[Recommendations for the structure and equipment of pediatric oncologic centers]

The yearly incidence of cancer in children and adolescents within Germany is about 2200. The regular medical care for these children is effected within prospective multicenter trials of the DAL and GPO respectively. These trials achieved excellent results and gained high international reputation. Following an initial funding by the Bundesministerium für Forschung und Technology the continuation of these trials nowadays is fully dependent on private third parties financial aid especially from the Deutsche Krebshilfe. Guarantee of progress in clinical research and of improvement in patient care as well is closely related to establishing pediatric cancer centers. Accruing about 80 new patients per year such centers have an optimum size justifying establishing stabile substructures. Integrated basic research and organization of special clinical domaines need a differentiated structure of management and a sufficient number of qualified personnel in time nonlimited positions. The recommendation of the Arbeitsgemeinschaft Deutscher Tumorzentren from 1979 for personnel equipment is largely insufficient with respect to the inpatients nursing staff for pediatric oncology units. A basic equipment of 1.75 nurses per patient and additional nursing staff with specific functions would seem appropriate as demonstrated by analyses and calculations within the last part of our recommendations. The ADT recommendations are also insufficient with respect to secretaries and documentation assistants. Concerning the physicians staff the ADT recommendations just need an adaption to the changes in working time in accordance with the tariffe. These recommendations, however, urgently need to be realized. The necessary staff for psycho-social work has been incorporated into our recommendations for the first time. The ratio of patient rooms to function rooms (excluding laboratories) in pediatric oncology centers diposing of an outpatient area and a day clinic should be about 1:3. Deficiencies in the personnel equipment and the generally pronounced lack in function rooms as well are hampering the daily work and have negative impact on the quality of care as experienced by the patient on the safety of medical and nursing practice and on the quality of teaching, medical education and advanced training.