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Cancer Care Efficiency Map

The Cancer Care Efficiency Heatmap is a visual display aiming to provide a better understanding of how efficiency measures, as identified in All.Can’s Policy blueprint: Building efficiency in cancer care, are embedded in national cancer control policies. Furthermore, the map is also looking to uncover core efficiency metrics already adopted by the surveyed healthcare systems and highlight the achievements of our members and national initiatives in advancing cancer care efficiency locally.

The information contained in the map was collected through surveys completed by the All.Can National Initiatives, All.Can individual members, as well as through desk research performed by the All.Can Secretariat, and reflects their best understanding of the state of national cancer control policies, health strategies or any other source consulted to conduct this research.

The survey questions, which provided the foundation for the information contained in the map, were developed in consultation with the All.Can Research and Evidence Working Group.

The outcome now takes the form of a digital, interactive global map where users can easily access country-specific information by clicking on the desired location.

This living resource will be periodically updated by the All.Can Secretariat to ensure that any new developments shared by national initiatives and members are promptly reflected, keeping the map up-to-date and valuable. In time, this will further allow to assess areas of change and improvement in patient care in relation to cancer care efficiency.

Disclaimer:

The information contained in the map is limited insofar as it was gathered from publicly available resources and only covers those areas in which All.Can is represented. The information contained in the map is intended as a reflection of the state of national cancer control policies and does not constitute an analysis of these policies, their implications, or any associated elements, and does not take into consideration any potential differences in the structure, functioning, or maturity of healthcare systems. No rights can be derived from the information contained in the map, and All.Can International, All.Can National Initiatives, All.Can individual members, nor any associated or affiliated persons, organisations or other entities, natural or legal, can be held liable or otherwise responsible for the information contained in the map.

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Argentina Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Oncology training (through targeted videos with oncologists) for Primary Care physicians in order to shorten the gap between first symptoms and cancer diagnosis. Videos are uploaded on All.Can Argentina YouTube Channel and have been target-distributed to physicians. We carried out three editions of Health Literacy seminars for oncologists.

Impact of these actions

We do have an excellent feedback from the professionals that either attended the seminars of watched the videos.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Chemotherapy at home (Hospital Militar) case, already included in the All.Can Efficiency Hub. CAPtyVa: an app to improve colon cancer prevention. Developed by two Argentinean Gastroenterology specialists to assist physicians in the task of indicating colon cancer screening and the appropriate interval of surveillance studies trough an intelligent calculator based on updated scientific evidence. www.all-can.org/efficiency-hub/at-home-chemotherapy-offering-treatment-outside-hospital-in-argentina/

Examples of inefficiencies in cancer care that have resulted in inequalities

The main factors that generate inefficiency in cancer care in Argentina are: the delay in diagnosis and in receiving the treatment needed. The lack of a multidisciplinary approach in many centers. The difficulty in accessing to specific cancer institutions in many regions of the country. The lack of an operational functioning of a navigator in many of the institutions.

New cancer control regulations and policies that could emerge in the coming period

In the short term, nothing significant. In the long term we can mention the deepening of secondary prevention for breast, colon and cervical cancer. And, despite being general to the entire health system, there is also the discussion of the creation of a health technology agency or the definition of new criteria for the reimbursement of high-cost drugs. This would have a strong impact on oncology.

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Argentina
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Austria Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Colorectal and cervical cancer programmes

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Study on tumor board practice, derived recommendations for further optimization of collaboration in tumor boards; pilot project on use of telemedicine in early cancer care phase

Impact of these actions

Too early to say as pilot project started in march 2023

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Austria
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Belgium Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

Members of All.Can Belgium ( including the Foundation against Cancer) took part in the creation of the cancer plan and its second edition.

Impact of these actions

Cancer barometer: actions taken by minister of public health Monitoring of cancer actions has been assigned to cancer center Anti-tobacco plan in place Anti-alcohol plan in discussion White paper on skin cancer ( UV)

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Optimoc project ( improving multidisciplinary onco consult ) Get checked early campaign on early detection for AYA Health literacy programs

Examples of inefficiencies in cancer care that have resulted in inequalities

participation to population-based screening programs: many regional and local differences reference centers and networks : not everyone has access to the same quality of care existing quality indicators need to be developed better and are not accessible and transparent

New cancer control regulations and policies that could emerge in the coming period

updated cancer plan and quality indicators

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Belgium
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Canada Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Sun safety

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

After assessing that cancer diagnoses and entering into cancer care is the top inefficiency in Canadian cancer care, All.Can Canada undertook mixed methods research to understand the current state, future state, outcomes that matter most to patients, and opportunities to improve. The results and recommendations are now continuously being shared with decision-makers. From this, we created a patient-led, multi-stakeholder collaborative governance approach, including a Steering Committee and three Working Groups devoted to stakeholder engagement, knowledge mobilization, and evidence. They are all working towards the same “common agenda” through a 3-year strategic plan and annual operational plans that are aligned with our research findings and recommendations. The short to mid-term outcomes are: to engage stakeholders to establish and grow collaborative relationships with them; to mobilize research findings, recommendations, and best practices amongst stakeholders; and to support the development and use of tools and practices that support people undergoing a cancer diagnosis and providers involved in the processes. Long-term outcomes are to influence system-level funding and policy decisions and to influence professional practices, accessibility, and behaviours, starting with supporting primary care. We are also in the process of building relationships with key decision-makers in four Canadian provinces (to start) in order to share our findings and recommendations plus, as they become available, our Canadian practice case studies. We have been presenting to professional audiences through various conferences to share the findings and recommendations with them and begin cultivating relationships. Our Evidence Working Group is currently in the process of developing practice case studies of practices in Canada that are moving the needles on one or more areas that are known to improve the efficiency of diagnosis and/or the achievement of outcomes that matter most to patients. All four jurisdictions that we are meeting with have expressed that (1) our findings validate their own region’s current state; and (2) they would like to receive these practice case studies to help them know what is working across the country and connect with colleagues to improve their work in their jurisdiction. All.Can Canada also works in coalition on numerous strategic priorities. Through the Patients Redefining the Future of Healthcare in Canada Summit working group on health data, we have endorsed and support the Declaration of Personal Health Data Rights, which is successfully being used in advocacy and engagement towards the aforementioned PanCanadian Health Data Strategy and Interoperability Roadmap. We are also involved with the Patients for Accountable Healthcare coalition, which is monitoring and advocating for federal and provincial accountability following the negotiation and signing of the Canada Health Transfer (CHT) and bilateral agreements.

Impact of these actions

Thus far, all jurisdictions and stakeholders with whom we’ve shared our findings and recommendations have shared that the results reflect reality in their part of the country and that they’ve found our research results “validating” of their own understanding and efforts. They are also all interested in receipt of our practice case studies once they are ready for dissemination. The development of the case studies will offer provincial policy-makers and decision-makers with researched, digestible examples of practices that they could adapt in their own jurisdictions. Further, the Declaration of Personal Health Data Rights in Canada has been endorsed by 27 patient and engaged citizen groups, who have supported the advocacy for and the development of the Pan-Canadian Health Data Strategy and Interoperability Roadmap. Our Steering Committee, Stakeholder Engagement and Knowledge Mobilization working groups are also in the process of organising our 3rd roundtable meeting, which will bring together a variety of stakeholders from Canada to deepen our understanding and define further actions when it comes to improving equitable cancer diagnoses, particularly for Indigenous and racialized people, in Canada.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

The practices that we have thus far developed case study reports for include: Diagnostic Assessment Pathways and Diagnostic Assessment Pathways-Electronic Pathway Solution (Ontario), Telehealth Clinic (Saskatchewan), the Clinical Practice Guideline Evaluation (British Columbia), Oncology Nurse Navigators (nationally), and the Rapid Access Breast Clinic (British Columbia). We also have a queue of case studies that are in development.

Examples of inefficiencies in cancer care that have resulted in inequalities

Our “current state” infographic is a good snapshot of the numerous inefficiencies related to cancer diagnoses in Canada and the specific challenges are outlined in our research report, organized by outcome (see full report here: https://drive.google.com/file/d/17YNd_Uvnx87h6tveqj9LTqqcfPMUbgcT/view?usp=sharing or contact all.can@saveyourskin.ca). One of the key structural inefficiencies in Canada is the division of healthcare responsibilities between the federal government (which also has six healthcare programs for specific populations like refugees and First Nations) and 13 provinces and territories, with a lack of proactive, systemic means for ongoing collaboration between the different governments, which results in issues such as inconsistent legislation, policies, service delivery and funding practices, data fragmentation, and different standards of care. This is especially the case when different population sizes mean that there are significant gaps in funding and services from province-to-province, with the 3 Territories and 4 Atlantic provinces having less resources to allocate across often large geographic areas. The inequities associated with the Territories is significant, given the higher population of Indigenous communities in the Territories. Indigenous populations, people who face racial discrimination, people who face poor determinants of health continue to have inequitable access to healthcare services in Canada, with the COVID-19 pandemic exacerbating, compounding and accelerating these issues. As a result of how healthcare is organized in Canada, while some jurisdictions have some practices in place that improve cancer diagnosis efficiency (and cancer care efficiency across the continuum), they are inconsistent across the country and there is no effective collaborative governance mechanism in place to promote ongoing learning and collaboration between the jurisdictions. Another issue is the lack of technology being consistently used to bridge the gap between urban care centres and rural populations, though variable efforts are being made to increase technological access to care in these areas. Infrastructure for basic connectivity remains uneven across the country, with rural and remote areas generally most lacking this vital infrastructure. In addition, generally, the need to travel for care from rural and remote areas is not covered by healthcare (or any public) budgets, resulting in significant inequities. Additionally, patients in Canada are often left alone to navigate diagnosis, treatment and survivorship, indicating a greater need for patient navigators. Many oncologists in Canada are also not open to informing their patients about patient groups; it is an ongoing struggle for patient groups to make their promotional material available in medical offices. Mental health and psychosocial supports have long wait lists across the country, compounded by the pandemic. The pandemic has created major back logs in access to primary care as well. Overall, primary care is poorly integrated into health care generally and cancer care specifically, with variable mechanisms for funding and accountability, including an ongoing proliferation of fee-for-service payment mechanisms in primary care and often no accountability agreements. As a result, team-based primary care is variable across the country, as are the existence and uptake of referral pathways for primary care practitioners to initiate and expedite an investigation for a possible cancer. Finally, genetic testing is still a rarity in Canada, meaning that screening for cancer often occurs at a later stage and patients are less prepared to advocate for themselves.

New cancer control regulations and policies that could emerge in the coming period

Short term: -Funding for more “innovative models of care” including for diagnosis (through CPAC) -Increasing focus on trauma-informed healthcare in response to the COVID-19 pandemic Mid-to-Long term: -Continued efforts to develop a Pan-Canadian Health Data Strategy and Interoperabiltiy Roadmap that allows for consistent data collection, interoperable data sharing, and rapid access to accurate data for patients, providers, health systems, and researchers across Canadian provinces and territories - Development of a national Cancer Data Strategy (being led by CPAC) -Ongoing efforts to refresh or develop cancer strategies in all provinces and territories

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Canada
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Colombia Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

yes, there are plans to strengthen all existing screening programmes

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

Clinical guidelines and contracting models for the healthcare system

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Modelo de Savia Salud EPS

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Colombia
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Denmark Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

The overall aim of All.Can Denmark is to create better conditions and sustainable cancer care for Danish cancer patients by prioritizing and launching initiatives that improve cancer treatment. Since 2020, the group has focused on early diagnosis. All.Can Denmark’s ambition is to set the agenda within cancer care by creating a strong interdisciplinary multi-stakeholder group within cancer care by combining visions, research, and day-to-day experience.

Impact of these actions

In 2020, the All.Can Denmark initiative was relaunched, and new strong members within the field of cancer joined the multi-stakeholder group. The multi-stakeholder group met twice in 2020, where they initiated the work, which in 2020 and 2021 is focusing on early diagnosis/detection and equal access to cancer treatment in Denmark. All.Can Denmark hosted two digital innovation meetings at the end of 2020. At the meetings, broad groups of central stakeholders discussed and qualified the ongoing focus on early diagnosis in Denmark and provided valuable insights to All.Can Denmark. The participants were hospital management, political actors, payers, interest organizations and KOLs etc. On the 15th of April 2021, All.Can Denmark hosted a big, digital event: ”Cancer Summit: Fra symptom til diagnose (From Symptom to Diagnosis)”.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Denmark
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France Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Address prevention early through health promotion in schools

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Yes, lung and, potentially, melanoma

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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France
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Germany Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Discussions are ongoing about introducing lung cancer screening with low-dose computed tomography

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Germany
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Greece Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Screening programmes for cervical and colorectal cancers are expected to start in 2023. Furthermore, a lung cancer diagnosis pilot programme is expected to start in 2023 as well.

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

Since its inception in 2019, All.Can Greece has been the most prominent public advocate for the development and the implementation of a National Cancer Control Plan (NCCP) and the creation of a National Cancer Registry. All.Can Greece has started a public consultation with health policy makers and the Greek Ministry of Health, stressing the immense need for the creation of a new NCCP as the most important prerequisite for the control of cancer in Greece, the improvement of cancer care & cancer care efficiency. Moreover, the Greek platform has provided well documented sustainable policy recommendations concerning: -the improvement of cancer care on all stages -the increased access of cancer patients in care & treatment services -the improvement of efficiency on available cancer care funds & resources -the implementation of prevention, early-diagnosis & screening programs in national level -the use of data and personalized medicine in current cancer care programs. During the second semester of 2022 All.Can Greece has compiled a white paper entitled “Policy Recommendations for the Cancer Care Control in Greece”. The White paper encompasses all the (aforementioned) policy recommendations highlighting the implementation of a National Cancer Care Plan as the first and most important prerequisite for the improvement of oncological care in Greece.

Impact of these actions

Thanks to All.Can Greece actions since 2019, the creation of a National Cancer Control Plan in Greece returned in the limelight of public consultation regarding cancer care & public health policies. Following several meetings with the health policy makers, the Greek government has implemented or are about to implement several cancer prevention and care policies and initiatives proposed by All.Can Greece. These recommendations comprise the introduction of screening schemes for breast cancer (since 2021), the imminent screening for cervical & colorectal cancer, expected to start during 2023, as well as the implementation of a pilot program about the early diagnosis of lung cancer. Moreover, the information that has been provided by All.Can Greece about the existing obstacles in cancer care & treatment, has resulted to the extension of the operating hours of radiotherapy departments in public hospitals. In addition, since 2020, the Greek public health & digital governance stakeholders have also started to develop a national digital health strategy in compliance with All.Can Greece recommendations. Furthermore, the Greek government legislated in February 2021 for the creation of a special National Pediatric Cancer Registry. More recently, in 2022, following All.Can Greece’s recommendations the Greek Ministry of Health enacted a Special Working Group for the creation of a National Cancer Registry, expected to start in 2023. The Committee comprise several members of All.Can Greece’s executive committee. Besides that, a similar Committee that will work on the development and creation of a National Cancer Control Plan is expected to be launched during 2023.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

An important initiative towards to more specialized personalized medicine was the establishment of the Hellenic Molecular Oncology Network (EDIMO) in 2022, successor of the National Network for Precision Medicine in Oncology, which was established in 2018. EDIMO aims to enhance the prevention, diagnosis and treatment of tumors, develop new detection techniques, personalize health care services offered to oncological patients and connect academic, health and research stakeholders relevant to cancer care and treatment. EDIMO’s function does not appertain to a wider Cancer Control plan strategy. As aforementioned, the Greek Ministry of Health accepted in 2021 the All.Can Greece recommendation for the extension of the operating hours of radiotherapy departments in public hospitals, that resulted to a remarkable rise on the number of radiotherapies and the cancer patients served. The Hellenic Cancer Federation has launched in spring 2020 a hospitality program for free accommodation of cancer patients undergoing treatment in major cities in Greece (Athens, Patra, Thessaloniki). The program offers free accommodation for oncological patients in fully equipped apartments and has repeatedly been awarded for its contribution to cancer community in Greece. Initially planned to last only during the Covid-19 restrictions in 2020, the program has been extended until today, completing 3 years of servicing patients throughout the country. Another important initiative has taken place in Crete, where the Department of Radiology of the University General Hospital of Heraklion University Hospital has created a special nutritional/culinary guide for cancer patients. In addition, Attikon General Hospital in Athens has created a special gym for cancer patients in its premises in 2022, followed by a specialized personalized physical activities program for every individual patient. Moreover, the Metropolitan Organization of Museums of Visual Arts of Thessaloniki (MOMUS) has recently inaugurated a visual psychotherapy program for cancer patients. The program aims to encourage cancer patients to be engaged with arts.

Examples of inefficiencies in cancer care that have resulted in inequalities

Greece is one of the few countries in Europe without National Cancer Registry and among the countries without a comprehensive national strategy for cancer through a National Cancer Control Plan. The lack of a National Cancer Registry as well as a National Cancer Control Plan hampers the improvement of provided cancer care in Greece with multifaceted direct and indirect repercussions for both patients and health professionals. Health expenditures, heavily affected by the prolonged financial crisis the country has suffered since 2010, remain low affecting the quality of public healthcare as well as the provided cancer care & treatment. Per capita health expenditure in Greece is lagging far behind the E.U. average, while health spending is largely covered by the individuals/households (roughly 1/3 of the total spending). As a result, vulnerable teams (estimated at around 25% of the population) are virtually partially or completely excluded from awareness and access on cancer care, treatment & prevention & diagnosis-on-time programs. The country is also below E.U average in the access on radiotherapy capacity, on the access on personalized medicine services as well as the access & quality of biomarker testing (mainly due to complex & slow public reimbursement approval process and funding restrictions for labs and hospitals). In addition, despite the numerous awareness & sensitization campaigns about cancer prevention, large proportion of mortality, including mortality related with cancer, can be attributed to behavioral and environmental risk factors (high proportions of smokers & obesity, lack of legislation connecting work-related cancers, etc.). Hence the mortality rate from preventable diseases, including deaths from cancers that could be prevented remains high. Moreover, long-care treatment, rehabilitation and palliative care services are not adequately integrated in the provided health & cancer care due to the lack of legislation and funding and despite attempts for the creation of an organized relevant framework in the past. Lastly, there is a huge geographical gap in the access in cancer care between large urban centers (Athens & Thessaloniki) and the rest of the country. More specifically, the vast majority of oncological hospitals, clinics and oncologists are concentrated in Athens & Thessaloniki, creating great access disparity with the rest of the country and especially with the remote mainlad parts and the islands. All the aforementioned factors have created great substantial inequalities, as the social, economic and geographical status of individuals remain the most crucial determinants about their access in cancer care as well as the quality of cancer care and treatment received. In other words, the access and the quality of the provided cancer care and treatment depends heavily on the financial capacity of the individuals as well as their educational level and their place of residence.

New cancer control regulations and policies that could emerge in the coming period

Since 2020 and boosted by the Covid-19 pandemic, the Greek public health stakeholders have started to develop a national digital health strategy in close collaboration with the Ministry of Digital Governance. As aforementioned a National Pediatric Cancer Registry was created in February 2021, while in 2022, and following All.Can Greece’s recommendations, the Greek Ministry of Health enacted a Special Working Group for the creation of a National Cancer Registry, expected to start in 2023. Besides that, a similar Committee that will work on the development and creation of a National Cancer Control Plan is expected to be launched during 2023. In addition, according to recent government announcements, Greece is going to integrate new screening schemes for uterine & colorectal cancer as well as the implementation of a pilot program about the early diagnosis of lung cancer. Moreover, a new legislation concerning the introduction of home care services was announced by the Greek government in May 2023. Starting from June 2023, the services include the provision of innovative therapies for patients at home projecting, among others, the implementation of chemo-therapies at home.

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Greece
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Israel Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Israel
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Italy Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Recommendations to introduce screening programmes for lung, prostate and gastric cancer

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Awareness and institutional initiatives with all stakeholders involved

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

Right to be forgotten Policies to promote reintegration of caregivers or former oncology patients into society Financing and introduction of new cancer screening programmes Financing and equal access to ATMPs

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Italy
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Japan Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

Since 2016, was involved in the establishment of the National Council for the Promotion of Nuclear Medicine Treatment, which included medical professionals, researchers, patient organisations, and companies, and worked to eliminate the dual regulations of the Medical Care Act under the jurisdiction of the Ministry of Health, Labor and Welfare and the Disability Prevention Act under the Nuclear Regulation Authority. Examined the 15-year history of the Basic Act on Cancer Control, enacted in 2006, together with medical professionals, researchers, patient organisations, and companies, and compiled into the “White Paper on Cancer Control"

Impact of these actions

In 2019, the Medical Law Enforcement Regulations were partially revised regarding the safety management system related to medical radiation and the handling of medical radioisotopes and positron tomography radioisotopes. Participating as a member of the Cancer Control Promotion Council since 2022, participating in the formulation of the 4th Basic Plan for Promotion of Cancer Control Measures, and contributing to the introduction of patient and citizen participation.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

Nothing in the universal health insurance system has led to inequality.

New cancer control regulations and policies that could emerge in the coming period

At present, the “measures to be taken'' in the Basic Plan for Promoting Cancer Control Measures will be considered within six years. Recently, the introduction of HPV testing in cervical cancer screening has been discussed at the Study Group on Cancer Screening.

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Japan
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Mexico Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Paediatric

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Plans to strengthen all existing screening programmes

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

-Infrastructure analysis and design of the national cancer registry -Implementation of population-based cancer registries in ten localities of the Mexican population, organised by a National Network of Cancer Registries

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

“Codigo Cancer”: It is a project that aims to develop a comprehensive proposal for the rapid and efficient referral of patients with suspected cancer to specialized care, training of doctors and social workers to guide patients towards the timely diagnosis and treatment of cancer. Through the identification, navigation, diagnosis and timely treatment of patients with suspected cancer within the National Health System.

Examples of inefficiencies in cancer care that have resulted in inequalities

Salary gap and socioeconomic inequalities in Mexico generate in contexts that are less conducive to preventing cancer and, in general, to access timely, effective and quality care systems.

New cancer control regulations and policies that could emerge in the coming period

- Greater control and guidelines in the screening of cancers with the highest incidence in Mexico - Regulations to improve the lifestyle of the Mexican population in order to reduce risk factors.

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Mexico
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Netherlands Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Lung cancer

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Netherlands
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Norway Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

Prehabilitation: -Prehabilitation is about optimising efforts between the point of diagnosis and prior to treatment. -Ensuring patients are better prepared for treatment will improve experiences and assist with more effective rehabilitation. -Exercise, diet, quitting smoking along with increasing knowledge should be included as part of prehabilitation. Reliable & Safe discharge -All cancer patients should receive a clear description of what their individual follow-up plan entails and how this will move forward within the health care system. -Contact people, follow-up plans and rights that apply should be made available as part of the discharge process. It must be clear what the patient is responsible for following up – and what will be followed up by other resources. -All.Can Norway wants a clarification and specification of the ongoing work on the “Cancer Patient Home Plan”. -All.Can Norway would like the cancer coordinator scheme to be further developed, and that it continues to be followed up by the public health system.

Impact of these actions

Prehabilitation is now a term and widely discussed in both the political environment and within the cancer environment in Norway. Several results are published and testing programmes are implemented Some municipalities are now doing implementation and are seen as national best practise

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

See above about prehabilitation

Examples of inefficiencies in cancer care that have resulted in inequalities

We have a regional hospital strategy. This causes differences and obstacles between the regions.

New cancer control regulations and policies that could emerge in the coming period

Use of new threatment vs. cost and results is the big debate

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Norway
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Poland Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

All.Can Poland supported preparation and promotion of recommendations of report "Standards of patient service in the treatment of breast cancer". All.Can Poland prepares on yearly basis report "Diagnosis of changes in oncological care" listing improvements and pointing out challenger and needs. Now All.Can Poland supports preparation (and promotion in future) of the report on genetic diagnosis and a need to make it available in all cases where it is needed.

Impact of these actions

The recommendations of report "Standards of patient service in the treatment of breast cancer" have been presented at 3 workshops to directors and staff of oncological hospitals in order to supply them with the best knowledge about how to work out the best standards of care and what results it can bring. Report Diagnosis is an unique source of knowledge to clinicians and decision makers about existing needs and challenges.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

Due to wrong valuation of drug programs, despite reimbursement of immunotherapies and targeted therapies, chemiotherapy is still used and more often that it is needed. This affects the option to use optimal treatment as well as overall results. This situation tends to be encountered especially with melanoma, but also in lung and digestive system cancers. According to current law, hospitals may apply for reimbursement of the drugs administered parenterally only in the amount given to the patient, despite the size of vial. The hospital may use those leftovers but the proces of drug administration is not paid. It generates loses for the hospitals.

New cancer control regulations and policies that could emerge in the coming period

introduction of next cancer units (uro, lung) the law on quality in medical care

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Poland
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Qatar Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Lung and thyroid

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

Awareness raising on the importance of efficiency in cancer care

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

PROMs

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Qatar
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Slovenia Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Awareness about UV radiation (including artificial one emitted by sunbeds)

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Yes, Slovenia is seeking to begin nationally funded initiatives for lung, prostate, and gastric cancers but schemes are not yet established.

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Impact of these actions

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

Examples of inefficiencies in cancer care that have resulted in inequalities

New cancer control regulations and policies that could emerge in the coming period

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Slovenia
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South Korea Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Yes, for cervical, colorectal, gastric, liver and lung cancers.

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Types of advocacy actions undertaken to improve efficiency in cancer care

Delivered policy proposals to members of the National Assembly's Health and Welfare Committee and held policy forums

Impact of these actions

Raised awareness among key legislators (Health and Welfare Committee) about the need to improve the efficiency of the cancer care environment and the need for psychological support for cancer patients

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

National health screening for early detection of cancer National Health Insurance to help cover treatment costs Cancer Survivorship Centre to promote the health of cancer survivors and their families and help them return to school and society

Examples of inefficiencies in cancer care that have resulted in inequalities

Crowding of cancer treatment into metropolitan areas (inequities in healthcare infrastructure)

New cancer control regulations and policies that could emerge in the coming period

Management/control policies for pediatric cancer patients, Support and management/control policies for cancer survivors, Policies to implement cancer precision medicine, etc.

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South Korea
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Spain Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

No. Objective 13 of the 2021 Cancer Strategy does not support the implementation of screening activities for other cancers (either on a specific population or following an opportunistic approach) until their efficacy and effectiveness prove to be more beneficial than the adverse effects arising from their implementation. - Nevertheless, nowadays some regions have implemented pilot projects on screening for lung and prostate cancer.

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety

Chapter 1, Section 6

Implement a data-driven learning environment

National/institutional digital health strategy in place

Common data standards and processes to allow for national and international interoperability

Data governance legislation adopted

Measures to collect data and metrics both at patient and process-related levels

Cancer registry

Data regularly collected on patients and used in guiding decision making

Chapter 1, Section 7

Investment in efficient technology

Implemented regulatory and policy frameworks that incentivise efficient technologies

Measures to implement outcomes-based reimbursement schemes

Measures to support technology adoption and equitable access in practice

Biomarker testing systems

Telemedicine and remote patient monitoring

Chapter 1, Section 8

Metrics

Time to diagnosis

Percentage of cancers diagnosed through emergency presentation

Primary care interval (nr of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)

Time from tissue diagnosis to treatment

Percentage of patients documented as having seen a Clinical Nurse Specialist

Presence of multi-disciplinary team

Percentage of screened population segments

Adequacy of follow-up pathways

Patient experience measured routinely with surveys

Patient involvement in decision making

End-of-life and palliative care (Percentage of patients who received chemotherapy in the last 14 days of life)

Financial toxicity and financial impact of care

Others

Chapter 2

National advocacy and engagement initiatives

Your contribution to the development of the NCCP

Types of advocacy actions undertaken to improve efficiency in cancer care

All. Can Spain is becoming one of the key initiatives regarding cancer in Spain and addressing its efficiency. Briefly, it has undertaken the following steps: -Constitution of the Scientific Committee, which is composed of representatives of tier-one cancer-related Scientific Societies and Patients -Launch of the initiative's 1st Report, focused on identifying the reasons why cancer patients feel sometimes lost within the system from the appearance of symptoms up until diagnosis -The Scientific Committee conveys the urgency of accelerating cancer diagnosis to Health Spokespersons of the Congress of Deputies on National Cancer Day -Approval of a parliamentary initiative in Congress Plenary session with the support of the main political parties in the country, either on the left on the right side of the ideological spectrum -Identification of best practices and working towards the goal of disseminating them to key health leaders of the different regions in Spain (already been capillaries to Catalonia and Galicia)

Impact of these actions

- The Report was presented to the Congress Health Committee, one of the main decision-making arenas in Spain relating to health-related political and regulatory issues. Commitment to present 2nd report on 2024 World Cancer Day - Following the presentation in Congress, the report was shared with key decision-makers in the Ministry of Health, EU Spanish presidency, regions, and political parties in order to achieve maximum dissemination and awareness of the Platform. - Regional best practices identification. - Approval of parliamentary initiative in World Cancer Day with the unanimous support of the Congress. All.Can Spain was mentioned on different occasions by the spokespersons of the parliamentary groups.

Examples of best practice initiatives/actions/projects to improve cancer care efficiency in your country

In Spain, the strength of the welfare state, especially through healthcare, is a position shared by the main political groups. For this reason, efficiency in spending/processes has never been at the center of the discussion, but rather the quantity of resources.

Examples of inefficiencies in cancer care that have resulted in inequalities

- Lack of centralized coordination has led to different strategies in different regions. In addition, there is a lack of sharing of best practices between territories due to the absence of a common forum for sharing information. All of this has led the Spanish Association Against Cancer to warn that, in Spain, the main factor in determining the quality of care an oncology patient will receive is their postcode, above other considerations such as their genetic code, the type of cancer, or the stage they are at. - Waiting lists have been used as one of the main indicators in the approach to cancer when the main focus should be on measuring health outcomes. - In some cases, the need to have an oncology service close to home has taken precedence over specialization and patient volume.

New cancer control regulations and policies that could emerge in the coming period

Short-term: -Biomarkers (next legislature 2023-2027) -The right to oncological oblivion (next legislature 2023-2027) -Increase speed in access to most innovative treatments (next legislature 2023-2027) -Lung screening (TBC)

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Sweden Cancer Policy

Chapter 1, Section 1

Cancer control plans

National cancer control plan developed

National cancer control plan implemented

Chapter 1, Section 2

Investment in evidence-based prevention measures (Primary Prevention)

Primary prevention

Policies to address cancer health literacy among the general public

Description

Primary prevention - Policies that address known modifiable risk factors

Tabacco control legislation

Pollution control

Awareness about diet / alcohol /active lifestyle

Other

Description if other

Primary Prevention - Programmes for vaccination against cancer causing viruses

HPV

Hepatitis B

Chapter 1, Section 2

Investment in evidence-based prevention measures (Secondary Prevention)

Secondary prevention - Existence of screening schemes and scope of diseases

Breast cancer

Cervical

Lung

Prostate

Colorectal

Gastric

Other

Secondary Prevention

Plans to strengthen and/or extend evidence-based screening programmes

Description

Screening programs for lung cancer and prostate cancer are investigated and tested

Chapter 1, Section 2

Investment in evidence-based prevention measures (Tertiary Prevention)

Measures for tertiary prevention

Psychological support

Nutritional care

Palliative care

Chapter 1, Section 3

Access to prompt well-coordinated, multidisciplinary specialist treatment

Measures to adopt “precision oncology”

Streamline patient referrals through e-referral systems

Establish interprofessional and multidisciplinary clinical practices

Measures to integrate cancer navigators in the national health systems

Support access to well coordinated cancer care?

Appropriate care pathways

Clinical Guidelines

Specialist expert centres

Other

Chapter 1, Section 4

Empower and partner with people

Measures to improve communication between healthcare professionals, patients and carers

Measures to employ patient-reported outcomes

Measures to support and promote patients’ and carers’ access to patient organisations and support groups

Allocate governmental support for patient organisations

Chapter 1, Section 5

Support healthcare professionals to build efficiency

Support healthcare professionals’ (other than the oncology workforce) training on cancer care

Measures for investment and planning to meet workforce capacity and skill mix needs, based on projections of demand and linked to job creation and economic growth

Supporting undergraduate education and continuous professional education and training

Policies that protect the workforce wellbeing and safety