P Mufaddal Moonim Elisabeth Nacheva Larry Norton Thomas Pabst Alessandro Morabito Gerd Nagel C. Nos Doreen Pace Brendan Moran Velu Nair Urban Novak Carlos Pacheco Rudolf Morant Robert Nam Marek P. Nowacki Furio Pacini Marianne Morch Moise Namer Mohammad Nowrousian Anwar Padhani Paulo Moreira Rosanna Nano Geoffrey Nuttall Marianne Paesmans Gema Moreno Kikkeri Naresh Giovanni Paganelli Lorenzo Moretta Maurizio Nava O Olivia Pagani Bruno Morgan Anne Naysmith Kjell Öberg David L. Page Ignazio Morgana Jan P. Neijt Nermina Obralic Arcangelo Pagliarulo Giuseppe Morgia Heidi Nelson T. O'Brien Lars Pahlman Carlo Alberto Mori Gia Nemsadze Mary O'Brien José Palacios Calvo Bruce Morland Italo Nenci Reto Obrist Francesca Palandri Françoise Mornex Flavio Nervi Adrian Ochsenbein Emilio Palazzo Hans Morreau Clara Nervi Stephen J. O'Connor Giovanni Palladini Gillian M. Morris-Kay Zora Neskovic-konstantinovic Ichiro Oda Holger Palmedo Monica Morrow Andreas Neubauer Gianenrico Odazzi Giorgio Palù Isabel Mortara Lechtman Hartmut P.H. Neumann Ann O'Doherty Shani Paluch-Shimon Dion Morton Rainer Neumann Gillian O'Dowd István Palugyai Maria Cristina Mosconi Heli Nevanlinna Donald Ogilvie Antonio Palumbo Paola Mosconi Herbie Newell Niall O'Higgins Minggui Pan Daniela Mosoiu Donald Newling Kutluk Oktay Rumen L. Pandev H.T. Mouridsen Elliot Newman Kathy Oliver Gerassimos Pangalis Nicola Mozzillo Julia Newton-Bishop William Oosterlinck Pietro Panizza Gulham Mufti Niels Neymark Daniel Oppenheim Guido Paolucci Tariq Mughal John Nicholls Cristina Marinela Oprean Dimitrios Papageorgiou Kathrin Mühlemann Andrew Nicholson Daniel Orbach Demetris Papamichael Hasan Mukhtar Nicola Nicolai Roberto Orecchia Enrico Papini John Mulhall Pilar Nicolas Alberto Orfao Giovanni Pappagallo Gudrun Munkel Bruno Niederle Fabio Orlandi Mario Pappagallo Auxilia Chideme Munodawafa Dietrich Niethammer Laura Orlando Evangelos Paraskevaidis Elisabetta Munzone Omgo E. Nieweg F. Orsi Santilal P. Parbhoo François J. Murat Branka Nikolic Michael Osborne Rolland Parc Liam Murray Tore Nilstun Ana Osorio Laura Pardo Mirza Musanovic Jacques Ninane Gerry O'Sullivan Sunil Parekh Renato Musumeci Blaise Nkegoum Jaques Otten Purvish Parikh Katalin Muszbek Franco Nolé Renée Otter Chris Parker Paolo Muto Mark Noppen Andrea Ottolenghi Maxwell D. Parkin Otieno Mwanda Bernard Nordlinger Memet Ozek David R. Parkinson K. Mystakidou John.M Northover Enis Ozyar Karen Parles Hans Nortier Ozgur Ozyilkan Giorgio Parmiani

88 ESO FACULTY

Ann H. Partridge Pedro Pérez-Segura Miguel Angel Piris Mark Pritchard Patrizia Pasanisi Giorgio Perilongo Xavier Pivot Kathy Pritchard Jones Anes Pasic Rosario Perona Maria Pizzamiglio Sebastian Probst Renata Pasqualini Francesco Perrone Simona Pizzi Paolo Pronzato Jakob R. Passweg Carlo Peruselli Hilary Plant Giancarlo Pruneri Ugo Pastorino Andrea Pession Vesna Plesinac-Karapandzic Eric Pujade-Lauraine Jean-Jacques Patard Solange Peters Marta Podda Jean Louis Pujol Poulam Patel Finn Bo Petersen Alfredo Polo Marco Pullia Julietta Patnick Jean-Yves Petit Vladimir Polyakov Cornelis J.A. Punt Leonardo Patrlj Liliana Petkova C. Polyzoidis Dinesh Purandare Catherine Patte Marija Petkovic Luisa Ponchio Andrea Pusic Marilyn Elizabeth Patterson Julian Peto Thierry Ponchon Y. Patyutko Sylvaine Petoin Dimitrije Ponomarev Q Antonello Paulesu Giuseppe Petrella Lucia Ponsanesi Yu Qiang Marco Paulli Lubos Petruzelka Maurizio Ponz de Leon Yuri Quintana Michael Paulussen Lucio Petruzziello Maurilio Ponzoni Leticia Quintanilla-Fend Lorenzo Pavesi Ekatherina Peytcheva Chris Poole Phil Quirke Steve Pavletic Francesco Pezzella Philip Poortmans Elisabeth Quoix Nicholas Pavlidis Luciano Pezzullo Sanjay Popat Miguel A. Pavlovsky G. Pfeifer Razvan Popescu R Santiago Pavlovsky Jacobus Pfisterer David G. Poplack Guenter Raab Michele Pavone Macaluso Michael Pfreundschuh Ivan Popov R. Raab Eduardo Payet Paul Pharoah Davina Porock Farhang Rabbani Vladimir Pazin Kelly Anne Phillips Russell K. Portenoy Wayne Rackoff Fedro Alessandro Peccatori Robert A. Phillips Pieter E. Postmus Stojan Radic Salvatore Pece Christine Phillips Graeme John Poston Paolo Radice Michael Peckham Robin Phillips John D. Potter Davorin Radosavljevic Sergio Pecorelli Martine Piccart Richard Pötter Gordana Radosavljevic - Asic Carla Pedrazzani Maria Picchio Pierre Pouillart Ljiljana Radosevic-Jelic Claudio Pedrazzoli Piero Picci Jacques Pouyssegur Svjetlana Radovic Christa Pedrazzoli Aldo Piccolo Pierre Pouysségur Najib Rahman Andrew Peet Tom Pickles Simon Powell Nazneen Rahman Francois Pein Marco Pierotti Ray Powles Kanti Rai Pier Giuseppe Pelicci Torsten Pietsch Thomas Powles Massimo Raimondo Giuseppe Pelosi Sandro Pignata E. Pozzi Vinod Raina Elisabetta Pennacchioli Adriana Concetta Pignatelli Marleen Praet Dick Rainsbury Marzia Pennati Francesco Pignatti Lorenzo Preda Tiziana Rancati Emma Pennery Aldo Pinchera Marco Presta Tomislav Randjelovic George Pentheroudakis Herbert Michael Pinedo Joza Pretnar Antti Rannikko Alberto Peracchia Luis Pinillos Maja Primic-Zakelj David Ransohoff Ivy Percy Ross Pinkerton Suman Prinjha Guglielmina Nadia Ranzani Edith Perez Marco Piolini Kathleen I. Pritchard Shahnawaz Rasheed

89 Mark Ratain Alessandro Riva Giovanni Rosti Julian Sampson Andri Rauch Michel Rivoire Arnaud Roth Martin G. Sanda Peter Ravdin Licia Rivoltini Mace Rothenberg Gemma Sandberg Isabelle Ray-Coquard Giorgio Rizzatto Christian Rothermundt Jaspreet S. Sandhu Darius Razavi Vittorio Rizzoli Nicole Rotmensz Claudio Sanelli Emma K. Ream Mach Roach III Philppe Rougier Judith Sanitt Gregory H. Reaman Lukas Rob Dimitrios Roukos Piero Giovanni Filippo Sanna Sixto Recavarren Arce Anita Roberts Lewis Rowett Richard J. Santen Kathy Redmond J.Trevor Roberts Eric Keith Rowinsky Pierluigi Santi Malcolm W. Reed John F.R. Robertson Ales Rozman Armando Santoro Nick Reed Mercedes Robledo Sanja Rozman Giuseppe Santoro J.K.H. Rees Helena Robova Patrizia Rubbini Paglia Massimiliano Santoro Lea Regolo Bernardo Maria Rocco Luigia Rubio Carlos Santos Jaroslaw Regula Francesco Rocco Curzio Rüegg J. Sanz-Ortiz James Reid Nicola Roche Hope S. Rugo Frank Saran Alfred Reiter Thomas Röche Joanne Rule Enrico Sartori Mary V. Relling Sjoerd Rodenhuis Carolyn Runowicz Brian Saunders XiuBao Ren Kostas Roditis Tiziana Rusca Fadda Jean Christophe Saurin Giuseppe Renne Ana Cecilia Rodriguez Rossitza Ruseva Edward A. Sausville Christoph Renner Patrik Rogalla William Russell-edu Charles Sawyers Lazzaro Repetto Ralf Rohn Emiel J. Th. Rutgers Elena Scaffidi Alessandro Repici P. Romano Harm J. Rutten Giorgio Scagliotti Pierre Reusser Giovanni Romeo Jean-François Ruys Pierre Scalliet Victor E. Reuter Sergio Romeo Malanda Giovanni Scambia Domenico Ribatti Pedro Romero S Domenico. Scannicchio Umberto Ricardi Monique Roobol Fred Saad Gianfranco Scaperrotta Riccardo Riccardi Michael Rorth Roberto Sabbatini Peter Scardino Enrico Ricevuto Juan Rosai Virgilio Sacchini Vincenzo Scattoni Michael Richards Riccardo Rosati Peter Sagar Niklaus Schäfer Sue Richards Carsten Rose Giuseppe Saglietti Jack A. Schalken Alison Richardson Steven T. Rosen Gianni Saguatti Lidia Schapira Antonella Richetti Angelo Rosolen Tapan K. Saikia Christof Scheid R. Ridolfi Gill Ross Marcel Sailer Howard I. Scher Gert Riethmüller Merrick J. Ross Fernando Salas Arnaud Scherpereel Mario Rietjens Marco Rosselli Del Turco Agim Sallaku Norman Scherzer Héla Rifi Attia el Hili Roberto Rossetti Gilles Salles Maria Pia Schieroni Gino Rigotti Plinio Rossi Manuel Salto-Tellez Charles Schiffer Henny Rijken Sandro Rossi Massimo Salvatori Mark Schiffman Franco Rilke Virginia Rossi Roberto Salvioni Francesco Schittulli Andrea Rinaldi Carl Rossi Diana Salvo Peter Michael Schlag Brian I. Rini Inga Rossion Antonella Salzano Heinz-Peter Schlemmer Carla Ida Ripamonti Riccardo Rosso Joao Carlos Sampaio Goes Richard Schlenk

90 ESO FACULTY

G. Schmitt Susan Shanley Enrico Solcia M. Stoeckle Maurice Schneider Zhi-Ming Shao E. Solsona Jelena Stojsic Dominik Schneider Lena Sharp Pieter Sonneveld Steven Stone Patrick Schöffski Frances Shepherd Gabriella Sozzi Dominique Stoppa-Lyonnet Nicolas Schönfeld Carmel Sheppard Lorenzo Spaggiari Maria Rosa Strada Harry Schouten Prabhakar Shetty Antonio G. Spagnolo Florian Strasser Heidemarie Schreiber Janet Shipley Andrea Spano Victor J. Strecher Dirk Schrijvers Margaret A. Shipp Alain Spatz Tomaz Stupnik Fritz H. Schröder Sergeij Shiryayev Pol Specenier Georg Stüssi Andreas Schuck Shiva Shivananda Stuart Spechler Eric Suba Gerold Schuler Marco Siano Andrea Spelta Somasundaram Subramanian Hans Joachim Schulz Antonio Sica Margaret Spittle Stefan Suciu Marieke Schuurmans Mario Sideri Filippo Spreafico Paul Sugarbaker Gilberto Schwartsmann T. Siegal Giuseppe Spriano Tullio Sulser Gordon F. Schwartz Salvatore Siena Rolf A. Stahel Marco Sumini Nigel Scott Peter Siersema Sheila Stallard Hildrun Sundseth Crispian Scully Karol Sikora Georgios Stamatis Stéphane Supiot David Sebag-Montefiore P.A.E. Sillevis Smitt Ljiljana Stamatovic Antonella Surbone Massimo Seccia Alchiede Simonato Davor Stamenovic Sergio Suriano Nevena Secen Mhairi Simpson Hana Stankusova Jordi Surralles Siegfried Segaert Shalini Singh Dusan Stanojevic Heather Sutherland Anna Segatti Percival Angelo Siragusa Dan Stark Christer Svedman Dimitrije Segedi Per Skaane Anastasios Stathis Bohuslav Svoboda Giuseppe Segni Petr Skapa Georgios Stathopoulos Philippe Swennen Joe Selby Radek Skoda Jeremy Steele William F. Symmans Axel Semjonow Nicole Skoetz Bernardina Stefanon Ala Szczepura Suresh Senan Warner V. Slack Petar Stefanovski Moica Sencar Sarah Elizabeth Slater Guenther Steger T Elzbieta Senkus-Konefka S. A. Slavin Harald Stein Monica Taborelli Hans Jorg Senn George W. Sledge Hans Steinert Gianni Taccini Cecilia Sepulveda Maurice Slevin William Steinmann Emile Tan Ettore Seregni Rosemarie Slevin Perocchia Jutta Steinseifer Stephan Tanneberger Davide Serrano Phil Sloan Eva Steliarova-Foucher Ian Tannock Vincenzo Serretta Ian Smith Andrew J. Stephenson Mario Tarabbo Cristiana Sessa Malcolm Smith Anita Stern Roberto Taramelli Mark E. Sesto Matthew R. Smith Cora N. Sternberg Paola Tarchi Thomas Seufferlein John Smyth Michael C.G. Stevens Aleksandr Tatosyan Andrew Severn Gordon Brian Snow Fiona Stewart Sean V. Tavtigian Pankaj M. Shah Alberto Sobrero Lesley Stewart Ali Tawfik Jatin P. Shah Riccardo Soffietti Clinton Stewart Claire Taylor Ashok Shaha N. Sofikitis Ewout Steyerberg Irving Taylor Stephen M. Shalet Miha Sok Stephan Stilgenbauer Malcolm Taylor

91 Ayalew Tefferi Diego Tosi Maria Carla Valli Giancarlo Vecchio Paris Tekkis Karim Touijer Dominique Valteau-Couanet Charles J. Vecht Borut Telban Nicoletta Tradati Simon J. P. Van Belle Vitor M. Veloso Jennifer Temel Mario Traina Eric Van Cutsem Thierry Velu Catherine Terret Jean Paul Travagli Jan Willem van de Loo Anna Rita Vento Daniela Terribile Paola Tredici Marjan Van de Pol Sophie Venturelli Carlo Terrone Srbobran Trenkic Cornelis J.H. Van De Velde S.C. Verhagen Tatiana Terrot Steven Treon M.J. Van den Bent Marcel Verheij Ivan Terziev Nadja Triller Sabine Van den Bosch Nancy Verheis N. Testa Bruce Jeffrey Trock Janny van den Eijnden Jan B. Vermorken Pier Alberto Testoni Joze Trontelj Agnes van der Heide Paolo Veronesi Alessandro Testori Claes Trope Theo van der Kwast Umberto Veronesi Ash Tewari Ivana Truccolo Gert Van der Laan Renato Versace George Thalmann Livio Trusolino A.P. Van der Meijden Ellen Verschuur-van der Voort Nicholas Thatcher Vladimir Tsaryuk Joost R.M. Van der Sijp Rogier Versteeg Patrick Therasse Catrin Tudur Smith Elsken Van der Wall Jaap Verweij Richard L. Theriault Nina Tunariu Ate Van Der Zee Giuseppe Viale Catherine Thieblemont Jill Turner J.E.W.M. Van Dongen-Melman Leonardo Vicentini Richard L. Thierault A. Turrisi Wim H. Van Harten Frank Vicini Huw Thomas Andrew Tutt Diana van Heemst Andrew Vickers J. Meirion Thomas Petra Tuyp Paul Van Houtte Snezana Vidakovic Christoph Thomssen Nikolay Tzankov Erik Van Limbergen Petra Viehweg Steinunn Thorlacius Valentina Tzekova Jan Van Meerbeeck Riccardo Vigneri Philip E. Thorpe Erik van Muilekom Gaetano Villa Maria Grazia Tibiletti U Janine van Nes Peter Villiger André Tichelli Hashim Uddin Ahmed Allan T. Van Oosterom Matthieu Vinchon Corrado Tinterri Axel Ullrich Hendrik Van Poppel Paolo Vineis Umberto Tirelli Michael Untch Wim van Putten Antonella Viola Emmanuel Tiret Miguel Urioste Paul Van Schil Katherine S. Virgo Sergei Tjulandin Tatyana Ushakova Jozef van Thillo Claudio Viscoli Jeffrey Tobias Nico Van Zandwijk Milan Visnjic Andreas Tobler V Geoffroy Vanbiervliet Umberto Vitolo Vladimir Todorovic Kirsi Vahakangas Margaret Vance Agnese Vivaldi Michele Tomamichel Ashok Kumar Vaid Luc Vanuytsel Petr Vlcek Zorica Tomasevic Jayant.S Vaidya Marco Varaldo Emile E. Voest Bertrand Tombal Luca Vaienti Hans Vasen Nicholas Vogelzang Ilija Tomic Roberto Valcavi Helen Vasilatou Kosmidis Lawrence von Karsa Ian Tomlinson Riccardo Valdagni Suzana Vasovic L. von Karsa Carlo Tondini Unnur Valdimarsdottir Gilles Vassal Gunter Von Minckwitz Valter Torri Vincenzo Valentini David Vaughan Roger von Moos Rosalba Torrisi Laura Valle Peter Vaupel Gustav K. von Schulthess Uwe Torsten Carlos Vallejos Solguren Andrea Vavassori Adri Voogd

92 ESO FACULTY

Amish Vora Zoe Whale N. Younis Hilda Vorlickova Jeremy Whelan Zihao Yu Julie M. Vose Jeffrey White P.A. (Tom) Voûte Donald Lawrence Wickerham Z Damir Vrbanec M. Wickman Vesna Zadnik Eduard Vrdoljak Anders Widmark Nadia Zaffaroni Jacoba Vrieling - den Hertog Thomas Wiegel Ivana Zagar Svetlana Vrzic-Petronijevic O. Wiestler Vittorina Zagonel Tamara Vujkov Theodoor Wiggers Magdalena Zajac Hans Wildiers Alberto Zambelli W J. Wildiers Nicolaos Zamboglou Stefan Wachter David Wiljer Alberto Zaniboni Theodor Wagener Hans Jochen Wilke Marcello Zanini Anna Wagstaff Yvonne Willems Cavalli Vittorio Zanini Wong Wai Lup Rein Willemze Bojan Zaric Jaroslaw Waligora Roel Willemze David Zaridze David Walker Dillwyn Williams Filiberto Zattoni Lisa Walker E.D. Williams Andrew Zelenetz Sidney Wallace Bob Williamson Arthur Zelent Sonia Wallin Petra Wilson Marc Zerbib Huaqing Wang Robin Wilson Janez Zgajnar P. Wang Guenther Winde You Hui Zhang Luciano Wannesson De Nicola Eric Paul Winer Xiang Zhang Andrew Wardley Raimund Winter Xiongzeng Zhu Raymond Warrell Manfred Wirth Marina Ziche Donald Weaver Martine Woler Christoph Zielinski Jeffrey Weber Johannes M. Wolff Anthony Laurence. Zietman M. Webster Bruce Wolff Horst Zincke Ulrich Wedding Lynn Faulds Wood Stephen H. Zinner Walter Weder Mary Woods Pier Luigi Zinzani Eva-Maria Weiler-Mithoff Paul Workman Daniel Zips Roy S. Weiner Brad Wouters Aleksandar Zivanovic Olaf Weingart Michael C. Wright Leonida Zografos Dennis Weisenburger Joern Wulf P. Zola Robin Weiss Wojciech Wysocki Lucia Zoppegno Ralph Weissleder Daniel Wyss Pierluigi Zorat Michel Weller Emanuele Zucca Mary Wells Y Valeria Zurlo Yvonne Wengström Joachim Yahalom Stefano Massimo Zurrida Rudi G.J. Westendorp George D. Yancopoulos Heinz Zwierzina Steven D. Wexner Nilgun Yaris Matjaz Zwitter Wilma K. Weyrather Kenneth Young

93 30 YEARS OF ESO COURSES

In its first 30 years ESO has organised almost 750 courses, conferences, masterclasses and symposiums. Most of these were conducted in the school’s official language of ‘bad English’, but ESO also ran many courses in German, French, Spanish, Italian and Portuguese.

1983 Principles and practice of radiotherapy Plastic surgery Breast cancer Curso sobre cancer de mama Radiotherapy: scientific basis and clinical practice Medical oncology Medical oncology Adjuvant treatment in oncology Malignant melanoma Nutrition and cancer Gynaecological oncology Genito-urinary tract tumours Oesophageal cancer Medical oncology Colorectal cancer Leukaemia Breast cancer Controversies in the management of early-stage Pharmacology of anti-cancer drugs 1984 Hodgkin’s disease Cancer screening Paediatric oncology Breast cancer Scientific writing and editing Medical oncology Cancer du sein Bone and soft tissue sarcomas 1989 Malignant lymphomas 1987 Primary chemotherapy Breast cancer Design, analyses and overviews of randomised trials Immunodiagnosis Gynaecological tumours Growth factors and their receptors Growth factors Pain treatment in oncology Advances in tumour imaging Diet, nutrition and cancer Paediatric oncology Psychosocial oncology and palliative care 1985 Interferons: cell regulators for cancer therapy The biological basis of cancer therapy Head & neck tumours New directions in cancer surgery Malignant lymphomas Chest tumours Breast cancer Colorectal cancer Occupational cancer: epidemiology and Genito-urinary tract tumours Genito-urinary tract tumours prevention Breast cancer Choosing a computer in radiotherapy Nutrition and care Mechanisms of resistance to chemotherapy Brachytherapy in gynaecology Genito-urinary tract tumours Chest tumours Medical oncology Medical oncology Medical oncology Scientific writing and editing Breast cancer Purging bone marrow for transplantation Conservative treatment in breast cancer 1o Curso Português de oncologia urologica Role of viruses in cancers Brain tumours Breast cancer Treatment of early breast cancer 1986 New trends in the treatment of acute leukaemia Radiation physics for clinical radiotherapy Paediatric oncology Principles and practice of radiotherapy Breast cancer Biological response modifiers Monoclonal antibodies in oncology Advances in colposcopy Conservative treatments in breast cancer Endoscopy in digestive oncology Cancer nursing 1988 Malignant melanoma Breast cancer 1990 Human tumour xenografts in anticancer drug Myeloma and immunoproliferative diseases Oncology for general practitioners development Head and neck cancer Leukaemias

94 ESO COURSES

Breast cancer Magnetic resonance imaging and Basic clinical radiobiology Advanced bladder cancer spectroscopy in oncology Breast cancer Medical oncology Basic clinical radiobiology Current concepts in psycho-oncology Secretaries in oncology Neurological adverse reactions to chemotherapy Biological agents in cancer therapy Chest tumours Cancer occurrence and causes Primary neo-adjuvant chemotherapy Lymphomas Microsurgery in oncology: practical course Psychosocial oncology and palliative care 1991 Uterine malignancies Radiation physics for clinical radiotherapy European winter oncology conference Medical oncology for industrial product Paediatric oncology Breast cancer managers Radiotherapy 2000: research strategies for the Sexuality and cancer Hyperthermia in clinical oncology next decade Breast cancer Gastric cancer Modern aspects of clinical oncology Clinical radiobiology and dose fractionation Oncogenes, suppressor genes and growth Breast reconstruction Medical oncology factors Pain treatment in oncology Bone marrow transplantation Chronic myeloproliferative disease Scientific writing and editing Genito-urinary tract tumours The role of radiotherapy in the management of Postgraduate training for cancer screening Lymphomas cancer New trends in the management of malignant Principles and technical aspects in clinical Data monitoring in cancer clinical trials lymphomas radiotherapy Introduction to the molecular biology of cancer Paediatric oncology 1992 Quality assurance in radiotherapy Secretaries in oncology Breast reconstruction Methodology of clinical trials Immunotherapy of tumours Leukaemias Lympho-haematopoietic growth factors Head and neck reconstruction in oncology Therapeutic strategies in cancer pain control Gynaecological oncology Gynaecological oncology Gynaecological oncology, surgery and urology Radiolabelled antibodies in clinical oncology Anticancer drug development Chest tumours Drug delivery in cancer care The scientific writer, editor, referee or publisher Molecular biology for clinicians Genito-urinary tract tumours Head and neck tumours Neuro-oncology Breast cancer Radiotherapy dosimetry Paediatric oncology Air pollution and human cancer Radiation physics for clinical radiotherapy Secretaries in oncology Controversies in breast cancer treatment Immunodiagnosis of tumours Lymphomas Burkitt-like lymphoma in Central Europe New trends in the treatment of acute leukaemia Quantitative pathology in clinical oncology The role of radiotherapy in the management Methodology of clinical trials Il-2 and lymphocytes in haematologic of cancer Current topics in lung cancer malignancies Cancer and the immune system Familial cancer Colorectal cancer Medical oncology for industrial product Interferons in oncology The scientific writer, editor, referee or publisher managers Lung cancer Principi del nursing oncologia

95 Primary liver cancer Principles and technical aspects of radiotherapy Sarcomas Methodology of clinical trials Aspects of familial cancer Papel actual terapia intensiva en oncologia Lymphoma and bone marrow transplant Update in haematology/oncology seminar on Bases moléculaires del cancer Breast cancer cytokines Lung tumours: current status and future Nutrition and cancer Tumour imaging directions Thyroid tumours CME in oncology Gynaecological oncology Bioethics in oncology 5th Psycho-oncology update Molecular genetic and preventive aspects Cutaneous melanoma Breast cancer of breast/colon/prostate cancers Immunodiagnosis of tumours Anti-androgens in prostatic diseases Medical oncology Prostate cancer Lymphomas Lung cancer Chemoprevention of cancer Palliative care of cancer patients Breast cancer Tobacco carcinogenesis and control Cancer clinical trials Retinoids and cancer Postgraduate Athens leukaemia seminar Growth factors: from basic science to the clinic Soins infirmiers en oncologie: actualité et Breast cancer Cancer de l’enfant perspectives Progress in biology and therapy of metastasis Cost effectiveness in cancer care Curso de ensayos clinicos Haematopoietic growth factors and biological Gynaecological and breast tumours Palliative care of cancer patients response modifiers Lung cancer Secrétaires médicales en oncologie Immunology: molecular biology histopathology Plastic reconstructive surgery in oncology 1993 Gene therapy: a future in cancer management Good clinical practice AIDS-related tumours Retinoids in oncology Bone marrow transplantation Techniques chirurgicales en senologie 1st Euro-American forum on lung cancer Cancer clinical trials Minimal residual disease: direction and Head and neck tumours management 1994 Medical decision-making in oncology Mediastinal tumours update Secretaries in oncology Scientific writing Cancer tête et cou Quality of life research in cancer Breast cancer screening: practical aspects Cancer nursing Techniques chirurgicales en senologie Psico-oncologia Tobacco carcinogenesis and control Cancer nursing Cancer epidemiology Antiemetics in supportive care of cancer patients Cancer of the pancreas and liver Data management in cancer clinical trials Paediatric oncology Lymphomas Gynaecological/breast tumours: diagnostic Molecular biology for clinicians Testicular germ cell cancer prognostic factors Breast cancer Skin cancer and melanoma Smoking cessation methods Paediatric oncology 1995 Secretaries in oncology Colorectal cancer Oncologia para voluntarios Chest tumours Oncogeriatria: aspectos epidemiologicos Bases tecnicas de la radio-terapia externa Controversies in breast cancer y terapeuticos Molecular biology for clinicians New tools in early diagnosis education in Radiotherapie pratique traitement des cancers Malignant lymphoma melanoma du sein Bordeline lesions Gynaecological oncology Update in urological oncology Tumour biology Breast reconstruction with autologous tissue 1st Educational convention Gastrointestinal tumours Techniques chirurgicales en senologie VI Curso avanzado de oncologia medica Cancérologie digestive pratique Malignant lymphomas 1st Educational forum on leukaemia Colorectal cancer

96 ESO COURSES

Secretaries in oncology Diagnóstico precoz cancer de mama Psico-oncologia Breast cancer update Patología mamaria: errores que esta Head and neck cancer: oral cavity and Maladie de Kaposi et infection par VIH Melanoma oropharynx Clinical trial statistics Imaging in oncology Avances en oncología pediátrica Update in haematological oncology IV: news on Molecular biology cytokines and applications Neuro-oncology 1997 Imaging lymph nodes in oncology and staging of Secretaries in oncology Summit: prostate cancer tumours Oncogenes y cáncer Molecular genetics in solid tumours for clinical Oncologia clinica: 7 o curso avanzado Mieloma multiple oncologists Radiotherapy 2000 Mikroskopier-kurs AIDS-related malignancies Quimioterapia intensiva Cancer nursing Paediatric oncology Medical oncology Breast reconstructive surgery Breast reconstructive surgery Melanoma and non-melanoma skin cancer Gynaecologic pathology Digestive tract: gastroesophageal tumours Curietherapie endobronchique Management of infections in cancer Breast reconstructive surgery Breast reconstructive surgery Small-cell-lung cancer Breast cancer Breast cancer XVII o Curso multidisciplinario de oncologia Chest tumours Tratamiento de los tumores testiculares cáncer de ovario Medical oncology Ensayos clinicos en enfermeria oncologica Malignant lymphoma Head and neck tumours: larynx Radiation oncology in early-stage breast Paediatric oncology and hypopharynx cancer/lymphoma/CNS tumours Palliativbetreuung von tumor-patienten Radiotherapy 2000: preclinical and Gynaecological oncology Curso de actualizacion en cáncer de mama clinical strategies Postgraduate leukaemia-lymphoma course Recent advances in the management of Cours supérieur sur le facteur temps en head and neck cancer 1998 cancerologie Urological cancer Improving the quality of life for children Uro-oncologie Gastroesophageal tumours with cancer Cancer oral cervicaux faciaux Tratamiento de soporte en oncología Molecular biology for clinicians Chest tumours 2nd Educational convention Breast reconstructive and cancer surgery I Orthopaediatric app treatment primary and 8°curso avanzado de oncología medica New trends in the treatment of acute leukaemia metastatic bone tumours Gynecologic oncology New approaches to medical therapy, drug Psico-oncologia: informacion y comunicacion Medical oncology development with a focus on breast cancer con el paciente 2nd Forum on leukaemia and haematological Colorectal cancer Symposium internacional sobre oncologia malignancies Breast reconstructive and cancer surgery II ginecológica Supportive care for cancer patients Cancer chemoprevention course Breast reconstructive surgery 1999 Head and neck tumours Quimioterapia intensiva en oncología Translational research in paediatric oncology Breast cancer Master course on thyroid surgery 1996 Cancer clinical trials Malignant lymphoma and leukaemia Oncología para voluntarios Chest tumours Breast reconstructive and cancer surgery Fortbildungskurs: klinische onkologi Pathology of soft tissue tumours 1st Milan breast cancer conference Curso sobre pacientes del tracto genital Prostate cancer Medical oncology

97 Bladder cancer Sarajevo breast cancer course 2004 Master course on neck surgery Anaemia and cancer therapy 2nd London colorectal cancer conference Melanoma International task force on early diagnosis of Leukaemia / lymphoma Biological basis for antiangiogenic therapy cancer Masterclass in clinical oncology Workshop on imaging and angiogenesis I tumori femminili Sentinel node biopsy on melanoma and breast 2002 Red Square seminar: thyroid cancer Advances in solid tumour treatment Familial cancer Madrid 2000 Breast cancer: oncological and reconstructive Il carcinoma della prostata Breast reconstructive and cancer surgery surgery Gynaecological oncology Aggiornamenti in oncología 4th Milan breast cancer conference Europa Uomo Breast reconstructive and cancer surgery Masterclass in clinical oncology 6th Milan breast cancer conference Course on solid tumours Progressi terapie integrate oncología Advances in radiation therapy High-dose chemotherapy with haematological 2nd Colorectal cancer conference 1st Milan thyroid cancer conference support Hb level: more than a lab value? How to practise evidence-based oncology Melanoma Current breast cancer management Mikroskopierkurs für anfänger Chest tumours Abu Dhabi conference Oncology for medical students Breast cancer 2nd international conference on 2nd Milan breast cancer conference 2003 cancer on the Internet Ethics in oncology Winter masterclass in clinical oncology Multimodale therapieansätze Palliative care for European cancer patients Anaemia and cancer therapy Moscow breast cancer forum Cancérologie digestive Advances in solid tumour treatment Hirntumoren Medical oncology in the third millennium 2nd Paediatric oncology conference Breast cancer and melanoma Fatigue, asthenia, exhaustion and cancer Biology and treatment of malignant lymphomas Onkologische krankenpflege Anaemia and cancer therapy Red Square seminar: advances in lung cancer fortgeschrittene praxis Paediatric oncology Evidence-based medicine of breast cancer in Sarajevo 2005 2001 Cancer in the elderly Challenge Cairo meeting Seminário in oncología Task force on impact of management and Bronchuskarzinom Colorectal cancer conference organisation on cancer outcomes Il carcinoma della mammella: chirurgia Corso di oncología medica: dalla teoria alla Oncologic and reconstructive surgery e immagine corporea pratica 5th Milan breast cancer conference Europäischer Weiterbildungslehergang Advances in solid tumour treatment First international conference on cancer on the ‘Palliative Care’ High-dose chemotherapy with haematological Internet Oncologia a al femminile: cinque seminari support High-dose chemotherapy di aggiornamento Breast cancer: oncologic and reconstructive Thérapeutiques ciblées Onkologie in Klinik und Praxis surgery Cáncer de mama Haematological malignant disease 3rd Milan breast cancer conference 1st Milan thyroid cancer conference Palliativ- und Supportivtherapie von High-dose chemotherapy with haematological New strategies in anticancer therapy Tumorpatienten support I tumori femminili Biologie clinique en oncologie Leukaemias and lymphomas: clinical and Methodik klinischer prüfung in der Onkologie molecular problems Challenge Rome meeting

98 ESO COURSES

Nuovi farmaci in oncologia: dal laboratorio advanced cancer 2006 alla clínica Gastrointestinale Tumoren + update Nuovi farmaci in oncologia: dal laboratorio alla Cáncer de pulmón Mammakarzinom 2005 clinica Il carcinoma della prostata Oncologia ematologica: mutato atteggiamento 5th Masterclass in clinical oncology Ärzte-fortbildungskurs in Klinischer Onkologie nella diagnosi e terapia Advances in radiation therapy 4th Masterclass in clinical oncology Mikroskopierkurs für Fortgeschrittene Ärzte-Forbildungskurs in klinischer Onkologie Improving cancer services Onkologische krankenpflege: forgeschrittene Controversies in complementary and alternative Skin melanoma: yesterday and today praxis medicine (CAM) in oncology I tumori femminili Degro-Ögro-Sasro brachytherapie meeting The role of endoscopy in the management of Stadienadaptiertes Management von Patienten Interdisziplinäres Management gastrointestinal neoplasia mit Lungenkarzinom Gastrointestinaler Tumoren Advances in clinical oncology (EASO) 3rd Sarajevo breast cancer conference Oncologie médicale Supportivtherapie / Palliativmedizin Bronchialkarzinom/Non-Hodgkin-Lymphome: Ritornare alla vita: il ruolo della riabilitazione Stadienadaptiertes Management von Patienten Stand der hd-Chemo-therapie oncologica nella lotta al cancro mit Lungenkarzinom und Pleuramesotheliomen Grundkurs Palliativmedizin Breast cancer: special issue in young women Modifying cancer response to therapy: from Immunology for oncologists Moscow breast cancer forum molecular signalling to care Palliative-betreuung von Tumorkranken Urologische Tumore im Alter Risikoadaptierte Lokaltherapie von Clinical oncology for military doctors Nuevas dianas terapéuticas y sus rutas de prostatakarzinomen und gynäkologischen Advances in clinical oncology señalización Karzinomen Oncologia: il valore dell'esperienza Deutschsprachig-europäischer Advances in paediatric oncology Ritornare alla vita: il ruolo della riabilitazione Weiterbildungslehrgang ‘Palliative Care’ Thyroid and colorectal cancer oncologica nella lotta al cancro Onkologie in Klinik und Praxis Internationales Seminar: Palliativ-Betreuung von Advances in clinical oncology Biologie clinique en oncologie Tumorkranken Malignant lymphoma Il carcinoma della mammella: chirurgia e Leukaemia and lymphoma Corso per infermieri di ricerca immagine corporea Lo sviluppo di nuovi farmaci in oncologia: basi ESO colorectal cancer observatory Breast cancer in young women teoriche e applicazioni pratiche Breast and cervical cancer seminar Cáncer de mama y linfoma: aspectos clínicos e Krebs-Immuntherapie (KIMT) in der klinischen Konzepte und Therapieergebnisse implicancias de la biología molecular Anwendung Molekularbiologischer Tumor-Therapien Methodik klinischer prüfung in der Onkologie Cure del termine della vita Breast cancer screening: quality issues in Malignant lymphomas, cervical cancer and I tumori femminili detection and diagnosis gastric cancer Evidence-based management of lung cancer Geriatrische Onkologie: akute Leukämien Colorectal cancer conference Ethics in oncology Infektionsmanagement La qualité des soins dans les pays à ressources Imaging nucleare in oncologia: basi di How to practise evidence-based oncology limitées fisiopatologia e biologia molecolare in oncologia Oncology for medical students Challenge Hammamet meeting nucleare Communication skills e modalità relazionali in Kombinierte Chemo-Radiotherapie Konzepte und Therapie-ergebnisse oncologia molekularbiologischer Tumortherapien 3rd International conference cancer on Gynaecological oncology the Internet Familial cancer conference Controversies in locoregional control of Myelom/CUP: Pharmakogenetik/-genomie

99 3rd International conference on cancer Cancer in the elderly Prostate cancer on the Internet Avances en radioterapia Should this patient undergo an autotransplant? Oncology for medical students Breast cancer in young women Immunology for oncologists Mikrospierkurs Metodiche per studi traslazionali in oncologia Patients with a gastrointestinal obstruction due Palliative cancer care Nuovi farmaci in oncologia basi teoriche e to advanced cancer have to stay in hospital I tumori femminili sviluppo clinico Predictive modeling in prostate cancer Onkologische Krankenplege: forgeschrittene ESO Colorectal Cancer Observatory Imaging e terapia medico nucleare dei carcinomi Praxis ESO symposium: new drug development tiroidei differenziati Skin melanoma Oncology for medical students Locally advanced rectal cancer Multidisziplinäre Behandlung thorakaler 1st EASO Masterclass in clinical oncology EASO course on lung cancer and mesothelioma Tumoren 1st Global Insight Conference on Leukaemia Stereotactic radiotherapy for stage I NSCLC: Geriatrische Probleme der Hänatologie und EORTC Guidelines on the use of erythropoietin triumph of technology over biology? Onkologie ESO Observatory: cancer on the Internet Controversial issues in the management of Masterclass in paediatric oncology Is there still a role for UICC? locally advanced head and neck cancers Il carcinoma della mammella: chirurgia e Masterclass in palliative cancer care Improving clinical skills in early breast cancer immagine corporea I tumori femminili Leukaemia and lymphoma Onkologie in Klinik und Praxis ESO 25 th anniversary media forum Do we need radiotherapy in early Hodgkin Cáncer colorectal Carcinoma della mammella: chirurgia e lymphoma? Haematological oncology immagine corporea 3rd Familial Cancer Conference EASO meeting Rome Epidemiologia, diagnosi precoce e prevenzione Advanced polypectomy at colonoscopy: pushing Interdisziplinäre Behandlung von HNO-Tumoren del cancro del colon retto the boundaries! 1st International conference on ambulatory Epigenetics and new therapies in cancer Breast Cancer in Young Women symposium cancer medicine Surgery of renal cell carcinoma in 2008 Cancer and pregnancy 2008 Oncology for medical students Saving lives in cancer: policies and practices that The concept of metastatic breast cancer Hormonal therapy in combination with local make a difference guidelines treatment of prostate cancer Methodik klinischer Prüfung in der Onkologie Tailored treatment for elderly women with The role of adjuvant chemotherapy in endocrine Colorectal cancer symposiums breast cancer responsive breast cancer Nuovi farmaci in oncologia: Nuovi farmaci in oncologia: dal laboratorio alla CNS response after erlotinib therapy in a patient dal laboratorio alla clinica clinica with metastatic NSCLC with an EGFR mutation Intensified neoadjuvant chemotherapy in early- Advanced course on rectal cancer 2007 relapsing breast cancer Treating breast cancer in a breast unit Il carcinoma transizionale della vescica e il Excessive and unnecessary surgery in melanoma Neoadjuvant chemotherapy for resectable liver carcinoma della prostata Fondamenti di radioterapia oncologica e metastases 1st Masterclass in oncology nursing adroterapia Screening for lung cancer with spiral CT is not 6th Masterclass in clinical oncology The use of adjuvant chemotherapy in elderly justified Malignant mesothelioma of the pleura patients with colorectal cancer Tumores neuroendocrinos: mecanismos Infermieri di ricerca 2nd Masterclass in oncology nursing moleculares y aplicaciones clìnicas Red Square Seminar on colorectal cancer 7th Masterclass in clinical oncology Moving to HPV-based cervical cancer screening Ricerca clinica e preclinica in oncologia Leukaemias: molecular insights to treatment and prevention programmes 1st Interconference Breast Cancer Meeting paradigms La chirurgia oncoplastica nel carcinoma della

100 ESO COURSES

mammella gynaecologic oncology Internet applications and cancer Advanced course for research nurses 2nd Interconference Breast Cancer Meeting Breast cancer in young women Chronic lymphocytic leukaemia: one or two Approach to pleural cancer: state of the art Patient Advocates: from fear to hope diseases? 2nd Global Insight Conference on Breast Cancer The Role of endoscopy in the management Molecularly targeted therapy of sarcoma and Lymphoma of gastrointestinal cancer The role of endoscopy in the management of Nuovi famaci in oncologia: dal laboratorio alla Biobanking for cancer research: rules and roles gastrointestinal neoplasia clinica: corso introduttivo 2nd ESO-ESTRO Masterclass in radiation New oncoplastic techniques which avoid the Clinical oncology update conference oncology need for mastectomy 2nd Conference on epigenetics and new 2nd ESO-SIOP-Europe masterclass in therapies in cancer 2011 paediatric oncology Evidence-based oncology: systematic reviews ESO-ESSO Masterclass in colorectal cancer The World Cancer Declaration and guidelines in a European context surgery Mechanisms of disease: angiogenesis and the ESO Colorectal Cancer Observatory: a look into EASO course in evidence-based oncology management of breast cancer the future 6th Leipzig international course in head and neck 1st Masterclass in radiation oncology ECCLU Educational Cancer Convention Lugano surgery and oncology: larynx and hypopharynx 2nd EASO Masterclass in clinical oncology Oncology for medical students Endoscopy in gastrointestinal oncology Cairo media event: The Big Debate SenoNetwork meeting 3rd EASO educational workshop on breast Decision-making for systemic treatment in non- Lung cancer reconstructive surgery small-cell lung cancer EASO course on urogenital cancers Rare solid cancers: an introduction How to integrate EGFR targeting in the 10 th ESO-ESMO Masterclass in clinical oncology management of head and neck cancer 2010 ESO-EONS Masterclass in oncology nursing Biomarkers of angiogenesis for the development 3rd Masterclass in clinical oncology 2nd Interdisciplinary conference in prostate of antiangiogenic therapies in oncology Task force on prostate units cancer: predictive models for decision making Treatment of Hodgkin lymphoma today 2nd EASO course on breast reconstructive Gene profiling in clinical oncology surgery Balkan Masterclass in clinical oncology 2009 9th ESO-ESMO Masterclass in clinical oncology ECCLU: What's new and what's true in genito- EASO day on lymphoma 4th Masterclass in oncology nursing urinary oncology? Nomograms in prostate cancer: ECCLU – What’s new in haemato-oncology? 3rd clinical oncology update who, why, and when Masterclass in clinical oncology Leukaemia and lymphoma Systemic chemotherapy and new experimental Clinical oncology updates ESO Colorectal Cancer Observatory: innovation approaches in the treatment of metastatic Angiogenesis in the tumour microenvironment and care in the next 12 months prostate cancer 4th Familial Cancer Conference 8th ESO-ESMO course on oncology for medical Nuovi farmaci in oncologia: dal laboratorio alla 3rd ESO-SIOP-Europe Masterclass in paediatric students clinica: corso avanzato oncology Prostate cancer units: purpose and requirements Open issues in state-of-the-art of adult soft- Lung cancer and mesothelioma 3rd EASO Masterclass in clinical oncology tissue sarcoma medical therapy ESO Colorectal Cancer Observatory: a look into ABC1: Advanced Breast Cancer First Consensus 3rd ESO-EONS Masterclass in oncology nursing the future Conference 8th ESO-ESMO Masterclass in clinical oncology 7th ESO-ESMO course on oncology for Breast reconstructive surgery medical students Red Square Seminar: state of the art Cancer on the Internet

101 2012 Lymphomas and leukaemias: state of the art and CREDITS evolving therapies Active surveillance for low-risk prostate cancer Book Illustrations 11 th Masterclass in clinical oncology www.jasoncook.co.uk 5th ESO-EONS Masterclass in oncology nursing 11 th ESO-ESMO Masterclass in clinical oncology Illustration picture credits 4th EASO Educational workshop on breast Page 6 Jason Harris, Ennio Leanza reconstructive surgery Page 12 Ennio Leanza ESO-OECI course on cancer molecular Page 20 Attilio Rossetti pathobiology Page 24 Ennio Leanza ECCLU: What's new in haemato-oncology? Page 30 Mark Thomas, Jason Harris ESO-OECI International study day on cancer Page 36 Ennio Leanza survivorship Page 48 Johan Gunseus 2nd Balkan and Eastern European Masterclass in Page 54 Tobias Hase clinical oncology Page 60 Jason Harris 4th Clinical oncology update conference Page 66 Heidelberg University Hospital Onkologia 2012 Page 72 Corbis Bridge / Alamy 5th Familial cancer conference 9th ESO-ESMO course on oncology for medical Other students Page 44 10/10 Against Cancer © Copyright Comic Evidence-based cancer care and research: the Company 2012 www.comiccompany.co.uk role of systematic reviews 2nd ESO-Maymet meeting on breast cancer management World Oncology Forum 3rd ESO-ESTRO Masterclass in radiation oncology BCY1: Breast Cancer in Young Women Conference 4th ESO-SIOP-Europe Masterclass in paediatric oncology

102 Learning to Care ESO at 30

The European School of Oncology is in the enviable position of financial independence, with no ties to any particular interests, professional or commercial.

For the past 30 years, the School has been able to set its own agenda, working with anyone who can contribute to its mission to reduce the number of cancer deaths and ensure early diagnosis, optimal treatment and holistic patient care.

This book tells the story of how ESO has helped shape cancer care in Europe, and how it is gearing up to the challenges of today.