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 and still ongoing, the All.Can Germany initiative aims to optimise the patient pathway in cancer care. A number of activities are planned throughout the year, including the All.Can roadshow.
The roadshow consists of a series of events at locations across Germany. It will provide a platform for stakeholders to discuss with policymakers crucial challenges in the current cancer patient pathway. It aims to identify best practice at each location.
Discussions will span topics including: diagnosis; specialised cancer treatment; psycho-oncology; translational cancer research; specialist cancer nursing; support services during treatment; returning to everyday life and follow-up care; palliative care; rehabilitation and regional specificities in cancer care and oncology networks.
Locations have been selected based on where links to these topics, such as existing expertise or initiatives, were strongest. The roadshow aims to identify opportunities in cancer care and raise awareness of examples of best practice that may be reproducible elsewhere in Germany.
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.
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). The All.Can Germany initiative is financially supported by Bristol-Myers Squibb.
All.Can is a trademark of The Health Policy Partnership Ltd.
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