Ambitious 10 year plan aims for survival rates that will be among the top in Europe, by focusing on prevention, early diagnosis, treatment and quality of life
Minister for Health, Simon Harris, today (Wednesday) launched Ireland’s ambitious new ten-year National Cancer Strategy, following its approval by Government.
The National Cancer Strategy 2017 – 2026 is focussed on preventing cancer across our population, diagnosing cancer early, providing optimal care to patients and maximising their quality of life.
The Strategy sets out four goals:
- Reduce the Cancer Burden;
- Provide Optimal Care;
- Maximise Patient Involvement and Quality of Life; and
- Enable and Assure Change.
Launching the Strategy, Minister Harris said “There are very few families in Ireland that have been untouched by cancer and sadly we are all too aware of the hardship, pain and loss it can bring. It is a challenge that we all must face together as a country. Great strides have been made under the current National Cancer Strategy, in relation to improved surgical, radiation and medical oncology services, rapid access clinics and cancer screening. This progress has resulted in improved outcomes for patients and better survival rates. Now we must take the next step.”
Key recommendations in the Strategy include:
- HSE’s National Cancer Control Programme to develop a cancer prevention function in conjunction with the broader Healthy Ireland initiative.
- Appropriate endoscopy capacity to be provided in hospitals to allow for the expansion of BowelScreen to all aged 55-74 by end-2021.
- Development of a plan to enhance the care pathways between primary and secondary care for specific cancers.
- HSE’s National Cancer Control Programme to develop referral criteria to ensure that GPs have direct access to cancer diagnostics within agreed timelines
- The appointment of a National Lead for Cancer Molecular Diagnostics for solid and liquid malignancies.
- An age appropriate facility to be designated for adolescents and young adults with cancer within the new children’s hospital.
- Links between cancer services to be strengthened, facilitated by the appointment of a National Clinical Lead in Geriatric Oncology.
- Cancer consultants and Advanced Nurse Practitioners to have protected time to pursue research interests in their new posts.
- Appointment of a National Clinical Lead for Cancer Nursing to support practice and research.
- HSE’s National Cancer Control Programme to develop, publish and monitor a programme of national quality healthcare indicators for cancer care, in line with international standards.
The Minister said “The burden of cancer on individuals and on society will grow, unless significant progress is made on improved prevention, early diagnosis and treatment. The number of cases of cancer in Ireland is expected to increase by 50% in men and 40% in women by 2025, and to nearly double by 2040. This Strategy sets an ambitious target and we aim to be in the top quartile of European countries for cancer survival by the end of the Strategy period. Cancer prevention offers the most cost-effective, long-term approach for cancer control. In fact, 30-40% of cancers are avoidable through improved diet, more exercise, reduced alcohol intake, limited exposure to ultraviolet radiation and of course not smoking.”
The Minister added “If we are to reach our targets then early diagnosis of cancer is vital. Cancer screening plays a crucial role in reducing the treatment interventions needed and in achieving successful outcomes. The new Strategy recommends the continued expansion of cancer screening. BreastCheck, which currently covers women aged 50-64 years of age, is being expanded to women of 65 to 69 inclusive, and the expansion of BowelScreen over time to all aged 55-74 is also recommended. The new Strategy also aims to ensure that patients receive the required care, in a timely fashion, from an expert clinical team in the optimal location. It recommends the expansion of radiation and medical oncology, as well as the concentration of surgical services in the designated centres.”
Minister Harris said he was particularly glad to see that the patient voice had been an integral part of the development of the new Strategy, “there are currently about 150,000 cancer survivors and this number will grow as cancer incidence grows and treatments improve. As this Strategy was developed the Cancer Patient Forum provided strong, informed patient input. This has proved to be invaluable in producing a strategy that is responsive to the needs of patients now and into the future. Patient involvement will continue with the establishment of a Cancer Patient Advisory Committee, involving patient representatives in policy making and planning. Today I would also like to thank the members of the Cancer Strategy Steering Group for their dedication to this work and Professor John Kennedy, Chairman of the Group in particular for his tireless leadership and his insight during this process.”
Speaking at the launch, Catherine Byrne, T.D., Minister of State for Health Promotion and the National Drugs Strategy said “I am glad to see that under this new Strategy the HSE’s National Cancer Control Programme will develop a cancer prevention function and will lead in the development and implementation of policies and programmes focused on cancer prevention. We must all remember that we can all impact on our own level of risk of developing cancer and healthier lifestyle choices and behaviours are, in fact, cancer prevention in action.”
Professor John Kennedy, Chairman of the Cancer Strategy Steering Group said “I see this Strategy as a blueprint for the further development of cancer services over the next 10 years in line with international advances in addressing the disease.”
Mairéad Mangan, the representative of the Cancer Patient Forum, said:
“Sometimes being a cancer survivor is a very lonely place to be. The involvement of the patient voice in the development of this strategy and its strong focus on survivorship, psycho-oncology and psycho-social services is very encouraging.”
Tony O’Brien, Director General of the HSE, said:
“In welcoming the third cancer strategy I am mindful of the enormous progress made under the previous strategies, evidenced by significantly improved survival rates. The HSE is fully committed to achieving similar levels of progress over the next decade. Our focus will be evolving our services, developing new initiatives, enhancing clinical research and to further improve quality, treatment outcomes and survivorship for Irish cancer patients.”
Notes to Editors
The Need for the Strategy
The number of cases of cancer in Ireland is expected to increase over the period of the Strategy, and to nearly double by 2040. This is mainly due to an increasing and an ageing population, as cancer is a disease where the risk increases with age. Due to improvements in cancer treatments, the number of people living with cancer is also increasing – there are now over 150,000 people in Ireland who have survived cancer. While many of these people are in good health, the increasing numbers, allied to increased co-morbidity with age, are putting significant pressures across the spectrum of health services.
Developing the Strategy
In order to identify key areas of focus for the new Strategy, the Department of Health engaged an international Evaluation Group to independently review our cancer services. The report of the Evaluation Group (published in early 2015) highlighted the progress made under the 2006 Strategy, in particular the establishment of the National Cancer Control Programme (NCCP) and the establishment of the eight designated cancer centres, but also identified a number of areas in need of attention. These included the requirement for further centralisation of surgical services, the need to address staff shortages in all areas of cancer care and the need to provide a comprehensive psycho-oncology service and supports. At the same time, the NCCP produced a detailed report on its work since it was established in 2007.
The Department carried out a Public Consultation to inform the development of the Strategy. Members of the public were invited to submit their views on the strengths and weaknesses of cancer services and to make suggestions on how they could be improved. The main issues raised were the need for service reconfiguration (both human and physical infrastructure), the need for more social and financial support, the need for the development of community based services and the importance of cancer prevention and increasing public awareness.
A Cancer Strategy Steering Group, comprising a broad range of people involved in cancer services, was established in April 2015 to develop proposals for a new National Cancer Strategy. At the same time, a Cancer Patient Forum was established. Members of the Forum represented patients or organisations with experience of many cancer types and from a wide range of locations. The Forum was represented on the Steering Group to more readily facilitate the patient input and to ensure that all members of the Forum were always fully informed on all issues pertaining to the development of the Strategy.
2. Vision and Goals of the Strategy
The vision of the Strategy is as follows:
“Together we will strive to prevent cancer and work to improve the treatment, health & wellbeing, experiences and outcomes of those living with and beyond cancer”.
The Strategy sets out four goals that will be crucial to the achievement of this vision, with a number of objectives pertaining to each goal. The goals are as follows:
- Reduce the Cancer Burden;
- Provide Optimal Care;
- Maximise Patient Involvement and Quality of Life; and
- Enable and Assure
Reduce the cancer burden
- Prevention offers the most cost-effective, long-term approach for cancer control, with 30% – 40% of cancers attributable to modifiable lifestyle and environmental factors.
- Prevention measures will be integrated with the overall health and wellbeing initiatives under the Healthy Ireland programme, including Tobacco, Alcohol, Diet and Exercise. The NCCP will develop a cancer prevention function.
- Diagnosing cancer at its earliest possible stage is crucial to reducing mortality and improving survival. Public and professional awareness of warning signs and the importance of early presentation are critical. The Strategy aims to improve GP access to diagnostics and to provide GPs with early referral criteria.
- Efforts will continue to ensure that people take up the offer of cancer screening when invited through the BreastCheck, CervicalCheck and BowelScreen programmes.
- The age extension of BreastCheck (65-69 year olds) will continue and the extension of BowelScreen to men and women aged 55-59 and 70-74 years is envisaged.
Provide optimal care
Improvements in the Model of Care
- The overall aim to have models of care so that patients receive the required care (diagnostics, surgery, radiation, etc.), in a timely fashion, from an expert clinical team in the optimal location.
- Technological advances are resulting in improvements in cancer detection, treatment and survival. Genomics, cancer genetics and molecular diagnostics provide the potential for improved diagnosis and personalised medicine. The Strategy outlines development to be made in these areas.
Getting the treatment right
- This Strategy builds on progress made to date by supporting the key role of designated cancer centres in cancer treatment. The centralisation of surgical services for more cancers will be progressed to ensure that optimal treatment is provided and outcomes are improved. Radiation oncology will also be further developed. Multidisciplinary team working will be used to a greater extent.
- The growth in cancer incidence and the number of patients on active treatment, together with new drugs, will increase the volume and complexity of medical oncology The NCCP will examine the model of care for patients requiring oral anti-cancer medications.
- Cancer services for children and adolescents/young adults are an area of focus in the Strategy. The new children’s hospital will provide the opportunity to establish an age-appropriate facility for adolescents and young adults with cancer.
- Other areas covered in the Strategy include:
- Haematological malignancies / Lymphoma
- Rare cancers
- Cancer in older patients
- Psycho-social care
- Palliative care
Maximise patient involvement and quality of life
- Patient involvement in policy and service delivery will be promoted at local, regional and national levels. A Cancer Patient Advisory Committee will be established.
- There is a need to develop and implement survivorship programmes for patients with cancer. The emphasis in the Strategy is on maximising the quality of life.
- Patients will also be offered Patient Treatment and Summary Care Plans as part of their support that will guide them towards self-management of their care.
Enable and Assure Change
- The NCCP will continue to provide leadership and direction to ensure that service priorities are aligned with desired outcomes. They will focus in particular on funding and commissioning, as well as on oversight and performance review.
- The Strategy will aim to ensure that cancer research is aligned with cancer control priorities and integrated with cancer care. A envisages increasing the level of involvement of Irish people who have cancer in clinical trials.
- A major focus will be placed on workforce planning. An early emphasis will be placed on addressing gaps in areas such as nursing, medical oncology and urology, as well as other health and social care professionals.
Implementation will largely be undertaken by the NCCP, with policy support from the Department of Health. Other agencies and stakeholders, such as the National Cancer Registry and the National Screening Service, will be involved on particular aspects.
Monitoring of the implementation will be carried out by the Department and the NCCP s. The NCCP will engage with the Hospital Groups, the Community Health Organisations and Primary Care to ensure that quality cancer services are provided at all levels.
A concise annual report (first at end 2018) will be published by the Department on the implementation of the Strategy, focusing on the implementation of the recommendations and the degree to which the Key Performance Indicators are being met.
The recommendations of the Strategy will be reviewed towards the end of 2021, at the mid-point of the Strategy period, to ensure that the aims and direction continue to be appropriate.
National Cancer Strategy 2017 – 2026