New oncological plan alarm – la Repubblica
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An ambitious document, but too general in the formulation of objectives and without funding. The National Oncological Plan (PON) 2023-2027 recognizes the centrality of assistance to cancer patients, but does not define the concrete actions to be implemented. In particular, the most critical aspects concern the Regional Oncological Networks, still without dedicated resources, the failure to indicate the tools to achieve the coverage envisaged for breast, colorectal and cervical cancer screenings, the absence of reference to the quality of surgical services in oncology and the absence of radiotherapy equipment from the list of those that need to be modernised. Not only. The criteria for planning the creation of molecular biology laboratories on the national territory are not defined and the necessary urgent regulatory interventions for rehabilitation are not envisaged.
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Failure to define these aspects risks compromising patient care and their quality of life, as well as increasing the cost of the disease. For this FAVO (Italian Federation of Oncology Volunteer Associations), together with all the scientific societies dealing with oncology, have an appeal today on the occasion of the presentation of the 15th Report on the welfare condition of cancer patients. The appeal is to set up a working table for the drafting of a structured and defined implementation regulation, which makes the NOP operational in the various areas; to identify and appoint a coordination group for the annual assessment of the indicators and their punctual publication and to define the operational tools which, on the basis of the monitoring and the annual indicators, allow proceeding with the necessary and timely corrective measures.
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The European plan
“The European Plan to fight against cancer, presented by the European Commission, reports for 2020 in the countries of the European Union 2.7 million cancer diagnoses and 1.3 million deaths from this pathology, estimating, in the absence of strategic interventions , a further increase in mortality of over 24% by 2035. Also in Italy in this perspective it is essential to plan a cancer control strategy within our NHS, with defined and above all feasible initiatives and objectives. This may be the public health goal for adequate cancer control at all stages of the disease. In a health strategy and planning aimed at guaranteeing the effective feasibility of the NOP, it is essential to integrate the technical-scientific statement with aspects more directly correlated to the operation and effectiveness of the interventions. From a general point of view, it should be emphasized that some issues of a more strategic nature require a necessary alignment with the European Plan, such as specific planning and programming indications in terms of identifying needs, specific indications of the resources to be invested or at least of the standards of reference. It is essential for public health to intervene in areas with repercussions on regional health systems, such as the implementation of cancer screening with regional objectives and growth trends over time, the requalification of intermediate care and home care, psychological assistance and rehabilitation oncology. In addition, it is necessary to provide for operational interventions at the level of the healthcare providers that intervene with regard to the foreseen times, the monitoring indicators, the appropriateness of the settings based on the treatment path of the oncological and onco-haematological patient, enhancing on the one hand the proximity medicine and on the other the role of centers of excellence, and access to scientific innovation and research”, explains Carmine Pinto, President of FICOG (Federation of Italian Cooperative Oncology Groups).
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regional networks
A 6-8% reduction in cancer mortality would result in 10,000-14,000 fewer deaths each year in Italy. “This can be the public health objective for an adequate cancer control strategy, which includes all phases, from primary prevention and public awareness, to screening, diagnostics and equity of access to the best treatments on the entire territory – says Saverio Cinieri, President of AIOM (Italian Association of Medical Oncology) -. The Regional Oncology Networks are given much prominence in the PON, but no mention is made of the General Coordination of Oncology Networks, envisaged in the Document adopted by the State-Regions Conference on 17 April 2019. Furthermore, for the Regional Oncology Networks to achieve real efficiency, necessary dedicated resources that are not established by the NOP, starting from an assessment of needs and with direct spending autonomy. The central element of the Regional Oncological Networks are the Diagnostic Therapeutic Assistance Pathways, but even in this case there is no information on the funding essential to cover the necessary figures, such as clinical study coordinators, psychologists, nutritionists, physiatrists, social workers, professionalism that today is missing almost everywhere ” .
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Surgery
“The quality of surgical services in oncology is not mentioned in the PON – highlights Alfredo Garofalo, President Emeritus of SICO (Italian Society of Oncological Surgery) -. In solid tumors surgery often represents the first approach to the disease and an inadequate intervention can influence all the subsequent phases of the integrated therapeutic strategy. The identification of centers with a high volume of surgical activity for oncological pathologies is an obligatory step to ensure patients a quality of services that allows for the most modern and effective approach to the disease. For the recognition of the ‘highly specialized oncological surgery’ operating units, the centers should certify the minimum volumes of activity of the last three or five years and be equipped with organizational characteristics to guarantee high levels of efficiency and quality”.
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Precision oncology
“Precision oncology, one of the most important innovations that is changing the prognosis of patients, requires a bio-molecular characterization of tumors, to optimize the results of therapies in terms of efficacy and saving on toxicity – underlines Nicola Normanno, Past President SIC (Italian Cancer Society) and President of IQN Path (International Quality Network for Pathology) -. The NOP lacks references for developing governance at national and regional level for molecular biology laboratories and, in particular, for carrying out next-generation gene sequencing tests. It is essential to define stringent criteria for the creation of molecular biology laboratories within the Regional Oncological Networks, which consider population volumes, logistics, test quality and IT platforms. Finally, connection paths between the Oncological Networks and clinical research activities must be organised, to facilitate the access of oncological patients to new therapies”.
The technology park
“The PON does not provide for a plan to update the radiotherapy technology park, which instead requires technologies and human resources capable of offering adequate treatment throughout the country, in compliance with the principle of equity and to contain healthcare migrations which have a heavy impact on patients and caregivers – says Cinzia Iotti, President of AIRO (Italian Association of Radiotherapy and Clinical Oncology) -. The NOP does not define what is meant by innovation nor does it mention an investment plan that takes into account the needs of the territory and the context in which the most innovative equipment should be located. There is also the need to set up the circuit of regional radiotherapy networks, able to monitor the needs and the appropriate distribution of technological and professional resources”.
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Labor protection
“People living after a cancer diagnosis in Italy are rapidly increasing: from 2.5 million in 2006, their number exceeded 3.6 million in 2020. Almost a third, about one million citizens, can be considered cured – says Giordano Beretta, President of the AIOM Foundation -. The strategic lines, with reference to the implementation of specific interventions for the protection and reintegration into work of patients, the recovered and the caregivers are still generic. The Oncology Plan does not intervene on the need to promote and support the approval by Parliament of regulations to protect work for patients and caregivers and on the request for a law on the right to be forgotten oncology, for which the AIOM Foundation has promoted a national petition, which has already collected around 106,000 signatures”.
Direct and non-direct costs
“The new scenario requires the development and ever-increasing use of appropriate economic planning and evaluation tools. Being able to design care pathways and access to timely care (accompanied by a punctual stratification of patients) allows for a reduction of both direct costs and costs relating to social security expenditure, without forgetting the fundamental objective which is? represented by the improvement in the health status of patients. A recent study of ours (EEHTA CEIS Tor Vergata University) was able to estimate an annual expenditure for direct hospital costs alone of over 4 billion euro, plus 2.5 billion in indirect costs borne by the social security system ( care expenditure). The analysis of mobility further underlines the need for an effort to smooth out regional differences in terms of hospital supply, prevention and territorial medicine. Spending on prevention and screening programs needs to return to and exceed pre-pandemic levels. In fact, the increase in costs for carrying out these procedures is in any case largely compensated by a more efficient allocation of resources and, above all, by an important and evident reduction in costs, both direct and indirect, in the medium-long term thanks to early management followed by effective treatments”, explains Francesco Saverio Mennini, Director of EEHTA-CEIS, University of Rome ‘Tor Vergata’ and president of SiHTA.
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