Cancer Strategy 2019

Objectives

The cancer strategy seeks to reduce cancer incidence, morbidity and mortality, improve quality of life and survivorship, and deliver equitable, holistic and person-centred care across the full pathway from prevention to palliative and end-of-life care.[1][2][3]It treats cancer as an increasingly chronic condition requiring prevention, timely diagnosis, effective treatment, rehabilitation, survivorship support and care for families and carers.[1][4]

• Reduce avoidable cancer risk through healthy lifestyles, tobacco and alcohol control, healthy diet, physical activity, weight management, breastfeeding, vaccination, infection control and reduced environmental and occupational exposures.[5][6][7][8]
• Expand evidence-based screening and early detection, prioritising cervical and colorectal cancer programmes while using risk-based approaches and further local evidence to guide breast, lung, prostate and other cancer screening policies.[9][10][11][12][13]
• Improve diagnosis and treatment through coordinated multidisciplinary services, modern technologies, molecular diagnostics, genomics, timely referral and investigation, and cancer-specific patient pathways.[14][2][15][16]
• Strengthen survivorship, rehabilitation, psychosocial support and palliative care, including smoother transition between hospital, primary care, community and residential-care settings.[17][4][3]
• Use surveillance, research, innovation, technology, partnerships and community resources to inform policy, service planning and evidence-based cancer control.[18][1][19][20]

By 2025, the strategy includes population-health ambitions to reduce premature mortality from non-communicable diseases, including cancer, by 25% from baseline; reduce harmful alcohol use, insufficient physical activity and tobacco use; halt the rise in obesity; maintain 95% hepatitis B vaccination coverage; improve human papillomavirus vaccination completion; and increase cervical and colorectal screening coverage.[21]It also envisages improved cancer data, stage-specific survival reporting, advanced technology, coordinated patient resources, survivorship pathways, palliative support and research outputs.[22][4][3][23]

Implementation

Implementation is designed as a coordinated territory-wide model involving government policy leadership, public and private healthcare delivery, research, civil society and patient participation.[24][25]The Food and Health Bureau leads policy formulation and resource allocation; the Department of Health delivers preventive, public-health and statutory functions; and the Hospital Authority provides most public cancer care through cluster-based services.[24][25]

• Govern through the Cancer Coordinating Committee, chaired by the Secretary for Food and Health, which advises on prevention and control strategy, reviews epidemiology, services, research and planning needs, receives functional-area reports and facilitates implementation.[25]Support its work through the Cancer Expert Working Group on Cancer Prevention and Screening, which reviews local and international evidence and recommends locally appropriate prevention and screening measures.[5][9][26]
• Organise Hospital Authority cancer services across seven geographical clusters and oncology centres, with regional hospitals or cancer centres providing diagnostic radiology, pathology, endoscopy, surgery, radiotherapy, chemotherapy and palliative care.[2][27]Develop the Strategic Service Framework for Cancer Services over five to ten years to strengthen cross-specialty, cross-disciplinary, disease-specific and cluster-level care.[2][27]
• Improve access and timeliness through stronger communication between primary care, private doctors and the Hospital Authority; standardised referral information; triage; cancer-specific investigation checklists; streamlined multidisciplinary diagnostic services; coordinated specialised investigations; and information systems integrating test results and patient tracking.[21][14][28]
• Expand treatment capacity through additional endoscopy sessions, ambulatory and satellite chemotherapy services, radiotherapy capacity, specialist outpatient services, oncology centres, beds, operating theatres and public-private diagnostic collaboration.[28][29][15][16]
• Deliver multidisciplinary and holistic care through doctors, nurses, allied health professionals, medical social workers, psychologists, pharmacists, spiritual-care workers, volunteers and case managers.[2][30][29]Extend case management, standardise care pathways and support patients' social, psychological, rehabilitation and financial needs.[2][29]
• Strengthen primary and community care through District Health Centre Networks, medical-social collaboration, public-private partnerships, non-governmental organisations, patient groups and carers.[10][21][17]Establish community coordination mechanisms, including a Cancer Network of Partners, to identify service gaps, avoid duplication and align support with patient and carer needs.[17]
• Provide lower-risk survivors with structured primary-care follow-up and rapid re-referral to specialist cancer teams for relapse or complications, alongside rehabilitation, supportive care and transition to community or palliative services.[4][3]
• Build palliative care across hospital and community settings through ambulatory, day, home and residential-care-home services, collaboration with welfare and community partners, and enhanced end-of-life planning and support.[3]
• Strengthen the workforce through recruitment, specialist training, career development and updated professional education, while developing Chinese Medicine and Integrated Chinese-Western Medicine services within defined public-healthcare arrangements.[30]
• Apply health technology assessment and evidence-based review to decisions on equipment, diagnostic technologies and medicines, considering safety, efficacy, effectiveness, cost-effectiveness and organisational, legal, ethical and social implications.[29][16][17]

The Hong Kong Cancer Registry is central to implementation, collecting and reporting population-based incidence, mortality, staging, clinicopathological and survival data to support service planning, monitoring and research.[22][25]Planned improvements include more complete stage information through collaboration with cancer experts and private providers, quicker annual reporting, stage-specific survival rates for ten prevalent cancers, and public access through fact sheets, databases and a dedicated website.[22]

Monitoring combines population indicators, screening coverage, vaccination coverage, treatment waiting times, cancer burden trends, service data and research outputs.[22][21][14][23]The strategy provides for periodic review, including annual Cancer Coordinating Committee review and review of non-communicable disease targets after the first two implementation years, although several extracts do not specify a single consolidated reporting timetable or comprehensive accountability framework.[24][21][25]

Research delivery is supported through the Health and Medical Research Fund, the Research Council and Expert Advisory Panels, open calls for investigator-initiated studies, fellowships, Health@InnoHK, clinical-trials centres, the Hong Kong Genome Institute and collaboration among universities, public bodies and industry.[19][20][23]Priority research includes prevention risks, screening, diagnostics, treatment, survivorship, genomics, personalised medicine and big-data applications, with findings intended to improve policy and implementation.[19][20]

Monitoring & Evaluation

Cancer monitoring is centred on territory-wide surveillance, evidence review, service-timeliness measures and periodic strategic review. The Hong Kong Cancer Registry (HKCaR) collects and reports population cancer data to inform service planning, assess programme impact and monitor disease trends.[24][22][25]The Cancer Coordinating Committee reviews cancer epidemiology, services, planning needs, research and recommendations annually, while the broader strategy is intended to undergo regular review.[24][25]

• Strengthen HKCaR data collection, completeness, efficiency and reporting through collaboration with cancer experts and private healthcare providers, including better staging, clinicopathological and stage-specific survival information.[22]
• Reduce the annual cancer-statistics reporting lag from 22 or 23 months to 20 months by 2025, report high-quality stage data and stage-specific survival for ten prevalent cancers, and broaden public access through fact sheets, databases and an HKCaR website.[22]
• Track cancer burden using incidence, mortality, age-standardised trends, survival, service use and waiting-time data. Cancer caused 14,446 deaths in 2018, while new cases were projected to exceed 42,000 by 2030.[31][32]
• Monitor treatment timeliness through the interval from decision to treat to commencement of radical radiotherapy and the interval from diagnosis to first treatment for breast, colorectal and nasopharyngeal cancers. In 2017-18, the 90th-percentile radiotherapy interval was 28 days, while diagnosis-to-treatment intervals were 74 days for colorectal, 65 days for breast and 56 days for nasopharyngeal cancer.[14][28]
• Review screening policies through the Cancer Expert Working Group on Cancer Prevention and Screening, using evidence on disease prevalence, test performance and safety, clinical effectiveness, harms, feasibility, resources, health-system capacity and public acceptance.[9][10]
• Measure prevention progress against 2025 targets, including a 25% reduction in premature mortality from non-communicable diseases relative to baseline, 95% hepatitis B vaccination coverage, 70% completion of two human papillomavirus vaccine doses in the first cohort, and increases in cervical and colorectal screening coverage.[21]
• Evaluate research-supported interventions, including colorectal screening effectiveness, cost-effectiveness, user and provider satisfaction, public understanding, acceptability and equity.[23]
• Review cancer medicines for safety, efficacy and cost-effectiveness, and increase the prioritisation of self-financed medicines for the Samaritan Fund and Community Care Fund safety net from annually to twice yearly.[29]
• Assess technology needs regularly through health technology assessment covering safety, clinical efficacy, effectiveness, cost, cost-effectiveness, organisational, social, legal and ethical implications.[16]

Accountability includes Hospital Authority accountability to the Government through the Secretary for Food and Health, corporate cancer committees that identify service gaps and priorities, and Committee oversight of functional-area reports and expert recommendations.[25][27]The available material does not specify a single consolidated reporting timetable, independent evaluation process, sanctions, or comprehensive performance-accountability framework across all strategy areas.[17][4][26][33][12]

Costing & Financing

Financing combines Government resource allocation, hospital development investment, surveillance support, research funding, public-private subsidies and patient-affordability mechanisms. The Food and Health Bureau leads resource allocation and planning, while its Research Office administers funding for health and medical research, including cancer research.[24][25][27]

• Allocate 3 million in the 2019-20 budget year to strengthen HKCaR deliverables and surveillance.[22]
• Provide earmarked allocations of 200 billion for the first Ten-year Hospital Development Plan and 270 billion for the second plan, supporting beds, theatres, oncology centres, radiology and related cancer-care infrastructure.[15]
• Earmark 5 billion for the Hospital Authority to upgrade and acquire medical equipment, including cancer-treatment equipment.[16]
• Allocate 10 billion Hong Kong dollars to establish InnoHK Clusters at Hong Kong Science Park, including Health@InnoHK research activity.[19]
• Fund infrastructure for two Phase I Clinical Trials Centres with 80 million over five years, followed by 100 million from May 2019 over five years for novel pharmaceutical products, including cancer treatments.[20]
• Support community prevention through Department of Health funding of up to 250,000 for each District Council in 2019-20.[7]
• Use public-private subsidies for colorectal screening, Community Care Fund support for cervical-screening services and preventive education for low-income groups, and Health and Medical Research Fund support for breast-cancer risk research.[10]
• Support medicine affordability through the Hospital Authority Drug Formulary, Samaritan Fund, Community Care Fund Medical Assistance Programmes and pharmaceutical-company patient access programmes. Means-test changes in 2019 counted half of household net assets when assessing disposable financial resources for drug-subsidy applications.[29]
• Apply an additional daily patient charge of 200 Hong Kong dollars for Integrated Chinese-Western Medicine services.[3]

Resource decisions are intended to consider cost-effectiveness, including whether screening-related case-finding, diagnosis and treatment costs are economically balanced against overall medical expenditure.[9]Technology assessment also incorporates cost and cost-effectiveness alongside clinical and wider implications.[16]Although the strategy identifies significant investment needs in workforce, equipment, information systems, diagnostics, ambulatory capacity, palliative care, community services and research, the material does not provide a consolidated cancer-plan budget, recurrent expenditure forecast, detailed programme costs, funding gap or broader economic assumptions.[28][30][17][3]