Cancer care : assuring quality to improve survival.

159 Pages·2013·2.941 MB·English

by  OECD

OECD Health Policy Studies O
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Cancer Care D
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ASSURING QUALITY TO IMPROVE SURVIVAL lt
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Contents lic Cancer Care
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Executive summary S
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Chapter 1. Cancer care systems: Increasing burdens and existing performance gaps d
ie ASSURING QUALITY TO IMPROVE SURVIVAL
Chapter 2. Resources for cancer care s
Chapter 3. Cancer care practice
Chapter 4. Governance of cancer care systems
Chapter 5. Explorative analysis
Chapter 6. Policy recommendations
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81 2013 01 1 P

OECD Health Policy Studies
Cancer Care
ASSURING QUALITY TO IMPROVE SURVIVAL
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Please cite this publication as:
OECD (2013), Cancer Care: Assuring Quality to Improve Survival, OECD Health Policy Studies,
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FOREWORD
Foreword
C
ancer remains a major health care challenge in OECD countries and the financial burden
associated with cancer is also growing. However, despite recent improvements in cancer treatment
and prevention, countries are not doing as well as they could to fight the disease: an estimated
one-third of cases could be cured if detected on time and adequately treated, and another one-third
could be prevented entirely if more far-reaching public health measures were in place. Furthermore,
cancer survival data show almost a four-fold difference across OECD countries. While some
countries are lagging behind in cancer care performance, other countries have designed systems that
make them global leaders in the fight against cancer.
This report aims to share best practice and improve cancer care performance across countries.
Drawing on questionnaires and structured interviews conducted with cancer experts in 35 countries,
it describes variations in the resources countries allocate to cancer care, care practices and
governance systems for cancer care. It explores the policy trends in cancer care across countries over
the past decade and identifies which policy approaches are associated with the best cancer survival.
The report concludes by offering concrete recommendations for creating and supporting high-quality
cancer care systems.
CANCER CARE: ASSURING QUALITY TO IMPROVE SURVIVAL © OECD 2013 3
ACKNOWLEDGEMENTS
Acknowledgements
T
his OECD study was undertaken by the OECD Health Care Quality Indicator (HCQI) project
which monitors and evaluates quality of health care and system performance across countries. The
report was developed by Rie Fujisawa, Ian Forde and Vladimir Stevanovic. The report benefited from
valuable comments and suggestions from Mark Pearson and NiekKlazinga. Many thanks also to
MarlèneMohier and Nathalie Bienvenue for their editorial contribution in preparing the document
for publication.
The authors would also like to extend gratitude to the country representatives for theHCQI
project and national experts who responded to questionnaires and data request and participated in
interviews, and also external collaborators, Riccardo Capocaccia, Michel P. Coleman, David Forman
and Andrea Micheli for their input and guidance to thisstudy.
4 CANCER CARE: ASSURING QUALITY TO IMPROVE SURVIVAL © OECD 2013
TABLE OF CONTENTS
Table of contents
Acronyms and abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Chapter 1. Cancer care systems: Increasing burdens and existing performance gaps 15
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Cancer: What it is and recent trends in rates of incidence . . . . . . . . . . . . . . . . . . . . 16
Cancer is associated with great financial cost within the health care sector
and beyond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Cancer is causing an increasing numbers of deaths . . . . . . . . . . . . . . . . . . . . . . . . . 20
Performance of cancer care is uneven across countries . . . . . . . . . . . . . . . . . . . . . . 25
A fundamental question: Do certain cancer care policies lead to fewer deaths? . 29
How this report is structured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Chapter 2. Resources for cancer care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Availability of cancer drugs is expanding with consideration for financial
sustainability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Medical devices are increasing in number, but often without concern
for rational use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Institutions and professionals are becoming specialised for delivering
quality cancer care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Chapter 3. Cancer care practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Anti-smoking steps have been taken but additional prevention measures
are needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Early diagnosis has also been promoted, but maintaining high screening levels
is a challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Medical practice varies, but delivery of evidence-based cancer care
has been enhanced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Timely delivery of cancer care is not always ensured, but efforts
have been made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
CANCER CARE: ASSURING QUALITY TO IMPROVE SURVIVAL © OECD 2013 5
TABLE OF CONTENTS
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 4. Governance of cancer care systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
National policies are often set out to steer cancer control efforts . . . . . . . . . . . . . . 92
Countries are setting national targets but the development of national guidelines
varies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Monitoring of cancer control efforts has been improving but remains uneven . . . 102
Quality assurance mechanisms have been set up but not in all countries . . . . . . . 104
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Chapter 5. Exploratory quantitative analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Results of the univariate analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Results of multivariable analysis at the domain level . . . . . . . . . . . . . . . . . . . . . . . . 117
Multivariable analysis across domains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Annex 5.A1. Methodologies for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Annex 5.A2. Variables used in explorative analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Annex 5.A3. Results of fractional polynomials univariate analysis . . . . . . . . . . . . . 130
Annex 5.A4. Results of fractional polynomials multivariable analysis . . . . . . . . . . . 135
Chapter 6. Policy recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Allocating resources adequately and effectively to ensure fair and affordable
access to cancer care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Promoting best practice in cancer care: doing the right thing at the right time . . 140
Strong governance: ensuring quality and continuously improving care . . . . . . . . . 143
Demonstrating and promoting success through better data . . . . . . . . . . . . . . . . . . 144
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Annex A. List of experts on cancer care systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Tables
2.1. Financial access to cancer care, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3.1. Breast cancer screening programmes and financial access, 2010 . . . . . . . . . . . 72
3.2. Rollout years of breast cancer screening programmes, 2010 . . . . . . . . . . . . . . . 72
3.3. Rollout years of cervical cancer screening programmes, 2010 . . . . . . . . . . . . . . 73
3.4. Average referral time between GP and specialist visit, 2010 . . . . . . . . . . . . . . . 81
6 CANCER CARE: ASSURING QUALITY TO IMPROVE SURVIVAL © OECD 2013
TABLE OF CONTENTS
3.5. Average waiting time between cancer diagnosis and initial treatment
(surgery, radiotherapy and/or chemotherapy), 2010 . . . . . . . . . . . . . . . . . . . . . . 82
4.1. Introduction of national cancer control programmes or national health
policies or strategies with a focus on cancer care, 1996-2010 . . . . . . . . . . . . . . 93
5.1. Multivariable analysis for cancer resources, p-value and adjusted R2 . . . . . . . 118
5.2. Multivariable analysis for cancer screening, p-value and adjusted R2 . . . . . . . 118
5.3. Multivariable analysis for the practice of cancer care, p-value
and adjusted R2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
5.4. Multivariable analysis for the governance of cancer care, p-value
and adjusted R2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
5.5. The predictors resulting from multivariable modelling across domains . . . . . 120
5.A3.1. Fractional polynomials univariate analysis, breast cancer in 2002 . . . . . . . . . . 130
5.A3.2. Fractional polynomials univariate analysis, cervical cancer in 2002 . . . . . . . . 131
5.A3.3. Fractional polynomials univariate analysis, colorectal cancer in 2002 . . . . . . . 131
5.A3.4. Fractional polynomials univariate analysis, lung cancer in 2002 . . . . . . . . . . . 132
5.A3.5. Fractional polynomials univariate analysis, breast cancer
by GDP level in 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
5.A3.6. Fractional polynomials univariate analysis, cervical cancer by GDP level
in 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
5.A3.7. Fractional polynomials univariate analysis, colorectal cancer by GDP level
in 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
5.A3.8. Fractional polynomials univariate analysis, lung cancer by GDP level in 2002 134
5.A4.1. Fractional polynomials multivariable analysis, resources in 2002 . . . . . . . . . . 135
5.A4.2. Fractional polynomials multivariable analysis, practice in 2002 . . . . . . . . . . . . 135
5.A4.3. Fractional polynomials multivariable analysis, governance in 2002 . . . . . . . . . 135
Figures
1.1. All cancers incidence rates, total population, 2008 . . . . . . . . . . . . . . . . . . . . . . . 16
1.2. Percentage of total health expenditure spent on cancer care . . . . . . . . . . . . . . 19
1.3. All cancers mortality rates, males and females, 2009 (or nearest year) . . . . . . 20
1.4. Breast cancer mortality, females, 2000 and 2009 (or nearest year). . . . . . . . . . . 22
1.5. Cervical cancer mortality, females, 2000 and 2009 (or nearest year) . . . . . . . . . 23
1.6. Colorectal cancer mortality, 2000 and 2009 (or nearest year) . . . . . . . . . . . . . . . 23
1.7. Lung cancer mortality, males and females, 2009 (or nearest year) . . . . . . . . . . 24
1.8. Breast cancer five-year relative survival, 1997-2002 and 2004-09
(or nearest period) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.9. Cervical cancer five-year relative survival, 1997-2002 and 2004-09
(or nearest period) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
1.10. Colorectal cancer, five-year relative survival, 1997-2002 and 2004-09
(or nearest period) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
1.11. Lung cancer relative five-year survival, up to 2003 . . . . . . . . . . . . . . . . . . . . . . . 29
1.12. Conceptual framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.1. Years of authorisation for tenselected innovative cancer drugs . . . . . . . . . . . . 38
2.2. Medical technology resources per million population, 2010
(or nearest year available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
CANCER CARE: ASSURING QUALITY TO IMPROVE SURVIVAL © OECD 2013 7
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2.3. Positron emission tomography scanners, per million population, 2010
(or nearest year available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
2.4. Radiotherapy equipment per million population, 2010
(or nearest year available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
2.5. Use and density of medical technologies, 2010
(or nearest year available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
2.6. Certified oncologists per million population, 2010 . . . . . . . . . . . . . . . . . . . . . . . 53
3.1. Percentage of population aged 15+ who are daily smokers,
2002 and 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
3.2. Mammography screening, percentage of women aged 50-69 screened,
2002 and 2010 (or nearest year available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
3.3. Cervical cancer screening, percentage of women screened aged 20-69, 2002
and 2010 (or nearest year available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.4. Breast cancer treatment methods and incidence, 2009,
per 100000women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
5.1. Relationships between cancer survival and total national expenditure
on health with 95% confidence limits, based on fractional
polynomial model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
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