June 2014

On the safe side

The National Center for Tumor Diseases in Heidelberg, Germany, is regarded as one of the world's leading clinics in cancer treatment. Helsana clients can come here for a second opinion from an interdisciplinary team.

Onkologiezentrum Heidelberg

Combined expertise: in the National Center for Tumor Diseases, various specialists discuss which therapy is most suitable for the patients.

«When patients come to us, they are not passed off from one department to the next», says Dirk Jäger. Precisely the opposite is the case: «The various specialists come together to discuss which therapy is most suitable for the patients.» Dirk Jäger is Director of Medical Oncology at the National Center for Tumour Diseases (NCT) in Heidelberg, Germany. Since each cancer case is different – and even individual cells may vary within a single malignant neoplasm itself – patients react differently to the same therapy. If you want to put it another way, every patient has their own unique tumour, explains the oncologist. This makes a precise analysis all the more important.

Rapid treatment

Helsana clients can now take advantage of the expertise of the Heidelberg scientific committee thanks to Primeo supplementary insurance. For a Swiss patient, let's call him Peter Rutishauser, the consultation he receives in Heidelberg could take the following form: At the cantonal hospital near his home town, oncologists have diagnosed a colorectal tumour. The news came as a shock both to him and his family. Peter Rutishauser turns to Helsana for a second opinion, which establishes contact to the NCT. A case manager in Heidelberg discusses the next steps with the patient.

The first thing Rutihauser does, in consultation with the attending doctors at the cantonal hospital, is to arrange for his medical records to be sent to Heidelberg. Once they have arrived, an oncologist consults the file (containing the diagnostic findings and the MRI scans) and crystallises the most important information. Together with a case manager, he invites the specialists to a meeting. «Within two weeks the case is discussed in the tumour board», says Heike Wachow, one of the case managers. Heike Wachow has been on board since the first interdisciplinary board was held in Heidelberg. «We wanted to break new ground and make the treatment options available more efficient.» Today, these meetings involving various specialists are standard, with over 5,000 cases discussed each year, she says.

New research findings

In Peter Rutishauser's case, a liver surgeon also takes part in the board, because the cancer has already spread to the liver. He is in a position to assess whether the metastases can be removed surgically without impairing the functioning of the liver. A radiologist is also involved to help the other colleagues interpret the MRI images correctly, while an oncologist like Dirk Jäger explains the benefits and risks of a course of chemotherapy. A specialist in nuclear medicine is also present, since he is well versed in radiation therapies. «Based on the latest research findings, we as a team compile a customised treatment recommendation for each patient», says Dirk Jäger. "We are convinced that our approach leads to less procedures being carried out unnecessarily.»

This takes a massive weight off patients' shoulders, and also allows us to stay in better control of healthcare costs. Dirk Jäger also sees great potential in the field of research and diagnostics, as he demonstrates using the example of a patient with colorectal cancer. The cancer was successfully operated on. Surgeons also removed the metastases in the lymph nodes. Sixty to 70 percent of those affected are given the all-clear after this operation; the remainder suffer a relapse. «We can lower this relapse rate with chemotherapy.» However, since tumour cells of this

Onkologiezentrum Heidelberg

«We are convinced that our approach leads to less procedures being carried out unnecessarily.»

Dirk Jäger

Oncologist and clinic director

kind react differently, the success rate of standardised treatment is just 15 percent. «A disaster! If we had a better understanding of the biology of the cells, we would be able to develop more effective therapies.» This is precisely what the NCT together with the German Cancer Research Center (DKFZ) in Heidelberg and other renowned institutions around the world are researching. With the help of molecular diagnostics, continues Dirk Jäger, we are having more and more success in deciphering the flaws in the DNA of cancer cells. Indeed, not only are we already able to locate all the flaws present in the DNA, we are also able to better understand what these flaws mean. «That's like being told to read 1,000 books each with 1,000 pages containing 1,000 words and having to find 100 to 500 typos», he says. The NCT is involving lots of patients in these studies and examining whether molecular tests for individual tumours could make the treatments more precise.

After the five experts have studied Peter Rutishauser's case, he is invited to a meeting in Heidelberg. "When the patient arrives at our centre, we explain our assessment of the situation and recommend a therapy,» says Dirk Jäger. In the best case scenario, this is congruent with the course of treatment prescribed by our counterparts in Switzerland. The scientific committee in Heidelberg does not always come to the same conclusion as the doctors who initially diagnosed the patient. «f this happens, we contact the hospital from which the patient was referred and define the next steps together.»

All in a day's work

At the NCT, patients also benefit from advice from nutritionists and physiotherapists, as well as other specialists in the fields of counselling, social services and ethics; thus, alongside the pure medical committee, the NCT also involves a second team of experts in every case. «Since 80 percent of cancer patients have to deal with changes in taste, lose a large amount of weight or suffer from digestion issues, nutrition counselling is also included in the offering», says nutritionist Ingeborg Rötzer.

She and her team of five help patients prepare their body as best they can for the disease and the effects it will have. Many lose their appetite completely or are unable to keep down their meals. «Therefore», explains Ingeborg Rötzer, «it is vital that patients keep up their calorie intake and get enough protein in their diet.» If this is not possible by ingesting food in the normal manner, or this is possible only to a limited degree, we look for alternatives. Since Swiss patients are usually in Heidelberg only for a limited time, the nutritionists and physiotherapists consult with the specialist teams in Switzerland where required, who then take over care for the patient at their place of residence. «This naturally also applies to all medical questions», elaborates oncologist Dirk Jäger. «We want to avoid redundancies in all cases.» Patients travel back to Switzerland on the same day, wherever possible – safe in the knowledge that specialists in one of the world's leading cancer clinics have scrutinised their case.

Text: Christian Schiller