National Cancer Plan Research Articles

Cancer control planning: self-assessment for pre-planning, development, implementation and evaluation of national cancer control plans.

The development of cancer control plans as a clearly defined concept began in the U.S. in the early 1990s. On an international level, the same concept has been described as "national cancer control planning" or national cancer control plan (NCCP) development and implementation. Recent efforts by the National Cancer Institute's Center for Global Health and its partners have increased international and country-level interest in NCCPs. Central to the development of these plans has been a need for countries to understand the crucial factors and foundational elements necessary to develop and successfully implement a national cancer plan. This article describes the process by which a tool developed by the International Cancer Control Partnership (ICCP) helps countries and international partners assess their efforts to develop and implement a NCCP.

Are there variations in adherence to colorectal cancer clinical guidelines depending on treatment place and recommendation novelty? The French EvaCCoR observational study

Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients' socioeconomic position (SEP)-related variation in CRC guidelines. All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients' SEP was approached by an ecological social deprivation index. We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices. Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.

Cervical cancer screening in Germany

Cytological examination for the early detection of cervical cancer (CCS) has been available in Germany since 1971. Women over the age of 20 are entitled to aPap smear every year; however, thus far an organized screening program and personal invitations have been missing.The incidence rate of cervical carcinoma declined dramatically in the decades following the introduction of CCS, but the incidence rate has stagnated in recent years. The cause of cervical cancer is apersistent infection with high-risk types of human papillomavirus (HPV). HPV tests have been approved by the American Food and Drug Administration (FDA) for CCS for several years. Furthermore, since 2006, the HPV vaccination has been offered as aform of primary prevention.As part of the German National Cancer Plan, the European Guideline for Cervical Cancer Screening was implemented and adopted into the 2013 Law on Cancer Screening and Registration. The Federal Joint Committee (G-BA) was commissioned with the implementation of an organized cervical cancer screening program.In April 2018, the G‑BA published updated key points for the implementation of an organized nationwide screening program in Germany. While annual cytological screening for women between the ages of 20 and 34 will continue, women over the age of 34years will be given aco-test comprising a Pap smear and an HPV test, every threeyears. Women between the ages of 20 and 60 will be contacted by their health insurance provider every fiveyears and receive an information leaflet. After atest phase of at least sixyears, the new program will be evaluated.

Cancer care and public health policy evaluations in France: Usefulness of the national cancer cohort.

BackgroundIn the context of the national Cancer Plans of France that have changed the healthcare landscape, it has become necessary to better document and assess the related actions, and to promote research and understanding. The national cancer cohort, an exhaustive population-based cohort, was set up on the basis of the National Health Data System (SNDS) by the French National Cancer Institute.ObjectivesThe aim is to describe the French national cancer cohort.MethodsAll people living in France (67 million population) with universal insurance coverage and diagnosed, treated or followed up for a cancer, such as survivors, are included and will be followed up for 25 years. It contains all healthcare consumptions and reimbursements (i.e. hospitalization, outpatient care, medication…) since 2010. Every year, around 650 000 new cases are included.ResultsFrom 2010 to 2015, 6.2 million subjects have been included. Most subjects were entered in 2010, in 2015 it concerned 0.6 million. In 2015, the median age was 65 [54–76]; 51% were women. The primary cancer organ could be attributed with certitude to 87% of the people. The most frequent locations were skin (16%), breast (15%), prostate (12%), colon-rectum (11%) and lung (9%). In 2015, 40% of included subjects underwent surgery for cancer, 16% chemotherapy at hospital and 11% at least one session of radiotherapy.ConclusionBased on SNDS, the cancer cohort has been designed to study cancer care use in the short-, medium- and long-term, and evaluate healthcare and public health policies.

Integration of oncology and palliative care: a Lancet Oncology Commission.

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.

Cancer prevention policy in the EU: Best practices are now well recognised; no reason for countries to lag behind

Through the application of science to public health practice, National Cancer Control Programmes provide the framework for the development of policies on cancer control, with the ultimate goal of reducing cancer morbidity and mortality, and improving quality of life. In the last decade, a substantial number of Member States in the European Union (EU) have formulated and/or updated their National Cancer Control Programmes, Plans or Strategies including primary prevention (health promotion and environmental protection), secondary prevention (screening and early detection), integrated care and organization of services, and palliative care as main elements. Although tobacco control and population-based screening policies are examples of best practices that are gradually being implemented in most of the EU countries, there are still large regional differences in cancer burden arising from the wide variety of social determinants and other epidemiological factors, along with gaps in the policy and practical articulation of cancer control within the health systems. On the other hand, few quantitative assessments are available with regard to evaluating the success or failure of the implementation of these programmes, especially in terms of reducing cancer incidence or mortality. An EU framework to better assess of the effectiveness of cancer prevention policies and the factors triggering shortfall in best practices implementation seems imperative.

Implementation and Incidence Data of Cancer Registries Network in Algeria

Background and context: Cancer is becoming a true health public problem in Algeria in the last years. The National Cancer Plan (2015-2019), has given a priority to cancer registration, and the Ministry of Health proceeded to the institutionalization of cancer registries. Aim: The objective is to implement a cancer registries network covering a large population, and provide cancer incidence data for Algeria. Strategy/Tactics: Regional organization of the cancer registries network. Training of coordinators of cancer registries on cancer registration tools. The new cases recorded were from 18 registers covering a population of 20,224,844, from a general population of 38,700,000 inhabitants for the year 2014. The data are entered and analyzed by the CanReg software 5, provided by IARC. Program/Policy process: The cancer registries network covers is becoming an important tool for the cancer control in Algeria. It provides data public health and cancer research. Outcomes: The coverage of national registration rate is 82% with 52% of cancer registries were validated. The number of new cases during the year 2014 is 41,870 cases (16,748 men and 25,122 women). The overall crude rate is 106/100,000 (h), the standardized rate is 114.5/100,000. Crude and standardized rates in men are respectively 100.2 and 109.2/100,000. In women are respectively 111.8 and 119.8/100,000. In men, frequent cancers are lung, colon-rectum, bladder, prostate, stomach, pharynx naso, NHL, larynx and leukemia cancers. In women, breast cancers followed by colorectal, cervical, thyroid, NHL, stomach, biliary and leukemia cancers.

Financial Toxicity of Cancer in China

Background and context: Cancer is not only a medical problem, but also a socioeconomical issue as the high prevalence with poor prognosis brings heavy financial burden to the society. From 2005 to 2013, the incidence and mortality rates have sharply increased in China. The most common types of cancer in males in China are lung cancer, gastric cancer, and liver cancer while breast cancer, lung cancer, colorectal cancer are the major types of cancer among Chinese females. The prognosis for most types of cancer is poor and the treatment costs have been high and hence cancer has caused significant financial burden on patients and negatively impacted their lives. Since the 1970s, Chinese government has been paying attention to cancer burden and applying the nationwide cancer management strategy. Population-based cancer screening, public health education of cancer prevention and treatment on general population, and catastrophic disease medical insurance policy providing additional funding for cancer treatments have been widely implemented in the country. However, cancer in China still imposes the greatest financial burden on the patients, the families, and the society. It is imperative for the Chinese government to develop effective policies to address the financial toxicity of cancer in China. Aim: Through analyzing the data, we introduce and explain how Chinese government implements cancer control strategy in recent decades and how the national health insurance policies work on curing cancer disease. Strategy/Tactics: With presenting the available data from 2005 to 2013, we analyze the overall prevalence trend of cancer incidence and mortality in China. In terms of cost, we analyze the overall inpatient cost, inpatient expenses on the most common cancers, and anticancer pharmacies to explain the economic loss that cancer caused to Chinese people. Program/Policy process: Considering the alarming prevalence and economic burden of cancer, China has been paying attention to cancer prevention and treatment and conduct national cancer plans and insurance policies. The plans focused on taking actions to lower cancer burden in high risk groups and regions, strengthening public education and professional training, and promoting cancer standardized treatment guidelines in the nation. Insurance policies were emphasized on critical disease health coverage, including cancer. Outcomes: To mitigate the situation where patients have become indigent due to critical diseases, since 2012, the Chinese government has issued the Critical Disease Insurance Policy to provide financial assistance through supplementary insurance to patients who have incurred a critical disease such as pediatric leukemia, lung cancer, and cervical cancer. What was learned: We learned how Chinese national cancer prevention plans and health insurance policies were efficient worked in releasing the cancer prevalence trend and decreasing the economic cost in recent decades.

National cancer control plans: a global analysis.

There is increasing global recognition that national cancer plans are crucial to effectively address the cancer burden and to prioritise and coordinate programmes. We did a global analysis of available national cancer-related health plans using a standardised assessment questionnaire to assess their inclusion of elements that characterise an effective cancer plan and, thereby, improve understanding of the strengths and limitations of existing plans. The results show progress in the development of cancer plans, as well as in the inclusion of stakeholders in plan development, but little evidence of their implementation. Areas of continued unmet need include setting of realistic priorities, specification of programmes for cancer management, allocation of appropriate budgets, monitoring and evaluation of plan implementation, promotion of research, and strengthening of information systems. We found that countries with a non-communicable disease (NCD) plan but no national cancer control plan (NCCP) were less likely than countries with an NCCP and NCP plan or an NCCP only to have comprehensive, coherent, or consistent plans. As countries move towards universal health coverage, greater emphasis is needed on developing NCCPs that are evidence based, financed, and implemented to ensure translation into action.

Jimmie Holland: The founder, developer, and the soul of the International Psycho-Oncology Society.

Jimmie Holland: The founder, developer, and the soul of the International Psycho-Oncology Society.

Tumorbank@uza: A Collection of Tissue, Fluid Samples and Associated Data of Oncology Patients for the Use in Translational Research

Tumorbank@UZA is an academic hospital integrated biobank that collects tissue, blood and urine samples from oncology patients. We work according to a quality management system and have established SOPs for all work procedures in the biobank. Tumorbank@UZA is funded by the National Cancer Plan, an initiative from the Belgian government since 2009. Samples from our biobank are available for both academic as well as commercial researchers, through a well-established access procedure. Currently the collection consists of more than 85.000 samples of more than 8000 patients. Funding statement: Tumorbank@UZA is funded by the National Cancer Plan (initiative 27) from the Ministry of Health of the Belgian Federal Government.

Access to cancer care in Colombia, a middle-income country with universal health coverage

In this paper, we present the most currently available data on real access to high quality diagnostic and curative and palliative care in Colombia, a middle income country with relatively recent large healthcare reforms. We will focus on cancer types with a good average prognosis when detected and treated adequately and which are prioritized in national policies and cancer plans: cancers of the breast, cervix, prostate, colorectum and childhood cancers. These cancers have a quite poor prognosis compared to high-income countries. We find that, despite having achieved an almost “universal health coverage”, Colombia suffers serious problems in accessibility to preventative, diagnostic and treatment services for patients with cancer. People living in poverty have lower real access to all types of care, but other problems are due to lack of health literacy, beliefs and knowledge. Much can be gained by early detection, the advanced stages at diagnosis of many cancers can be avoided by increasing awareness amongst both the general public and health care professionals. Delays in diagnosis and treatment can be reduced, changes in legislation and bureaucratic processes, and increases in trained human resources and equipment is needed. The economic impact of getting a cancer diagnosis to patients and their families is understudied but seems to be substantial, as well as studies on quality of life of cancer patients and survivors - providing ample room for improvement.

“The disease is mine, the body is mine, I decide”: Individual, interpersonal, and institutional barriers and facilitators among survivors of women's cancers in Andean countries

ABSTRACTRecent national cancer plans address high cancer mortality in Latin America, particularly in Andean countries. Little is known about which individual, interpersonal, and institutional facilitators and barriers persist, particularly from the perspective of cancer survivors. We conducted 15 semi-structured interviews with survivors of breast and cervical cancers during and after a Pan American Health Organization sponsored conference on women's cancers in Lima, Peru. We analyzed data using an inductive content analysis approach. Patients reported primarily psychosocial barriers and facilitators at individual, interpersonal, and institutional levels. Additionally, survivors provided recom-mendations to refine existing policy to improve the cancer care experience for patients.

National Cancer Information Service in Italy: an information points network as a new model for providing information for cancer patients.

The international literature data report that good information and communication are fundamental components of a therapeutic process. They contribute to improve the patient-health care professional relationship, to facilitate doctor-patient relationships, therapeutic compliance and adherence, and to the informed consent in innovative clinical trials. We report the results of a multicentric national initiative that developed a 17-information-structure network: 16 Information Points located in the major state-funded certified cancer centers and general hospitals across Italy and a national Help-line at the nonprofit organization AIMaC (the Italian oncologic patients, families and friends association), and updated the already existing services with the aim to create the National Cancer Information Service (SION). The project is the result of a series of pilot and research projects funded by the Italian Ministry of Health. The Information Service model proposed is based on some fundamental elements: 1) human interaction with experienced operators, adequately trained in communication and information, complemented with 2) virtual interaction (Help line, Internet, blog, forum and social network); 3) informative material adequate for both scientific accuracy and communicative style; 4) adequate locations for appropriate positioning and privacy (adequate visibility); 5) appropriate advertising. First results coming from these initiatives contributed to introduce issues related to "Communication and Information to patients" as a "Public Health Instrument" to the National Cancer Plan approved by the Ministry of Health for the years 2010-2012.

Multidisciplinary Tumor Boards: Facts and Satisfaction Analysis of an Indispensable Comprehensive Cancer Center Instrument

Background The established standard to ensure State-of-the-art cancer treatment - as a prerequisite in the national cancer plan and for comprehensive cancer centers (CCCs) today - is through interdisciplinary tumor boards (TBs). Methods This analysis assessed a newly founded CCC-TB for multiple myeloma (MM) patients, namely a) questions solved therein, b) level of compliance and c) evidence, d) frequency of clinical trial (CT) inclusion, d) progression free (PFS) and overall survival (OS) and e) satisfaction of TB-participants, referring physicians and MM patients. Results With initiation of the MM-TB, patients discussed therein substantially increased. TB-questions mostly involved symptomatic patients and recommendations on best treatment. The level of compliance and evidence were 94 % and 96.5 %, respectively; all noncompliance being coherently justified. CT inclusion was improved through the TB, leading to 18.8 % of patients being treated therein. Median PFS and OS were 2.9 and 4.7 years, respectively; also those of substantially pretreated, relapsed/refractory patients were favorable. The satisfaction of 58 participants, 33 referring physicians and 100 MM patients with the MM-TB was rewarding. Conclusion The detailed assessment of this CCC-TB on TB-questions, compliance and evidence levels, survival and satisfaction responses could serve as a valuable example for other TBs and CCCs and excite subsequent analyses on TBs.

Epidemiology and survival of cervical cancer in the French West-Indies: data from the Martinique Cancer Registry (2002–2011)

ABSTRACT Background: The Caribbean ranks seventh among world regions most affected by cervical cancer. Social health inequalities, such as differences in access to screening services, engender disparities in incidence and mortality between low- and middle-income countries and industrialized countries. The French National Cancer Plan 2014–2019 focuses on reducing inequalities in cervical cancer. Objective: The aim of this study was to describe the geographical distribution and overall survival of cervical cancer, based on data from a population-based cancer registry in Martinique (French West-Indies). Methods: We included all cases of cervical cancer diagnosed between 2002 and 2011. The geographical distribution was described by zone of residence and by aggregated units for statistical information (IRIS). Based on the results of the model, standardized incidence rates (SIRs) were calculated using a Gamma Poisson model. Survival rates were calculated using the Kaplan–Meier method. Cox proportional hazards models were used to investigate the risk factors for cervical cancer mortality. Results: A total of 1253 cases were analyzed (947 in situ tumors and 306 invasive cancers). 1230 cases with geolocalization were used to map the distribution of the incidence of in situ and invasive cervical cancers. Five IRIS were significantly over-incident. The 5-year overall survival rate was 55%, with a median survival of 6.5 years [95% CI: 4.9–10.1]. Multivariate analysis confirmed age at diagnosis (HR = 2.15 [1.50–3.09]; p < 0.0001), FIGO stage (HR = 3.53 [2.50–4.99]; p < 0.0001) and zone of residence (HR = 1.51 [1.06–2.13]; p = 0.02) as risk factors. Conclusions: Prognostic factors suggest that cervical cancer needs to be diagnosed at an early stage. Our results could allow cervical cancer screening programs to clearly identify geographical areas that would benefit from targeted interventions with a view to reducing incidence and mortality of cervical cancer in the Caribbean.

Understandability of Patient Information Booklets for Patients with Cancer.

The improvement of health literacy in general and the information of individual patient is a major concern of the German national cancer plan and similar initiatives in other western countries. The aim of our study was to assess the readability and understandability of information booklets for cancer patients available at German Web sites. A support vector machine (SVM) was used to discriminate between laymen- and expert-centric patient information booklets about nine most common tumor types. All booklets had to be available for free at the Internet. A total of 52 different patient booklets were downloaded and assessed. Overall, the assessment of all booklets showed that an understandability level L of 4.6 and therefore increased medical background knowledge is required to understand a random text selected from the sample. The assessed information booklets on cancer show very limited suitability for laymen. We were able to demonstrate that a medical background is necessary to understand the examined booklets. The current study highlights the need to create information material adjusted to the needs of laymen. Assessing understandability before publication, especially for laymen with low health literacy, could ensure the suitability and thus quality of the information material.

Improvement of cancer control in mainland China: epidemiological profiles during the 2004–10 National Cancer Prevention and Control Program

BackgroundFollowing the appeal of the World Health Assembly for national cancer plans and programmes, the Chinese Ministry of Health issued governmental outlines of the National Cancer Prevention and Control Programme (2004–10). This study aimed to evaluate the efficacy of that programme in mainland China. MethodsThe Chinese Ministry of Health outlines aimed to establish a national cancer registry system, enhance the population health education, and organise prevention, early detection, and early treatment for principal cancers, especially in rural areas for high-incidence cancers. We retrieved the crude incidence and mortality (per 100 000 people) in urban and rural areas from annual reports of the National Central Cancer Registry from 2004 to 2010. We estimated mortality index [MI=mortality/(incidence+mortality)] to represent the overall efficacy of screening and treatment for cancers. Trends of epidemiological profiles were observed over time. Only descriptive results are provided in this abstract, a statistical test was not performed. FindingsThe all-cancer incidence reached the peak at the 2008 and then decreased, whereas the all-cancer mortality changed accordingly. All-cancer incidence was higher in urban areas than in rural areas, but the urban MI was lower. The all-cancer MIs decreased more sharply in the rural population (from 43·2% to 39·8%) than in the urban population (from 38·8% to 37·8%), while rural-to-urban ratios of MI were decreased, especially among women (from 1·19 to 1·05). Lung, colorectal, and breast cancers were predominant among urban populations, whereas oesophageal, gastric, and liver cancers were predominant among the rural population. Particularly, rural-to-urban ratios of oesophageal cancer incidence and mortality were decreased from 3·73 to 1·65 for incidence and from 3·82 to 1·61 for mortality, but MIs never differed between rural and urban populations. The rural-to-urban ratio of MI for breast cancer was decreased from 1·47 to 1·08. InterpretationThe National Cancer Prevention and Control Programme (2004–10) obtained obvious achievement in narrowing the urban-rural gap of the worse cancer incidence or survival in the rural areas, especially for oesophageal and breast cancers respectively. However, the overall health burden from cancers is still heavy in mainland China and requires further governmental support to improve the cancer control. FundingNational Natural Science Foundation of China (81301866) and Outstanding Young Scientific Scholarship Foundation of Sichuan University, from the Fundamental Research Funds for the Central Universities of China (2015SCU04A43).

Disparities in psychosocial cancer care: a report from the International Federation of Psycho-oncology Societies.

The aim of the study was to understand the characteristics of the International Federation of Psycho-oncology Societies (FPOS) and possible disparities in providing psychosocial care in countries where psycho-oncology societies exist. A survey was conducted among 29 leaders of 28 countries represented within the FPOS by using a questionnaire covering (i) characteristics of the society; (ii) characteristics of the national health care system; (iii) level of implementation of psycho-oncology; and (iv) main problems of psycho-oncology in the country. Twenty-six (90%) FPOS returned the questionnaires. One-third reported to have links with and support from their government, while almost all had links with other scientific societies. The FPOS varied in their composition of members' professions. Psychosocial care provision was covered by state-funded health services in a minority of countries. Disparities between countries arose from different causes and were problematic in some parts of the world (eg, Africa and SE Asia). Elsewhere (eg, Southern Europe and Eastern Europe), austerity policies were reportedly responsible for resource shortages with negative consequences on psychosocial cancer care. Half of FPOS rated themselves to be integrated into mainstream provision of care, although lack of funding was the most common complain. The development and implementation of psycho-oncology is fragmented and undeveloped, particularly in some parts of the world. More effort is needed at national level by strong coalitions with oncology societies, better national research initiatives, cancer plans, and patient advocacy, as well as by stronger partnership with international organizations (eg, World Health Organization and Union for International Cancer Control).

Psycho-oncological support for breast cancer patients: A brief overview of breast cancer services certification schemes and national health policies in Europe

Psycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes.