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ESO marks 25 years of championing excellence in education

§ Anna Wagstaff

The European School of was set up in 1982 to help prevent needless death and suffering by educating Europe’s young cancer doctors. ESO looks to a future where all patients are treated by specialist teams who keep abreast of developments and keep an eye on their own level of performance. But we’re not there yet.

his year the European is not their own – the official language of cine. It was also becoming exceptionally School of Oncology cele - ESO is ‘bad English’. Furthermore, no complex, demanding close cooperation brates 25 years dedicated matter how hard the alumni work or between disciplines that traditionally to its mission of reducing how much they learn, it will never count neither trained nor worked together. deaths from cancer due to towards their yearly requirement of “Medical oncology was an emerging Tlate diagnosis and inadequate treat - CME points, because the CME system specialty, surgical oncology was also a ment. During this time, many thou - only works within national borders. Yet new specialty, and even radiation oncol - sands of young oncologists from every whether the course is a full-immersion ogy was changing from the old died-in- discipline and every European country Masterclass on Palliative Care held in the-wool practice to a new modern style,” have benefited from the chance to come Tbilisi, or on Oncology Nursing in Malta, says Peckham, who had himself been together to absorb cutting-edge know- or three days on Predictive Modeling in responsible for developing some of these ledge from leaders in the field, and to Prostate Cancer in Venice, or two days modern techniques, including ‘mantle’ exchange ideas and experiences. Many on Evidence-Based Management of radiotherapy, which had transformed have been stimulated to join the Euro - Lung Cancer in Belgrade, these courses the outlook for patients with Hodgkin’s pean clinical research effort – some - have never been short of applicants. Disease. The problem was how to trans - times joining forces with people they The reason for this, says Sir Michael fer the knowledge that was being gener - first met at an ESO Masterclass. It Peckham, one of the school’s founders, ated in isolated cancer centres to the won’t be long before the first ESO is that ESO filled a big need – and con - clinicians who were actually treating the alumni are themselves invited back as tinues to do so, though the landscape has patients in hospitals across Europe. faculty to teach the next generation. changed significantly over the interven - Peckham often recounts the story of Being a European school has its dif - ing 25 years. Back in the early 1980s, how, as head of radiotherapy at London’s ficulties. Teachers have to teach and oncology was rapidly becoming one of flagship Royal Marsden Hospital, he students have to learn in a language that the fastest developing areas of medi - was reluctantly called away from a busy

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clinic to meet a dashing young surgeon “It’s a great chance to share experiences from whose mission was to get his with experts. We learned about the most backing for the proposal to launch a advanced treatments, but we also European educational initiative. “I don’t covered the basics as well as social think he in any sense had to twist my aspects, and palliative and community arm. I approved of the idea tremen - care. Because people come from so dously. I’d already been interested in many countries you get a really good the idea of bringing different interests flavour of international practice, and and specialties together in the UK, and can compare what happens elsewhere I’d written about it in the Lancet , with the practice at your own hospital. because I thought the competition It really boosts your confidence.” between different cancer specialties – Rana Mahmood, Beatson Oncology Centre, surgeons and oncologists in particular – Glasgow, UK wasn’t terribly good and it would be perfect if there was a sort of umbrella, and education was the perfect medium for that.” The dashing young surgeon was Alberto Costa, who would later go on to become director of ESO. Though more than happy to give the project his blessing, Peckham did won - der at the time if they might be aiming a bit high. “I suppose I thought, My God! Have they got a hope in hell of pulling this off? A European school sounds very grand, and the track record of Europeans working together in this area hadn’t been brilliant.” The group who were leading the bat - tle for a European School were by no means sure they could ‘pull this off’. The next generation. Students at the 6th ESO Masterclass in Clinical Oncology spent a packed However, they had a lot going for them, week at the end of February learning from 35 experts based in 13 countries not least tremendous self-belief.At their core was the ‘Milan group” headed by “You can always go to congresses to Umberto Veronesi, a surgeon based at the hear the latest data, but when you city’s Istituto Nazionale Tumori, whose are new to oncology, you need to development of the quadrantectomy learn all the data. ESO Master- technique for breast conservation had classes are led by experts in their recently propelled him onto the world field, and they can summarise 30 stage. The Institute was at that time also years’ worth of data for you. They are playing a pivotal role in the growing field very focused at your level and let you of medical oncology. It was here that really get into the subject, part- Gianni Bonadonna developed the gold- icularly when you break into standard ABVD protocol for Hodgkin’s groups to discuss specific cases.” Disease, led the first trials of adjuvant Annemiek Walenkamp, Groningen University CMF, and conducted the clinical devel - Hospital, Netherlands opment of adriamycin – an Italian drug which became one of the most widely

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WITHOUT FEAR OR FAVOUR

The vast majority of continuing medical boss Gianni Agnelli – ESO had education courses today are reliant on been spending a fortune on sponsorship from companies who have a taxis transporting faculty vested commercial interest. ESO is finan - members to and from the cially independent, which is why it is able to course venues. set its own agenda. Topics in medical oncol - The Principessa also mentioned ogy form an important part of the curricu - the work of ESO to the iconic lum, but so do psycho-oncology, cancer designer, Hubert de Givenchy. nursing, and advances in surgical tech - Givenchy at that time was griev - niques. The big killers have traditionally ing over the death of Audrey been a priority for ESO, but it also runs Hepburn, who had been his courses on rarer that are of scant great inspiration and an ambas - commercial interest, such as brain tumours sador for his chic ’60s designs and paediatric cancers. and Amarige perfume. Hepburn That it has been able to do so is thanks in had died of appendiceal cancer, large part to a few powerful people whose having been misdiagnosed for a commitment to ESO emanates from their per - year as suffering from ‘stress’. sonal experiences… Givenchy went on to embrace When she was diagnosed with , the work of ESO, giving both the Principessa del Drago – a member of the use of his name, and a sub - Italy’s former royal family – flew straight to the stantial donation to finance a Memorial Sloan Kettering in New York, only French-language programme to be told by her surgeon that the operation that ESO wanted to run. she had undergone had been invented in Italy But it was the promise of a leading figure in It wasn’t stress. When Hepburn died from by Umberto Veronesi. She felt ashamed Italian industry that was to give ESO the con - cancer of the appendix after having been that she had assumed the US was more fidence it needed to launch its activities, and wrongly diagnosed for a year, Givenchy, who advanced in treating breast cancer than her continues to sustain the school to this day. had designed this and many other of her own home country, and His was another story of dresses, offered ESO valuable support on her return she met misdiagnosis. His general with Veronesi, who told practitioner had treated Veronesi must have made a convincing case, her of his idea for a him for arthritis for a because in 1982, ESO was bequeathed the European school that whole year before the nec - family fortune, in the form of yearly interest could build on the good essary scans were done from a trust fund. The money would become work being done in can - and it was found that the available once the last member of the fam - cer in Europe. pain he had been suffer - ily had died. This, Veronesi was assured, The Principessa be- ing was from bone metas - would not be long, as the last member of the came ESO’s President, tases originating from family was 82 years old. The School was she gave the school its prostate cancer. He went launched on the strength of this promise. The first major donation, to Veronesi as Italy’s lead - last surviving family member, went on to live and she continues to ing cancer doctor, and to the ripe old age of 101. use her influence to Veronesi told him of the Those were difficult years of pitching for open doors. It was ESO’s founding president. For the plans for a school that sponsorship and filling out endless grant through her request Principessa del Drago, supporting would help prevent simi - applications. Today, however, thanks to the that ESO was given two ESO represented a vote of lar misdiagnoses hap - interest from that trust fund, ESO’s future cars, courtesy of Fiat confidence in European oncologists pening in future. independence is secured.

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“I thought, My God! Have they got a hope in hell of pulling this off?” used cancer treatments ever. sive approach, sometimes treating Europe as a whole was also growing patients with chemotherapy when they in confidence and beginning to assert were terminally ill,” says Peckham. “They itself as a counterbalance to the US. had a different concept of palliation and There was the beginnings of the Euro - of care at the end of life. Ours tended to pean Common Market. The European be a far more gentle approach. However, Organisation for the Research and Treat - there was an upside. Advances such as ment of Cancer was founded in Bel - MOPP – a key development in the gium in 1962, followed by the European chemotherapy of Hodgkin’s Disease – Molecular Biology Organisation, came from the US. But certainly we EMBO, in Heidelberg. 1975 saw the didn’t operate in that way.” launch of the European Society for Med - Costa, who has continued working ical Oncology (ESMO) in Lugano; five as a breast cancer surgeon alongside years later the radiologists and radio - his ESO responsibilities, mentions also therapists followed suite with ESTRO. the rather brutal approach to patients. “We didn’t like the American way of A E UROPEAN CULTURE OF CARE saying, ‘This is your lung Xray, you are Yet European cancer doctors were still going to survive six months.’ At that flooding to the US to pursue training and time they were very keen on being tough research opportunities. The size of the in telling the truth to patients. We were problem was brought home to the Milan against this. We wanted the Americans group when they found out that 92 of the to teach us the technology and the basic An international effort. ESO director Alberto clinical researchers at the US National science, but we didn’t want them to Costa ( left ) with Umberto Veronesi, the school’s Cancer Institute were Italian. It wasn’t teach care.” Learning to care would later founder, concluding an agreement on just that Italian patients and hospitals be adopted as the formal ESO motto, to cooperation with University College Dublin, 1992 could benefit if those researchers carried emphasise the difference between out their clinical work back home. There teaching a purely clinical approach to patients have access to the best possible was also a strong feeling that the Euro - treating disease, and helping young care no matter who they are or where pean approach to cancer care differed in oncologists learn how to care for the they may be treated. “The fight for edu - important ways from the US approach – whole needs of their patients. cation is a basic tool fighting inequali - that there already was a European The view of healthcare as a social ties,” says Costa. ‘school’ of oncology, in the sense of a cul - rather than a private responsibility was The Milan group set about gathering ture and tradition, and that the role of another big difference between Europe around them key European players. ESO would be to teach oncology from and the US. From its very inception, There was Bob Pinedo from the Nether - this European perspective. ESO has been conscious of the role it lands, who had strong links with the “The States had a much more aggres - could play in ensuring that all Europe’s US, not least via Bruce Chabner, deputy “They had a different concept of palliation and of care at the end of life. Ours was a far more gentle approach”

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director of the NCI, with whom Pinedo Teaching patient-centred co-edited annual editions of Cancer care. Frits Duparc (centre), Chemotherapy – the medical oncolo - a patient of Pinedo and gists’ bible. Louis Denis, a senior urolo - director of the famed gist from Belgium, who had been Mauritshuis art museum instrumental in setting up the European in the Hague, attended an clinical research organisation EORTC. ESO Masterclass in 2003 Franco Cavalli, a haematologist in to help the students learn Switzerland, who had played the lead how to talk freely and openly role in setting up ESMO. And then of with their patients. Pinedo course Michael Peckham, who went on (who is seated on the left) to co-edit the Oxford Textbook of Oncol - and Franco Cavalli (on the ogy with Pinedo and Veronesi. Peckham right), are both founding was one of the few British medics who members of ESO had strong links to Europe and actually spoke a second language, having trained ing documents of ESO, including the sary axillary dissections will be performed with Maurice Tubiana at the Gustave mission statement that has guided its until the last centre in the world has Roussy in Paris. work for 25 years. learned about the sentinel node tech - This was the multidisciplinary, mul - Costa, like all cancer clinicians, nique?” he asks. “The big cancer centres ticultural and multilingual group that in dreams of the day when ESO will no do the discovery, but the time from dis - 1982 met up the side of a Swiss moun - longer be needed. That time, however, covery to being adopted into clinical tain, inAscona, and drew up the found - has not yet come. “How many unneces - practice is still far too long.” “The time from discovery to being adopted into clinical practice is still far too long”

A tranquil setting. This former hospital on the island of San Servolo in the Venice laguna was the setting for ESO’s early oncology courses. Today’s courses are held in venues across the length and breadth of Europe

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