Íslenskri Krabbameinsáætlun Til Ársins 2020

Objectives

The proposed Icelandic Cancer Control Plan to 2020 establishes a comprehensive, user-centred framework to reduce cancer incidence and mortality, improve quality of life for people with cancer and their relatives, and deliver equitable, efficient, evidence-based care across prevention, early detection, diagnosis, treatment, rehabilitation, survivorship and palliative care.[1][2]It responds to a projected near-50% increase in annual cancer diagnoses between 2009–2013 and 2029–2033, driven particularly by population growth and ageing.[3]

• Reduce cancer risk through population health promotion, tobacco and alcohol control, healthier diets, physical activity, ultraviolet-radiation protection, infection prevention, individual risk assessment and action on social inequalities.[4][5][6][7]
• Strengthen evidence-based, organised screening for breast and cervical cancer, prepare colorectal screening, and assess other screening approaches according to benefits, harms, quality and affordability.[8][9][10]
• Provide timely, coordinated and individualised diagnosis, treatment and follow-up, using multidisciplinary teams, clinical guidelines, appropriate technology and shared decision-making.[11][12][13][14]
• Ensure access to specialised services, including oncology, haematology, radiotherapy, surgery, nursing, psychology, social work, rehabilitation, nutrition, palliative care and support for relatives.[15][16]
• Improve survivorship, rehabilitation and psychosocial care through systematic assessment of symptoms, distress, quality of life, late effects and service needs, followed by tailored support.[17][18][19]
• Embed palliative care early and throughout illness, regardless of diagnosis, age, prognosis or place of care, addressing physical, psychological, social and spiritual needs.[20][21]
• Develop comprehensive cancer registration, quality management and research as foundations for prevention, service planning, outcome assessment and continuous improvement.[22][23][24]

Implementation

Implementation is designed as an integrated, cross-sector undertaking involving health services, public authorities, patient organisations, research bodies and wider society.[2]The plan favours concentrated specialist provision centred on Landspítali University Hospital, combined with coordinated primary care, home nursing, regional services and international collaboration where specialised treatment or expertise is unavailable domestically.[25][26][27]

• Establish a project-management function to develop implementation and follow-up arrangements and lay the foundations for an Icelandic cancer centre or cancer council to coordinate the organisations involved.[28][29]
• Use multidisciplinary clinical teams and pathway teams to guide diagnosis, treatment, follow-up and service coordination, with treatment decisions generally made in professional consultation meetings.[30][14]
• Assign service co-ordinators or navigators from diagnosis to assess needs, support people and relatives, coordinate care, provide social-resource guidance and link hospital, primary-care and home-nursing services.[12][31][32]
• Provide written treatment, discharge and follow-up plans, compatible health-record systems and a secure interactive website linked to the patient record for personalised information, support and counselling.[12][33][34]
• Strengthen workforce capacity, education, specialist nursing, diagnostic facilities, equipment and home-based services in response to rising demand and identified staffing shortages.[25][35][36][37]
• Maintain nationwide cancer registration under the Director of Health, while the Icelandic Cancer Society hosts and largely finances the registry with Ministry of Welfare support.[22]Develop electronic quality registration modelled on Sweden’s INCA system, linking treatment providers and enabling feedback, comparisons and quality improvement.[38][39]
• Benchmark services against recognised international standards, publish comparative performance results annually, and use regularly reviewed quality indicators to guide improvements.[40][41]
• Monitor key operational measures, including screening participation, diagnostic waiting times, multidisciplinary-team access, rehabilitation assessment, patient information and equipment oversight.[42][37][43][44]
• Support financing for implementation, infrastructure, equipment, workforce, research and quality systems, although the source does not provide a consolidated budget, detailed funding allocation or quantified financing gap.[29][45][46]

Monitoring & Evaluation

The plan proposes a national monitoring and quality-improvement system centred on comprehensive cancer registration, standardised quality indicators, service-user experience, clinical outcomes and public reporting. It combines population surveillance, screening quality assurance, pathway measures, workforce and service-capacity assessment, and patient-level assessment of symptoms, rehabilitation and support needs.[22][23][47]

• Maintain the Icelandic Cancer Registry, which records approximately 99% of cancers diagnosed nationally and includes diagnosis, treatment and patient-outcome information.[22]
• Expand registration from epidemiological surveillance to clinical, treatment, service, social and economic information, drawing on Sweden’s Information Network for Cancer Care model for standardised, interactive quality registration.[38][23][48]
• Use near-real-time data exchange and comparable quality indicators to benchmark providers, identify improvement needs and assess outcomes across diagnosis, treatment, rehabilitation, palliative care and follow-up.[39][47]
• Monitor quality measures including case-registration coverage, multidisciplinary-team discussion, surgical complications requiring reoperation, prolonged postoperative stays and participation in treatment research.[49]
• Publish comparative cancer-service performance results annually and make them accessible to the public.[40][50][23]
• Assess adherence to clinical guidelines, waiting times, emergency and outpatient use, rehabilitation and home-care use, symptoms, psychosocial support, patient experience and relatives’ experience.[47]
• Measure implementation of service standards, including multidisciplinary teams, service co-ordinators, communication pathways, rehabilitation plans, equipment oversight and staffing standards.[37][44][32]
• Track diagnostic waiting time against a proposed maximum of 20 working days from the start to completion of diagnosis.[43]
• Assess wellbeing, distress, symptoms, treatment side effects, quality of life, rehabilitation needs and social-support needs at diagnosis, treatment initiation and regularly thereafter.[17][51]
• Use validated distress and symptom tools, including the distress thermometer and Edmonton Symptom Assessment System, which are integrated into Landspítali’s SAGA electronic record but require more systematic use.[52]
• Subject organised screening to regular quality assurance, detailed recording of procedures and outcomes, international comparison, and assessment of false positives, false negatives, overdiagnosis, participation and programme outcomes.[8][9][10]
• Review screening implementation independently each year against recognised European standards, while monitoring availability of risk assessment, information materials and proactive primary-care encouragement.[42][53]
• Monitor breast-screening participation of approximately 60% against European acceptable participation of 70% and desirable participation above 75%, and cervical-screening participation of approximately 73% in 2014 against European guidance of at least 85%.[54][55]
• Use cancer incidence, mortality, survival, lost life-years, service activity and workforce projections as evidence for planning, while recognising data limitations in pathology, diagnostic imaging and some hospital activity records.[3][56][57]
• Assign implementation and follow-up to a proposed project-management group and establish foundations for an Icelandic cancer centre or cancer council, although the source does not specify a complete national indicator set, reporting architecture or independent accountability framework.[28][29]

Costing & Financing

The plan identifies substantial financial pressures from growing cancer incidence, increasingly complex diagnosis and treatment, specialist workforce needs, advanced medicines, equipment, registration and rehabilitation. It calls for sufficient financing for implementation and priority areas, but provides no consolidated Icelandic budget, quantified funding gap, costing methodology or resource-mobilisation plan.[58][29][59]

• Recognise that targeted cancer medicines commonly cost between 500,000 and 1,000,000 Icelandic krónur per month and may be needed for months or years.[60]
• Address medicine costs through clinical-trial participation, early collaboration with pharmaceutical companies, international cooperation and potential joint Nordic procurement, although savings are not quantified.[60][61]
• Plan for capital investment in advanced diagnostic and surgical technology, radiotherapy capacity, facilities and equipment renewal, noting that newer biological medicines and equipment are increasingly expensive.[58][62][63]
• Address identified resource gaps, including insufficient funding for dedicated cancer-registration and treatment-data staff at Landspítali, limited resources for real-time quality registration, and inadequate operating funds for medical-equipment oversight.[30][46][44]
• Maintain and increase public funding for the Icelandic Cancer Registry, which is mainly financed by the Icelandic Cancer Society while the Ministry of Welfare pays one third of operating costs.[22]
• Recognise that cancer accounted for around 6.5% of health expenditure, equivalent to about nine billion Icelandic krónur in 2013, with expenditure mainly attributed to inpatient treatment, outpatient treatment and medicines.[27]
• Use organised screening where it offers greater benefit at lower cost than opportunistic testing, while assessing the affordability and cost of colorectal screening and existing opportunistic colonoscopy.[64][65][66]
• Consider public-health financing through alcohol and tobacco taxes and charges on unhealthy foods, including increasing the share of alcohol and tobacco sales-tax revenue directed to the Public Health Fund.[67]
• Protect affordability for patients, as rising cost-sharing may lead some people to decline treatment; proposed support includes reasonable patient contributions and travel, accommodation and other assistance for patients and relatives.[68][69]
• Provide appropriate financing for rehabilitation, differentiated for people requiring specialised and complex interventions, but without a specified allocation.[70][71]
• Plan specialist palliative-care capacity against estimates of 50 to 100 beds per million inhabitants, equivalent to 16 to 32 beds in Iceland, without a stated budget.[20][21]