National Cancer Control Plan 2024-2030

Objectives

The Bermuda National Cancer Control Plan 2024–2030 provides a national framework to reduce the burden of cancer and improve quality of life through prevention, early diagnosis, treatment, integrated care, survivorship, palliative care, surveillance, workforce development and health equity. It supports the Bermuda Health Strategy vision of healthy people in healthy communities and equitable access to essential health services without financial hardship.[1][2][3]

• Promote healthy living and prevent cancer by addressing physical inactivity, unhealthy diet, overweight and obesity, tobacco use, harmful alcohol use, sun exposure, cancer-causing infections, chemical exposure and environmental contamination.[3][4][5]
• Increase hepatitis B vaccination coverage and achieve higher human papillomavirus vaccination coverage, including a target of 90% among adolescents aged 15 by 2030.[4][5]
• Strengthen tobacco control, smoke-free environments, cessation support, public education and protections for young people under the Tobacco Control Act framework.[6][7]
• Improve food and physical-activity environments, including healthy school policies, active spaces, nutritional information and measures intended to increase access to fruit and vegetables.[7][8]
• Provide evidence-informed, patient-centred, timely and equitable screening, diagnosis and integrated cancer care, with particular attention to early detection and underserved populations.[3][9][10]
• Develop national screening guidance, reminder and recall systems, rapid diagnostic access, timely imaging, familial-genetics support and outreach to populations facing barriers to screening and diagnosis.[11][10]
• Design coordinated care pathways for breast, prostate and colorectal cancers, acute oncology, treatment and supportive care, with the aim of improving patient experience, clinical outcomes and operational performance.[12][13]
• Optimise treatment by reducing delays, improving access to oral chemotherapy and gene-expression assays, and adapting to developments in radiation and systemic therapies.[14][15]
• Optimise quality of life for people affected by cancer through reviewed palliative and end-of-life care, survivorship standards and personalised survivorship care plans covering treatment summaries, follow-up and health promotion.[14][16]
• Strengthen cross-cutting policy, surveillance, health-information systems, workforce capacity, equity and on-island cancer research.[17][18][19]

The plan is motivated by cancer being Bermuda’s second leading cause of death after heart disease and contributing to approximately one-third of annual deaths. It uses findings from the 2022 National Cancer Assessment, national data, evidence and best practice to define goals, objectives, strategies, targets and performance indicators across four priority areas: prevention; early detection, treatment and integrated cancer care; survivorship and palliative care; and cross-cutting priorities.[1][2][20]

Equity is integral to the framework: the plan seeks equitable access to prevention, screening, diagnosis, treatment and survivorship while reducing financial hardship, socioeconomic disparities and differences in cancer outcomes.[21][18]

Implementation

Implementation is designed as coordinated, phased national action involving government, health-service providers, insurers, community organisations, employers, schools, media, professional groups, cancer survivors and residents. Actions are sequenced as immediate measures in 2024, short-term measures in 2025–2026 and longer-term measures in 2027–2030, with Annex 2 identifying recommended strategies, lead agencies and timelines for objectives.[2][3][22]

• Coordinate governance through the Ministry of Health and its Department of Health, Health Insurance Department, Office of the Chief Medical Officer and Ageing and Disabilities Services, alongside the Bermuda Hospitals Board and Bermuda Health Council.[2]
• Deliver community health, health promotion, environmental health, laboratory and administrative services through public provision, while relying predominantly on private primary care and Bermuda Hospitals Board facilities for secondary care.[23]
• Use overseas health centres for cancer services unavailable on the island, while maintaining collaboration with overseas institutions to support patient safety and clinical quality.[23][13]
• Engage Bermuda Cancer and Health Centre, the Bermuda Tumour Registry, PALS, general practitioners, specialist providers, payers, faith-based and community organisations, employers, schools and media in prevention, care access, survivorship and public communication.[1][22][16]
• Draw on technical support from the Caribbean Public Health Agency, Pan American Health Organization, United States National Cancer Institute and Union for International Cancer Control.[2]
• Establish or strengthen Cancer Navigator and Care Coordinator roles, nurse-led care, multidisciplinary teams and standardised pathways to improve referral, communication, continuity, safety and follow-up.[12][13][15]
• Prevent patients falling out of care pathways through internal controls and automated follow-up for missed appointments and active surveillance.[12][15]
• Review palliative-care services and patient journeys, identify staffing needs and integrate treatment with supportive and palliative care.[14][16]
• Maintain cancer screening and treatment without co-payments where provided through the Bermuda Health Plan and Universal Health Coverage arrangements, while using the Equal Access Fund to support underinsured and uninsured people.[18][24]

Surveillance and performance management rely on defined objectives, baseline measures, targets, data sources and indicators. Priority measures include cancer incidence, mortality, stage at diagnosis, screening uptake, diagnostic and treatment intervals, hospital stay, patient experience, vaccination coverage, risk-factor prevalence, palliative-care access, data quality, workforce capacity and financial protection.[4][5][25][26][19]

The Bermuda Tumour Registry and Epidemiology and Surveillance Unit provide core cancer data, while the plan proposes mandatory timely case reporting, National Healthcare Identifiers and a multi-institutional clinical registry using systems such as PEARL and ARIA to link diagnosis, treatment, pathology, demographic and survival information.[20][17][16][26]

Operational monitoring includes routine reporting of incidence and mortality, improved recording of stage at diagnosis and survival, disaggregation of data by demographic characteristics, audits of pathology and radiology, review of inpatient volume and length of stay, workforce reporting, and monitoring of environmental and occupational exposures.[9][21][13][24][19]

Several indicators require baseline values or future targets to be established, including youth physical inactivity, diagnostic and treatment waiting times, patient experience, palliative-care access, survival, workforce capacity and workforce satisfaction.[4][25][26][19]

Monitoring & Evaluation

Monitoring is structured around key performance indicators, baselines, targets, data sources and phased implementation across prevention, integrated cancer care, palliative care, survivorship, workforce, equity and research priorities. Annex 3 is intended to define indicators, targets and timeframes for each objective, with alignment to national, regional and global health targets where appropriate.[2][3]

• Monitor prevention through measures of overweight and obesity, physical inactivity, smoking, binge drinking, harmful alcohol use, melanoma incidence, hepatitis B and human papillomavirus vaccination coverage, and chemical-exposure-related poisonings, emergency visits, occupational illness and dangerous occurrences.[4][5]
• Establish and update baselines through routine surveillance of adults and young people, potentially including the Global School-Based Health Survey, the STEPS survey, the Premier’s Youth Fitness Programme and immunisation reporting systems.[8][4][5]
• Track cancer outcomes through incidence, mortality, stage at diagnosis, survival, early-onset cancer trends and inequalities between population groups. Incidence and mortality monitoring is to use age-standardised three-year averages for all cancers combined, by sex and key cancer sites.[17][26]
• Use reported baseline incidence values of 219 per 100,000 overall, 237 per 100,000 for males and 210 per 100,000 for females, alongside mortality values of 81, 98 and 70 per 100,000 respectively.[26]
• Strengthen surveillance through timely mandatory cancer-case reporting to the Tumour Registry, National Healthcare Identifiers, integration of hospital, laboratory and registry systems, and a multi-institutional clinical registry using PEARL and ARIA software.[17][16][26]
• Improve data quality by standardising Tumour Registry reporting, refining stage-at-diagnosis records, aligning race categories with the Census, improving survival-data collection, and reporting completeness and statistically significant changes.[21][16][24]
• Measure early detection and care through mammography uptake, the proportion of cancers diagnosed at Stage III or IV, referral-to-diagnosis and diagnosis-to-treatment intervals, hospital length of stay, and patient satisfaction or experience.[25]
• Audit pathology and radiology performance, review inpatient volumes and length of stay, and use pathway controls, automated follow-up for missed appointments, active surveillance and multidisciplinary quality control to support patient safety and continuity of care.[13][15]
• Monitor palliative care through providers per 100,000 population and the proportion of cancer patients needing palliative care who receive it; baselines and targets for access remain to be established.[25][26]
• Report workforce staffing, retention, vacancies, challenges, successes, experience and satisfaction, while measuring cancer personnel per 100,000 population.[18][24][19]
• Assess equity through insurance coverage, access to essential services, financial barriers along cancer pathways and the proportion of households whose health expenditure exceeds 10% of total household expenditure or income.[18][19]

Several indicators remain incomplete, including youth physical inactivity, diagnostic and treatment intervals, patient experience, palliative-care access, survival, race-disaggregated outcomes, workforce capacity and workforce satisfaction. The extracts do not provide a single comprehensive reporting timetable or a fuller formal evaluation and accountability framework beyond the specified registry, institutional, audit and routine-reporting mechanisms.[4][25][26][19]

Costing & Financing

The plan does not provide a quantified implementation budget, detailed costed interventions, stated funding gap, financing total or economic assumptions. It nevertheless identifies the wider health-financing context, financial-protection commitments and several prospective fiscal, funding and cost-analysis measures.[27][4][5][25]

• Record private health insurance as the principal source of health financing at 62%, followed by public-sector funding at 23%, out-of-pocket payments at 15% and charitable donations at 1%.[23]
• Note that total health expenditure increased from 427 million in financial year ending 2006 to 737 million in financial year ending 2018, with per-capita expenditure of 11,529 in financial year ending 2018.[23]
• Identify financial year ending 2018 expenditure of 308 million for the Bermuda Hospitals Board, 93 million for overseas care, 89 million for local practitioners, 72 million for health-system administration, 45 million for prescription drugs and 37 million for the Ministry of Health and Seniors.[23]
• Maintain cancer screening and treatment without co-payments through the Bermuda Health Plan and Universal Health Coverage arrangements, while Bermuda Cancer and Health Centre provides specified clinical services without co-payments.[18]
• Support underinsured and uninsured people through the Equal Access Fund, which is supported by community donations to subsidise clinical services.[18]
• Consider fiscal measures including a sugar tax intended to subsidise fruit and vegetable access, financial incentives for fruit and vegetable purchases, and policies designed to discourage alcohol consumption.[8][28]
• Improve insurance coverage for smoking-cessation services, provide funding to sustain sun-safety education, and ensure vaccine cost does not impede access.[29][8]
• Undertake a cost-benefit analysis comparing quadrivalent and nonavalent human papillomavirus vaccines.[29][28]
• Review financial barriers and potential financial toxicity along cancer pathways, particularly for underserved, uninsured and underinsured people.[18][10]

Prevention is characterised as the most cost-effective cancer-control strategy, but this is not accompanied by quantified savings or investment requirements. Workforce expansion, cancer navigation, nurse-led care, diagnostic improvements, registries, pathway redesign and integrated multidisciplinary services are identified as resource implications without assigned monetary values.[3][10][13][15][24]