Cancer care in Germany
In Germany, quality of cancer care is at its highest and access to treatment is generally available to all. However, challenges remain, such as demographic changes and the fact that increased survival rates due to innovative therapies have led to more pressure on services to provide long-term care.
All.Can Germany initiative
All.Can Germany was established in a kick-off event in November 2016, where members of the steering group convened to define key needs in German cancer care. The initiative looks holistically at the whole patient pathway, from diagnosis and specialised cancer treatment to rehabilitation, returning to everyday life and follow-up care – not to forget crucial aspects such as psycho-oncology, specialist cancer nursing and translational cancer research. All.Can Germany aims to develop concepts to overcome gaps between these steps and in the future of cancer care: between self-help and physicians, intersectorally between stationary and ambulatory care, and linking cancer care with cancer research. Creating better links and interactions helps to reduce inefficiencies and improve cancer care overall, always focusing on patient needs.
Activities and milestones
Initiated in 2017, the All.Can Germany initiative aims to optimise the patient pathway in cancer care. The All.Can roadshow has been an integral part of achieving that goal.
The roadshow consists of a series of events at locations across Germany. It provides a platform for stakeholders to discuss crucial challenges in the current cancer patient pathway with policymakers, and aims to identify best practice at each location.
Locations have been selected based on where links to these topics, such as existing expertise or initiatives, were strongest. The roadshow identifies opportunities in cancer care and raises awareness of examples of best practice that may be reproducible elsewhere in Germany.
So far, there have been ten stops, with topics ranging from diagnosis (Buxtehude) to specialised cancer treatment (Hamburg), and psycho-oncology (Magdeburg) to cancer survivorship (Hamburg). Another stop is planned for the topic of translational research in early 2019.
With the All.Can roadshow coming to an end, the steering committee met in September 2018 to prepare a preliminary final report together with the secretariat. The report will contain concrete objectives and proposals for the future activities of All.Can Germany.
The final report will be presented and discussed at two regional conferences and subsequently presented to the German parliament. Following the political discussions, the implementation of the concrete measures and projects from the final report will commence.
Bremen | 8 August 2017
The All.Can roadshow began by visiting the Bremen Cancer Society to exchange views on the topic of therapy accompanying measures.
Together with representatives from political parties CDU and SPD, the local health insurers AOK and hkk, the food supplier EDEKA and a self-help organisation, the members of the All.Can steering group discussed therapy accompanying measures and their important role in cancer patient care. The focus was on nutrition and light exercise. In order for offers of light exercise to be covered by statutory health insurance, bureaucratic hurdles need to be overcome. Thus, the local government used this opportunity to offer a pilot project in this area together with the cancer society.
Magdeburg | 24 August 2017
During the second expert discussion, including a public panel discussion, the participants dealt with the subject of psycho-oncology.
The representatives of the cancer society of the psycho-oncological department of the university clinic Magdeburg and the self-help organisation agreed that psycho-oncological care needs to be centrally regulated and recognised as a task for the whole of society. Sustainable financing must therefore be ensured, which concurrently means moving away from project funding and a convergence of institutional funding.
Through the assurance of sufficient counselling centres in the region, supply gaps can be closed, especially in the outpatient sector. Greater attention should be paid to verbal communication in medical care.
Buxtehude | 25 August 2017
The third stop of the roadshow took place in Buxtehude and was devoted to cancer diagnosis.
Under the banner of ‘Dealing with the diagnosis of cancer – cooperation between practitioners and self-help organisations’, the practitioners and self-help representatives attending the event reported how the Buxtehude self-help organisation and doctors have become a team. Through exchange within the self-help group, questions can be answered and tips given; additionally, the doctor of the group conveys knowledge and tips via targeted training, for example in regard to side-effect management, which in return has a positive influence on the course of therapy. The self-help group can support the patient in dealing with their illness without replacing the role of social and medical consulting. Self-help is strongly depended on volunteer commitment.
There is often a need to overcome bureaucratic hurdles, hindering the development of larger networks. Participants agreed that start-up financing, in particular, fosters the development of self-help structures.
Hamburg | 6 November 2017
Discussion at the Martini-Clinic in Hamburg focused on how highly specialised cancer therapy works.
The Martini-Clinic has specialised in treating prostate carcinomas for over 12 years, and is a world-leader with more than 2,200 prostate surgeries. Due to its internal structure (Faculty-System) and the introduction of patient-reported outcome measures (PROMs), they succeeded in maintaining a high standard in the quality of care. During the fourth stop of the roadshow, it was impressively demonstrated how, through specialisation and improved internal structures, the highest standard of care for cancer patients can be achieved. Close consultation with the patient can ensure patient-oriented care. This was demonstrated during the conversations between the healthcare insurer BARMER, the German Association for Oncological Pharmaceutics, the Martini-Clinic and All.Can. The participants agreed that minimum quantities improve quality, which can be achieved more easily by the specialisation of a clinic.
St Peter-Ording | 6 December 2017
Rehabilitation following a cancer therapy represents an important pillar of the holistic care of cancer patients.
When it comes to rehabilitation, the aspect of reintegration into the workforce is especially important. At the fifth stop of the roadshow, the members of All.Can Germany discussed this topic at the specialised clinic for oncological and follow-up rehabilitation in St. Peter-Ording. They were joined by representatives of the regional constituency, the German Pension Insurance North and the staff of the Clinic Nordfriesland. Due to increasing ‘chronification’, improved treatment options and a rising number of long-term survivors, rehabilitation plays an increasingly important part in the care of cancer patients. Occupational reintegration is an especially important goal for younger cancer patients. The developed concept of ‘medical-occupational oriented rehabilitation’ (MBOR) was implemented at the specialised clinic step-by-step, and it is recognised as an MBOR-clinic in oncology. During the discussion, it became apparent that in addition to increased acceptance of rehabilitation within the medical profession, organised discharge management is necessary in order to ensure seamless care for cancer patients.
Essen | 7 March 2018
During the sixth stop of the roadshow, palliative care of cancer patients was discussed.
For more than a decade, the Network Palliative Medicine Essen (NPE) has supported a permanent implementation of nationwide quality-assured palliative medical care. In addition to the members of the network and All.Can, representatives of the healthcare insurer AOK, the Association of Statutory Health Insurance Physicians North-Rhine and the city of Essen participated, as well as the regional constituency representative and the Patient and Care Representative of the Federal Government, Ingrid Fischbach. Patients with a cancer diagnosis represent the largest group among the palliative care and hospice sector. Through the dedication and initiative of the NPE, a palliative identification card was created, the so-called ‘Essener Standard’ was developed, and the city joined the Charta for the care of critically ill and dying persons. During the discussion, it was agreed to broaden the offer of patient information about possibilities in palliative care. There was also agreement that the financing of palliative care must be ensured. During the discussion it became apparent that regional networks can sustainably improve the care of cancer patients.
Miltenberg | 11 July 2018
The seventh All.Can roadshow stop focused on networks for more care efficiency.
In particular, discussions centred around integrated care strategies and the benefit of regional healthcare networks for the dismantling of sectoral borders between the individual professional groups within the healthcare sector. The ‘Health region plus’ Miltenberg is one of the 41 project regions funded by the Bavarian State Ministry with the goal of ensuring healthcare and prevention close to home for patients. The interlinked, cross-sectoral and interdisciplinary cooperation of all healthcare actors in the region, and solution-oriented work, was particularly highlighted. With the interlinking of actors and the common goal of optimal care for patients in the Miltenberg region first results could be delivered, such as the cross-carrier CareNetwork District Miltenberg – which, among other things, deals with the challenges that come with the shortage of young care personnel.
München | 18 July 2018
Through digitalisation and the flexibility of structures, care close to the home can also be ensured in more rural areas.
The eighth stop of the All.Can roadshow dealt with how digitalisation and regionality in oncological care fit together. The delegation of medical services to qualified personnel can improve care, especially for immobile patients in rural areas, which increases the quality of life for patients and relatives and relieves pressure on doctors. All participants agreed that the support of digital applications can expand the care spectrum of delegated services. During the discussion it was, however, stated that there is a need to clearly define which services can be delegated from the doctor to other qualified personnel. Additionally, qualification requirements must be developed, and training opportunities and appropriate remuneration ensured.
Halle (Saale) | 22 August 2018
Specialised oncological care was the focus of the ninth All.Can roadshow stop in Halle (Saale).
Currently, Halle (Saale) is the only location in Germany that offers a primarily qualifying bachelor with medical assignments. The goal is to create conditions until 2020 in which graduates of this programme can be accepted and recognised not only in the inpatient but also the outpatient environment. All participants agreed that transferring competences can unburden all parties involved and thus the system as a whole, improving quality of care. However, it was also agreed that there was still a long way to go to break down barriers and prejudices.
Hamburg | 27 August 2018
During the tenth stop of the All.Can roadshow, one of the major oncological challenges of the next few years was discussed: cancer survivorship.
The All.Can Germany steering group met the team from the University Clinic Eppendorf working on the CARE for CAYA project, which supports cancer survivors. Thanks to improved treatment there are an increasing number of long-term survivors with cancer. The project is a three-module programme for the follow-up care of cancer patients which deals with the prevention of long-term effects such as cardiovascular disease. At the meeting, everyone agreed that with the initial risk stratification, the implementation of a ‘survivorship’ register and guidance for cancer patients in the areas of movement, nutrition, psychological care and legal social consultation, cancer survivors can be comprehensively and sustainably cared for in the long term.
The All.Can international initiative comprises leading representatives from patient organisations, policymakers, healthcare professionals, research and industry. All members contribute their time for free to the initiative, and all publications from the group reflect consensus of the members, who hold full editorial control.
The All.Can international initiative is made possible with financial support from Bristol-Myers Squibb (main sponsor), Amgen, MSD and Johnson & Johnson (sponsors) and Varian (contributor), with additional non-financial (in kind) support from Intacare and GoingsOn. The All.Can Germany initiative is financially supported by Bristol-Myers Squibb.
All.Can is a trademark of The Health Policy Partnership Ltd.
RPP Healthcare Germany
Dr. Rainer Hess
GVG Committee on Health Goals
Dr. Patrick Jahn
Director for Clinical Nursing Research at University Clinic Halle (Saale) and board member at the Conference of (paediatric) oncological care
Tino Sorge, MP
German MP, Member of the Parliamentary Health Committee
Chair, Leukemia Support Group Rhine-Main
Former Patient Representative of the German Government
28 March 2019