Europe lacks comprehensive cancer care plans, says new report

A new report published today reveals variations in national cancer diagnosis and care planning.

A new report finds variation and gaps in national cancer public health programmes across Europe. The Analysis of National Cancer Control Programmes in Europe study, published today, shows that 15 of 31 European countries have not formulated national cancer control plans (NCCP).

These plans were recommended in 2002 by the World Health Organization, to help reduce cancer incidence and mortality and to improve the quality of life of cancer patients. NCCPs are designed to help governments and healthcare providers to plan a wide range of cancer services, including prevention, early detection, diagnosis, treatment and palliative care. They encourage practices, proven by research approaches in these areas, making the best use of available resources. Projections (Ferlay et al, 2007; IARC 2003) show cancer deaths worldwide may exceed combined deaths from malaria, tuberculosis and HIV/AIDS by 2030. The World Health Organisation estimated that in 2005, 15% of all deaths (7.6 million) were due to cancer.

Today's report is the first to compare the planning and implementation of public health cancer control programmes. It found that many plans omit, or vary greatly in, matters of governance, financing, resource allocation, targets and timelines for evaluation and the organisation of health systems for cancer care.

The study found that while some European countries have developed NCCPs, there were major differences in the comprehensiveness of these to tackle the growing cancer burden. This implies avoidable variation in the quality and range of services available to cancer patients. It may also mean that future provision of diagnostic or treatment may not be adequately funded or managed to meet national demand.

• Only 16 out of the 31 European countries studied had launched an NCCP 
• The 15 countries yet to develop NCCPs are: Austria, Bulgaria, Cyprus, Czech Republic, Finland, Germany, Greece, Latvia, Luxembourg, Romania, Slovakia, Slovenia, Sweden, Croatia and Turkey
• France and England had the most comprehensive plans in the analysis
• 5 NCCPs do not specify responsible organisations for the governance and delivery of their cancer control programmes
• 12 NCCPs have measurable targets to monitor their success. For example, France aims to reduce cancer mortality by 20% in the next 5 years
• 5 NCCPs do not mention allocating financial resources; the 14 NCCPs that do, however, are not always complete
• Only 9 NCCPs include a figure for financing the plan and only 4 specify how the available or new resources will be allocated;
• Only Belgium, England, France and Italy have included in their plans clear figures for additional investment for novel cancer drugs.

Professor Rifat Atun, chair of International Health Management at Imperial College Business School, lead author of the report, comments: "Europe should be leading the world in this area of public health yet we've found great variation between countries and some troubling gaps in some plans.

"NCCPS enable countries to clearly communicate to all the stakeholders how the burgeoning cancer burden will be managed. This helps to develop a shared sense of mission and clearly identify priorities reflecting the wishes of service users rather than of those who fund or deliver them. A plan also publicly commits those managing cancer control services to addressing cancer, making measurement of success possible."

The report highlights crucial measures that any NCCP should include and calls for a more comprehensive and systematic approach to cancer prevention and care across Europe. The six crucial points all cancer plans require are:

• Clear articulation of the evolving context and the challenges that need addressing
• The threats and opportunities which arise from these changing requirements for the national health system and the Cancer Control System
• Goals and objectives for National Cancer Control Plans, clearly explaining what the plan hopes to achieve in terms of diagnosis, treatment and survival 
• A clear indication of how any NCCP will be funded and where new resources will be allocated, should they become available
• New approaches to providing services to respond to an increase in cancer patients
• Details of organisation and governance which show who is accountable for the committed aims and related funding of the plan 

"The complexity of the fight against cancer and the burden of the disease make it one of the most serious threats to public health in Europe," said Professor Jose M Martin-Moreno from the University of Valencia, co-author of the report. "To best fight Europe's cancer problem, we must look beyond early detection and treatment and into the overall organisation of the health systems."

ends

Notes to Editors
For further information please contact:

Elliott White
Press Manager
Imperial College Business School
E-mail: e.white@imperial.ac.uk
Telephone: +44 (0)20 7594 9154

The study, which includes country-by-country comparisons, can be downloaded from here:
http://spiralbib.lib.ic.ac.uk/bitstream/10044/2/164627/2/Cancer%20Control%20vf2.pdf

It is also available at http://www.uv.es/jomarmo6/Home.html.

1 About the study

This study was confined to 31 European countries, which included the 27 European Union member states, two acceding countries (Turkey and Croatia) and two European countries that are not members of the EU but are members of the OECD (Norway and Switzerland).

This study was supported through an unrestricted research grant provided by European Cancer Organisation (ECCO) and Hoffmann-La Roche LTD to Imperial College Business School.

The 16 countries with existing NCCPs
Belgium, Denmark, Estonia, France, Hungary, Ireland, Italy, Lithuania, Malta, Netherlands, Poland, Portugal, Spain, UK , Norway and Switzerland.

The authors are:

• Professor Rifat Atun, MBBS, MBA, FRCGP, FFPH. A professor of international health management, Imperial College Business School, Imperial College London, UK
• Professor Jose M Martin-Moreno, MD, PhD, DrPH. Department of Preventive Medicine and Public Health and Quality Unit, Medical School and Clinical Hospital, University of Valencia, Spain.
• Toshio Ogawa, MSc. Doctoral Researcher, Imperial College Business School, Imperial College London, UK

References:

• Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006.Ann Oncol 2007; 18 (3):581-592.
• IARC. World Cancer Report. Lyon: International Agency for Research on Cancer. Press, 2003
• The constituent countries of the United Kingdom (England, Scotland, Wales and Northern Ireland) all had plans, bringing the total number of NCCPs to 19.

2 About Imperial College London

Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 13,000 students and 6,000 staff of the highest international quality.

Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.

Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve health in the UK and globally, tackle climate change and develop clean and sustainable sources of energy.