Dear Editor,
My co-authors and I would like to thank Doctor Tjalma for his comments, which give us the opportunity to explain in depth the differences between certification and recommendations and how Eusoma proceeds with its documents.
Here are our point by point replies to Doctor Tjalma's statements.
-
1.
“The manuscript presents “EUSOMA recomendations, yet according to the official EUSOMA breast centre certification register, fewer than 15% of the centres represented by the authors are EUSOMA-certified. Consequently, more than 85% of the recommendations originate from centres that have not undergone EUSOMA audit or certification. Author affiliation or expertise cannot be equated with EUSOMA-certified practice, creating a fundamental legitimacy gap”. To draw up the document on recommendations for improving multidisciplinary meeting optimization, EUSOMA convened a working group of international experts in breast cancer and multidisciplinary meeting management. They did not necessarily work in certified centres as certification is not a pre-requisite for authorship of EUSOMA multidisciplinary recommendation. Indeed EUSOMA selects authors from among prominent experts in breast cancer, on the basis of the topic that it wants to address.
-
2.
“The manuscript does not report which specific centres participated, despite referring to 43 of 44 European centres, while the official EUSOMA register listed 45 certified centres at the time. Moreover, the analysis appears to conflate EU versus non-EU centres with EUSOMA-certified versus non-certified practice, although EUSOMA certification is not restricted to EU countries.” The questionnaire was sent to 44 European EUSOMA-certified breast centres (the 45th was a non-European Centre) and 50 non-European (non-EU) breast centres in the United States, Australia, China and Brazil. The non-EU breast centres were proposed by the non-EU experts in the working group. Generally speaking, when survey results are presented, the participating centres are not specified by name but their provenance is indicated.
-
3.
“This lack of clarity regarding centre selection and categorization precludes independent verification, meaningful benchmarking against EUSOMA quality indicators, and assessment of representativeness”. Indicators and benchmarking are not pertinent to the topic as the paper aims at suggesting recommendations for multidisciplinary meeting optimization, hoping thus to provide support to centres, regardless of whether they are certified or not.
-
4.
“… …… manuscript frames its conclusions as ‘EUSOMA recommendations’, thereby implying normative authority.” Providing recommendations which may or may not be accepted and/or adhered to does not imply EUSOMA is a normative authority, keeping in mind that EUSOMA recommendations might be accepted by normative authority.
-
5.
“… ……… in the absence of transparent centre-level data, certification-based stratification, audit results, or benchmarking against EUSOMA quality indicators, the survey cannot support representative statements about ‘EUSOMA practice’. Doctor Tjalma appears to have confused the survey with the recommendations. The survey was designed and conducted only with the aim of obtaining insights into the current state of multidisciplinary meetings organization and management within European and non-EU centres, independently of the recommendations. And, again, benchmarking does not have any relationship with the topic of the paper.
-
6.
“This is particularly relevant given the availability of an updated EUSOMA quality indicator framework, which explicitly anchors multidisciplinary care in measurable, auditable standard. The work should therefore be interpreted as an expert consensus and descriptive survey, rather than guidance grounded in EUSOMA-audited implementation”. We can only repeat that quality indicators and recommendations are different. Quality indicators, as reported in the document EUSOMA published in 2023 (Rubio et al. EJC), aim at reducing diagnostic and therapeutic variability and thus improving patient outcomes. On the other hand, the present paper on multidisciplinary meeting optimization suggests how multidisciplinary meetings can be optimized, without reporting any indicator, measurement system or benchmarks.
-
7.
“EUSOMA is a quality label with a clearly defined meaning, grounded in external audit, verification, and measurable quality indicators. When its name is used, a clear distinction between certified practice and expert opinion is essential. Without such distinction, the authority of EUSOMA as a marker of verified quality is at risk of dilution”. We would like to thank Doctor Tjalma for his appreciative remarks about EUSOMA. As stated above we agree the paper “is an expert consensus and descriptive survey”.
We believe we have responded to all his comments.
CRediT authorship contribution statement
G. Curigliano: Conceptualization, Writing – original draft, Writing – review & editing. L. Marotti: Writing – review & editing. C. Barrios: Writing – review & editing. N.M.L. Battisti: Writing – review & editing. K.L. Cheung: Writing – review & editing. S. Chia: Writing – review & editing. S.L. Graff: Writing – review & editing. O.J. Hartmann: Writing – review & editing. I. Rubio: Writing – review & editing. D. Santini: Writing – review & editing. F. Sardanelli: Writing – review & editing. E. Senkus: Writing – review & editing. P. van Dam: Writing – review & editing. M. Walker: Writing – review & editing. J. Wu: Writing – review & editing. C. Aristei: Conceptualization, Writing – original draft, Writing – review & editing.
Declaration of competing interest
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CHB: Grants/research support: (to the institution) Amgen, Astra Zeneca, Aveo Oncology, BioNTech, BMS, Daiichi Sankyo, Dizal Pharma, Exelixis, Fortrea, Gilead Sciences, GSK, ICON, IQVIA, Janssen, Labcorp, Lilly, Medpace, MSD, Novartis, Novocure, Nuvisan, OBI Pharma, Parexel, Pfizer, PharmaMar, PPD, PSI, Regeneron, Roche/Genentech, Samsung, Sandoz, Sanofi, Seagen, Servier, Stemline, Syneos Health, Taiho, Takeda, Tolmar, TRIO, Worldwide. Academic Research Projects: CPO, PUCRS, LACOG, GBECAM. Ownership or Stocks: Tummi, MEDSir, CPO. Advisory Boards, Consulting, Travel, Presentation Honoraria: Adium, Novartis, Pfizer, Roche/Genentech, MSD, Astra Zeneca, Lilly, Daiichi, Gilead. SLG: Stock Ownership (Current, Self) HCA Healthcare; Consulting (All Relationships Ended, Self): Pfizer, SeaGen, AstraZeneca, DaiichiSankyo, Gilead Sciences, Menarini Stemline, Genentech, Novartis, Lilly/Loxo@Lilly; Research Funding (All Funds to Institution): AstraZeneca, Novartis, Daiichi Sankyo, Lilly, Hoffmann-La Roche/Genentech, NB: Advisory board: Pfizer, Abbott, Sanofi, Astellas, Merck, AstraZeneca, Travel grants: Exact Sciences, Pfizer, Lilly, Novartis, Speaker fees: Pfizer, AbbVie, Roche, Sanofi, Novartis, Servier,Gilead, AstraZeneca, Lilly, Exact Sciences, Johnson & Johnson FS and IR: Given their role as Editorial Board Member, they have no involvement in the peer review of this article and have no access to information regarding its peer review