Íslenskri Krabbameinsáætlun Til Ársins 2020

Objectives

The Icelandic Cancer Plan sets out a comprehensive, user-centred public-health and service framework to reduce cancer incidence and mortality, improve quality of life, and prepare health and social services for a growing number of people living with and after cancer.[1][2]It seeks systematic, evidence-based and economically efficient action across the full pathway, respecting individual wishes, values and needs in diagnosis, treatment, rehabilitation, follow-up and palliative care.[3]

• Reduce cancer risk through prevention, health promotion, individual risk assessment, lifestyle support, evidence-based screening and research into causes and risk factors.[4]
• Detect cancer earlier through organised, risk-targeted screening, clear public information and effective diagnostic pathways.[5][6]
• Provide timely, high-quality and personalised care through adequately staffed specialist units, recognised methods, clinical guidelines, appropriate technology and multidisciplinary decision-making.[4][7]
• Ensure continuous, co-ordinated services from diagnosis through treatment, discharge, follow-up, rehabilitation and long-term survivorship care.[8]
• Strengthen participation by people with cancer and relatives through accessible information, self-management support, shared decision-making, written treatment plans and individualised follow-up plans.[9][10]
• Improve wellbeing through systematic assessment and tailored management of symptoms, distress, treatment effects, rehabilitation needs, psychosocial needs and palliative-care requirements.[11][12]
• Protect equitable access, affordability and social rights, including support for travel and subsistence where specialised treatment is distant from home.[13][14]
• Develop comprehensive cancer registration, quality management, outcome measurement and research to improve prevention, treatment and services.[15][16]

Priority areas span epidemiology and registration, prevention, screening, early detection, research and quality management, treatment, workforce development, rehabilitation, follow-up and palliative care.[1]The plan also recognises that rising incidence, population ageing, increasingly complex treatment and expensive medicines will place growing demands on workforce capacity, infrastructure, equipment and health-system financing.[17][18]

Implementation

Implementation is intended to combine national oversight with multidisciplinary, person-centred delivery across hospitals, primary care, home nursing, municipalities, patient organisations, research institutions and social services.[19][20]A project management function is to develop implementation and follow-up arrangements and prepare the basis for an Icelandic cancer centre or cancer council to coordinate the organisations involved.[2][18]

• Coordinate governance through a single national oversight and coordination function, with clear responsibilities, measurable objectives, an implementation timetable and workforce assessment.[21][22]
• Concentrate core specialist cancer diagnosis and treatment at Landspítali University Hospital, while maintaining relevant activity at Akureyri Hospital and strengthening referral pathways across service levels.[23][24]
• Organise care through multidisciplinary teams that make treatment decisions, develop services for defined patient groups and apply regularly updated evidence-based clinical guidelines.[25][26]
• Assign a service co-ordinator after diagnosis to assess needs, guide people through services, improve communication and link hospital teams, primary care, home nursing and social support.[27][28]
• Develop standardised care pathways, including maximum diagnostic waiting times of 20 working days and personalised discharge, rehabilitation and follow-up plans.[29][30]
• Deliver prevention through health-promoting schools and communities, primary care, municipal policy, tobacco and alcohol controls, healthier environments, vaccination and targeted outreach to underserved groups.[31][32][33]
• Provide organised breast and cervical screening and prepare colorectal screening using faecal immunochemical testing followed by colonoscopy for positive results.[34][35]
• Strengthen palliative, psychosocial and rehabilitation services through early referral, specialist multidisciplinary provision, home-based collaboration, peer support and systematic symptom and distress assessment.[36][37]

The Ministry of Welfare appointed an advisory group in 2013 involving representatives of the Ministry, Landspítali University Hospital, the University of Iceland, the Directorate of Health, the Icelandic Cancer Society, the Capital Region Health Service, clinical experts, patients and relatives.[19]Five working groups were organised around epidemiology and registration, prevention and primary health care, research and quality management, treatment and workforce, and palliative care.[38]

Quality assurance should rely on the nationwide Icelandic Cancer Registry and expanded real-time quality registration modelled on Sweden’s Information Network for Cancer Care system.[39][40]Proposed mechanisms include standardised clinical data, quality indicators, annual public reporting, international benchmarking and continuous service improvement across diagnosis, treatment, follow-up and rehabilitation.[15][41]The Registry is managed by the Icelandic Cancer Society, while the Chief Medical Officer is responsible for it under the statutory health-register framework.[39]

Financing arrangements remain incompletely specified. The Registry is financed mainly by the Icelandic Cancer Society, with the Ministry of Welfare meeting one-third of operating costs, and increased public contribution is identified as necessary.[39]The plan calls for funding to accompany implementation and priority actions, but does not provide a total budget, costed implementation plan or quantified funding gap.[18]

Monitoring & Evaluation

The plan proposes a national monitoring and quality-management architecture centred on comprehensive cancer registration, real-time clinical data, quality indicators, annual public reporting and comparison with international standards.[42][15][41][40]The Icelandic Cancer Registry provides the core population-based surveillance infrastructure, with nationwide coverage reported at 99% of diagnosed cancers and responsibility assigned to the Chief Medical Officer under the health-register legal framework.[43][39]

• Develop a national quality-registration system, modelled on Sweden’s Information Network for Cancer Care system, to integrate epidemiological, clinical, treatment, patient-experience and outcome data across prevention, diagnosis, treatment, palliative care, rehabilitation and follow-up.[15][41][44][40]
• Collect standardised, near-real-time information from providers and use 78 quality indicators to assess performance, benchmark regions and institutions, and identify improvement priorities.[15][45][41]
• Publish evaluated cancer-service results annually and make them accessible to the public, with comparison against recognised international standards.[42][46][15]
• Monitor care quality through indicators such as guideline adherence, multidisciplinary review, waiting times, complications, prolonged admission, patient and relative surveys, use of emergency, outpatient, rehabilitation and home-care services, and participation in treatment research.[45][40]
• Assess screening programmes regularly for outcomes, participation, adverse effects, affordability and changes in disease burden, while applying recognised quality standards and independent annual review.[6][47][35]
• Track breast-screening participation against the European reference level of at least 70%, cervical-screening participation against the 85% reference level, and participation in colorectal screening and related education measures.[48][49][35][50]
• Measure maximum diagnostic waiting time against the target of no more than 20 working days, and monitor implementation of multidisciplinary teams, service coordinators, rehabilitation assessment and individualised care plans.[29][30]
• Use systematic assessment of distress, symptoms, quality of life, rehabilitation needs and relatives’ needs to guide referral, psychosocial support and rehabilitation.[12][51][52]
• Strengthen accountability through a project management function, a proposed national cancer centre or cancer council, and a single national oversight and coordination function; detailed reporting responsibilities and a complete plan-wide evaluation schedule are not specified.[44][21][18]

Costing & Financing

The plan identifies significant resource pressures from rising cancer incidence, complex diagnostics, specialist workforce needs, equipment, quality registration and increasingly expensive medicines, but does not provide a costed implementation plan, dedicated overall budget or quantified funding gap.[53][43][21][18]Cancer funding was estimated at approximately nine billion Icelandic króna in 2013, while direct and societal costs are expected to rise with case numbers and treatment costs.[53][43]

• Allocate cancer-related health-sector funding across inpatient or hospital-based treatment, outpatient treatment and medicines, reported respectively as 75%, 15% and 10% of cancer-related expenditure.[53]
• Address the high cost of targeted cancer medicines, commonly estimated at 500,000 to 1,000,000 Icelandic króna per month, and consider joint Nordic procurement to improve affordability.[54][55]
• Secure increased resources for the Icelandic Medicines Agency to oversee, test, maintain and renew cancer-related equipment, and arrange access abroad where domestic installation is impractical because of cost or low expected use.[56]
• Increase public support for the Icelandic Cancer Registry, which is financed mainly by the Icelandic Cancer Society while the Ministry of Welfare covers one-third of operating costs.[39]
• Fund prevention through proposed fiscal measures, including lower taxes on healthy foods, higher taxes and product charges on unhealthy foods, and greater allocation of tobacco and alcohol charges to the Public Health Fund.[57]
• Assess affordability and the cost of existing opportunistic colonoscopies before implementing organised colorectal screening; trade unions, sickness funds, companies and Icelandic Health Insurance have supported existing activity.[58][35]
• Provide affordable patient cost-sharing and financial support for travel, subsistence and other costs when patients and relatives must access specialised treatment away from home.[59][14]
• Resource implementation, workforce, premises, equipment, prevention, rehabilitation, palliative care and quality registration, although the source does not specify allocations, cost ceilings or financing timetables for these measures.[60][44][18][61][62]