Protocol
Occasion: First reporting day on the “National Cancer Programme for Switzerland 2011-2015”
Date: 2 May 2012
Location: Restaurant zum äusseren Stand, Berne
1. Welcome and introduction into the topic of the day
Hans Altherr, president of the Strategic Committee and senate president, AR
Hans Altherr resumed: The fight against cancer in Switzerland is working. The report on the 2011 National Cancer Programme for Switzerland simultaneously establishes that there are numerous opportunities for improvement and the fact that urgent action is needed in some areas.As President of the Strategic Committee,his aim is to ensure that these potential improvementsare implemented and existing inefficiencies are eliminated.All people of Switzerland are supposed to have equal entitlement to diagnosis at the earliest possible stage, to treatment, nursing care and support, both from the emotional as well as the social aspects.
In his opinion, the most important of all is to achieve concrete measures with measurable results and practical consequences in the key areas of action. He would like to make his contribution towards the various professions being able to work in closer cooperation and to depend to a much greater extent on sound bases and reliable framework conditions.
Glance over the fence:
2. Core Referat: National Cancer Plan for Germany
Success factors, barriers, location and horizons
Matthias W. Beckmann, Cancer Plan Germany, director of University Hospital of Erlangen
Matthias W. Beckmann opened the sharing with a "glance over the fence"to the National Plan for Germany. One of the most important necessities for this National Cancer Plan is a conclusion of the EU Council. This implies that EU members like Germany only receive funds if they have drawn up a National Cancer Plan.The organizational structure of the German National Cancer Plan includes a steering group that consists of actors and organisations of oncology care. There are three working groups on the following fields of activity:1. Development of cancer screening, 2. Development of care structures and quality assuranceand 3. Strengthening of the patient’s orientation. Beckmann emphasized that in the second field of activity there is happening a lot at the moment.
A cross-cutting issueof the National Cancer Plan for Germany is the tumor documentation. It is a big problem that the same patient must be documented in too many different systems. The goal is a data-sparing, uniform tumor documentation.In order to define priorities, the coordination in the steering group was very important, as well as the pressure of the experts towards the political protagonists and recurring reporting at conferences. The last one requires deadlines for activities that must be completed by then. In his opinion, key success factors for this Cancer Plan are that all organisations have to sit on a table, and the formulation of uniform definitions of objectives. Above all, quality must be transparent and honored accordingly.As the most important challenges of the plan he called among other things the breaking up of crusted individual items and special interests of the various involved organisations and the subject of cancer in competition with other health policy areas.
3.Short comment
Thomas Cerny, board member of Oncosuisse
Thomas Cerny pointed out that Germany is a very important example, because the Cancer Plan is already based on many other Cancer Plans and experiences.Then he looked at other countries: Canada was the first country that has done important developments with the publication of the Cancer 2000 report 20 years ago. As a result, 100 recommendations turned out that have been submitted to the politicians. But there was no implementation. At the 2nd Cancer Plan in 2006, the government has made available a very substantial sum, namely 160 millionEuros. England started in 1994 and finally published the first Cancer Plan for England in 2000. The second followed in 2007. In Ireland, the approach was similar. It was interesting that the Irishmen wanted to reduce cancer mortality in the under-65s between 1994 and 2004 by 15 % and have even surpassed that goal. This was also important for the continuation of the programme.
In the Netherlands, the specificity is that from the beginning the Ministry of Health worked together with the social insurance for a National Cancer Plan. This would also be interesting for Switzerland. Denmark has had the worst records in respect of the mortality in the Scandinavian region. That was the initiator for the publication of the National Cancer Action Plan in 2000 and later for the second Cancer Plan in 2005. In France, the first attempt failed because of the finances. In the second round the Cancer Plan 2003-2007 followed. The New Zealanders have published a National Action Plan published in 2005. Now they are working on the second edition of the National Cancer Control Programme.
Technical Part:
4. From report to strategy – an efficient structure needs resources
Marcel Wyler, Programme Director, Cancer Programme
Marcel Wyler explained what has happened at the National Cancer Programme in the last year. In this context, he talked about the order to the Programme Director for the four areas of communication, politics, development and documentation. The rough report was presented at a press conference on 28 April 2011. Based on this work, a communication plan was designed and approved by the Board on 2 December 2011. In summary, the concept has two lines: the communication within the community and the communication among relevant target audiences. The communication tools for the Cancer Programme include the website a newsletter and a project database.
On the subject of support in the policy, he mentioned that the Altherr motion was unanimously referred. There has been a parliamentarian workshop on 29 May 2012, where unfortunately only three politicians were present. The Presidency Strategic Committee is performed by Hans Altherr, senate president FDP AR. The co-presidency is being prepared by a representative NR. The coordination of public affairs is guaranteed by its own task force of all political representatives of Oncosuisse. On 19 April 2012 Oncosuisse was commissioned by the National Health Policy Dialogue to formulate the “Strategy to Combat Cancer”.
Powerful structure needs resources: In addition to the necessary financial resources, it concerns unified carrier, clear political, social support and a strong will as well as organisations with the required know-how in project management and medicine. Additional resources: enabled project managers and a working community. Every year, there will be a documentation of the progress of the NKP 2011-2015, the emerging problems and the adopted solutions and measures.
Introduction to the technical contributions
Kathrin Kramis, managing director of Cancer Programme
Kathrin Kramis introduced into the part "Technical implementation in the network".There are overarching objectives and areas that are found in all national programmes: the reduction of cancer mortality and cancer incidence and improvement of the entire continuum of cancer care.The National Cancer Programme will enable Switzerland to integrate the existing expertise and resources, develop a uniform quality and overcome federalist structures. Cancer organisations can play a key role in this respect by developing a coalition with partners from numerous areas as well as promoting a broad alliance of the key interests in both, the public and private sector, establishing networks and platforms.
Implementing a comprehensive cancer programme poses a significant and complex challenge. As a rule, implementation will be successful if the following applies: the collated expert knowledge is available, theme-related areas of focus are set on a joint basis and priorities are defined, the bases of the methodology are drawn up, roles, tasks and responsibilities are defined, existing activities are embedded within a properly coordinated overall framework, each partner is able to preserve its own identity and consideration is given to the principle of subsidiary. During the realization and implementation phase data should be continually collated and closely associated with the programme’s objectives. Also important is an ongoing impact evaluation of the programme and target validation. Finally, model lines of development will be set in the introduction to the technical articles.
5. Prevention: Colon Cancer Screening
Ursula Zybach, Swiss Cancer League
Ursula Zybach has primarily focused on one goal for the early detection, the implementation of systematic screening programmes for breast cancer, colon cancer and cervical cancer. The National Cancer Programme for Switzerland 2011-2015 is calling for systematic colon cancer screening to be included in the list of services offered under the health insurance and for the development of a corresponding national programme.She underlined the importance of early detection:In Switzerland around 4.000 people contract a colon carcinoma every year, with around 1.600 people dying from this disease. Here, early detection shows a great benefit because you have a great chance of survival. In Switzerland this early detection is not part of a systematic programme.
So the Swiss Cancer League decided in 2008 to promote the introduction of a systematic Colon Cancer Screening Programme, CCSP. In April 2011, together with other partners, it submitted the application to the Federal Office of Public Health, calling for the costs of a CCSP to be covered. The Federal Commission for Medical Benefits and Principles (FCMBP)could not finish the treatment of the application in November 2011. It instructed the sponsors to provide more detailed and additional information on specific points before giving its definitive decision. This is expected to be given by May 2012 so that the CCSP can be discussed further at the next meeting of the FCMBP in September 2012.
6. Medical quality assurance
Beat Thürlimann, president of SAKK
Beat Thürlimann reported on medical quality assurance. Progress in medical treatment and care is the result of innovations. These in turn are made from prospective randomized studies and case series for medical interventions, which cannot be randomized. Also important is a consistent nationwide implementation. In addition, incentives should be given. That means either to reward good quality (bottom-up strategy) or to combat or eliminate bad quality (top down strategy).Quality must be defined and transparent. Above all, quality should be measurable: What you can‘t measure, you can‘t manage.
He emphasized that in the area of oncology – providing there are no incentives for delay - there are still some gaps in the application of inventions on a nationwide basis. These gaps and the predictors to these have been clearly set out in the Patterns of Care of Breast Cancer in Switzerland. The availability of clinical research is the most important factor in the compliance with treatment guidelines, together with the number of cases and region in which the patients live. The Swiss Cancer League and Swiss Society for Senology have created a joint quality certificate. The label is intended to honor breast centers that meet clearly defined requirements on the quality of treatment and care of women with breast cancer. Basis for the label is a list of criteria that has been developed by SGS and based on the criteria Eusoma.
7. Oncological rehabilitation
Brigitte Baschung, Cancer League Switzerland
The presentation by Brigitte Baschung dealt with the topic oncological rehabilitation. Contrary to the first cancer programme the second programme takes oncological rehabilitation as an integral part of the whole plan. Interim results are already available. In all projects, coordinate tasks are performed. Processes and tools were developed to create a successful screening for rehabilitation needs. All projects have expanded existing rehabilitation services or plan to do so in the near future. The projects contribute to a better understanding among the various actors – with new collaborations or with practical cooperation. Interim reports are available on the website of the Cancer League Switzerland.
The focus of her lecture is to support initiatives in oncology rehabilitation.This includes the project “New networks in oncology rehabilitation”, which the Cancer League Switzerland launched between 2008 and 2012.Within this project the construction and embedding networks for oncological rehabilitation in three Swiss regions are supported. From 14 project outlines the Cancer League Switzerland selected three projects for financial support (regions of Fribourg, Valais and Zurich).For a better assessment of the funded projects and for general expansion of knowledge should be brought in experience, as in addition to the three funded projects, the 11 rejected projects have developed. A comprehensive evaluation report will be available in spring of 2013.
8. Research: Translational Research
Perspectives on ISREC-EPFL and the developing Cancer Center in Lausanne
Joerg Huelsken, ISREC-EPFL
Joerg Huelsken reported on the planning for the next 3-4 years, to build a new Cancer Center in Lausanne at the CHUV campus. Two new buildings will be constructed as part of the Center: a Cancer Treatment Center and a Translational Oncology Research Building. The greater Lausanne‐Geneva region was identified as the most important biotech research center of excellence in mainland Europe, on the basis of a per capita productivity comparison of over 40 European biotech centers. The ongoing effort to develop this center will bring together relevant expertise and involvement of basic, translational, and clinical researchers, as well as practicing clinical and surgical oncologists. Thenew center will combine efforts in clinical and translational oncology of UNIL/CHUV, and efforts in basic cancer research, bioinformatics, bioengineering and imaging of ISREC/EPFL.
Current therapy is largely suboptimal as demonstrated by the fact that the prognosis of patients has not significantly improved over the last two decades. Novel therapeutic modalities will most likely come from elucidation of the molecular/genetic biology of each individual patient’s tumor using high-throughput genomic technologies in order to provide a rational basis for therapeutic decision making. The translational research at the new Cancer Center will establish a novel Phase ½ unit for clinical trials of patients stratified based on genome scale diagnosis, a GMP unit for personalized immunotherapy and a rapid phenotype screening unit to functionally evaluate treatment options. The main goal is to provide the most advanced, integrated and compassionate cancer treatment by combining state-of-the-art care and clinical innovation.
Political Part:
9. Current political dossiers
Achievements and challenges
Rolf Marti, director of Cancer Programme
Rolf Marti talked about a strategy for fighting cancer, with which one can operate themselves and influence the legislative process. Objectives are achieved together because Confederation, cantons and “cancer community” pull together. He explained: We cannot only suggest the authorities, the administration, policy, where we go, but we are also involved in the implementation of these projects. In the given framework, we can initiate new laws. In addition, we may try very early to eliminate legal texts and to develop strategies with the administration.
He showed how the Swiss Cancer League, as a non-profit organisation, as well as other organisations in the “cancer community” pursue their policies. He used the following specific examples. From the beginning, the legislative process of the Human Research Law was accompanied by the Swiss Cancer League. For the implementation of the Cancer Registry they persecuted a nationally-cantonal strategy. It is carried out as a joint study on childhood cancer in the environment of Swiss nuclear power plants, in short CANUPIS study. In the radon federal strategy they work together in international affairs. In the areas of Palliative Care and Communication Skills they have done pioneering work. They have taken over the trade organisation of a stop smoking line to the prevention programmes.
On the part of politicians he expected to create a firm strategy for federal, cantonal and cancer community that says exactly who does what in which order and who is responsible for what. For Human Research Law he wishes efficient approval process for clinical trials, for the Prevention Law a national strategy and targets, for the Diagnosis Registry Law Switzerland-nationwide cancer registry with good depth of data, for the IV revision attention to the situation of cancer affected and for mammography and colorectal cancer screening access for all quality-assured screening programmes.
10. Health care in the cantons
Benefits of the National Cancer Programme. Goals, constraints and resources of a strategy against cancer
Carlo Conti, president of GDK, BS
Carlo Conti spoke about the perspective of health directors. He noted that the structures and services in Switzerland compared to other countries are relatively well. But potential for improvement does exist. Especially in the area of coordinated cancer strategy a Prevention Law would be of crucial importance. Then it might be possible for the first time to work out and define binding targets between the federal and cantonal. In terms of screening programmes increasing cooperation structures were urgently needed and would improve the quality of screening programmes significantly. The mission to advance the field of palliative care should be more structured and integrated. The cantonal cancer registries should have uniform standards, structures and data, so that at the end the decentralized collected data could be included into a superior register holistically.