Estratégia Nacional de Luta contra o Cancro, Horizonte 2030

Objectives

Portugal’s National Strategy for Cancer Control, Horizon 2030, provides a citizen-centred framework to reduce preventable cancer incidence, improve early diagnosis, survival and quality of life, ensure equitable access to care, support social and professional reintegration of survivors, and assist carers. It is integrated into the National Health Plan and aligned with Europe’s Beating Cancer Plan.[1][2]

• Organise cancer control around four strategic pillars: prevention; screening and early detection; diagnosis and treatment; and survivorship.[1][2]
• Reduce modifiable cancer risks through tobacco and alcohol control, healthy eating, physical activity, healthy weight, vaccination, and reduced environmental, occupational and ultraviolet exposure to carcinogens.[2][3][4]
• Reduce tobacco prevalence among people aged over 15 from 17% in 2019 to below 14% by 2025 and below 10% by 2030.[5][6]
• Reduce under-18 binge drinking from 18% in 2019 to 15% by 2030, and reduce alcohol abuse and dependence from 3.6% in 2017 to 3% by 2030.[3]
• Reduce adult excess weight from 67.6% to 65% by 2030, prevent further increases in childhood excess weight and obesity, and reduce physical inactivity among people aged 15 and over by at least 10% from the 2019 estimate.[7][4]
• Maintain human papillomavirus vaccination coverage above 90%, hepatitis B vaccination coverage above 95%, and hepatitis C cure rates above 95% after diagnosis through 2030.[8][9]
• Achieve 100% geographical coverage, more than 95% population coverage and more than 65% participation in breast, cervical and colorectal screening programmes by 2030, while assessing staged programmes for prostate, lung and stomach cancer.[10][11]
• Formalise the Oncology Referral Network by 2026, ensure that more than 90% of patients are managed in certified disease-specific units by 2030, and ensure that more than 85% receive multidisciplinary therapeutic decision-making before first treatment.[12][13]
• Improve timely access to surgery, radiotherapy and curative-intent pharmacological treatment, while expanding precision medicine, genetic counselling, nutritional care, psycho-oncology and palliative support.[13][14]
• Strengthen research, including by doubling ongoing cancer clinical trials and increasing patient recruitment by 100% from 2020 levels by 2027.[15]
• Improve survivorship outcomes through systematic assessment of morbidity, disability and quality of life, structured treatment summaries, physical-activity support, and strengthened social, employment and financial protections for survivors and carers.[16][17][18]

Implementation

Implementation combines national policy leadership, technical standard-setting, decentralised service delivery and independent monitoring. The strategy seeks coordinated, multidisciplinary action across the cancer continuum, using existing National Health Service resources more effectively while identifying investment and workforce needs to improve proximity and territorial equity of care.[19][20][12]

• Lead politically and legislatively through the Ministry of Health, provide technical and normative leadership through the Directorate-General of Health, and deliver operationally through the Executive Directorate of the National Health Service in coordination with the Central Administration of the Health System and Shared Services of the Ministry of Health.[20][21]
• Coordinate the strategy through an Executive Committee led by the Director of the National Programme for Oncological Diseases, with representation from health-system bodies, the government member responsible for science, the Agency for Clinical Research and Biomedical Innovation, and patient associations.[21][22]
• Establish thematic working groups involving relevant public and social-sector actors, hold regular coordination meetings, adapt information systems, and centrally procure essential goods and services where required.[21][22]
• Implement prevention through cross-government action with programmes for healthy eating, physical activity, tobacco control and viral hepatitis, alongside bodies responsible for addictive behaviours, mental health and environmental protection.[23]
• Regulate tobacco and alcohol products, marketing, sales and taxation; expand cessation and addiction interventions; strengthen primary-care brief interventions; and link health, social and community services through addiction referral and coordination networks.[6][3]
• Implement occupational and environmental protections by transposing European rules on carcinogenic and mutagenic substances, improving worker-exposure guidance, characterising occupational cancers, regulating ultraviolet-radiation establishments, and advancing air- and drinking-water-quality policies.[24]
• Coordinate population screening through a National Coordination Unit under the Executive Directorate of the National Health Service, harmonise procedures to Directorate-General of Health standards, improve information-system interoperability, and target barriers affecting underserved populations.[11][25][26]
• Develop the Oncology Referral Network and Integrated Oncology Centres as an integrated, hierarchical system linking hospitals and multidisciplinary services, with certification criteria, clinical audit and performance metrics for diagnosis and staging.[27][13]
• Support treatment quality through procedure catalogues, guaranteed maximum response times, access-management monitoring, certification of radiotherapy services, clinical guidance, and indicators of equitable access to surgery, radiotherapy and medicines.[14][15]
• Mobilise research through clinical-trial catalogues, research criteria for Integrated Oncology Centres, platforms linking public, private and social-sector research centres, patient involvement, training, and the National Cancer HUB’s support for European funding opportunities.[28][29]
• Deliver survivorship support by integrating quality-of-life measures into the National Cancer Registry, developing exercise advice tools and consultations, expanding home-based palliative care, improving mental-health support, and reviewing legal protections for patients, survivors and carers.[17][18]
• Monitor implementation through indicator collection and sharing, public screening information, service-performance measures, and an annual Executive Committee report to the Ministry of Health; the Doutor Ricardo Jorge National Health Institute conducts autonomous and impartial policy-impact studies.[21][11]
• Finance essential institutions through the Central Administration of the Health System and align contracting priorities with implementation, while pursuing European funding through Horizon Europe, EU4Health and the Digital Europe Programme. Quantified budgets, domestic allocations and funding gaps are not specified in the supplied text.[21][28][29]

Monitoring & Evaluation

The strategy establishes a national monitoring and accountability architecture combining independent policy-impact evaluation, indicator collection, annual implementation reporting, programme-specific targets and public disclosure of screening information. The Doutor Ricardo Jorge National Health Institute is responsible for autonomous and impartial studies of implemented health-policy impacts, while the Executive Committee reviews implementation information, agrees adaptations and submits an annual report on results and operational challenges to the Ministry of Health.[21][22]

• Collect and share indicators on the impact and execution of planned measures, following consultation with the Executive Committee.[21]
• Monitor implementation against defined targets, adapt measures where necessary, and strengthen accountability across governance levels.[2][20]
• Track prevention outcomes, including tobacco prevalence, binge drinking, alcohol abuse and dependence, excess weight, physical inactivity, vaccination coverage and hepatitis C cure rates.[5][3][7][4][8]
• Use time-bound prevention milestones, including 2025 actions on air quality, occupational carcinogen regulation, technical guidance, occupational-disease characterisation and ultraviolet-radiation regulation, alongside 2030 environmental, alcohol and weight targets.[24][7]
• Monitor annual food advertising aimed at children under 16 and healthcare professionals’ knowledge, attitudes and practices concerning physical-activity promotion.[4][30]
• Measure population-based screening performance against 2030 targets of 100% geographical coverage, more than 95% population coverage and more than 65% participation for breast, cervical and colorectal screening.[11][26]
• Define and publicly disclose screening monitoring and evaluation indicators, user satisfaction and perceived-quality measures, and improve interoperability between national and European screening information systems.[11][25][26]
• Conduct studies of screening effects on mortality, quantify access inequalities, evaluate participation interventions, and assess the effectiveness and cost-effectiveness of approved new screening programmes.[11][31][32]
• Provide anonymised screening-data repositories for scientific research.[31][33]
• Use certification and performance metrics to assure quality in the Oncology Referral Network, including targets for management in certified disease-specific units and multidisciplinary treatment decisions before first treatment.[12][13]
• Monitor guaranteed maximum response times and equity of access for cancer surgery, radiotherapy and curative-intent pharmacological treatment, using National Health Service systems and the National Oncology Registry where specified.[34][14][15]
• Require radiotherapy services treating National Health Service patients to achieve quality certification against International Atomic Energy Agency criteria by 2030, and develop quality criteria for innovative treatment and care without curative options.[35][36][37]
• Track research activity through clinical-trial catalogue and research indicators, trial numbers, recruitment, investigator-led studies and annual applications for European-funded projects.[28][29][38]
• Assess survivor morbidity, disability and quality of life, integrate agreed quality-of-life measures into the National Cancer Registry, and monitor digital physical-activity advice tools every six months through 2030.[16][17][39]

Several programme extracts do not specify indicator definitions, data sources, reporting frequency, evaluation designs, surveillance arrangements or sanctions for non-performance.[3][40][34][29]

Costing & Financing

No quantified national budget, cost estimate, funding gap, domestic financing commitment or economic assumption is specified in the supplied material. The strategy nevertheless assigns financing responsibilities to the Central Administration of the Health System, which must finance essential institutions and align contracting priorities with implementation needs, while Shared Services of the Ministry of Health supports information systems and centralised procurement.[21]

• Optimise existing health-system resources and identify investment needs through the national oncology referral network to improve equitable access to care.[19]
• Prioritise finite health resources transparently at local, regional and national levels for cancer-care delivery.[34]
• Propose staffing resources needed to implement and sustain population-based screening programmes, while assessing the cost-effectiveness of new programmes.[25][32]
• Minimise screening-related healthcare contacts to reduce costs and improve convenience and participation.[41]
• Provide reimbursement and/or free pharmacological treatment for tobacco dependence, although no funding mechanism or financial value is provided.[6][42]
• Use alcohol taxation as a prevention instrument, including annual proposals to update tax rates on alcoholic beverages, without projected revenue or allocations.[3][42][43]
• Seek European research funding through Horizon Europe, EU4Health and the Digital Europe Programme, with the National Cancer HUB supporting the capture of European funds and project applications.[28][29][38]
• Recognise the need for human and technical investment to strengthen the Oncology Referral Network and improve care supply and quality.[12]

Budgets, expenditure estimates, funding sources and resource-mobilisation plans for prevention, screening, treatment, research and survivorship actions are otherwise not specified in the supplied extracts.[4][31][35][17]