Εθνικό Σχέδιο Δράσης Για Τον Καρκίνο 2011-2015

Objectives

The National Cancer Action Plan 2011–2015 provides Greece’s framework for national cancer planning, consultation and coordinated action, seeking to strengthen public understanding of cancer as a common chronic disease and improve prevention, diagnosis, treatment and support.[1]Its overarching aims are to reduce exposure to cancer risks and future incidence, increase survival and quality-adjusted life years, improve quality of life for patients and families, reduce the burden and social cost of cancer, and ensure equitable access to integrated, modern services.[2]

• Reduce modifiable risks through primary prevention addressing tobacco, alcohol, unhealthy diet, physical inactivity, obesity, harmful solar exposure, infections including hepatitis B and C and human papillomavirus, and environmental or radiation-related risks.[3][4][5][6][7]
• Increase early diagnosis and participation in organised, population-based screening, particularly for cervical and breast cancer, using scientifically documented protocols and certified services.[2][8][9]
• Improve treatment quality and effectiveness through clinical protocols, guidelines, specialised centres, certified units, quality-assured diagnostic laboratories and stronger biomedical technology.[10][11]
• Reduce inequalities in cancer outcomes by addressing poorer access to services and later diagnosis among lower socio-economic groups, while applying socio-economic and access-barrier criteria to screening populations.[12][9]
• Develop rehabilitation, follow-up, psychosocial support, patient-rights protection, labour and social reintegration, home nursing, hospice care and support for families and carers.[13][14][15][16][17]
• Strengthen cancer intelligence, research and evidence-based decision-making through national registries, integrated health data, epidemiological research, environmental-risk recording, genetic mapping and professional education.[2][15][16][18][19]

Implementation

Implementation combines population prevention, organised screening, service-quality improvement, specialised care, patient support and data infrastructure, led principally by the Ministry of Health and Social Solidarity, its General Secretariat for Public Health and supervised bodies.[1][5]Delivery is intended to draw on health regions, hospitals, health centres, educational and research institutions, local government, professional societies, non-governmental organisations, civil-society organisations and, for selected actions, other ministries and the Church of Greece.[8][20][14][15][19]

• Implement prevention through anti-smoking measures, alcohol-reduction information campaigns, school and community health education, food and school-health legislation, cross-ministerial physical-activity policies, and targeted awareness for vulnerable and high-risk groups.[5][6][7]
• Deliver cervical and breast screening through health regions, hospitals, health centres and collaborating bodies; define target populations by age, socio-economic circumstances and access barriers; connect mobile units to permanent services; train staff; and establish regional referral hospitals and pathways for notification, referral, treatment and follow-up.[8][9]
• Coordinate screening through a body recommended by the National Public Health Council to oversee implementation and the overall screening process.[9]
• Strengthen treatment services by introducing National Health System clinical protocols and guidelines, certifying units and laboratories, developing diagnostic reference networks, improving biomedical technology management, and creating specialised centres for liver, lung and oral cancer.[10][11]
• Establish hospital oncology committees, referral networks and centres of excellence, while improving metastatic bone disease services, childhood leukaemia treatment, specialised radiotherapy, home nursing, hospices, counselling and supportive care.[20][14]
• Develop a national oncology-patient registry, a metastasis registry and a National Cancer Registry; integrate existing databases and the Health Map; connect registry functions to reporting networks; and use these systems to support epidemiological study and more effective interventions.[15][18]
• Build workforce and research capacity through continuing education for health professionals, patients and carers; environmental-risk and radiation recording networks; and collaboration with Greek and international research centres.[19][17]
• Use indicative implementation periods that generally span 2011–2015, including 2011–2013 for several prevention, registry and data-system actions, 2011–2014 for clinical protocols, and 2011–2015 for screening, certification, training and selected care actions.[5][7][8][10][18][19]

The National Strategic Reference Framework is a principal implementation and financing vehicle for communication, clinical-protocol, certification, treatment-centre, registry and health-information actions.[7][10][11][18]Identified allocations include 1,626,890.77 euros for the National Communication Campaign for Cancer Prevention, approximately 45 million euro for a biomedical technology project, and 6 million euros for two health-information sub-projects.[7][10][18]The available material does not specify a comprehensive plan-wide governance structure, performance indicator set, reporting schedule or consolidated budget.[2][5][18]

Monitoring & Evaluation

The plan identifies major weaknesses in cancer intelligence and proposes registries, linked information systems and screening-pathway oversight to strengthen surveillance and implementation, but it provides limited detail on formal indicators, reporting schedules, evaluation methodologies and accountability procedures.[21][4][9][18][19]

• Address gaps in cancer data, including the absence of a national cancer registry, weaknesses in death recording and insufficient information to quantify the national burden of cancer.[21][4]
• Establish a National Cancer Registry, assigned to the Centre for Disease Control and Prevention, to support epidemiological study, connect with the Health Charter and reporting networks, and inform more effective interventions during 2011 to 2013.[18]
• Establish a national oncology-patient registry and a metastasis registry, including monitoring and reassessment of women treated for precancerous lesions.[15]
• Integrate existing systems and databases, complete the Health Map and develop environmental-risk recording networks for radiation and toxic or chemical substances.[18][19]
• Monitor organised screening through systems for notification, referral, treatment, intervention and follow-up, overseen by a coordinating body recommended by the National Public Health Council.[9]
• Conduct research on morbidity and mortality from malignant neoplasms, involving the independent national statistical authority and supervised bodies of the Ministry of Health and Social Solidarity.[16]
• Use certification procedures, laboratory quality control, biomedical technology management, registries and observatories as operational quality mechanisms for cancer services.[10][11]
• Evaluate the action concerning two specialised radiotherapy centres modelled on major centres in Athens and Thessaloniki.[14]
• Assign delivery responsibilities for prevention activities primarily to the General Secretariat for Public Health and supervised bodies, with contributions from health regions, hospitals, educational institutions, local authorities, professional bodies and non-governmental organisations.[5][6][8]
• Apply indicative implementation periods, including 2011 to 2013 for communication, registry and information-system actions; 2011 to 2015 for screening, lifestyle, training and support actions; and 2011 to 2014 for clinical protocols.[5][6][8][10][18][19]

Quantitative performance measures, standardised reporting requirements, audit arrangements, evaluation criteria and a comprehensive accountability framework are not specified in the available extracts.[2][9][10][16][17]

Costing & Financing

Cancer is presented as imposing substantial direct, indirect and social costs, while the plan identifies several National Strategic Reference Framework-funded actions and a small number of explicit budgets.[22][23][7][10][18]

• Recognise direct treatment costs from hospitalisation, surgery, diagnostic examinations, therapeutic interventions and particularly expensive pharmaceutical treatment.[22]
• Estimate cancer treatment at approximately 6.5% of total health expenditure in Greece.[22]
• Recognise indirect costs from lost productivity, family-provided home care and lost working days for patients and carers, estimated at least twice direct treatment costs.[22]
• Address wider social costs affecting social development, prosperity, cohesion, dignity, social participation and family and professional life.[23]
• Finance the National Communication Campaign for Cancer Prevention through a National Strategic Reference Framework project that began in January 2011, with KEELPNO designated as beneficiary and a budget of 1,626,890.77 euros.[7]
• Support clinical protocols, certification of units and services, specialised treatment centres, the National Cancer Registry and health-information projects through the National Strategic Reference Framework.[10][11][18]
• Provide an estimated 45 million euro for a biomedical technology project, including pathology and cytology laboratory equipment for cervical cancer reference centres.[10]
• Allocate a combined 6 million euro budget to two sub-projects integrating existing systems and linking them with available databases during 2011 to 2013.[18]
• Assume that prevention and early diagnosis can reduce treatment costs, while actions on treatment, support and reintegration seek to reduce the social and economic burden of cancer.[8][14]

Beyond these identified projects and cost estimates, the available extracts do not specify a consolidated plan budget, expenditure by intervention, recurrent financing arrangements, resource-mobilisation targets, funding gaps or broader economic assumptions.[8][11][15][19][17]