De Nederlandse Kanker Agenda

Objectives

The Dutch Cancer Agenda is a shared, living national cancer plan led by the Netherlands Cancer Collective, with a 10-year mission to reduce cancer’s impact on society and improve life before, during and after cancer. It places people with cancer, citizens and close relations at the centre, irrespective of age, sex, background or circumstances.[1][2]The agenda contains 20 goals, selected from 41 co-created objectives, and prioritises five highlighted goals for collective action according to their impact, urgency and the attention they already receive.[3][4]

• Reduce cancer risk through sustainable prevention, including tobacco and nicotine control, lower alcohol consumption, safer sun behaviour, vaccination and prevention of cancer-related infections, healthier diets, physical activity, and reduced exposure to air and environmental pollution.[5][6][7][8][9]
• Improve early detection through equitable population screening, informed participation, hereditary-risk assessment, faster personalised diagnosis and reduced barriers for groups reached less effectively.[10][11][12][13]
• Provide personalised, evidence-based treatment with minimal burden, shared decision-making and timely access to effective diagnostic and therapeutic innovation, irrespective of treatment location.[14][15][16]
• Strengthen expert, coordinated care and research for rare cancers, aiming to improve survival by 2032 through earlier recognition, molecular diagnostics, expert networks, international collaboration and better access to effective treatments.[17][18][19]
• Ensure proactive palliative care and support for people with incurable cancer that reflects their values, wishes and needs, while improving coordination between healthcare, informal care and the social domain.[20][21]
• Improve quality of life, participation and support for people living with or after cancer through healthier lifestyles, prevention and management of late effects, education and employment support, financial guidance, and social and emotional support for relatives, carers and bereaved people.[22][23][24][25][26]

The agenda addresses three cross-cutting societal challenges: delivering people-centred cancer policy, maintaining operational and financial sustainability amid rising demand and workforce pressures, and reducing the environmental impact of cancer care.[27][28]It aligns with the European Cancer Mission and Europe’s Beating Cancer Plan, particularly their priorities on prevention, early detection, high-quality care and quality of life.[29][30]A quantified prevention objective is to reduce smoking by 2032 to 5% among adults and 0% among young people and pregnant women.[31]Other 2032 targets include no alcohol consumption among pregnant women and people under 18, low or no alcohol consumption among 65% of adults, and at least a 15% increase in safe-sun behaviour compared with a 2023 baseline.[6][32][33]

Implementation

Implementation is based on a bottom-up partnership model rather than a new standalone delivery organisation. More than 100 organisations, including patient organisations, healthcare providers, research institutions, civil-society organisations, funders and public bodies, participate in the Netherlands Cancer Collective and retain responsibility for their own contributions.[34][2]The Collective connects existing and new initiatives across regional, sectoral and disciplinary boundaries, combining expertise and resources to create synergies, accelerate progress and address under-represented issues.[1][2]

• Implement goals through six enabling means: organisation of care and support; research, innovation and implementation; data infrastructure; education; information and communication; and policy.[5]
• Develop plans for the five highlighted goals through acceleration teams, using a Theory of Change to connect underlying problems, activities and intended results; plans specify responsibilities and timing.[4][5]
• Support coordination through a small, flexible Netherlands Cancer Collective hub led by a programme manager, which facilitates plan development and implementation, connects partners, shares relevant initiatives and funding information, and undertakes communication and lobbying.[35][36]
• Map partners’ activities, responsibilities, milestones and contributions through the Collective’s website, while allowing additional organisations to join where they add value.[35]
• Use differentiated and inclusive measures to address persistent health inequalities, including barriers faced by people on lower incomes, people from non-Dutch cultural backgrounds and groups under-represented in research.[27][37][15]
• Integrate care across prevention, diagnosis, treatment, follow-up, palliative care and survivorship, including links between primary, secondary and tertiary care, employment, education and social support.[28][21][38][39]

Operational actions include strengthening cessation support alongside tobacco restrictions, improving vaccination access and targeted infection screening, expanding shaded environments and sun-safety communication, reducing emissions and air-pollution exposure, and improving access to healthy food and activity-friendly environments.[40][7][8][41][42]The agenda also proposes interoperable data infrastructure, broader use of molecular diagnostics where appropriate, real-world evidence, patient-reported outcome measures, expert centres and multidisciplinary networks.[5][13][16][19]

Governance is collaborative: partners share responsibility for implementation, while the hub has an initiating and coordinating role.[29][35]The hub is expected to develop a progress dashboard and initiate an annual evaluation, and the Collective evaluates and recalibrates goals annually as progress and priorities evolve.[36][2]The source does not specify the dashboard’s indicator set, a comprehensive reporting timetable or a formal accountability body.[36][2]

Resource mobilisation relies primarily on partner capacity and potential European programmes, including EU4Health, Horizon Europe and Digital Europe.[2][29]No implementation budget or costed financing plan is specified.[43]Cancer care nevertheless represented about 7% of Dutch healthcare expenditure in 2019, or approximately 6.5 billion euro, illustrating the agenda’s concern with financial sustainability.[43]

Monitoring & Evaluation

Monitoring arrangements combine annual review, website-based progress information and a planned dashboard, but the agenda does not yet specify a comprehensive indicator framework, standard reporting timetable, surveillance system or formal accountability procedure.[2][29][5][36]

• Evaluate and recalibrate the agenda’s goals annually, allowing emphasis on highlighted goals to change in response to progress.[2]
• Monitor implementation progress and adjust delivery where required, with all Netherlands Cancer Collective partners sharing responsibility for implementation.[29]
• Publish progress updates and relevant reports for the five highlighted goals through the agenda website; the Collective also maps partner activities, responsibilities, milestones and contributions online to support coordination.[5][35]
• Develop a dashboard to monitor progress towards agenda goals and initiate an annual evaluation, although its indicators, methodology, reporting arrangements and accountability procedures are not specified.[36]
• Assess goal effects in relation to cancer incidence, mortality, survival, quality of care, quality of life, social participation, health inequalities and the sustainability of cancer care.[1][27][28][44]
• Track quantified prevention outcomes, including reducing smoking by 2032 to 5% of adults and 0% of young people and pregnant women; ensuring no alcohol consumption among pregnant women and people under 18, while 65% of adults consume no alcohol or no more than one glass daily; and increasing safe-sun behaviour by at least 15% against a 2023 baseline.[31][6][33]
• Use structural measurement of sun behaviour and proposed exposure mapping, mobile-data analysis, air-quality data and real-time sensors to inform prevention and environmental action.[7][41]
• Monitor screening performance using participation and detection data. Reported 2022 participation was 68% for bowel screening and 71% for breast screening, while cervical screening participation increased from 46% after one year to around 65% after five years.[11]
• Use diagnostic pathway baselines, including median intervals from hospital referral to diagnosis, and compare them with the Organisation for Comprehensive Cancer Care Netherlands standard of no more than three weeks from first outpatient visit to diagnosis.[13]
• Use Patient Reported Outcome Measures and real-world evidence to assess treatment effects, including over-treatment, under-treatment and quality-of-life outcomes.[16]
• Strengthen evidence generation for rare cancers through structured diagnosis, treatment and quality-of-life data, linked molecular and clinical data, and real-world data; survival improvement by 2032 is the stated outcome direction.[17][18][19][45]
• Address evidence gaps concerning palliative care, late effects, lifestyle support, work, education, financial consequences and support for relatives. The source identifies needs for long-term data collection, linked patient-reported outcome data and further research, but does not establish plan-wide indicators or named reporting bodies for these areas.[22][46][24][47][48][25][49]

Costing & Financing

The agenda identifies growing cancer-care expenditure and sustainability pressures, but provides no costed implementation plan, dedicated agenda budget, allocation framework, quantified funding gap or stated economic assumptions.[28][36][43]

• Recognise that cancer care represented approximately 7% of Dutch healthcare expenditure in 2019, equivalent to about 6.5 billion euro.[43]
• Note that hospital care accounted for approximately 5.5 billion euro, or 84.6% of cancer-care costs, including expensive hospital medicines; medicines and medical aids accounted for 225 million euro, or 3.5%.[43]
• Address reported financial sustainability risks arising from increased demand, more complex needs, novel treatment options, rising cancer-care expenditure and healthcare workforce pressure.[28]
• Consider European programmes, including EU4Health, Horizon Europe and Digital Europe, as potential resources for research, implementation and European cancer cooperation.[1][29][30]
• Support co-financing of research and infrastructure for risk-based population screening, while recognising that the cost and specialist expertise required for molecular diagnostics constrain wider access.[12][13]
• Recognise that precision treatments may be costly and unevenly available, while faster market access and reimbursement for effective diagnostic and treatment innovations are policy objectives rather than funded commitments.[15][16]
• Address inadequate financing as a barrier to cross-setting palliative care, work-related support and lifestyle interventions, including the absence of cross-domain reimbursement for some programmes.[20][22][50]
• Recognise financial pressures on people affected by cancer, including income loss, additional expenditure, insurance and benefit barriers, and the deductible as a barrier to access to care and support.[38][25][51]
• Note that cancer-care expenditure was reported as 60% above the European Union average, but the source provides no causal analysis, future expenditure projection or quantified resource-mobilisation target.[43]