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3.5.6 Measurement of outcomes
Measurement of outcomes is a vital part of the
implementation of a cancer strategy. It is important that outcome targets are put in place from the beginning and that performance is measured against these. Review of performance against targets is an on-going process, and targets themselves may need to be changed over time.
An example is the New South Wales Cancer Plan
Performance Index, against which progress in meeting their objectives is measured. Also, the Cancer Quality Council of Ontario has developed indicators to track progress on outcomes in cancer care on a range of areas, including prevention, screening, diagnosis, treatment, recovery and end of life care.
3.5.7 Innovation and modernisation
It is recognised internationally that considerable resources are required to fund a comprehensive cancer service. The provision of modern equipment, more personalised medicine and access to the latest technologies and treatments comes at a high initial cost. In addition, the provision of the appropriate skill mix of staff, not only in the direct cancer treatment services, but across primary care and in areas such as radiology and pathology requires additional investment. Training and retention of sufficient numbers of staff to address current workforce deficits is most important. However, this is very challenging in the context of the international market for such trained personnel.
Cancer care is evolving rapidly and it is vital to ensure that research is a strong component of cancer services. The aim is to devise clear programmes of research within available resources, targeted at priority areas and leading to improvements in outcomes and the patient experience. The importance of encouraging patient involvement in clinical trials has been emphasised in cancer control plans from a number of jurisdictions, such as France, England and Slovenia.
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3.6. Priorities for the Next Ten Years
A number of high level conclusions can be drawn from this analysis which allow clear priorities to be established for the third National Cancer Strategy. Overall, the progress seen to date justifies the continuation of the current overall approach to cancer control. This involves a whole of population approach that deals with all aspects of cancer in a planned way. It emphasises the need for high quality cancer care that is equitably available to all cancer patients.
It also involves continuous monitoring, with a view to improving the quality of cancer care.
The projected growth in incidence and prevalence of cancer illustrates the need for a range of cancer control actions to prevent and treat cancer in an effective manner and to support those living beyond cancer. While prevention strategies can have a significant impact on cancer
incidence, it will take some time before this impact is seen.
Already most cancer services in Ireland are at full capacity.
Further actions, such as improving earlier detection, providing more effective treatments, and transforming how we provide services to those with a cancer diagnosis across the patient pathway, are required in order to reduce the burden of cancer.
Significant reorganisation of cancer services in particular in relation to diagnosis, treatment planning and initial treatment has taken place since the 2006 Cancer Strategy.
This is evident in the case of breast cancer and rare cancers.
However, progress remains to be made on a number of common malignancies.
There is growing appreciation nationally and internationally of the positive role that can be played through the
involvement of informed and empowered patients and citizens in cancer care. This should involve meaningful roles in the development, oversight and operational planning of cancer services. Patients with cancer are in a unique position to inform, to personalise and to improve the
co-There have been many significant scientific, technological and therapeutic advances in cancer diagnosis and treatment in recent years. In particular, diagnostics and treatments that exploit a better understanding of the molecular basis of cancer biology offer great hope for the future. It is essential that this Strategy provides a clear and structured mechanism to evaluate the evidence in respect of the efficacy and effectiveness of each of these developments and to ensure their incorporation into well organised patient centred care pathways that are fully audited and evaluated. Existing services, particularly diagnostic services, are challenged by limits on access.
The NCCP must play a strong role in ensuring the incorporation of evidence based care pathways into the delivery of the services offered to patients with cancer in a manner which ensures that issues of access are appropriately addressed. The end goal must be that access to, and experience of, cancer diagnosis and treatment is related only to the clinical need of patients who must use these services.
This will require that future provision for molecular diagnostic services, histopathology, radiological services, endoscopic services and other diagnostics are strategically planned so that they can achieve these goals within the resources that are and will be made available for cancer.
A particular existing challenge in respect of cancer and other services is ensuring that they are delivered equitably and that patients achieve equity in outcomes irrespective of age, sex, geographic location and social class. It follows that significant enhancement of our information capacity is required to enable transparent public reporting of process and outcome indicators in a way that allows us to assess the degree to which equity is being achieved across our cancer services.
Significant work has been done in recent years to strengthen our procedures for the incorporation of evidence based diagnostics and treatments into routine clinical practice
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developments in this regard will be required in respect of cancer care to ensure that the goals of equal access and equal outcome for clinical need can be met. Additionally, the policies and procedures in respect of prioritisation of new drugs and new technologies must continue to be strengthened and made more transparent and explicit to ensure access is determined by clinical need and that maximum value in terms of cancer outcomes can be achieved for a given level of investment.
Much progress has been made in establishing links with health authorities in Northern Ireland to improve cancer services for people on the island of Ireland. Opportunities for cross-border co-operation in relation to cancer services will continue to be pursued with a view to achieving mutual benefit. Similarly, international co-operation in relation to the various aspects of cancer prevention, care, research and survivorship will also be promoted and strengthened.
Healthy Ireland - A Framework for Improved Health and Wellbeing 2013-2025 provides for a co-ordinated cross-government means of tackling social determinants
of health and major lifestyle risks for cancer. There is encouraging evidence of progress in respect of many of the common lifestyle related risk factors, in particular in relation to tobacco consumption. It is clear however, that further progress is needed through effective, strategic and operational alignment between the National Cancer Control Programme and the goals of Healthy Ireland.
The NCCP has existed since 2007. It is reasonable that this Strategy give consideration to how best to strengthen the authority of the NCCP, which seeks to achieve a common standard of prevention, diagnosis, treatment and outcome in respect of cancer care across the country, when there is clear evidence that progress in respect of centralisation of many cancer services has not been universal. Aligning investment, new developments, staffing, indemnity and performance management and regulation with the objectives and requirements of the structure, process and outcome of cancer care pathway delivery is essential to ensure that the governance and management of cancer control services is fully aligned with the requirement to reduce the burden of cancer in all its manifestations.
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Challenges
• The projected increase in cancer cases
• The requirement to address the needs of cancer survivors
• The need to ensure that cancer control measures are delivered equitably - and achieve equitable outcomes
• The pressure on
infrastructure and resources
• The difficulties in attracting and retaining qualified people to work across our cancer services
• To achieve a balance between the benefits and costs of new drugs/
treatments
• To achieve a continuum of care across primary, secondary and tertiary services
• To attain a strong focus on outcomes through the integrated model of care
Lessons
• Integrated approach to cancer control
• Cancer prevention as a key area of focus
• Importance of improving early detection and diagnosis
• Centralisation of care provides for optimal treatment
• Survivorship care and psycho-social support needs to be developed
• Importance of patient input
• Need for on-going evaluation
• Value of learning from international developments
• Importance of strong governance and management