Piano Oncologico Nazionale: documento di pianificazione e indirizzo per la prevenzione e il contrasto del cancro 2023-2027

Objectives

Italy’s National Cancer Plan for 2023–2027 provides a whole-system framework for reducing cancer incidence, mortality, suffering, socioeconomic burden and inequalities in access, while improving quality of life for patients, survivors, families and caregivers. It spans health promotion, primary prevention, early detection, diagnosis, treatment, follow-up, rehabilitation, palliative care, survivorship, research, innovation, digitalisation, education and communication.[1][2][3]

• Prevent avoidable cancers by acting on tobacco and nicotine use, harmful alcohol consumption, unhealthy diets, physical inactivity, excess weight, infections, occupational hazards and environmental exposures.[4][5][6][7][8]
• Expand equitable, evidence-based organised screening for breast, cervical and colorectal cancers, improve participation and pathway quality, recover pandemic-related backlogs, and assess emerging risk-stratified approaches for lung and prostate cancer.[9][10][11]
• Personalise prevention and early diagnosis by identifying hereditary and familial risk, integrating genetic counselling, testing, surveillance and preventive pathways with population screening.[12][13][14]
• Strengthen cancer registries and interoperable information systems to provide complete, timely and comparable epidemiological data for surveillance, research, planning, assessment of care pathways and analysis of inequities.[15][16][17]
• Deliver high-quality, safe and equitable care through multidisciplinary Diagnostic, Therapeutic and Care Pathways, regional oncology networks, specialised referral centres and coordinated hospital, community and home-based services.[18][19][20]
• Improve access to innovation, including molecular diagnostics, genomics, advanced imaging, radiotherapy, radiopharmaceuticals, artificial intelligence, cellular and gene therapies, and patient-reported outcome and experience measures.[21][22][23][24]
• Address the needs of people with rare tumours, haematological cancers, children, adolescents and young adults, older people, people with frailty, and other groups facing social, cultural, clinical or geographical barriers.[25][26][27]
• Support survivorship through tertiary prevention, personalised follow-up, rehabilitation, psycho-oncology, nutritional care, palliative care, social inclusion, employment protection and caregiver support.[28][29][30][31][32]

Implementation

Implementation relies on coordinated national, regional and local action led by the Ministry of Health and regional health systems, with oncology networks linking prevention, screening, specialist hospitals, primary care, community services, palliative care, research institutions, patient associations and the third sector. The model combines nationally shared standards with regionally organised delivery, aiming to reduce persistent territorial variation in access, quality and outcomes.[1][33][34][35]

• Organise regional oncology networks around multidisciplinary and multiprofessional teams, tumour-specific pathways, case managers, referral arrangements and, where appropriate, Hub and Spoke structures that centralise complex procedures while maintaining local continuity of care.[36][19][37]
• Integrate hospital, territorial and home-based care through Community Houses, primary care, family and community nurses, electronic records, telemedicine, teleconsultation and remote monitoring.[38][39][40]
• Establish and complete the National Network of Cancer Registries, with regional articulation, quality accreditation, common data standards, linkage to administrative, screening and vaccination data, and periodic updating to reflect new data sources and technologies.[41][15][16]
• Coordinate screening through the Ministry, regions, the National Screening Observatory, cancer registries, evidence-based prevention networks, general practitioners, pharmacists, municipalities, scientific societies and patient organisations.[9][42][43]
• Embed early simultaneous palliative care, psycho-oncology, nutrition and rehabilitation in cancer pathways, with formal hospital-to-community procedures and specialist support matched to patient and family needs.[44][45][46][47]
• Involve patients, caregivers, associations and citizens in pathway design, monitoring, communication, research and service improvement, while strengthening health literacy, professional training and evidence-based public information.[48][49][50][51]
• Monitor implementation through registry coverage and timeliness, screening invitations and participation, pathway process and outcome indicators, multidisciplinary-team activity, access and waiting times, patient-reported outcomes, quality audits and regional adoption of specified programmes.[17][10][36][52][53]
• Use available financing channels including the National Health Fund, National Recovery and Resilience Plan missions on health, territorial care, digitalisation and research, European Union programmes, and targeted statutory allocations.[54][55][56]Specific allocations include one million euros annually from 2020 for regional cancer-registry infrastructure, 240 million euros annually from the National Prevention Plan financing quota, and 200 million euros annually from regional contributions under the 2005 State–Regions Agreement.[41][9]
• Fund selected precision-oncology measures through five million euros in 2021 and five million euros annually in 2022–2023 for next-generation sequencing, 200,000 euros annually in 2023–2025 for cholangiocarcinoma profiling, and 20 million euros annually for genomic tests in eligible early hormone-responsive breast cancer.[23][57]

Monitoring & Evaluation

The plan combines population surveillance, programme monitoring, quality assurance and pathway-level evaluation. It relies on cancer registries, screening information, prevention surveillance, digital health records and regional oncology networks, but many sections do not define common reporting schedules, indicator definitions or formal sanctions for non-performance.[58][17][59][34]

• Strengthen cancer registries as the core epidemiological surveillance infrastructure. The accredited network includes 50 population registries and seven specialised registries, covering 70% of Italy’s population, while the national database holds anonymised information on more than three million people diagnosed with cancer.[60]
• Complete the National Network of Cancer Registries, improve regional coverage, data quality, timeliness, comparability and interoperability, and link registry data with health, administrative, screening, vaccination and sociodemographic records.[61][16][62]
• Monitor registry implementation through the number of Regions with complete registration coverage, publication of incidence, prevalence and survival reports, publication delays of under three years, quality checks and access to core administrative and clinical archives.[17]
• Use measurable objectives and cancer-frequency data to assess programme effectiveness, while interpreting mortality trends and COVID-19-related disruption cautiously because attribution and service interruptions affect estimates.[63][64]
• Monitor screening invitation coverage, participation, diagnostic performance, pathway quality, access and territorial inequalities. In 2019, invitation coverage was 89.1% for cervical screening, 75% for colorectal screening and 89% for mammography; pandemic-related test volumes fell substantially in 2020.[10]
• Assess emerging screening approaches, including lung, prostate and risk-stratified protocols, through pilots, comparative evaluation, audits and impact assessment before wider implementation.[11][65][42]
• Use national screening-observatory support, cancer registries, audit systems and indicators from the New Health System Guarantee and National Prevention Plan to oversee screening quality and equity.[42][66][43]
• Track prevention risks through surveillance systems, including alcohol-risk indicators and Passi monitoring of weight, physical activity and sedentary behaviour. In 2017–2020, 31% of adults were physically active, 33% partially active and 37% sedentary.[67][68]
• Monitor vaccination through National Prevention Plan and National Vaccine Prevention Plan indicators, including annual progress towards at least 90% human papillomavirus vaccination coverage among eligible girls and boys by 2030.[69]
• Apply environmental and occupational surveillance through pollutant monitoring, cancer and mesothelioma registries, asbestos mapping, occupational exposure databases and monitoring of inspections, information and assistance activities.[70][8][71][72]
• Require oncology networks and Diagnostic, Therapeutic and Care Pathways to use written procedures, annual process and outcome indicators, digital traceability and periodic audits. Relevant measures include timeliness from suspicion to diagnosis and diagnosis to treatment, survival, complications, treatment toxicity, quality of life, patient-reported outcomes, satisfaction and resource consumption.[36][19][73][52]
• Monitor care integration, including regional programmes on healthy lifestyles, physical activity and nutrition for people with cancer; waiting times; multidisciplinary-team activity; access to palliative care; and the quality of regional oncology and rare-tumour networks.[54][74][75][76][25]
• Use patient-reported outcome measures and patient-reported experience measures to assess care quality, patient experience and long-term survivorship needs, including through digital oncology pathways.[53][77][78]
• Strengthen digital monitoring by recording home telemedicine through the SIAD information flow, integrating electronic health and oncology records, and monitoring electronic-record coverage, digital pathology traceability, survivor smart cards and telepathology-network activation.[79][78]
• Monitor research, training and communication through counts of strategic research projects, training pathways, continuing education courses, communication campaigns and mobile-health initiatives.[55][50][80]

Costing & Financing

Financing is drawn from national health and prevention funds, regional contributions, Recovery and Resilience Plan missions, European programmes and targeted statutory funds. Although several allocations are explicit, the plan generally does not provide a consolidated implementation budget, costed activity plans, quantified funding gaps or a common economic model.[9][43][23][56]

• Support regional cancer registries through authorised annual expenditure of one million euros from 2020 for network implementation and regional technological infrastructure.[41]
• Use National Recovery and Resilience Plan Mission 6, Component 2 and Investment 1.3, alongside EU4Health, the European Regional Development Fund, the Cohesion Fund and the European Social Fund Plus, to strengthen registry and health-data infrastructure.[17]
• Finance organised screening through an annual 240 million euros National Prevention Plan quota and 200 million euros annually from Regions under the 23 March 2005 State-Regions Agreement.[9]
• Allocate five per cent of the annual 240 million euros earmarked for National Health Plan objectives to prevention-plan networks, including screening, cancer-registration and evidence-based prevention networks.[43]
• Provide one million euros in each of 2021 and 2022 for lung-screening activity, comparison of low-dose computed tomography strategies and primary prevention for people at high risk.[65]
• Fund precision-oncology testing through five million euros in 2021 and five million euros annually in 2022–2023 for next-generation sequencing, plus 200,000 euros annually in 2023–2025 for cholangiocarcinoma profiling.[23]
• Provide 20 million euros annually in 2021–2023 for genomic tests for early hormone-responsive breast cancer, with the intended potential to avoid unnecessary chemotherapy and related costs.[57]
• Fund psychological wellbeing and access to psychological services with 10 million euros in 2021, allocated to Regions and Autonomous Provinces using school-age population and recent cancer-diagnosis data; a 10 million euros fund was renewed for 2022.[81][82]
• Support family caregivers through annual funding of 20 million euros in 2018–2020 and a subsequent annual 30 million euros fund in 2021–2023 for measures recognising unpaid family-care work.[83]
• Link supplementary National Health Service funding for Regions and Autonomous Provinces to implementation of the national three-year palliative-care programme, while seeking tariffs proportionate to palliative-care case complexity.[84]
• Recognise qualitative resource pressures where no monetary values are stated, including workforce and technology needs for radiotherapy, pathology, genomics, rare tumours, telemedicine, home care and multidisciplinary networks.[85][86][87][88]
• Identify potential efficiencies from prevention, vaccination, colorectal screening, coordinated pathways, early palliative care, appropriate genomics and reduced inappropriate follow-up, but without consistently quantifying savings. Actual estimated follow-up costs are reported as approximately ten times expected costs because of inappropriate examinations and visits.[5][89][11][44][30]