UICCs cancer control program

1

• UICCs cancer control program
• Odd Søreide
• Professor

2
UICC Global Cancer Control

• STRATEGIC AREAS
• Prevention and early detection
• Tobacco control
• Knowledge transfer
• Capacity building
• NATIONAL CANCER CONTROL PLANS

3
(No Transcript)
4
The Norwegian Cancer Plan

• Commissioned by the Norwegian Government 1996
• Published as a Norwegian Official Report 199720
• (250 pages)
• Initiated by The Norwegian Cancer Society (NGO
  UICC)
• Revised June 2004

5
Cancer plans Cancer control programs

• POLICY INSTRUMENT
• Public health program / service framework
• Cancer in a national perspective
• Comprehensive - not fragmented
• AIM
• Improve cancer care
• Reduce morbidity and mortality, increase QoL
• THE NGO PERSPECTIVE
• The role of NGOs

6
Norwegian cancer plan Analytical framework
7
FACTS
8
Which facts?

• Cancer burden
• Reliable base-line data (cancer registries)
• Cancer in the Nordic countries
• IARC
• Capasity assessment (facilities, personel,
  programs and services)
• Prevention based on realism (not perceived
  risk)

9
Cancer as a national problem (2004)
1993/97 2018/2020
Men Women
Increase 42
36 Incidence 4
11 Demography 37
25

• 50 will die (60 first year)

10
Lung cancer Nordic countries
Women
Men
11
Prevalence - all cancers
12
Hospital resources

• 12 of hospital stays in Norwegian hospitals
• 15 in regional (University) hospitals
• 20 of all in-hospital days
• 22 in regional hospitals
• 17 in district general
• 19 in community hospitals
• gt60 treated in surgical departments

13
PERSPECTIVES
14
Five leading cancers
15
Survival vs. stage.All cancers (men)
Localised disease All stages Regional
disease Distant metasteses
16
Cancer cure

• 50 will be cured
• 55 women,
• 45 men
• Treatment
• Surgery in 80 - 85
• Radiation in 40
• Medical 14
• (cytostatics, etc)

17
Cancer prevention Death reduction Norway 2000

• Men Women
• Smoking 18 8
• Alcohol 1 lt1
• Working environment 3 ltlt1
• Radon lt1 lt1
• External radiation (x-rays) 2 2
• Diet ? ?
• Infections 2 3
• Obesity/low physical activity lt1 1
• APMIS Suppl. 105 (105 1-146, 1997)

18
Cancer deaths - (preventable)
Sub-Saharan Africa
Europe (excl. Eastern
19
PRINCIPLES
20
War on cancer

• Primary prevention
• tobacco control, vaccines (hep. B / HPV)
• Secondary prevention (early diagnosis)
• Cervix, breast, colorectal (?), prostate (??)
• Tertiary prevention (better primary treatment)
• Better surgery and standardisation of treatment
  (10 survival advantage)
• Treatment of failures - ? importance

21
Principles (models) - (i)

• Evidence based
• clinical effectiveness, magnitude of effect
• palliative care can be evidence based
• Complimentary vs. school medicine
• terminology irrelevant, effect important
• The role of primary care in primary diagnosis,
  co-ordinator, etc

22
Principles (models) - (ii)

• No competition between palliative and potentially
  curative care
• Organisation of care (cancer networks)
• Responsibility for evidence base
• research and quality control (audit))
• industry or society
• Globalising evidence, localising decisions

23
Resource realities

• Medical services to be delivered (basic,
  essential or everything medical useful)
• often marginal benefits
• hope as treatment imperative
• Clinical and cost-effectiveness
• Health Technology Assessment
• Priority setting
• WHO essential drug list

24
SOCIETY
25

• Institutional ethos
• Pressure groups
• Opinion leaders
• Specialty bias
• Custom and practice
• Financial constraints
• Politics
• Research findings

Policy

Evidence
Decision
26
Society

• The role of social sciences
• risk behaviour / strategies for prevention
• social gradients (in incidence and outcome)
• The understanding and role of politics
• health care as a market (business opportunity)
• the conflict between standardisation and
  individual freedom
• priority setting (consequences of free-for-all)
  

27
The role of NGOs

• minimal reaction time, flexible
• demonstration projects
• initiator and facilitator
• working together with government
• watchdog
• UICC partnership with WHO

28
Demonstration projects(Oropeza, Peru)
Latin America Cervical Cancer Screening Project
29
Norwegian cancer plan Analytical framework
30
Conclusions

• Fundamental elements
• Framework concepts (definitions, outcome
  measures, etc)
• Comprehensiveness (prevention, early detection
  and diagnosis, treatment, rehabilitation,
  palliative care)
• Must be tailored to resource realities

31
(No Transcript)
32
FACTS
PRINCIPLES
CHALLENGES
PERSPECTIVES
SOCIETY
SPECIFIC RECOMMENDATIONS
National Cancer Plan
33
CHALLENGES (1)

• Optimising treatment - evidence based
• Standardisation
• Palliative care - capacity and competence
• Organising care, administrative and financial
• The informed patient
• Increase knowledge base, better education,
  quality assurance
• The evidence base - who is responsible

34
CHALLENGES (2)

• Prioritisation
• Rehabilitation
• Todays successes - tomorrows problems
• Better co-operation primary and secondary care -
  the importance of primary care in diagnosis and
  as coordinator
• Cancer prevention realistic strategies

35
Norwegian Cancer Plan

• Criteria for success
• Organisation of project
• Efficasy and transparency
• The Cancer Plan
• Professional, not wishful thinking
• Based on convincing facts
• Comprehensive
• Political buy-in (initiation and awareness)

36
Norwegian Cancer Plan

• Criteria of success
• Political acceptance after wide consultation
• Subsequent funding (National Assembly)
• Stepwise implementation - lump sum seeding
  inadequate
• Follow-up and evaluation (after 5 yrs)

37
Gorbatsjovs doctrineThe act of politics
FACTS (knowledge, evidence)
REFLECTION (confidence)
ACTION
Not an arena for promotion of professional
(subspeciality) interests or wishful thinking
38
Health care personel (professionals)

• Pathologists
• Radiation technicians
• Specialist nurses (cancer care)
• The role of education and training
• cancer surgery (not a separate speciality)