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The launch of the third national cancer strategy (2017-2026 ) is another important milestone in the effort to reduce morbidity and mortality from this disease. The document was written by a panel of experts with public consultation and draws on evidence and best practice from the experience of other countries in cancer control. It is comprehensive and contains more than 50 recommendations. It provides a clear road map of the actions required to build on the improvements in cancer care achieved through the implementation of the second cancer strategy (2006-2016).
An external evaluation of the 2006 strategy confirmed that significant progress had been made but that Ireland remained behind countries leading the way in cancer control. While overall cancer five-year survival rates in Ireland have improved from 45 per cent to 60 per cent since the mid-1990s, our current survival rates still fall below the median value for almost all the common cancers compiled by the OECD for 34 countries.
The new strategy strongly endorses the current overall approach to population-based cancer control, led by a single National Cancer Control Programme (NCCP). It recommends the strengthening of the leadership and authority of the NCCP through an enhanced role in the funding and commissioning of cancer services, and that the NCCP must have necessary authority to align resources to the strategic objectives of cancer control.
Priorities
Sensibly the report attempts to set priorities for the next decade. It identifies three areas of focus: reducing the cancer burden; providing optimal care; and maximising patient involvement in their own care.
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Based on a realistic understanding that we will not be able to treat our way out of the cancer problem, the report emphasises that a reduction of cancer burden, ie incidence and mortality, is achievable through cancer prevention and early diagnosis.
The report estimates that 30 to 40 per cent of all cancers in Ireland are due to modifiable lifestyle and environmental factors. Chief among these is tobacco use, where some modest progress has been made in reducing consumption. Obesity, which is reaching epidemic proportions, has been shown to be associated with an increased risk of cancer, though this risk is underappreciated. Similarly alcohol likely accounts for 900 new cases of cancer each year, mostly arising in the airway or digestive tract.
The report recommends that the NCCP develop a cancer prevention function and while working with the broader Healthy Ireland initiative it will lead in relation to the development and implementation of policies and programmes focused on cancer prevention. It is important to note here that the positive benefits of cancer prevention strategies will take 20- 40 years to bear fruit and as a result maintaining support and enthusiasm in pursuing these strategies will likely be problematic.
The report recommends improved early cancer diagnosis through the expansion of existing screening programmes, facilitating GP electronic referral and their timely access to diagnostics as well as increasing public awareness of warning signs of cancer.
A large part of the report is given over to current and future plans to provide optimal care. Part of this involves expanding and completing some unfinished components of models of care included in the previous strategy, notably the completion of the centralisation of cancer surgery to eight designated cancer centres and the expansion of rapid-access clinics for additional cancer types.
In addition there are recommendations to better integrate cancer care across the entire spectrum of the patient journey, the future organisation of cancer molecular diagnostic services and the expectation that every cancer patient will have access to a multidisciplinary team meeting to discuss their care plan.
Capital plan
There are also recommendations around workforce planning, expansion of nursing roles and other issues around the recruitment and retention of staff. There is an acknowledgment of the critical need for a rolling multiyear capital plan to procure new infrastructure and replace old and obsolete equipment.
The final area of priority identified was the support and involvement of patients in their own care and the support of cancer survivors. It recommends the establishment of a cancer patient advisory committee within the Department of Health and an expectation that patients will be involved in decision-making, practice and oversight of cancer services at the local, regional and national levels.
All in all, this is a thoughtful and well-developed strategy document.
The cost of the plan is expected to come in at between €1.5 billion and €2 billion in capital and medicinal costs. It remains uncertain whether Minister for Health Simon Harris will be able to convince his Cabinet colleagues to fund this proposal.
Finally there is a very important lesson from the second cancer strategy. No strategy has value unless it is implemented successfully, and without strong political support implementation will fail. Before proceeding further the Health Service Executive, the NCCP and the department need to produce a detailed implementation plan, adequately resourced, to ensure the success of this strategy.
Dr Tom Keane is a retired oncologist and served as the first director of the NCCP