Stratégie nationale contre le cancer 2014–2017

Objectives

The National Strategy against Cancer 2014–2017 provides an integrated Swiss framework for cancer prevention and screening, care, research, epidemiology and monitoring. It seeks to reduce cancer occurrence, suffering and mortality, improve cure and quality of life, and ensure that people affected by cancer and their relatives are involved in decisions and supported throughout the course of illness.[1][2]The strategy is guided by quality, effectiveness, coordination and equality of opportunity across Switzerland’s federal health system.[3][4]

• Strengthen prevention and health literacy by promoting healthy living conditions and behaviours, addressing tobacco use, alcohol-related harm, overweight, physical inactivity, diet, environmental carcinogens and other risk factors.[5][6][7][8]
• Establish systematic, quality-assured screening for breast, bowel and cervical cancer, while ensuring equitable access and nationally consistent standards.[8][9][10]
• Deliver integrated, person-centred cancer services spanning diagnosis, treatment, nursing, psychosocial and psycho-oncological support, rehabilitation, follow-up and palliative care.[11][12][13]
• Define patient pathways, therapeutic guidelines and quality standards to support coordinated care from diagnosis through curative, chronic and palliative phases.[4][13][14]
• Improve equality of access to screening, diagnosis, treatment and supportive services across population groups, regions and cantons.[15][1][12]
• Strengthen patient participation, self-efficacy and counselling, while recognising the needs of relatives, children, adolescents, long-term survivors and people with multiple conditions.[11][16][17][2]
• Develop national competence centres, regional networks and centres of excellence for rare cancers, enabling specialist knowledge to reach peripheral regions and supporting local long-term care.[15][18][16]
• Advance clinical, translational and health-services research, including research on public health, health economics, palliative care, rehabilitation and psycho-oncology.[19][20][21]
• Standardise cancer registration and epidemiological monitoring to support prevention, screening, treatment-quality assessment, outcomes research and evidence-based health-policy planning.[22][23][24]

Implementation

Implementation follows a decentralised, subsidiary model that retains cantonal and national structures while strengthening coordination among public authorities, professional bodies, research organisations, insurers, patient organisations and cancer-control institutions.[25][2]The strategy was prepared through consultation with relevant organisations, specialists, disciplines and cantons, and its priority projects were developed with partners across prevention and screening, care and research.[3][26]

• Coordinate national delivery through the Swiss Health Policy Dialogue, a joint platform of the Confederation and cantons, which mandated Oncosuisse to develop the strategy.[3][26]
• Assign Oncosuisse responsibility for establishing and managing the implementation organisation during 2013–2017, organising the National Cancer Programme Forum, and supporting appropriate use of implementation and quality-assurance instruments.[2][27]
• Use a coordination commission representing the Confederation, cantons and Oncosuisse to align mandates, monitor progress and deviations, adapt delivery where needed, and commission annual reporting to the Swiss Health Policy Dialogue.[27]
• Engage a monitoring group representing professional bodies, research-support organisations, health insurers and patient organisations to support implementation by umbrella organisations and coordinate the strategy with existing activities.[27]
• Use the National Cancer Programme Forum to convene implementation bodies, aggregate and disseminate project information, and develop instruments and recommendations.[27]
• Develop screening coordination through a progressive competence centre and through cooperation among existing and planned breast-cancer screening programmes via the Swiss Cancer Screening Federation.[9][10]
• Establish a national expert body on screening to examine medical, economic, ethical and legal issues, review evidence and evaluations, prepare recommendations for policymakers, and consider efficiency and effectiveness.[10]
• Implement care pathways through binding therapeutic guidance, interdisciplinary tumour boards, care management, outpatient and inpatient collaboration, and patient involvement in treatment decisions.[13][14]
• Build regional networks and competence centres to coordinate care across ambulatory, hospital and home settings, share specialist knowledge, and support service quality beyond major centres.[18][28][29]
• Strengthen workforce capacity through targeted basic and continuing education, including care-management roles, and measures to recruit and retain nursing, radiological medical technology and other essential professionals.[17]
• Implement nationally coordinated cancer registration through cantonal or regional registries, a national minimum dataset, a federal legal framework and a national coordinating body.[22][23][24]
• Monitor implementation through annual reporting, project-information analysis, tumour-registry data, screening outcomes and treatment-quality data.[23][27]Quantified performance targets, a consolidated indicator framework and formal accountability sanctions are not specified in the supplied extracts.[27]
• Secure financing for cancer-registration data collection and evaluation, screening programmes, interdisciplinary services, psychosocial support and rehabilitation where identified as implementation conditions.[8][13][22][30]Specific strategy-wide budgets, allocations and funding sources are not specified.[2][27]

Monitoring & Evaluation

The strategy’s evaluation architecture combines cancer registration, quality assurance, project monitoring and evidence transfer to support prevention, screening, care, research and health-policy decisions.[21][22][23]

• Use nationally coordinated tumour and cancer registries, supported by a federal legal framework and the National Institute for Cancer Epidemiology and Registration, to collect, analyse, publish and link standardised cancer data.[21][22][23]
• Achieve registry coverage of more than 90% of Switzerland’s population with high-quality data, and use epidemiological information to inform prevention and health policy.[24]
• Collect screening outcomes and treatment-quality information using internationally compatible indicators, enabling comparisons with other countries and assessment of treatment effectiveness.[23]
• Define clinically relevant process, structural and outcome-quality indicators for each patient pathway, document divergences between diagnosis and treatment, and use quality-development processes to promote transparency and continuous improvement.[14]
• Evaluate patient pathways in one or two pilot regions, document and disseminate experience, and link learning from service delivery with registry data, scientific evidence and innovation.[18]
• Apply national quality assurance to screening programmes, including standardised criteria for bowel, breast and cervical cancer screening and updated mammography quality requirements aligned with European guidelines.[8][9]
• Establish review functions for screening through a proposed national expert body that would assess medical, economic, ethical and legal matters, review evidence, follow evaluations and examine efficiency and effectiveness.[10]
• Use competence centres and regional networks to document illness trajectories, share specialist knowledge and support continuous improvement, including for peripheral regions and rare cancers.[28][29]
• Develop nationally standardised data collection and processing, including treatment-quality data and dataset linkages, and transfer findings into clinical practice and policy.[6][23]
• Evaluate authorisation and implementation procedures under the Human Research Act and use health-services research, including outcome data, to support planning.[19][20]

Implementation oversight is assigned to a coordination commission representing the Confederation, cantons and Oncosuisse. It is intended to align mandates and delivery, monitor progress and deviations, adapt implementation where needed, and commission annual reports to the Swiss Health Policy Dialogue.[27]A monitoring group is intended to support implementation by umbrella organisations and coordinate the strategy with related activity, while the National Cancer Programme Forum is intended to aggregate, analyse and disseminate information on individual projects and develop implementation instruments and recommendations.[2][27]

Earlier surveillance arrangements relied on tumour registries in most cantons and national coordination by the National Institute of Cancer Epidemiology and Registration. Registry data covered 68% of the population in 2010, with coverage above 90% expected from summer 2013.[26][31]Childhood cancer registration was nationally standardised from 1976, with near-complete coverage for children aged 0 to 15 from 1990, although registration for adolescents aged 16 to 20 remained incomplete.[31]

The extracts do not provide a consolidated national indicator set, quantified targets, a common reporting timetable beyond annual reporting to the Swiss Health Policy Dialogue, formal evaluation cycles, named monitoring bodies for every action area, or accountability sanctions.[10][13][2][27]

Costing & Financing

Financing is presented principally as an implementation condition for data infrastructure, screening, integrated care, rehabilitation and psychosocial services, rather than through a costed national budget.[8][13][22][30]

• Secure financing for collecting and evaluating cancer-registration data, including adequate support for the National Institute for Cancer Epidemiology and Registration and cantonal cancer registries.[22][24]
• Ensure transparent financing and sufficient resources for nationally coordinated, quality-assured bowel-, breast- and cervical-cancer screening programmes.[8]
• Provide compulsory health-insurance coverage, without application of the franchise, for mammographies delivered through systematic, quality-assured breast-cancer screening programmes for women resident in Switzerland.[9]
• Address financing for interdisciplinary services as a necessary condition for implementing patient pathways and integrated cancer care.[13]
• Clarify and secure financing for psychosocial services, psycho-oncology and oncological rehabilitation, including financing arrangements within basic healthcare and networked structures.[32][30]
• Consider cost-effectiveness when managing resources for prevention, screening, care and research, while taking account of existing strategies such as the national palliative-care strategy.[12]
• Use cancer-registration information to monitor treatment quality and costs associated with introducing the Swiss Diagnosis Related Groups tariff system.[23]

The strategy recognises resource pressures: limited resources support the need to concentrate and consolidate implementation, while increasingly complex treatments and a growing population of long-term survivors are expected to generate additional health-system costs.[25][15]Different financing systems for ambulatory and hospital services also need to be considered when organising integrated care.[14]

The supplied extracts do not specify total programme costs, expenditure estimates, monetary budget allocations, funding sources, funding gaps, resource-mobilisation targets, unit costs, or detailed economic assumptions.[6][7][2][27]