1. Where are we going « wrong »? Lack of coordination between the disciplines  Implication for the Patient – Not informed on the next steps – Not informed on when where and what by whom (loss of autonomy) – No guidelines publically available BUT does the medical training focus on coordination or on being good in its profession??? Are the medical specialist well trained?? Huge difference over Europe!

2. Where are we going « wrong »? Availability of guidelines on diagnosis and treatment BUT are these evidence based? If so why are they different between regions or countries?? And what is evidence –based? what is the right treatment? Personlised medicine GLs:Not applicable to all patients (how to explain this to patients but also to insurance companies)

3. Where are we going « wrong »? Depending on the GDP or NHE more or less high tech equipments available: MRI,PET scans, radiotherapy….but usually very expensive drugs are available in poor countries!!! Role (lobby) of pharmaceutical industries

4. EUROCARE-4 5-year relative survival, all cancers countries are orded by Total Expenditure on Healh Europe Berrino F. et al, The Lancet Oncology, 2007

5. Where are we going « wrong »? What is a dedicated team? Or what is a « good » hospital?? How to measure this? Volume per specialist ??? Volume per hospital?? NO: but volume per team But how to deal with this in a poor country with only a few inh/km 2 ?

6. Model for comprehensive oncological pathway

7. Where are we going « wrong »? Starting a population-based screening programme (political decision) – without any possibility to treat the referred patient adequatly (no specialized surgeon, no radiotherapy equipment…) – Without any possibility of evaluation of the effect of the screening (no monitor instrument as a CR including stage)

8. Where are we going « wrong »? More survivors due to better survival:  new « problem »: Rehabilitation into the society Back to work Who can give this kind of support to the patients? Who is paying for this?

9. Where are we going « wrong »? Antismoking campaigns? Not succesful because of the lobby of the tobacco industry: political issue!!! Health is less important than the economy: « the cheapest patient is the one who dies very fast, and never reaches his retirement »

10. In conclusion We miss the comprehensive approach (NCCP) We forget to consider the patient as a respectful « normal » person We always blame the doctors but they work within the health care system as build in their country We are still dealing with what is GOOD as we re not aware of all the factors responsible for GOOD outcome we still miss very important information on cancer care indicators

11. Growth of cancer 1 2 4 8 16 32 64

12. Histologie