Poursuite de la Stratégie nationale contre le cancer

Objectives

Switzerland’s National Cancer Strategy provides a coordinated framework for reducing cancer incidence and the consequences of cancer, while ensuring that patients and relatives receive support independent of particular interests. It was adopted for 2014–2017 and extended to 2020 because implementation under a subsidiarity model required more time and several projects remained incomplete.[1][2][3]The continuation retains the original vision and principles while adapting priorities to emerging needs, especially follow-up and survivorship for a growing population of people living after cancer.[2][4]

• Strengthen prevention and early detection through cancer-specific risk-factor measures, colorectal screening, breast-screening evaluation and national screening governance.[5][6][7][8]
• Improve care and follow-up through patient pathways, treatment recommendations, tumour boards, integrated care, rehabilitation, survivorship services and patient self-management.[5][6][9][10][11]
• Enhance care quality through continuously reviewed guidelines, certifications, transparent care structures, outcome indicators and treatment-quality data.[4][12][13]
• Develop professional, patient and relative competencies, including cancer literacy and digital learning opportunities.[4][5][14]
• Promote health-services, clinical and translational research, particularly on the effectiveness, safety, equity, appropriateness and economic implications of innovative cancer therapies.[5][14][15]
• Strengthen epidemiology, data, cancer registration, monitoring and knowledge transfer so that evidence can inform policy and practice.[1][4][13]
• Build an oncology community and a legitimate national platform, intended by 2020 to connect cancer institutions and support implementation of concepts and evaluated pilot projects from 2021 onwards.[16]

Implementation

Implementation is partnership-based, intersectoral and subsidiary. The Swiss Health Policy Dialogue, involving the Confederation and cantons, adopted the original strategy and mandated Oncosuisse to coordinate implementation; in 2017 it further mandated Oncosuisse to continue the work to 2020.[17][3]Delivery relies on collaboration among federal and cantonal authorities, cancer organisations, professional and specialist societies, research institutions, healthcare providers, patients and other partners.[1][2]Quality, innovation and coordination are cross-cutting requirements for activities across prevention, care, follow-up, research, data and communication.[18][19]

• Prioritise and revise projects through project leaders and partner organisations, including validation of activities, priority-setting and delivery timetables.[18]
• Support activity leads through SNC project management, using short-term expert panels where specialised knowledge is required.[19]
• Align cancer work with other national strategies and initiatives, notably the strategy on prevention of non-communicable diseases, Santé2020, digital health, quality policy, palliative care, rare diseases and highly specialised medicine.[5][20][21]
• Implement screening through systematic population-based colorectal programmes where appropriate, continued breast-screening evaluation, and a politically independent screening expert body initially established as a pilot.[7][8]
• Develop coordinated care through electronic clinical pathways, multidisciplinary tumour boards, Swiss Comprehensive Cancer Centers, a national networking concept and collaboration across ambulatory, hospital and community services.[12][9][10]
• Strengthen survivorship through oncological rehabilitation, interprofessional training, peer self-management and support during transitions such as late effects of childhood cancer.[11]
• Generate evidence through health-services research, clinical registries for innovative therapies, research partnerships and data collection on treatment outcomes, off-label use and equitable access.[14][15][13]
• Facilitate knowledge exchange through Oncosuisse, thematic symposia, expert exchanges, a cancer community, horizon scanning, targeted communications and regular thematic reports for practitioners and policy stakeholders.[13][16][20][22][23]

Monitoring is mainly embedded at project and activity level. An interim evaluation undertaken between October 2016 and February 2017 found that stakeholders regarded the strategy as valuable and essential, but identified limited ownership among some partners.[3]Activities are expected to define relevant quality and innovation indicators, assess whether criteria are met, identify improvement potential and consider wider transfer of results.[19]Specific mechanisms include evaluation of colorectal-screening objectives and clinical-pathway pilots, continued monitoring of breast-screening programmes, treatment-quality indicators, registry-based data linkage, and tumour-board documentation suitable for electronic reporting to cancer registries.[7][8][12][9][13]The source does not specify a consolidated national indicator set, numerical targets, common reporting timetable, overarching evaluation method or formal accountability framework.[24][3][19]

Financing is not set out as a strategy budget or project allocation. The source identifies annual direct cancer-care costs of approximately 4 billion Swiss francs and annual indirect costs of 5.8 billion Swiss francs, including lost income, early retirement and care provided by relatives.[17]It also identifies the costs, reimbursement, appropriateness and equitable access implications of innovative medicines as policy concerns, but does not specify funding sources, quantified resource requirements or funding gaps for the continuation period.[4][15]

Monitoring & Evaluation

Monitoring and evaluation combine programme-specific assessment, cancer registration, treatment-quality data, clinical registries, quality review and knowledge reporting. Oncosuisse coordinates implementation, commissioned an interim evaluation in 2016–2017, and is expected to support the continued assessment of activities.[3][17]

• Evaluate colorectal screening against its objectives and maintain standardised delivery and quality control from screening through diagnosis.[7]
• Continue evaluating and monitoring breast-screening programmes, establish national evaluation criteria and clarify institutional responsibilities.[8]
• Define quality indicators for cancer-care structures, processes and outcomes, including clinical and patient-reported outcomes, and make findings usable by cantonal authorities.[12]
• Review treatment guidelines and certification arrangements continuously, including the validity of certifications and possible certification of treatment networks.[4][12]
• Use pilot evaluations to assess colorectal clinical pathways, including their added value, implementation effort, intersectoral interfaces and resulting interprofessional collaboration.[12]
• Map multidisciplinary tumour boards, review common requirements and documentation standards, and use tumour-board reports as source data for treatment registration and electronic reporting to cancer registries.[9]
• Implement data and register mechanisms through the federal legislation on cancer-disease registration, including recording and linking treatment-quality data.[4][6]
• Operate multi-year clinical registries for innovative therapies to collect data on patients, disease course and treatment, including economic and appropriateness outcomes, and systematically document off-label use.[15]
• Specify additional data for registration so that detailed reports on treatment development and quality can initially be produced for colorectal cancer and potentially extended to other cancers.[13]
• Require activity leads to assess quality and innovation using relevant indicators, determine whether criteria are met, identify improvement potential and consider wider implementation or transferability.[19]
• Conduct horizon scanning, make knowledge on cancer trends available through the national platform, and issue thematic reports at regular intervals for practitioners and policy stakeholders.[16][20]
• Report regularly on implementation progress and provide detailed accounts of selected results in priority areas; further evaluation of internal and external communication is anticipated.[22]

No consolidated numerical indicator framework, common reporting timetable, evaluation methodology, surveillance targets or formal accountability structure is specified across the supplied extracts.[24][19][13][22]

Costing & Financing

Financial information is limited. Cancer is associated with substantial annual direct medical and indirect economic costs in Switzerland, while the continuation strategy identifies financing, reimbursement, access and economic assessment as policy issues rather than presenting a funded budget or costed implementation plan.[17][4][15]

• Recognise annual direct medical-care costs from cancer of approximately 4 billion Swiss francs.[17]
• Recognise annual indirect costs of 5.8 billion Swiss francs, including lost patient income, early retirement and care provided by relatives.[17]
• Assess cost, reimbursement, equitable access, individual effectiveness and appropriateness in relation to innovative medicines and precision or immuno-oncology treatments.[4]
• Examine economic efficiency and appropriateness of innovative interventions through clinical research and studies conducted under the Federal Health Insurance Act.[15]
• Maintain the Health Services Research in Oncology and Cancer Care encouragement programme, initially guaranteed until 2020, to support analysis of the quality and costs of cancer care and real-world access to services.[15]
• Consider medical, economic, legal and ethical issues in the work of the proposed cancer-screening expert body.[8]
• Assess investment requirements for establishing intersectoral clinical pathways through the colorectal pathway pilot.[12]
• Address financing of services in the national networking concept and in the establishment and embedding of ambulatory oncological rehabilitation.[10][11]
• Apply cost-benefit considerations as one aspect of quality assessment for strategy activities.[19]
• Note that participating stakeholders had made considerable investments in projects already launched under the strategy.[3]

The extracts do not specify a strategy-wide budget, project allocations, financing sources, resource-mobilisation plan, quantified funding gap or monetary estimates for screening, communication, care coordination, research, rehabilitation or the proposed national platform.[3][8][10][16][22]