With cancer cases growing worldwide and an increased number of late-stage diseases in elderly patients, there is an increasing need for an integrated approach. “Through evidence, cost, and acceptance of interventional oncology (IO), we can create value-based care and shift the treatment focus from volume to value”. This was the main take-home message presented by Thomas Helmberger (Public Hospital, Munich, Germany) at the European Conference of Radiology (ECR) 2022 (2–6 March, virtual).
Starting off the presentation, Helmberger provided some background on the future of patients with malignant diseases, with more patient cases currently in more and in less developed countries. He explained that “this growing number of patients translates to increasing cost and this demographic impact will challenge our healthcare systems”. He went on to explain that for example in colorectal malignomas 20–25% of patients exhibit stage four cancer, with the majority being elderly patients. He pointed out that this, therefore, means that we have to “deal with not only cancer but also comorbidities”. Discussing the “wave” of elderly patients, he explained the “Sisyphus effect”—more elderly expect to be fit and independent into older age, requiring more medical resources, creating more elderly patients.
Discussing the current developments in IO, Helmberger explained that IO techniques are resembling already known techniques, for example, radio-embolic techniques are resembling radiotherapy.
He drew attention to current issues in IO by making reference to an early closed randomised controlled trial (RCT) comparing surgery and percutaneous thermal ablation for hepatic metastases which had just recently illustrated drawbacks such as misconceptions about the eligibility criteria, unconscious bias towards surgery, and a lack of dedicated research nurses to name a few. The currently ongoing COLLISION RCT is dealing with the same comparison, however, it can be questioned to what extent artificial RCTs are still necessary for comparison to real-life data. Numerous studies over the past 15 years pointed to no difference in the overall survival in percutaneous thermal ablation compared to surgery in primary and secondary liver malignancies with diameters up to 3 cm (Otto et al, 2010; Lee et al, 2016). He also explained that combining transarterial therapies such as chemo- and radioembolisation can even enhance the therapeutical benefit of surgical and percutaneous ablative therapies (Hholami et al, 2020).
Helmberger raised the important factor of cost, with healthcare costs presenting differently in each country and between interventional approaches, with local ablation therapies usually costing less. However, in the sense of cost-effectiveness, Helmberger explained it is of limited use to only analyse a single procedure cost, as this does not provide sufficient information on the overall process costs. According to Helmberger, the effectiveness of IO is proven through evidence, cost, but still less acceptance, since “many guidelines and recommendations from professional societies are reluctant to implement interventional radiology techniques”. However, he stressed that IO embedded into interdisciplinary therapy concepts will optimise treatments to be given at the right time during a disease continuum. In doing so, he claims we can create more and more “value-based care”, which remains a central challenge in times of increasingly limited resources.