If it is implemented, the new cancer strategy should reduce inequalities and improve patient survival rates, writes Dr Muiris Houston, Medical Correspondent
With the announcement last week by the National Cancer Registry that the annual number of cases of cancer in the Republic is set to double to 28,785 by 2020, the launch of a new national cancer strategy is timely. Progress in cancer care since the publication of the last strategy in 1996 must be acknowledged.
Death rates from cancer in the over 65s have dropped and the overall survival rate has increased. However problems remain: there is inequity in both the availability and outcome of cancer services when measured by age, gender, social class and the area of the State where the patient lives.
In publishing a new strategy, the National Cancer Forum has introduced the concept of cancer control. Part of World Health Organisation policy, cancer control embodies a whole-system approach, with a greater emphasis on health promotion, prevention, palliative and supportive care as well as on diagnosis and treatment.
One of the key elements of cancer control is to focus strongly on the quality of services. This means introducing a method of evaluating policy and service delivery. Central to this function will be the health information and quality authority, whose remit is independently to review quality and performance in the health service.
The new strategy recommends that the authority establishes a national framework for quality in cancer control. As part of this framework, it will be responsible for licensing cancer services in both the public and private sectors.
The strategy clearly states that "only centres that meet licensing standards should be designated as cancer centres". The implication is that no patient should receive cancer care outside an approved centre, thus ensuring an ongoing improvement in both the quality and safety of cancer services.
Another important recommendation is that the authority should establish a cancer health technology assessment panel. Health technology assessment is a measure of cost effectiveness which summarises medical, social, economic and ethical aspects of a new drug or new treatment. Technology assessment will help ensure the speedy introduction of proven treatments and technologies for cancer patients.
The new strategy proposes that all care be provided through a national system of four managed cancer control networks. While it is up to the Health Service Executive to decide the geographic division of these networks, it is expected they will follow the designation of radiotherapy centres announced last year by the Minister for Health.
There are likely to be two managed cancer control centres in Dublin, with one each in Cork and Galway, each serving a population of about 1 million.
The networks will be headed by a director of cancer control who will be responsible for organising cancer care pathways connecting each element within the network.
Each network will have cancer centres serving a minimum population of 500,000, giving a total of eight such centres. These hospitals will manage and treat cancers of the breast, prostate and bowel. However, less common cancers will be treated at certain cancer centres only, based on their particular expertise and on having a sufficient throughput of cases needed to ensure a good quality outcome.
In a move that will be welcomed by campaigners for local hospital services, the strategy states: "The development of cancer centres should allow for certain circumstances in which care may need to be delivered in non-cancer centres [under the supervision of a cancer centre] for pragmatic reasons such as patient convenience."
What will it all mean for patients? The key concept that will affect people from the moment they present to family doctor with symptoms suggestive of cancer is the cancer care pathway. Essentially a map to be followed by patients, each pathway deals with a specific cancer type.
So, if a GP in a region is concerned that a patient might have lung cancer, the map will clearly outline where best to refer the patient within the region to ensure the person is looked after in an integrated way that best suits his or her needs.
The proposals for cancer screening will also have a direct impact on patients. Not surprisingly, it has recommended extending the upper limit of breast cancer screening to 69.
It calls for the national roll out of cervical cancer screening as a matter of priority. The strategy has come out against a national screening programme for prostate cancer, citing a lack of evidence of the usefulness of current screening tests.
Perhaps most significantly, it calls for the establishment of a colo-rectal (bowel) screening programme for men and women aged 50 to 74.
One of the strengths of this strategy is its inclusion of a number of policy indicators that will help identify whether targets for cancer care are being met.
As well as survival rates and waiting times from diagnosis to treatment, these indicators will include the percentage of patients where care is consistent with health information and quality authority guidelines. When it comes to improving the inequalities currently inherent in cancer care in the Republic, such measurements will be crucial.
The 2006 strategy for cancer control is well thought out, but as ever with such schemes, the key will be to ensure that it is properly funded and consistently implemented. If it does become reality, it should enhance the survival prospects of the growing number of people with cancer and improve the quality and uniformity of care to cancer patients.