[Medicolegal aspects of tumor boards]. / Medizinrechtliche Aspekte von Tumorboards.

The presentation of tumor patients to tumor boards has widely developed into a medical standard. The necessary compliance to the medical standard can lead to obligatory presentation if the complexity of a case dictates that this cannot be comprehensively covered by a single treating physician. The organization of a tumor board must be so that the structure and specialist competence guarantees an adequate consultative function of the represented specialties. Tumor board members are not automatically promoted to become part of the treating team just by participation and therefore do not have a guarantor position but do have the obligation of care of a consulting physician. Tumor board decisions have a recommendation character, are not binding in the legal sense and do not relieve the treating physician from the obligation to critically scrutinize the recommendations before implementation. On the other hand the treating physician must be able to justify not following the recommendations on the basis of the medical obligation to care. The tumor board must fulfil the same requirements for documentation as any other consultative activity.

HER2 testing in the UK: consensus from a national consultation.

OBJECTIVE: To gain an understanding of current attitudes among oncologists and pathologists to prospective HER2 testing in breast cancer and to gauge whether a national consensus exists regarding extent and quality of testing. DESIGN: Qualitative study, with semi-quantitative components, using emailed questionnaires and open-ended discussion documents. PARTICIPANTS: 186 relevant specialists, including 76 breast oncologists and 99 pathologists, representing all but three of the UK cancer networks. RESULTS: A strong consensus was seen in favour of universal, non-selective testing for HER2 at the point of breast cancer diagnosis. Similarly, an overwhelming majority of participants agreed that, to optimise the quality of test results, all laboratories undertaking HER2 testing should be CPA-accredited, participate in the recognised national external quality assessment scheme (UK NEQAS), and carry out a formal annual audit of its testing service. A further recommendation that testing be restricted to laboratories undertaking a minimum 250 tests per annum for immunohistochemistry and 100 tests per annum for in situ hybridisation techniques met with majority support. However, this was not a clear consensus; a significant minority of participants favoured continued use of local services falling short of these criteria. CONCLUSION: This study was successful in gauging national specialist opinion regarding the extent and quality assurance of HER2 testing in the UK.

Legislación actual en Radioterapia y su contribución al nivel de calidad y seguridad / Current legislation in Radiotherapy and its contribution to the level of quality and safety

La radioterapia es una especialidad médica de gran complejidad técnica y que conlleva un cierto grado de riesgo en su aplicación. Por este motivo es objeto de una extensa y restrictiva regulación legal. En el presente artículo se analizan las consecuencias que tienen sobre ella las distintas disposiciones legales, haciendo especial hincapié en el Real Decreto de los Criterios de Calidad en Radioterapia (AU)

Because of the great technical complexity and the degree of risk in its application, Radiotherapy is a unique medical speciality with extensive and restrictive legal regulations. This work analyses the consequences of the different legal provisions, with special emphasis on the Royal Decree establishing the Quality Criteria in Radiotherapy (AU)

Sectorización de las enfermedades oncológicas. La experiencia del Reino Unido / Sectorization of oncological care. The experience of the United of Kingdom

No disponible

[Patient autonomy: from the clinical routine of an oncologic department]. / Patientenverfügungen: aus dem klinischen Alltag einer onkologischen Abteilung.

Advance directives are an important help for physicians, patients and relatives when it comes to evaluating the patients wishes and preferences in the terminal phase of life. They also help to safeguard the patients right of self-determination. When the directives are clearly expressed and of recent date, they should be accepted without question. At present, only a few patients make use of this right, and we doctors should be in future inform patients more often about it.

Medicare coverage for oncology services.

Medicare's mission is to assure health care security for our beneficiaries. Title XVIII of the Social Security Act (the Act) provides the Health Care Financing Administration (HCFA) with the authority to fulfill this mission. Although Medicare is considered a defined benefit program, the Act vested Medicare with the discretionary authority to make specific policy decisions when necessary. HCFA's discretionary authority, which is found at section 1862(a)(1)(A) of the Act, enables HCFA to provide coverage for services that are reasonable and necessary for the treatment and diagnosis of illness or injury or to improve the functioning of a malformed body member. To determine whether a service is reasonable and necessary, HCFA relies on authoritative evidence. This evidence includes, but is not limited to, approvals from appropriate federal agencies, such as the Food and Drug Administration, and systematic evaluations of scientific literature via technology assessments. HCFA also may decide that a service warrants a unique type of coverage policy, which is referred to as coverage with conditions. This form of coverage is a middle ground between strict noncoverage and general coverage for a medical service that appears promising, but still is evolving. All these policy specifications effect Medicare coverage of oncology services. This means that reasonable and necessary diagnostic and therapeutic cancer-related services that are not otherwise prohibited by Medicare's statute, regulations, and manual instructions are covered and paid for by the program. Prior to the Balanced Budget Act of 1997 (BBA '97), Medicare provided coverage for some beneficiaries to undergo mammography and Papanicolaou smear screening. As a result of BBA '97, Congress has mandated expanding coverage for these services as well as adding coverage for pelvic examinations, prostate cancer screening, colorectal screening, and antiemetic drugs used as part of an anticancer chemotherapy regimen. Other specific coverage policies that relate to cancer treatment include coverage for Group C cancer drugs and off-labeled use of some drugs. HCFA is committed to providing its beneficiaries with quality health care services and will continue to monitor the progress of oncology services with an eye to establishing national policies for those services that demonstrate through authoritative evidence that they are reasonable and necessary.