Cancer Care: Assuring Quality to Improve Survival

More than five million new cases of cancer are diagnosed every year in OECD countries. Mortality rates are declining, but not as fast as for other big killers such as heart disease, and cancer survival rates show almost a four-fold difference across countries. In short, many countries are not doing as well as they could in the fight against cancer.

Cancer Care: Assuring Quality to Improve Survival surveys the policy trends in cancer care over recent years and looks at survival rates to identify the why some countries are doing better than others. It sets out what governments should do to reduce the burden of cancer in their countries. As well as an adequate level of resourcing, a comprehensive national cancer control plan appears critical, emphasising initiatives such as early detection and fast-track treatment pathways. Countries also need better data, particularly for patients’ experiences of care, in order to provide high quality, continuously improving cancer care.

Contents:

Acronyms and abbreviations 9

Executive summary 11

Chapter 1. Cancer care systems: Increasing burdens and existing performance gaps 15
- Introduction 16
- Cancer: What it is and recent trends in rates of incidence 16
- Cancer is associated with great financial cost within the health care sector and beyond 18
- Cancer is causing an increasing numbers of deaths 20
- Performance of cancer care is uneven across countries 25
- A fundamental question: Do certain cancer care policies lead to fewer deaths? 29
- How this report is structured 32
- References 33

Chapter 2. Resources for cancer care 35
- Introduction 36
- Availability of cancer drugs is expanding with consideration for financial sustainability 36
- Medical devices are increasing in number, but often without concern for rational use 46
- Institutions and professionals are becoming specialised for delivering quality cancer care 51
- Conclusion 58
- References 59

Chapter 3. Cancer care practice 61
- Introduction 62
- Anti-smoking steps have been taken but additional prevention measures are needed 62
- Early diagnosis has also been promoted, but maintaining high screening levels is a challenge 65
- Medical practice varies, but delivery of evidence-based cancer care has been enhanced 76
- Timely delivery of cancer care is not always ensured, but efforts have been made 80
- Conclusion 86
- References 87

Chapter 4. Governance of cancer care systems 91
- Introduction 92
- National policies are often set out to steer cancer control efforts 92
- Countries are setting national targets but the development of national guidelines varies 96
- Monitoring of cancer control efforts has been improving but remains uneven 102
- Quality assurance mechanisms have been set up but not in all countries 104
- Conclusion 107
- References 108

Chapter 5. Exploratory quantitative analysis 109
- Introduction 110
- Methods 110
- Results of the univariate analyses 113
- Results of multivariable analysis at the domain level 117
- Multivariable analysis across domains 120
- Conclusion 121
- References 123
- Annex 5.A1. Methodologies for analysis 126
- Annex 5.A2. Variables used in explorative analysis 128
- Annex 5.A3. Results of fractional polynomials univariate analysis 130
- Annex 5.A4. Results of fractional polynomials multivariable analysis 135

Chapter 6. Policy recommendations 137
- Introduction 138
- Allocating resources adequately and effectively to ensure fair and affordable access to cancer care 138
- Promoting best practice in cancer care: doing the right thing at the right time 140
- Strong governance: ensuring quality and continuously improving care 143
- Demonstrating and promoting success through better data 144
- Conclusion 148
- References 148
- Annex A. List of experts on cancer care systems 151

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