Estratégia Nacional de Luta contra o Cancro, Horizonte 2030

Objectives

Portugal’s National Cancer Control Strategy to 2030 seeks to reduce preventable cancer, premature mortality and inequalities while improving survival, quality of life and support for patients, survivors, carers and families. It is aligned with the National Health Plan, the United Nations 2030 Agenda and Europe’s Beating Cancer Plan, and is organised around prevention, early detection, diagnosis and treatment, and survivorship.[1][2][3]

• Reduce modifiable cancer risks through multisectoral action on tobacco, alcohol, diet, excess weight, physical inactivity, ultraviolet radiation, environmental and occupational carcinogens, and oncogenic viruses.[3][4][5]
• Achieve prevention targets including tobacco prevalence below 10% among people aged over 15 by 2030, under-18 binge drinking of 15%, alcohol abuse and dependence of 3%, excess weight prevalence of 65%, and at least a 10% reduction in physical inactivity from the 2019 baseline.[6][7][8]
• Maintain two-dose human papillomavirus vaccination above 90%, hepatitis B vaccination above 95% in the relevant cohorts, and hepatitis C cure above 95% after diagnosis through 2030.[9]
• Strengthen population-based screening for breast, cervical and colorectal cancer, targeting 100% geographical coverage, over 95% population coverage and over 65% participation by 2030, while assessing staged prostate, lung and stomach screening.[10][11]
• Standardise early detection and risk management for hereditary cancer syndromes, including Lynch syndrome and BRCA1 or BRCA2-associated hereditary breast cancer.[12][13]
• Provide integrated, equitable and timely diagnosis, treatment, supportive care, palliative care, research opportunities and survivorship services across the National Health Service.[14][15][16]
• Formalise an Oncology Referral Network by 2026, enable certified units to clinically manage more than 90% of oncology patients by 2030, and ensure multidisciplinary therapeutic decisions before first treatment for more than 85% of patients.[17]
• Expand precision, genomic, predictive and pharmacogenomic medicine; genetic counselling; nutritional support; psycho-oncology; and access to surgery, radiotherapy and pharmacological therapies.[17][18][19]
• Strengthen cancer research, including clinical trials, patient recruitment, investigator-initiated studies, European funding applications and patient involvement in research design.[20][21]
• Improve long-term survivorship by measuring morbidity, disability and quality of life, providing structured treatment summaries, supporting rehabilitation and physical activity, and protecting survivors’ employment, social and financial rights.[16][22][23]

Implementation

Implementation combines national political leadership, technical regulation, integrated National Health Service delivery, cross-government collaboration, civil-society participation, population-health interventions and targeted service improvement. Governance is intended to monitor implementation and targets, support adaptations, strengthen accountability and mobilise organisations involved in cancer control.[24][25]

• Allocate political priorities, legislation and resources through the Ministry of Health in collaboration with other government areas, while the Directorate-General of Health provides scientific and technical guidance through standards, directives and thematic working groups where required.[24]
• Coordinate operational delivery through the Executive Directorate of the National Health Service, alongside the Directorate-General of Health, Central Administration of the Health System and Shared Services of the Ministry of Health.[25]
• Use the National Programme for Oncological Diseases and its Executive Committee to coordinate the Strategy, involving governance bodies, support institutions, civil society, patient representatives and, where needed, thematic working groups.[25][26]
• Finance essential implementing institutions and align contracting priorities through the Central Administration of the Health System, while using Shared Services of the Ministry of Health for information systems and centralised procurement.[25]
• Deliver prevention through coordinated healthy-eating, physical-activity, tobacco-control, viral-hepatitis and addictive-behaviour programmes; regulation; taxation proposals; public communication; health literacy; and primary-care brief interventions.[2][7][27]
• Protect people from environmental and occupational carcinogens through air- and water-quality policies, worker risk assessment and surveillance, asbestos action, transposition of European requirements, and regulation of commercial ultraviolet-radiation facilities.[28][29]
• Establish a National Coordination Unit for population-based oncology screening, standardise invitations, improve information systems and European interoperability, run awareness campaigns, and design interventions for groups facing lower participation or access.[30]
• Coordinate decentralised screening units through the National Coordination of Screening Programmes, minimise unnecessary contacts with services, identify staffing and resource requirements, and assess new programmes for effectiveness and cost-effectiveness.[12][31]
• Develop an integrated, hierarchical Oncology Referral Network and Integrated Oncology Centres, using multidisciplinary teams, referral arrangements, certification criteria, clinical audits and performance measures to match patients to appropriate technical capacity.[32][17]
• Monitor treatment access through procedure catalogues, prioritisation criteria and the National Health Service Integrated Access Management System, including radiotherapy monitoring by pathology, technique and therapeutic priority.[15][19]
• Support research through trial catalogues, networked research platforms, pragmatic trials, training in clinical research and innovation, and the National Cancer HUB’s engagement with European initiatives and funding.[33][21][34]
• Integrate survivorship with continuing care, palliative care, mental-health coordination, the National Oncology Registry, structured patient summaries, the Cancer Survivor SmartCard and legal measures on insurance, employment and carers’ rights.[16][22][35]
• Evaluate progress through regular health-policy impact studies by the National Institute of Health Doutor Ricardo Jorge, indicator collection by the Executive Directorate of the National Health Service, Executive Committee review, working-group meetings and an annual report to the Ministry of Health.[25][26]
• Publish and use indicators for screening coverage, participation, satisfaction, quality and mortality impact; treatment access and certification; prevention targets; research activity; and survivor morbidity, disability and quality of life.[30][20][22]
• Identify investment and resource needs for equitable care, although the supplied material does not specify an overall budget, costed activities, funding allocations or quantified financing gap.[14][32]

Monitoring & Evaluation

The strategy establishes a governance-led monitoring system spanning implementation, targets, service performance, population outcomes, research and survivorship. The Executive Committee coordinates implementation, reviews monitoring information, agrees adaptations, meets working groups and coordinates an annual report with the National Institute of Health Doutor Ricardo Jorge for submission to the Ministry of Health.[26]The National Institute of Health Doutor Ricardo Jorge conducts regular autonomous and impartial studies of health-policy impacts, while the Executive Directorate of the National Health Service collects and shares indicators on implementation and impact after consulting the Executive Committee.[25]

• Monitor delivery against the Strategy’s defined targets and adapt actions where necessary through the proposed governance model.[3]
• Strengthen accountability by supporting the autonomy and responsibility of implementing entities, interdisciplinary collaboration and cross-government action.[24]
• Track prevention outcomes, including tobacco prevalence among people aged over 15, with targets below 14% by 2025 and below 10% by 2030, compared with 17% in 2019.[6]
• Measure alcohol-related outcomes, including under-18 binge drinking, targeted to decline from 18% in 2019 to 15% by 2030, and alcohol abuse or dependence, targeted to decline from 3.6% in 2017 to 3% by 2030.[7]
• Monitor environmental and occupational prevention through air-quality and drinking-water benchmarks, health surveillance of exposed workers, compliance with occupational exposure limits, and national characterisation of occupational diseases including occupational cancers.[28][29]
• Track excess weight, childhood obesity, physical inactivity, food reformulation, implementation of nutrition-related regulation, physical-activity assessment and brief counselling in primary care, food advertising to under-16s, and health professionals’ physical-activity promotion practices.[8]
• Use vaccination coverage and hepatitis C cure measures for virus-associated cancer prevention, including targets exceeding 90% for two-dose human papillomavirus vaccination, exceeding 95% for hepatitis B vaccination among the relevant population, and exceeding 95% hepatitis C cure after diagnosis.[9]
• Define publicly accessible indicators for population-based oncology screening, including user satisfaction and perceived quality, and conduct mortality-impact studies.[30]
• Assess the feasibility, effectiveness and cost-effectiveness of new screening programmes through staged implementation and pilot studies.[10][12]
• Track screening coverage and participation targets, including 100% geographical coverage by 2030 for breast, cervical and colorectal screening, population coverage above 95%, and participation above 65% among eligible users.[11]
• Monitor inequalities in screening access and participation among people without a family doctor, migrants, transgender users, people not fluent in Portuguese, and people living in rural or socio-economically deprived areas.[30]
• Develop cancer-care metrics covering diagnosis, staging, treatment access, centre certification, multidisciplinary decision-making, nutritional support, psycho-oncology provision and clinical audit in paediatric oncology.[17][18]
• Monitor surgery and radiotherapy access through quality, prioritisation and response-time criteria, including use of the National Health Service Integrated Access Management System for radiotherapy by pathology, technique and therapeutic priority.[15][19]
• Measure research performance through clinical-trial catalogues, trial activity, patient recruitment, investigator-initiated studies, European funding applications and research-activity indicators in clinical practice.[20][21]
• Assess survivorship through morbidity, disability and quality-of-life measures integrated into the National Oncology Registry, with morbidity and disability assessment in 2026 and 2030 and systematic quality-of-life assessment by 2030.[22][35]

Several pillar-specific extracts do not specify detailed reporting timetables, data-source methodologies, surveillance protocols or additional formal accountability arrangements beyond the governance bodies, indicator development and monitoring actions described above.[31][32][23]

Costing & Financing

The Strategy does not provide a total budget, costed implementation plan, quantified funding gap, expenditure allocation or economic assumptions in the supplied material.[25][15][16]Financing responsibilities are nevertheless distributed across national institutions: the Ministry of Health allocates resources in collaboration with other government areas, and the Central Administration of the Health System finances essential implementing institutions and is expected to align contracting priorities with the Strategy.[24][25]

• Identify investment needs and optimise existing health-system resources to support equitable access through the Oncology Referral Network.[14]
• Provide the human and technical investment needed for the proposed Oncology Referral Network, without a quantified allocation.[32]
• Assess the cost-effectiveness of new oncology screening programmes and minimise avoidable user and service costs by reducing unnecessary contacts with health services.[12][31]
• Support smoking cessation through possible reimbursement or free provision of pharmacological treatment, although no value or financing mechanism is specified.[36]
• Use fiscal policy relating to tobacco and alcohol, including annual proposals to update Alcohol and Alcoholic Beverages Tax rates, without stated revenue projections or tax amounts.[7][28]
• Mobilise external research funding by increasing applications to European programmes, including Horizon Europe, EU4Health and the Digital Europe Programme.[20][21]
• Use the National Cancer HUB and National Contact Points for the European Health Programme to support applications, dissemination and follow-up for cancer research and innovation funding.[33][34]

No machine-readable monetary cost items are available because the supplied extracts contain no explicit financial amounts, allocations, costs or funding-gap estimates.[12][37][38]