The National Cancer Plan 2011-2015

Objectives

The National Cancer Plan 2011-2015 sets a national, patient-centred framework to reduce cancer incidence, improve survival, prolong life where cure is not possible, and secure the best attainable quality of life for people with cancer and their families.[1][2][3]It combines population health action on preventable risk factors with coordinated care across diagnosis, treatment, survivorship, terminal care and bereavement.[2]

• Prevent avoidable cancers by reducing tobacco exposure, harmful alcohol use, unhealthy diet, obesity, physical inactivity, excessive sunlight exposure, occupational carcinogens and environmental risks.[4][5][6][7]
• Strengthen early detection through organised breast, cervical and colorectal screening, timely presentation and referral, and improved public and primary-care awareness of early cancer signs.[8][9][10]
• Improve quality and equity of care through prompt specialist access, multidisciplinary working, clinical guidelines, modern diagnostic capacity, specialist treatment and coordinated services across primary, secondary and tertiary care.[11][12][13]
• Provide person-centred support by respecting patients’ preferences and rights, improving information and participation, assigning a key worker, and addressing physical, psychological, social, spiritual and economic consequences for patients and carers.[12][14][15]
• Expand palliative, rehabilitation and bereavement care, including community and inpatient provision, to relieve pain and symptoms and support families from diagnosis through end of life.[14][16]
• Build workforce, surveillance and research capacity to improve knowledge of cancer incidence, survival, service quality, outcomes, causation and the effectiveness and cost-effectiveness of treatments.[17][18][19][20]

Implementation

Implementation is designed as a cross-government and whole-system programme, delivered in conjunction with other health strategies and through collaboration among public bodies, healthcare professionals, voluntary organisations, communities, patients, carers and families.[1][21][2]A central committee acting for the Minister responsible for Health is to coordinate the plan, obtain progress reports, action plans and financial accounts from entities within the Ministry of Health’s remit, oversee expenditure and commission scientific studies of key indicators.[22]

• Deliver prevention through education, legislation and support for sustained behaviour change, including tobacco-control restrictions, cessation services, alcohol controls, healthier food environments, obesity action, occupational-exposure surveillance and environmental protection measures.[5][23][24][25][6][7]
• Operate organised population-based screening programmes with defined target populations, invitation and follow-up systems, referral links, quality control and outcome monitoring.[8]Expand colorectal screening from 2012, assess human papillomavirus vaccination in 2011 before offering it to a selected cohort from 2012, and introduce organised cervical screening from 2014.[10]
• Establish fast-track pathways from family doctors to specialists, allocate dedicated investigation capacity, provide electronic clinical-record access, and use a named key worker to coordinate each patient’s pathway and communication.[26][13]
• Meet operational waiting-time objectives of no more than 10 working days from first hospital specialist contact to indicated imaging or diagnostic surgery, and no more than five working days from tissue or cell sampling to pathology reporting.[27][28]
• Develop and update evidence-based clinical guidelines that define multidisciplinary team membership, roles, referral arrangements, treatment pathways, follow-up and compliance requirements.[12][3][29]
• Strengthen diagnostic and treatment infrastructure through staff recruitment and training, modern imaging, installation of a positron emission tomography/computed tomography scanner, radiotherapy expansion, oncology and palliative-care development, and a new cancer treatment facility at Mater Dei Hospital.[27][30][31][22]
• Develop workforce capacity through an early needs analysis, a human-resources plan, undergraduate and postgraduate education, continuing professional development, overseas training and specialist career pathways and retention incentives.[17][32][18]
• Coordinate surveillance through the Directorate of Health Information and Research, linking the Cancer Register, Mortality Register, hospital information systems, patient administration systems and clinical databases.[19]Use registry, clinical and quality data to monitor incidence, mortality, prevalence, survival, treatment results and service performance.[18][19]
• Evaluate implementation through clinical indicators, guideline compliance, screening quality measures, waiting times, patient feedback, commissioned studies, a mid-term review and an end-of-term evaluation.[9][12][22]
• Finance delivery through substantial investment in human and material resources, including Government commitment of more than ten million Euros for plan measures during 2011-2015.[22]Support the planned cancer treatment facility, estimated at around 60 million Euros, through sought European Regional Development Fund assistance, and fund the projected 2.8 million Euros positron emission tomography/computed tomography scanner with Swiss Government assistance.[22]

Monitoring & Evaluation

The Plan establishes a broad monitoring and evaluation approach combining cancer surveillance, clinical-quality measurement, screening quality assurance, research, financial oversight and formal implementation review. It relies principally on the Malta National Cancer Registry, the Mortality Register, hospital information systems, clinical databases and the Directorate of Health Information and Research to track cancer burden, survival, treatment quality and service outcomes.[18][19][20]

• Monitor incidence, prevalence, mortality, survival, lifestyle factors, treatment results and the quality and impact of services across primary and secondary care.[18][19]
• Cross-reference Cancer Register and Mortality Register data to produce survival statistics and improve the quality of both registers, supplemented by patient administration systems, pathology registers and clinical databases.[19]
• Implement and publicise electronic submission of hospital and clinical data to the cancer registry to improve the completeness and timeliness of surveillance information.[20]
• Collect clinical indicators actively at departmental or hospital level, analyse them at hospital level, and transmit them to the National Cancer Registry for surveillance and quality assurance.[12][26]
• Monitor adherence to clinical guidelines and protocols, treatment effectiveness, and the implementation of evidence-based care pathways.[12][29][30]
• Measure diagnostic waiting times against targets of no more than 10 working days for indicated imaging and diagnostic surgery, and no more than five working days from sample collection to pathology analysis and reporting.[27][28]
• Assess screening effectiveness principally through mortality, incidence and mortality among the full target population and separately among attenders and non-attenders, supported by quality control of screening materials and processes.[8]
• Evaluate breast screening after its first three-year cycle against participation, recall and false-positive criteria, including a response rate above 70%, recall of 5% or less and false-positive results of 3% or less.[9]
• Monitor cancer stage at diagnosis through the Malta Cancer Registry and measure public awareness of early cancer signs as part of awareness-campaign development.[10][11]
• Use research to evaluate Plan implementation, investigate socio-economic and regional inequalities in incidence and survival, assess new treatments and technologies, and inform future clinical guidelines.[2][33][20]
• Gather patient experience through satisfaction surveys, focus groups and user panels, and consider incorporating patient assessments of treatment into nationwide satisfaction studies.[19][20]
• Require progress reports, action plans and financial accounts from entities within the Ministry of Health’s remit when requested by the central committee acting for the Minister responsible for Health.[22]
• Conduct a mid-term review and end-of-term evaluation covering implementation progress, achievement of targets and the general cancer situation in Malta.[22]

Several sections provide baseline data, including cancer survival, tobacco and alcohol behaviours, screening uptake, palliative-care activity and place of death, but do not define comprehensive reporting cycles, indicator specifications or accountability arrangements for every intervention.[34][35][36][14][16]

Costing & Financing

The five-year strategy requires substantial investment in physical infrastructure, technology, medicines and the cancer workforce. Government committed more than ten million Euros for Plan measures during 2011-2015, alongside major investments in a cancer treatment facility and positron emission tomography/computed tomography capacity.[22]

• Allocate funding to colorectal and cervical screening programmes and to new medicines, including human papillomavirus vaccine.[22]
• Construct a new cancer treatment facility at Mater Dei Hospital, estimated at around 60 million Euros, while seeking European Regional Development Fund support.[22]
• Procure and install a positron emission tomography/computed tomography scanner at Mater Dei Hospital at a projected cost of 2.8 million Euros, with Swiss Government assistance.[22]
• Resource screening through equipment, endoscopy and surgical capacity, supplies, information-technology adaptation, and professional training and retraining.[9]
• Invest in staff recruitment, retention, training and specialist development for oncology, radiotherapy, pathology, imaging, surgery, palliative care and wider cancer services.[31][32][37]
• Develop financial-control systems for cancer medicines, including expenditure and procurement-price monitoring.[30]
• Consider risk-sharing arrangements for emerging cancer medicines, under which industry or importers fund initial treatment cycles and public funding may support subsequent cycles where treatment proves effective and improves prognosis.[30]
• Assess new medicines and technologies for quality, safety, effectiveness, health and economic consequences, organisational implications, cost-effectiveness and added value.[29][20]
• Support cancer-specific clinical and clinical-quality databases through a possible fund linked to conditions such as annual reporting, and help researchers access project and European Union funding.[19][20]

In 2008, medicines used solely for cancer patients cost 4.9 million Euros, while other medicines often used by cancer patients, including in palliative care, cost 1.6 million Euros.[29]Cancer-medicine expenditure is expected to rise with increasing incidence, more sophisticated therapies, longer treatment periods and investment in advanced pathology and biomarker diagnostics.[29]Palliative care is free for people entitled to free healthcare, and voluntary-sector provision is partially Government-funded.[38]Most other sections identify resource needs but do not specify allocations, funding gaps, unit costs or wider economic assumptions.[21][22]