Cancer Strategy 2019

Objectives

Hong Kong’s first Cancer Strategy, implemented from 2020 onwards and subject to regular review, provides a whole-system framework to reduce cancer incidence, mortality and local burden while improving quality of life, survivorship and support for people with cancer, families and carers.[1][2][3]It covers prevention, screening, early detection, diagnosis, treatment, survivorship, palliative care, surveillance and research across the full patient journey.[1][2]

• Reduce avoidable cancer risk by promoting healthy lifestyles, tobacco and alcohol control, healthy diet, physical activity, weight management, vaccination, and reduced exposure to environmental and occupational carcinogens.[4][5][6][7]
• Deliver evidence-based, population-level and risk-stratified screening, with established cervical and colorectal programmes and recommendations tailored to individual risk for other cancers.[4][7][8][9][10][11]
• Improve early diagnosis, timely treatment and patient outcomes through integrated, multidisciplinary and technologically enabled cancer services.[12][13][14]
• Provide holistic, equitable and patient-centred care that recognises cancer as a chronic illness and addresses clinical, psychological, social, rehabilitation, survivorship and end-of-life needs.[2][15][16][17]
• Strengthen cancer-control capacity through surveillance, data, innovation, technology, research, partnerships and community resources.[1][2][3][18]
• Achieve specified 2025 outcomes, including improved cancer-data timeliness and accessibility, cancer-specific diagnostic checklists and pathways, enhanced treatment capacity, broader drug coverage, survivorship support, an online information hub and a civil-society platform.[19][14][20][16]

Prevention is positioned as a central component of cancer control, reflecting the assessment that around 40% of cancers are preventable through healthier lifestyles.[19][5]The strategy seeks to integrate cancer prevention with prevention of other non-communicable diseases by addressing shared risks such as tobacco use, harmful alcohol use, poor diet, physical inactivity, overweight and obesity.[5]It also promotes hepatitis B virus and human papillomavirus vaccination to prevent relevant cancers.[4][6][7]

Screening policy is explicitly evidence-led: programmes should be introduced only where early detection or identification of precancerous disease is expected to improve outcomes and where benefits outweigh harms.[7][8]Routine screening is not recommended where evidence is inadequate, including chest X-ray or sputum cytology for lung cancer, while low-dose computed tomography screening for asymptomatic populations remains insufficiently supported by evidence.[21][9]

The strategy also prioritises research and precision medicine to support prevention, diagnosis, treatment and survivorship, including genomics, clinical trials, novel therapies, implementation science and big-data analytics.[18][22][23]

Implementation

Implementation is intended to be focused, coordinated, proactive, evidence-based and accountable, linking policy and service delivery across prevention, primary healthcare, specialist care, community support and palliative care.[4]The Food and Health Bureau leads healthcare policy formulation and resource planning, while the Cancer Coordinating Committee steers cancer-control work and advises on prevention and control strategies.[3][24]

• Coordinate delivery through the Department of Health, Hospital Authority, Hong Kong Cancer Registry and Research Office of the Food and Health Bureau.[3][24][25]
• Engage public and private healthcare providers, academia, non-governmental organisations, patient groups, survivors, families, carers, community partners and the wider public.[1][2][3][17]
• Strengthen primary healthcare as the first point of contact for prevention, risk assessment, early identification, referral, self-management, supportive care and palliative care.[26]
• Develop District Health Centre Networks across all 18 districts, using medical-social collaboration and public-private partnership to address cancer risk factors and support community care.[26][12]
• Operate cervical and colorectal screening through population programmes and public-private arrangements, including subsidised faecal immunochemical testing and follow-up colonoscopy for eligible participants.[2][8][27]

The Hospital Authority is the principal public provider of cancer detection, diagnosis, treatment and related services.[12]It delivers services through seven geographical clusters, with major cancer services concentrated in regional hospitals or oncology centres and selected diagnostic, endoscopy and palliative services provided at other cluster hospitals.[14][25]A Strategic Service Framework for Cancer Services is intended to guide service models and infrastructure over five to ten years, covering the pathway from symptom presentation through diagnosis, treatment and survivorship.[14][25]

Operationally, the strategy calls for multidisciplinary cancer-specific diagnostic pathways, coordinated investigations, triage protocols, diagnostic checklists, better referral communication, integrated clinical information systems and automated alerts for abnormal results.[12][13][14]Capacity measures include additional endoscopy sessions, advanced imaging, expanded radiotherapy and chemotherapy, satellite chemotherapy centres, operating-theatre capacity, outpatient services and relevant inpatient beds.[13][28][29][20]

Care coordination is supported through the Cancer Case Manager programme, which guides patients through diagnosis and treatment, facilitates communication and promotes standardised care pathways.[15]Multidisciplinary teams are expected to include medical, nursing, allied health, social work, psychological, rehabilitation, spiritual-care and volunteer roles, reflecting the strategy’s commitment to clinical and psychosocial support for patients and carers.[15]

The approach includes regular evidence review by the Cancer Expert Working Group on Cancer Prevention and Screening, which develops local prevention and screening recommendations.[7][24]Health technology assessment is to inform adoption, training and allocation of technologies by considering safety, clinical effectiveness, cost-effectiveness, organisational implications and local applicability.[30]The Hospital Authority also reviews cancer medicines for safety, efficacy and cost-effectiveness and seeks to enhance access through formulary decisions, safety-net mechanisms and patient access programmes.[28][29]

Surveillance is a core implementation mechanism. The Hong Kong Cancer Registry collects, validates, analyses and reports population-based cancer incidence and mortality data to support epidemiological research, service planning and assessment of cancer-control programmes.[31]By 2025, surveillance aims include more timely, complete and accessible cancer information, including stage-specific data and survival rates for the ten prevalent cancers, and reducing the annual-statistics reporting lag to 20 months.[19]

Governance includes annual Cancer Coordinating Committee review of cancer epidemiology and service provision, consideration of changing service needs, endorsement of recommendations and review of cancer-related research plans and outcomes.[24]The document does not specify a single comprehensive implementation timetable or a consolidated performance-management framework for the whole strategy.[4][24]

Monitoring & Evaluation

The strategy establishes cancer surveillance, evidence review and service monitoring as core mechanisms for planning, implementation and accountability, led by the Hong Kong Cancer Registry, the Department of Health, the Hospital Authority and cancer-governance committees.[3][24][31]

• Improve the timeliness, completeness, accuracy and accessibility of cancer information by 2025, including stage-specific data and survival rates for the ten prevalent cancers.[3][19]
• Reduce the reporting lag for annual cancer statistics from 22 or 23 months to 20 months by 2025, following a reported 22-month gap in registry data.[32][19]
• Use the Hong Kong Cancer Registry to collect, validate, analyse and report incidence, mortality, demographic, tumour-topography and histology data, and to monitor cancer patterns and the effects of cancer-control services.[31]
• Publish and make surveillance information accessible through fact sheets, bulletins, a dedicated website and interactive databases for policymakers, researchers, providers and the public.[19]
• Monitor progress against 2025 targets for premature mortality from non-communicable diseases, tobacco use, harmful alcohol use, physical inactivity, obesity, hepatitis B and human papillomavirus vaccination, and cervical and colorectal screening coverage.[26]
• Review screening evidence through the Cancer Expert Working Group, assessing disease burden, test accuracy, feasibility, service capacity, public acceptance, benefits, harms and economic balance before recommending programmes.[7][8]
• Track treatment timeliness, including waiting time from decision to treat to radical radiotherapy and from diagnosis to first treatment for colorectal, breast and nasopharyngeal cancers.[13][14]
• Review cancer epidemiology, service provision, evolving needs, expert recommendations and Food and Health Bureau-funded research annually through the Cancer Coordinating Committee.[24]
• Evaluate research and programme interventions, including colorectal screening effectiveness and cost-effectiveness, tobacco-control measures, breast-cancer risk prediction, and clinical trials of cancer treatments.[23]
• Regularly review cancer technologies, drug-formulary decisions, survivorship services, palliative care and integrated Chinese-Western Medicine services using evidence on safety, efficacy, effectiveness and cost-effectiveness where applicable.[28][30][17]

Formal accountability is supported by the Food and Health Bureau's policy and resource-planning role, the Cancer Coordinating Committee's oversight, and the Hospital Authority's accountability to the Government through the Secretary for Food and Health.[3][24][25]The source does not specify a single comprehensive monitoring framework, standard reporting timetable, independent evaluation process, audit protocol or sanctions applicable across the entire strategy.[5][20][9]

Costing & Financing

Financing combines earmarked public investment, research funding, programme subsidies, patient-support mechanisms and resource planning, but the source does not provide a consolidated costed cancer-plan budget or quantified funding gap.[3][29][22]

• Allocate 3 million for 2019-20 to enhance Hong Kong Cancer Registry deliverables and its surveillance function.[3]
• Provide up to 250,000 Hong Kong dollars to each District Council in 2019-20 for community activities to prevent and control non-communicable diseases.[31]
• Earmark 5 billion for the Hospital Authority to upgrade and acquire medical equipment, including equipment for cancer treatment.[30]
• Fund the first and second Ten-year Hospital Development Plans with earmarked allocations of 200 billion and 270 billion respectively, supporting capacity development that includes oncology facilities and services.[29][20]
• Mobilise research funding through the Health and Medical Research Fund, including 80 million over five years for infrastructure at two Phase I Clinical Trials Centres and an additional 100 million from May 2019 over five years for novel pharmaceutical-product development.[22]
• Allocate 10 billion to establish InnoHK Clusters at Hong Kong Science Park, including Health@InnoHK healthcare research.[22]
• Support access to cancer medicines through Hospital Authority formulary review, Samaritan Fund and Community Care Fund Medical Assistance Programmes, and pharmaceutical patient-access programmes that share or cap patient treatment costs.[29]
• Use public-private partnerships and targeted funds to support subsidised colorectal screening, cervical-screening services for lower-income groups, breast-cancer research and selected diagnostic imaging services.[8][25]
• Apply health technology assessment and drug review to assess safety, clinical effectiveness, cost-effectiveness, organisational implications and the appropriate allocation of resources for technologies and treatments.[28][30]

Several resource requirements are identified without quantified costs, including workforce expansion, District Health Centre Networks, genetic and genomic services, diagnostic pathways, radiotherapy and chemotherapy capacity, survivorship and palliative care, technology infrastructure and research activity.[26][14][18]The source does not specify recurrent expenditure, unit costs, detailed financing sources, costed implementation plans, overall economic assumptions or funding gaps for these activities.[13][17][25]