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Policy and Planning

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16/6/2021 | 7 minutes to read

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Cancer Policies

The Czech Republic has a National Cancer Control Programme (NCCP) since 2006. Its main objectives address cancer prevention, lowering the incidence and mortality rate, improving quality of life of patients, rationalising the costs of diagnosis and treatment and optimising access to new diagnostic and treatment procedures.[1] Proposed by the Czech Oncological Society, the NCCP has been supported by Czech hospitals, and also by the Ministry of Health.[2] The  cancer plan addresses elements such as the continuum of cancer services and supportive and palliative care, but it lacks in addressing patient-centred care or including specific targets. The document lacks an implementation framework (including for example details on leadership, a timeline and financial resources) and monitoring and evaluation details. Lack of specificity on these aspects makes a concrete and coordinated national effort against cancer difficult to achieve. Indeed, it has been noted that as the programme was initiated by the Czech Oncological Society, a professional body, it is not properly resourced, while it lacks broad social and political support.[3]

As to general policy, I would say that there is a lack of a conceptual work, on the national level,” notes Jirina Bartunkova, Board of the Czech Society of Immunology and Head of the Department of Immunology of the 2nd Faculty of Medicine of Charles University in Prague &Motol University Hospital. “I would say things are moving in a chaotic way” 

Tomas Dolezal, Managing Director of the Institute of health Economics and Technology Assessment (iHETA), adds: “there is no KPI that should be achieved within 5-10 years, or what the tools are to get there”. A well-structured plan is especially important in times of uncertainty, providing stability for the cancer project. According to Jana Prausova, President of the Czech Society for Oncology, there is a risk that Covid-19 may disrupt pre-existing plans in the field of cancer. “We need a long-term vision of sustainability, of high-quality treatment, and motivation for realising a long-term concept,” she adds. Similarly, Dr Špecián notes: “We have seen funding diverted to other urgent areas such as Covid, and it is important to have funding for all health areas. It is important to have money in our budgets allocated to cancer.

But progress in this area is happening. The current NCCP has been revised and updated, and in April 2021 a newer version was presented to the Ministry of Health, though it has not yet been adopted. Expected changes include an emphasis on multidisciplinary teams, patient-centred care, new types of treatment, and a larger emphasis on prevention and screening programmes.[4] A final version is expected by the end of 2021, according to Veronika Cibulova, General Secretary of the patient organization VERONICA. “Now the documents will be presented to the respective stakeholders, I expect that patients will be one of the groups that should be commenting on it,” she adds.

ICP assessment of national cancer control plan, Czech Republic

Existance of national cancer plan Comprehensivness of cancer control plan Implementation framework for cancer control plan Monitoring and evaluation of cancer control plan
Score 0-2 Score 0-3 Score 0-3 Score 0-2
2 2 0 0

Note: A higher score means better performance

Source: ICP

Data and Research

The country performs much better in the assessment of its population-based cancer registry (PBCR), joining Australia and South Korea in the top position globally for this indicator. The Czech national PBCR was started in 1976 and data collection is legally required. The registry publishes updated data online every month which serves as a basis for the creation, realisation and evaluation of preventive medical programmes, as well as the evaluation of financial costs of oncological care.[5] [6] Professor Bartunkova sees this as one of the big achievements of the country: “the cancer registry functions very well and information is very easy to get.”

Indeed, the national registry is recognised as a “high quality,”[7] and based on the ICP assessment it covers a broad range of attributes, including: incidence, patient demographics, tumour characteristics, stage of disease, treatment and outcomes. It is also linked to the National Health Information System (NHIS), a nationwide information system of public administration. The NHIS collects and processes information from various public administration registries and tracks the cost-effectiveness of specific treatments, the quality of healthcare, and the capacity of the healthcare system.[8] [9]

There are signs of further improvements in this regard. Miroslav Špecián, Board Member at the Hippokrates Endowment Fund, refers to the development of an act on digitalisation of healthcare, currently in parliament, which can benefit patients directly. “I believe that this act of the digitisation of healthcare will allow much better care for patients. It will allow a better assessment of the scope of care provided to them, drug interactions between the medicines they are taking, so patients will benefit.”

 The Czech Republic also attains a perfect score on the ICP’s indicator measuring the development of cancer research. Among a network of 18 Complex Oncology Centres,[10] two national centres (associated with the Prague Motol Hospital and Masaryk Memorial Cancer Institute Brno) are designated as research facilities, as well as treatment facilities.[11] [12]

Knowledge is regarded as a strong area in the country. Mrs Cibulova refers to the long history of the cancer registry, but also the Institute of Health Information and Statistics of the Czech Republic (UZIS), which collects epidemiological data from hospitals for insurance companies. Professor Bartunkova also refers to the work of the Academy of Sciences and a local biotech company developing cancer drugs. In her view, even though there is no centralised government effort to promote research in this field, local institutions benefit from various funding.

Health promotion

The Czech Republic performs well in indicators measuring policy efforts for health promotion. It ranks 6th among the 29 countries in terms of tobacco control. Based on WHO data, the country meets the following attributes: it has a policy or plan to reduce the burden of tobacco use, it complies with smoke-free regulations, it has health warning labels for tobacco packages in place and bans of some (but not all) forms of tobacco advertising. Efforts also include making cigarettes less affordable since 2008. Furthermore, the country attains a top score on policies for healthy lifestyles and diet. As reported by the WHO, there are operational policies to support healthy diets, physical activity and reduction of alcohol use. But there seems to be limited visibility of action in this field. Dr Dolezal notes: “there is no support for healthy lifestyles, no support for people to behave correctly so that they not become cancer patients.

Indeed, promoting healthy lifestyles appears to need more attention. The country faces challenges in high prevalence of smoking and obesity, for example, and experts point to culture influencing people’s habits. “From the socialist times, the general feeling is that the state will take care of me, always,” notes Professor Bartunkova. “The personal responsibility should be emphasised.” Mrs Cibulova concurs and further adds: “people don’t appreciate health as the highest value; this is a legacy of the past.” Dr Prausová highlights the need for education: “I would say that the overall knowledge in society of the importance of a healthy lifestyle is an area open for improvement.”

Notes

1]  Czech Oncological Society, National Cancer Control Programme (Národní onkologický program), 2013. Available from: https://www.onconet.cz/index.php?pg=narodni-onkologicky-program--plne-zneni

[2] Linkos.cz, List of entities that have signed up for the National Oncology Program of the Czech Republic, 2021. Available from: https://www.linkos.cz/narodni-onkologicky-program/prihlaska-k-nop/seznam-subjektu-ktere-se-prihlasily-k-narodnimu-onkologickemu-programu-cr/

[3] Medical Tribune CZ, Will the National Cancer Program be a government priority?, 2019. Available from: https://www.tribune.cz/clanek/44996-bude-narodni-onkologicky-program-vladni-prioritoucv 

[4] The National Cancer Control Programme of the Czech Republic (Národní onkologický program České republiky). Available from: https://www.linkos.cz/files/pro_odborniky/nop/Narodni-onkologicky-program---eske-republiky-2021--upraveno-vyborem---OS.pdf

[5] Linkos.cz, The National Cancer Registry (Národní onkologický registr), 2021. Available from: https://www.linkos.cz/lekar-a-multidisciplinarni-tym/ekonomika/sledovani-a-predikce-dat-v-onkologii/narodni-onkologicky-registr/

[6] Institute of Health Information and Statitsics of the Czech Republic, The National Cancer Registry. Available from: https://www.uzis.cz/index.php?pg=registry-sber-dat--narodni-zdravotni-registry--narodni-onkologicky-registr#o-registru

[7] American Cancer Society, The Cancer Atlas. Available from: https://canceratlas.cancer.org/data/compare/

[8] Institute of Health Information and Statitsics of the Czech Republic, National Health Information System (Národní zdravotní informační systém). Available from: https://www.uzis.cz/index.php?pg=nzis

[9] Ministry of Health, The National Health Information System has Been Approved by Senate (Národní zdravotní informační systém schválil Senát), 2016. Available from: https://www.mzcr.cz/tiskove-centrum-mz/narodni-zdravotnicky-informacni-system-schvalil-senat/

[10] Linkos.cz, The National Cancer Network (Národní síť). Available from: https://www.linkos.cz/lekar-a-multidisciplinarni-tym/narodni-onkologicka-sit/

[11] University Hospital in Motol. Oncology Clinic of the 2nd Medical Department of Charles University and Motol Hospital in Prague (Onkologická klinika 2. lékařské fakulty Karlovy Univerzity a Nemocnice Motol). Available from: https://www.fnmotol.cz/kliniky-a-oddeleni/cast-pro-dospele/radioterapeuticko-onkologicke-oddeleni/

[12] The Masaryk Memorial Cancer Institute (Masarykův onkologický ústav). Available from: https://www.mou.cz/

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