Poursuite de la Stratégie nationale contre le cancer

Objectives

Switzerland’s National Cancer Strategy 2017–2020 continues the 2014–2017 strategy, retaining its vision and principles while adapting priorities and projects to current needs and sustaining cancer-related work beyond 2020.[1][2][3][4]Its strategic priorities are quality, innovation and coordination across prevention and screening, treatment and follow-up, research, epidemiology, monitoring and knowledge transfer.[2][5]The framework comprises three domains, seven fields of action and 15 projects.[6]

• Reduce cancer risks by maintaining or introducing measures for risk factors not fully addressed through the national non-communicable diseases strategy, including ultraviolet radiation, chemicals, fine particulate matter and other environmental influences.[6]
• Improve screening by supporting population-based colorectal screening, facilitating appropriate opportunistic screening, ensuring balanced information and equitable access, and developing national mammography recommendations and evaluation criteria.[7]
• Strengthen patient-centred care by developing clinical pathways, improving treatment recommendations and tumour boards, advancing integrated care, and extending the care domain explicitly to follow-up and survivorship.[3][4][8][9]
• Improve rehabilitation, self-efficacy and health literacy for people affected by cancer, relatives and professionals, recognising the needs of more than 320,000 cancer survivors in Switzerland.[10][11]
• Develop professional competencies, health-services research and clinical research to transfer evidence into policy and practice and assess innovative therapies’ efficiency, appropriateness, equity and long-term effects.[11][12]
• Strengthen epidemiology and monitoring through cancer registration, treatment-quality data, data linkage and technical databases capable of producing reports on trends and treatment quality.[13]
• Build an oncology community that aligns organisations and networks around shared priorities and high-quality, equitable cancer care.[14][15]

Implementation

Oncosuisse coordinates implementation on behalf of the Swiss Health Policy Dialogue and was mandated to lead the 2017–2020 design work under the direction of the Swiss Cancer League and strategy project management.[16][1]Delivery relies on project leaders, partner consultation, cross-sector networks, cantonal and federal authorities, professional bodies, researchers, providers, patient organisations and civil society.[1][2][17]The approach combines project adaptation, quality assurance, coordinated care, digitalisation, evidence generation, communication and alignment with wider Swiss health-policy strategies.[3][15][18]

• Continue projects by requiring project leaders to redefine objectives, identify adaptations and priorities, propose complementary activities and tailor implementation to changing needs and operating conditions.[2][3]
• Consult partner organisations to validate activities, rank priorities and establish implementation timetables.[2]
• Integrate quality, innovation and coordination into each activity by defining relevant indicators, assessing compliance and improvement potential, considering cost-benefit implications, and supporting transfer of successful approaches across fields.[5]
• Maintain quality assurance by reviewing treatment guidelines and certificates continuously, while applying comparable principles to prevention and follow-up concepts.[3]
• Develop electronic, intersectoral and interprofessional colorectal cancer pathways, pilot their use, and use findings to extend care networks and potentially transfer the model to other cancers.[8][19]
• Strengthen multidisciplinary tumour boards, standardise their documentation, incorporate psychosocial and supportive-care dimensions, and support electronic reporting to population-based cancer registries.[9]
• Use digital and eHealth solutions, align work with Swiss eHealth Strategy 2.0, and develop networked, digital competency offers for professionals, patients and relatives.[3][8]
• Establish screening governance through professional collaboration, a colorectal-screening charter, a breast-screening symposium, and a politically independent expert body to assess medical, economic, legal and ethical issues and communicate screening benefits and risks.[7][20]
• Expand clinical registries and research collaboration to analyse innovative therapies, including effectiveness, appropriateness, cost-effectiveness, reimbursement, off-label use and nationwide access.[12]
• Coordinate registration and treatment-quality data through a working group led by Oncosuisse and the Swiss Society of Medical Oncology, with potential extension to additional cancers.[13]
• Operate a national cancer platform and oncology community to connect organisations, develop concepts, evaluate pilots, exchange knowledge and undertake inter-institutional horizon scanning.[14][15]
• Align activities with Health2020, the national non-communicable diseases strategy, environmental initiatives and related care, digital-health, quality and disease-specific programmes to avoid duplication and exploit synergies.[15][21][18]
• Strengthen communication through a three-year communication concept, active brand management, German- and French-language information, regular progress reporting, stakeholder engagement and audience-specific knowledge transfer.[22][17]

Monitoring & Evaluation

The National Cancer Strategy 2017–2020 embeds monitoring, evaluation and accountability across screening, care pathways, treatment quality, research, cancer registration, knowledge transfer and governance. Its approach combines project-level evaluation, quality indicators, registry-based evidence, expert review and regular communication, although no single consolidated performance framework is specified.[5][13][22]

• Evaluate strategy implementation through an interim evaluation commissioned by Oncosuisse between October 2016 and February 2017, which found broad stakeholder support for the strategy’s coordinating and networking role but identified limited ownership among some implementing partners.[1]
• Assess each activity against questions on quality, measurable indicators, compliance with criteria, scope for improvement, cost-benefit implications and transferability of improvements to other fields.[5]
• Assess innovation through defined indicators and improvement criteria, including its relevance to the field concerned and the potential to implement and scale successful innovations.[5]
• Define and assess coordination across treatment settings, professional groups, organisations, institutions and the wider health system, including the conditions for embedding activities in coordinated care.[5]
• Evaluate colorectal cancer screening to determine whether its objectives are achieved, while supporting uniform delivery through diagnosis, quality control and equitable access.[7]
• Establish national evaluation criteria for existing breast-screening programmes and clarify responsible parties; monitor international scientific developments and comparable screening provision through the planned independent expert body.[7][20]
• Evaluate the colorectal clinical-pathway pilot for added value across care interfaces, investment requirements and resulting interprofessional collaboration.[8]
• Compile and compare cancer-care models, structural, process and outcome indicators, and certification arrangements, including certification of treatment networks.[8]
• Map multidisciplinary tumour boards, review their requirements and standardise reporting to support electronic submission to population-based cancer registries.[9]
• Maintain ongoing review of treatment guidelines and certificates, and apply quality-control principles to prevention and follow-up concepts.[3]
• Evaluate the peer-supported self-management pilot for breast-cancer survivors and assess the feasibility and prototype of digital learning for professionals.[10][11]
• Analyse multi-year clinical-registry data to assess innovative therapies, including effectiveness, appropriateness, long-term effects and cost-effectiveness; quantify and document off-label use and compare findings internationally.[12]
• Collect additional treatment-quality data through national cancer-registration infrastructure, link datasets where appropriate, and produce reports on cancer trends and treatment quality.[23][13]
• Evaluate pilot projects developed through the national oncology platform before planned implementation from 2021, and circulate resulting knowledge within the oncology community.[14]
• Undertake systematic inter-institutional horizon scanning and prepare regular thematic reports for practitioners and policymakers, developing and assessing action where reports identify political need.[14][15]
• Report regularly on implementation progress and selected priority results, using subsequent evaluation findings to strengthen communication and engagement.[22]
• Address the absence of a specified consolidated indicator set, reporting timetable, surveillance architecture and formal accountability framework for the strategy as a whole.[24][4][21][17]

Costing & Financing

The strategy identifies a substantial economic burden from cancer and incorporates economic considerations into quality assessment, screening advice, rehabilitation, service financing and research on innovative therapies. However, it provides no overall programme budget, quantified allocation, financing plan, resource-mobilisation mechanism or stated funding gap for the 2017–2020 continuation.[16][5][12]

• Recognise annual direct cancer-care costs of approximately 4 billion Swiss francs, covering hospitalisation, medicines, and medical and nursing services.[16]
• Recognise annual indirect cancer costs of approximately 5.8 billion Swiss francs, including lost income, early retirement and care provided by relatives.[16]
• Consider cost-benefit implications when assessing the quality of activities, without specifying a methodology, threshold or monetary allocation.[5]
• Consider economic appropriateness in breast-screening recommendations and require the planned screening expert body to take economic, legal and ethical issues into account.[20]
• Address financing of services as a key issue when developing networks linking care professions, institutions and care units, while leaving financing arrangements unspecified.[19]
• Examine financing and economic efficiency in oncological rehabilitation and innovative therapies, including analysis with health insurers within the framework of the Health Insurance Act.[10][12]
• Maintain clinical registries for innovative treatments to assess cost-effectiveness, appropriateness, reimbursement-related issues and equitable nationwide access, without providing monetary assumptions or reimbursement amounts.[3][12]
• Support health-services research through the programme “Health Services Research in Oncology and Cancer Care”, initially guaranteed until 2020, covering quality and costs of cancer care, access to services and real-world service use.[11]
• Note that some projects required considerable investment by participating actors, although neither the amount nor the sources of these investments are specified.[1]
• Recognise that the proposed national oncology platform depends on support from cantons because of its subsidiary role, without defining the form, value or mechanism of that support.[14]
• Address the absence of specified budgets, expenditure lines, funding sources, resource allocations, funding gaps and broader economic assumptions for implementation, communication, data infrastructure and stakeholder activities.[13][21][17]