Personnel, technical and organisational criteria defining the status of Comprehensive Cancer Centre (CCC) and Children's Cancer Centre (ChCC) (Ministry of Health Gazette No. 7 of 28 November 2008)
1) Personnel criteria
a) The specialty of medical oncology has the following staff at its disposal:
- In a Comprehensive Cancer Centre, at least 5 doctors with specialised qualification in the field of medical oncology, each having a full-time job in that Centre.
- In a Children's Cancer Centre (for childhood solid tumours), at least 5 doctors with specialised qualification in the fields of paediatric medicine and medical oncology at the same time, or doctors with specialised qualification in the field of paediatric oncology and haematology, each having a full-time job in that Centre.
- Non-medical health care professionals with qualification according to Act No. 96/2004 Coll., on conditions of obtaining and recognition of qualification for the performance of non-medical occupations in health service and for the due performance of activities related to the provision of health care and amending certain related laws, and to the Decree No. 424/2004 Coll. of the Czech Ministry of Health; in a Children's Cancer Centre, paediatric nurses and a paediatric psychologist, among others.
b) The specialty of radiation oncology has the following staff at its disposal:
- Doctors with specialised qualification in the field of radiation oncology, at least one doctor per 150 new patients per year; at least 3 doctors with this qualification, each having a full-time job in that Centre.
- At least 2 medical radiological physicists with specialised qualification in the field of radiotherapy, each having a full-time job in that Centre. The required number of radiological physicists also depends on the number of radiotherapy units and on the number of patients treated per year, according to the recommendation of the European Federation of Organisations for Medical Physics from 1997 (hereinafter referred to as the “ EFOMP 7/1997”).
- Medical engineers with specialised qualification, radiological physicists, radiological technicians, biomedical engineers, and biomedical technicians in numbers as recommended by EFOMP 7/1997.
- Radiological technologists:
- linear accelerator – 3 technologists per 1 shift per 1 instrument, each having a full-time job,
- cobalt unit - 2 technologists per 1 shift per 1 instrument, each having a full-time job,
- simulator – 2 technologists, each having a full-time job,
- treatment planning system - 2 technologists, each having a full-time job, if planning is not ensured by other qualified professionals (such as radiological technicians, radiological physicists).
- Other staff: doctors undergoing specialist training in radiation oncology, radiological physicists undergoing specialist training in radiotherapy, general nurses, social workers, other health care professionals, and auxiliary and other medical staff. The actual number of these workers depends on the equipment and scope of activity of the respective Centre.
- Professional staff for brachytherapy:
- Doctors with specialised qualification in the field of radiation oncology, their number depending on their scope of activity and the number of patients, but at least 2 doctors, each having a full-time job.
- A least one full-time medical radiological physicist with specialised qualification in the field of radiotherapy, the number depending on the number of instruments and number of patients treated per year, according to the EFOMP 7/1997
- Radiological technologists:
- simulator or C-arm – at least one technologist,
- remote-controlled afterloading instrument – at least two technologists.
- Other staff: medical engineers with specialised qualification, biomedical engineers, biomedical technicians, perisurgical nurses and other workers in numbers as recommended by EFOMP 7/1997.
Table 12.1: Minimum numbers of technical staff (in WTE = whole time equivalent) at a radiotherapy department, adopted from EFOMP 7/1997.
|Type of instrument or other specification||Number p**||Technical staff (WTE)||Minimum number of qualified medical radiological physicists within technical staff (WTE)|
|kt coefficient(according to EFOMP)||kf coefficient (dle EFOMP)|
|Treatment planning system: external beam therapy||0.38||0.16|
|Treatment planning system: brachytherapy||0.08||0.04|
|100 patients* per year – external beam therapy||0.27||0.11|
|100 patients* per year – brachytherapy||0.22||0.09|
* "100 patients per year" relates to new patients, renewed treatments or new treatment plans
** number of instruments or number of patients
Notes to the table:
- The term "technical staff" concerns medical radiological physicists with specialised qualification in the field of radiotherapy, radiological physicists, radiological technicians, medical engineers with specialised qualification, biomedical engineers, biomedical technicians and other health care professional, according to the Act No. 96/2004 Coll. and Decree No. 424/2004 Coll.
- The term "medical radiological physicists" stands for radiological physicists with specialised qualification in the field of radiotherapy, according to the Act No. 96/2004 Coll. and Decree No. 424/2004 Coll.
- At least one medical radiological physicist must be constantly present at each radiotherapy department.
- The minimum number of staff depends on the radiological equipment of a given facility (i.e., number of instruments), the number of patients and the complexity of performed procedures.
- The total number of staff is expressed in a whole time equivalent (WTE). Coefficients kt and kf express the equivalent of full-time job of technical staff and medical radiological physicists.
- The table does not include requirements regarding the supervision of radiation protection, which corresponds to approximately 0.50 WTE, nor other jobs ensuring postgraduate education and research, depending on the extent of these activities in a given health care facility.
2) Technical criteria
a) Radiotherapy equipment:
- two or more linear accelerators (from which at least two dual accelerators).
- brachytherapy instrument (automatic afterloading system, C-arm, application room),
- simulator or CT-simulator,
- 3D treatment planning system,
- equipment for absolute, relative and in vivo dosimetry,
- modelling laboratory,
- equipment for specialised radiotherapeutic techiques (IMRT,TBI).
b) Equipment for systemic treatment:
- comprehensive diagnostic possibilities for systemic treatment - establishment of all recommended prediction parameters,
- central preparation unit for cytostatic drugs,
- fully-equipped short-stay ward with the possibility of two-shift operation and long-term outpatient treatment
- close cooperation with ICU (intensive care unit).
3) Other criteria
CCCs and ChCCs have been established on the basis of health care facilities dealing specifically with cancer patients. The core of a Cancer Centre consists of a cancer care facility which is comprehensively equipped to provide radiotherapy and systemic treatment (including drugs which can be only administered in the Cancer Centres), both to hospitalised patients and to outpatients treated at short-stay wards.
a) CCCs and ChCCs ensure:
- interdisciplinary cooperation with adequate surgical, internal and complementary disciplines
- interdisciplinary cooperation with adequate specialists in paediatrics with respect to surgical and internal disciplines, anaesthesiology and resuscitation, anatomical pathology, medical genetics, radiology and imaging techniques, and with doctors having specialised qualification in the field of paediatric radiology (this item applies to ChCCs only).
- coordination of professional help to cancer care facilities at lower level in a respective region, and maintenance of professional cooperation with them,
- education and research in oncology,
- specialist training in medical oncology, radiation oncology, paediatric oncology and haematology, based on the obtained accreditation.
b) Requirements on diagnostic methods:
- The housed imaging methods in the fields of radiology, sonography, nuclear medicine and endoscopy comply with the contemporary standards,
- the laboratory methods of cancer diagnosis are available in the fields of biochemistry, haematology and histopathology, including the perioperative histological diagnosis,
- oncogenetic consultations are available in indicated cases.
c) Requirements on medical oncology:
- An independent inpatient department for cancer patients is available, with 30 beds at least, capable of providing intensive care to these patients,
- a daily-operated outpatient department for cancer patients is available,
- an existing unified system for centralised preparation of cytostatic drugs,
- a short-stay ward to provide chemotherapy to outpatients is available.
d) Requirements on radiation oncology:
- All needed instrumental equipment is available, particularly instruments for irradiation, dosimetry and planning, as required by the Czech Society for Radiation Oncology, Biology and Physics,
- an inpatient department is available, dedicated partly or fully to the care of cancer patients undergoing irradiation procedures (this can be shared with the department of medical oncology)
- a daily-operated outpatient department of radiation oncology is available.
e) Surgical care is specifically focused on cancer patients, ensuring:
- Ability to provide specialised care with respect to surgical diagnosis and treatment of solid malignant tumours in the following fields of oncology: digestive, thoracic, mammary, dermal, gynaecological, urological, orthopaedic, neurosurgical, otorhinolaryngological, and maxillofacial,
- assurance of close cooperation among the surgeons and physicians with specialised qualification in the field of anatomical pathology, particularly histopathologists, and the provision of guaranteeing their responsibility for the quality of tissue samples sent for examination.
f) Supportive and palliative care:
- Assured availability of specialized outpatient care and second opinions, particularly in the fields of pain management, nutrition, clinical psychology, stoma treatment,
- availability of treatment of infection-related complications,
- existence of a well-developed system of palliative care of cancer patients for whom anticancer treatment was terminated, in compliance with the principles of continuity of cancer care, as well as the physician’s commitment not to abandon the patient,
- the assurance that specialized inpatient palliative care is available.
g) The Centre guarantees the maintenance of documentation on cancer patients, with particular focus on:
- comprehensive documentation on cancer patients, including the findings of imaging methods (both through conventional and digital media), as well as archived histopathological samples
- records on patients' informed consents to treatment,
- due documentation on the individual stages of cancer treatment, i.e. operation protocols, records on radiation therapy and chemotherapy, all in compliance with the respective standards
- the submitting of a comprehensive Report on Malignant Neoplasm for each cancer patient for whom the responsibility was duly assumed, and the submitting of regular Follow-up Reports,
- records on the numbers of cancer patients sorted by individual diagnoses, the readiness to make these numbers public in de-identified form, the submitting of data into clinical registries monitoring the quality of cancer care,
- evaluation of results of rendered cancer diagnosis and treatment using self-evaluation and local programmes of health care quality control.
h) The Centre guarantees the follow-up care of cancer patients, with particular focus on:
- follow-up care provided to each cancer patient with respect to the type of his/her disease, the overall condition and preferences; this follow-up care is provided by the CC or, if otherwise agreed, by another specialist.
- all necessary documentation on the patient’s treatment and the possibility of further cooperation between the CC and the follow-up physician.
i) The Centre has established responsibility for cancer patients, namely:
- in each stage of the patient’s examination, treatment or follow up, the patient knows (and it is obvious from our documentation) who is responsible for his/her treatment and to whom he/she can refer in case of problems or if consultation is needed.
j) The Centre guarantees clinical trials and implementation of new procedures:
- compliance with the guidelines by expert societies as regards cancer diagnosis and treatment
- a transparent system for the participation of patients in clinical trials and the implementation of new procedures, which involves specifying responsibility, as well as cooperation with the ethics committee.
k) The Centre actively participates in the organization of cancer care in the respective region and guarantees (in addition to the highest level of cancer care):
- the establishment and smooth running of a regional network of cancer care facilities,
- consultations to cancer care facilities at lower levels of hierarchy.