제4차 암관리 종합계획 2021-2025

Objectives

The fourth comprehensive cancer control plan aims to reduce individual suffering and harm from cancer, lessen its social burden and improve public health.[1]It establishes a five-year strategic framework under the Cancer Control Act, centred on activating cancer big data, advancing prevention and screening, strengthening treatment and response, and creating an equitable foundation for cancer control.[1]

• Strengthen prevention and early detection through evidence-based screening, targeted management of high-risk groups and action on preventable cancers, particularly stomach, colorectal, liver and cervical cancers.[2][3]
• Improve screening quality by replacing lower-accuracy methods where appropriate, considering newer technologies such as human papillomavirus DNA testing, and strengthening assessment of screening institutions.[4]
• Develop data-driven, personalised cancer management by linking clinical, public, genomic and imaging information, supporting public-interest research and providing reliable cancer information.[5][6]
• Strengthen treatment quality and financial protection through expanded health-insurance coverage, patient- and outcome-centred assessment, and enhanced public responsibility for rare and difficult-to-treat cancers.[7][8]
• Reduce geographical and social inequalities by ensuring access to quality cancer treatment and care regardless of location, with tailored support for children, older people, disabled people and other vulnerable groups.[5][9]
• Support survivorship and social reintegration through integrated services spanning different stages of survivorship, including personalised recurrence-risk management and health-promotion support.[10][9]
• Prepare for emerging risks by adapting screening, treatment and survivorship support to infectious-disease outbreaks and demographic ageing.[10][11]
• Advance research, international exchange and innovation through artificial intelligence, big data, advanced radiotherapy, anticancer medicine development and partnerships with international cancer institutions.[2][10][12]

Implementation

Implementation combines national governance, data infrastructure, evidence-based service reform, regional delivery networks and annual performance management. The National Cancer Control Committee deliberates on the five-year plan under the Cancer Control Act, while annual implementation plans are to be reported to the National Cancer Management Commission and reviewed through specialist committees.[1][13]

• Build the K-Cancer Data Warehouse by linking clinical, public-sector, genomic and cancer-imaging data, including pseudonymised data combinations for public-interest research, with an intended scale of about 3 million patient records by 2025.[5][6]
• Designate a National Cancer Data Centre, potentially the National Cancer Centre or another qualifying institution, to coordinate national cancer-data activities and operate an open national cancer-data portal.[6]
• Expand surveillance by improving cancer-registry variables, linking external datasets, automating registration through pathology reports and electronic medical records, and using artificial intelligence to reduce manual workload.[6][2]
• Reform screening through consultation with screening institutions, professional societies and other stakeholders; assess lung-cancer eligibility and methods, evaluate private-sector screening, and expand cloud-based registration and interpretation systems from lung screening to breast and cervical screening.[14][4]
• Implement targeted prevention measures by considering expanded Helicobacter pylori testing and eradication-treatment reimbursement, primary colonoscopy screening, stronger liver-cancer risk management and wider cervical-cancer vaccination eligibility.[3][14]
• Provide trustworthy public information through a national cancer knowledge and information centre, an integrated carcinogen information system, monitoring of social and new-media misinformation, and research on complementary and alternative treatments.[4][7]
• Apply treatment financing decisions progressively, considering clinical utility, cost-effectiveness and fiscal conditions, while directing medical-cost support towards people with greater economic need.[7]
• Strengthen rare-cancer capacity through the National Cancer Centre’s research function, clinical-trial platforms, standardised clinical-resource management and collaboration among industry, academia, research institutions, hospitals and international partners.[8]
• Position the National Cancer Centre as a policy, specialist-service and research leader, and strengthen regional cancer centres through defined service capacity, referral pathways and multi-institutional clinical research links.[11][12]
• Link central and regional survivorship support centres with primary care, public-health centres, community services, treatment hospitals and hospice providers to deliver integrated local support.[15]
• Establish expert committees for prevention, screening, patient management and data management to involve external expertise before major policy decisions.[15]
• Manage delivery through representative indicators and targets for 2023 and 2025, outcome indicators for detailed tasks, at least twice-yearly specialist-committee reviews, public disclosure of performance and coordination of joint ministerial and institutional tasks.[13]

Monitoring & Evaluation

The plan combines national cancer surveillance, data-system development, screening and service-quality assessment with annual implementation management through the National Cancer Management Commission. It provides several baseline cancer-control indicators, but does not set out a consolidated indicator framework, reporting timetable, performance thresholds, evaluation methodology or sanctions for non-performance.[16][13]

• Monitor baseline population outcomes, including 244,000 new cancer cases in 2018, 81,000 cancer deaths in 2019, age-standardised cancer mortality of 74.2 per 100,000 population in 2019, and five-year relative survival of 70.3% for 2014–2018.[16]
• Track service-coverage indicators, including cancer-screening participation of 45.5% in 2018, health-insurance coverage for cancer patients of 78.5% in 2019, and hospice use by 22.9% of people dying from cancer in 2018.[16][17]
• Expand cancer-registry variables and link external data to produce indicators on genetic-test results, detailed stage and treatment; develop complementary life-course surveillance through patient panels, medical-expenditure studies, terminal-patient and family surveys, and patient-reported outcome surveys.[6]
• Automate cancer registration, extraction, collection and management using pathology reports, electronic medical records and artificial-intelligence methods to reduce manual workload and improve data efficiency.[6][2]
• Use scientific evidence to revise screening guidance, develop early-diagnosis methods and assess screening effectiveness and harms; evaluate colorectal-screening options through the pilot begun in 2019, including preferences, bleeding, perforation and effectiveness.[2][3]
• Assess private-sector cancer-screening items, strengthen evaluation and oversight of screening institutions, address underperformance, and consider a future accreditation system.[14][4]
• Monitor cancer-related misinformation and claims circulating through social and new media, including information concerning foods, deworming medicines, and new diagnostic and treatment technologies.[4]
• Shift cancer-care assessment towards patient-centred and outcome-focused evaluation across the treatment pathway, while intensifying quality-improvement activities in lower-rated institutions.[7][8]
• Analyse 2020 cancer-registration statistics, calculated in 2022, to assess COVID-19 impacts and identify vulnerable groups needing cancer-management responses during infectious-disease periods.[10]
• Evaluate regional cancer centres under the Cancer Control Act, provide feedback, and offer preparatory education and improvement guidance where designation criteria are not met.[15]
• Prepare annual implementation plans, review detailed task progress through specialist committees at least twice yearly, select representative indicators and manage targets for 2023 and 2025.[13]
• Develop outcome indicators for detailed tasks, report, assess and disclose implementation performance and policy outcomes through the National Cancer Management Commission, and publicise major achievements.[13]

Costing & Financing

Financial protection is principally pursued through strengthened health-insurance coverage, progressive reimbursement decisions for anticancer medicines and treatments, and revised medical-cost support targeted towards people facing greater economic hardship. The available sections do not specify a total plan budget, programme allocations, expenditure profile, funding gap, costing methodology or broader economic assumptions.[7][11][12][15]

• Strengthen health-insurance coverage and apply reimbursement decisions progressively for anticancer medicines and other treatments, taking account of clinical utility, cost-effectiveness and fiscal conditions.[7]
• Revise medical-cost support to align more closely with low-income objectives and provide stronger assistance to medical-aid recipients and other patients with substantial economic burdens.[7]
• Maintain financial-protection measures that include strengthened insurance coverage and the catastrophic medical expense support programme introduced in 2018.[1]
• Record the increase in cancer patients’ health-insurance coverage from 49.6% in 2004 to 78.5% in 2019, without specifying the associated expenditure or financing source.[16][17]
• Consider financial requirements when expanding lung-cancer screening and review reimbursement criteria for Helicobacter pylori testing and eradication treatment, although no quantified allocation or funding source is provided.[3][14]
• Invest in cancer-data infrastructure, research capacity, advanced technology, survivorship centres, regional cancer services, haematopoietic stem-cell-transplant wards and affiliated-hospital remodelling, without quantified costs.[5][11][12]
• Support cancer research investment, for which output was reported as 2.03 Science Citation Index papers per 100 million Korean won in 2018, compared with 0.21 papers per 100 million Korean won across national research and development.[18]
• Use international development-cooperation channels, including official development assistance, the Economic Development Cooperation Fund and international-organisation trust funds, while leaving monetary allocations unspecified.[15]
• Note that the supplied sections do not specify funding gaps, resource-mobilisation targets, cost-effectiveness methodology beyond reimbursement considerations, or economic assumptions.[19][5][6][2][3][14]