by Marija Miletić
I took place in an EJP RD Research Mobility Fellowship, which was challenging yet rewarding; an unforgettable experience in my life!
I learned about the potential for the exchange from my older colleague from Croatia, Prof Ana Fröbe. She told me there was funding for an exchange programme to stimulate knowledge sharing and collaboration between healthcare professionals in the ERNs. The hospital I work for, University hospital center Sisters of Mercy, Zagreb, Croatia, was an Affiliated Partner of ERN eUROGEN.
I am a medical oncologist and PhD student in medical oncology, and my area of interest is urogenital tumours, including patients with penile cancer. Because a different specialist manages penile cancer, there are often gaps and inadequacies in coordinated care. Moreover, the optimal orchestration of primary treatment modalities (i.e., surgery, chemotherapy, radiotherapy) is largely unknown. Across countries, there are differences in medical care organisation and other cultural factors that may affect treatment patterns and the survival of patients with penile cancer. I have used CPMS to present several penile cancer patients’ cases to ERN eUROGEN’s experts to help guide their clinical management. There are no clear guidelines for many clinical cases, and practitioners have had to rely on their experience and a few studies with low-level evidence to guide practice. In my home country, Croatia, there is no dedicated pathway to manage this rare but very aggressive disease.
So, for my EJP RD Research Mobility Fellowship, I visited an expert, high-volume ERN eUROGEN full member healthcare provider, UZ Leuven, to analyse the data on patients with penile cancer including expert opinion and practice patterns, presenting disease characteristics, modalities of treatment, and oncologic outcomes.
My visit’s primary aim was to investigate the viewpoints of different cancer specialists regarding challenges unique to the treatment of penile cancer patients and to identify the potential shortcomings and knowledge gaps. I wanted to expand clinical knowledge on other practices in managing patients with penile cancer, especially metastatic disease, among highly specialised, high-volume healthcare providers. Working in international environments, building a global network, developing collaborative relationships, and improving communication and collaboration between centres, has undoubtedly contributed to my professional development. I also wanted to collect benchmark data that can be used to raise disease awareness among different medical specialists and to define current practices and treatment patterns.
My supervisor was Prof Maarten Albersen (head of the clinic at UZ Leuven and a uro-oncologist focusing on penile and renal cancer research) and his uro-oncology team. I would also like to highlight MD Laura Elst (PhD student in urology) and MD Eduard Roussel (PhD student in urology), who helped me during my entire stay in Belgium. I also spent some time in the oncology department. In oncology, my supervisors were Prof Herlinde Dumez (medical oncologist) and Prof Benoit Beuselinck (medical oncologist).
Newsweek has chosen UZ Leuven Gasthuisberg Campus as one of the best hospitals in the world (31st out of 200) and UZ Leuven as the best Belgian hospital. I think that speaks for itself about the excellence of the centre I visited. Personally, it was challenging but fascinating to compare the way healthcare organisations in a country like Belgium compare to the ones we have in Croatia.
I can certainly say I’ve learned a lot, particularly when it comes to working in an expert centre for rare diseases and conducting research. I saw a lot of new therapies and new therapeutic possibilities. The difference in the therapeutic options in Croatia and Belgium is enormous. At the same time, I am happy because their patients have many great and new therapeutic options, but also sad because the situation in my country is so different.
I was involved in several different research projects. My first project was an ERN eUROGEN survey study entitled “Are there differences in high-risk penile cancer management among penile cancer specialists in European centers?”. I have started to collect data from all penile cancer patients treated at UZ Leuven from 1989 to 2021. We aim to compare the outcomes between the two time periods (before and after they started with the implementation of the dedicated pathway in Belgium to treat penile cancer patients, i.e. before 2015 and after 2015). This project is ongoing, and I hope we will finish data entry soon. They also included me in a retrospective study entitled: “Retrospective study on prediction of local recurrence and its impact on long-term outcomes after low-risk organ-sparing surgery defined as wide local excision, circumcision, and glans resurfacing for penile squamous cell carcinoma”.
The fellowship has also been an excellent opportunity to practice English and improve my language skills. Belgium has three official languages: Dutch (Flemish), French, and German, but unfortunately, I know just a little bit of German. The language barrier made it difficult to communicate with patients and fully participate in a multidisciplinary team, but my colleagues helped me with translation and understanding. Another challenge for me was the requirements for the writing format and the quality of work with scientific resources. I was unaware of the number of strict standards you must satisfy to perform well. Nevertheless, the seriousness of the work contributes to the deep understanding of a subject, which is an indisputable advantage of such an approach.
I think data collection from penile cancer patients treated in UZ Leuven will help with the multidimensional data collection for the ERN eUROGEN registry. I believe that survey results will identify knowledge gaps, areas of poor coordination of care, and varying views between different cancer specialists. Overall, we will help to identify priorities in clinical research and help with ongoing clinical trial recruitment.
The three months at UZ Leuven were very useful for me as I gained a lot of life and learning experiences. Hence, the fellowship was an invaluable contribution to self-development in my education, clinical experience, and everyday life. I realised that combining clinical and research work simultaneously is possible if you are well organised and have support.
I don’t have the words to fully share the excitement which overflows me after this wonderful fellowship visit. All I can say is that it is one of the most beautiful experiences in my life, unforgettable, and I would recommend it to anyone who has the opportunity.