EARLY CANCER DIAGNOSTIC IN NORWAY OLE ALEXANDER OPDALSHEI, THE NORWEGIAN CANCER SOCIETY

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1 EARLY CANCER DIAGNOSTIC IN NORWAY OLE ALEXANDER OPDALSHEI, THE NORWEGIAN CANCER SOCIETY

2 Norwegian Cancer Society in brief - The only national cancer society in Norway - Around 180 employees (different professions: nurses, social scientists, journalists, lawyers, social workes, etc) - Headquarter in Oslo and 8 local offices - Around members - Cooperate with 13 patients organizations - Allocated 46,5 million to core activities, of this 24 million to cancer research - Financed around 25 percent of the total amount to cancer research in Norway (2007)

3 Extent of cancer in Norway Cancer is the largest cause of death in Norway (citizens up to 55 years) Around Norwegians are diagnosed with cancer each year (population 5 million) 2 out of 3 are cured Norwegians live with a history of cancer The number of new cases of cancer is expected to increase dramatically towards 2030

4 Predictions of new cancer patients toward Prediksjon av antall nye kreftpasienter pr år frem til Antall nye kreftpasienter pr år Tidsperiode

5 Cancer treatment in Norway is good, but Tittel på 5

6 we can be better Tittel på 6

7 Denmark as the inspiration for cancer care

8 a paradox? (Nordcan)

9 The reason for the interest in cancer care in Denmark

10 Early cancer diagnoses the Norwegian experiences National Cancer Strategy Diagnoses of potential cancer diseases in the specialist healthcare services must take place within reasonable timeframes, must be suitably organized, must be of high standards and must be equally accessible Patient Rights Act ( old version ): Patients referred to a hospital or specialist outpatients clinic, have the right to receive an evaluation of their health within 30 working days after the referral has been received. In case of suspected serious or life-threatening conditions, the patient has the right to an even speedier evaluation.

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12 The 16 most important risk factors in cancer care 2009 (Source: Norwegian Board of Health Supervision) Konsekvenser Katastrofal: Tap av liv. Svært alvorlig skade Høygradig invaliditet Svært alvorlig: Irreversibel helseskade. Tap av leveår. Prognosetap. Alvorlig: Reversibel helseskade. Uheldige belastninger. Moderate skader. Mindre alvorlig: Lettere, forbigående helseskade uten varig men Diagnostikk - Strålebehandling Kirurgi Radiologi Patologi Volum- kvalitet Infeksjoner - Henvisning Kompetanse Informasjonsflyt Komplikasjoner Palliasjon Overbehandling Kontinuitet Arbeidsmiljø Kommunikasjon Ikke alvorlig: Ingen påvist helseskade Svært usannsynlig (Sjeldnere enn hvert år) Usannsynlig Lite sannsynlig Sannsynlig Svært sannsynlig (ukentlig) Sannsynlighet for at hendelsen inntreffer i en region (RHF)

13 Prime Minister Jens Stoltenberg (june 2011) The time it takes from referral is received and treatment is initiated, should be under 20 business days for more than 80 % of the cancer patients. This means that referral must be considered within 5 days, further diagnostic started within 10 days and treatment started within 20 days.

14 Share (%) who starts treatment after 20 working day breast cancer

15 Share (%) who starts treatment after 20 working day colon cancer

16 Share (%) who starts treatment after 20 working day lung cancer

17 New national cancer strategy Presented spring 2013: collaboration between Ministry of Health, The Norwegian Directorate of Health, and The Norwegian Cancer Society

18 The strategy define 5 national goals for cancer care: A more patient oriented cancer care Norway shall be a pioneer country to optimize good patient processes Norway shall be a pioneer country for cancer prevention Increase the number of cancer survivors and increase the years of living with cancer Best possible life quality for both cancer patients and their relatives

19 A pioneer country?

20 Summer 2013: revision of the Act of patient right Norwegian Cancer Society: The cancer guarantee should be a legal right Ministry of Health: No New Patient Rights Act: Patients referred to a specialist health care shall, within 10 working days after receiving the referral, been given information on when the assessment or treatment will begin. (Old version: have the right to receive an evaluation of their health within 30 working days after the referral has been received )

21 Autumn 2013: New government From their political platform: Establish multidisciplinary diagnostic centers in all health regions, providing faster diagnosis for suspected cancer and other serious illnesses. Strengthen cancer care by introducing a rule that cancer diagnostic should start within 48 hours, introduce cancer pathways and make time limits legally binding in the Patient Rights Act. Supplementing the national strategy on cancer with a cancer plan. (dismantle The Regional Health Authorities after creating a national health and hospital plan)

22 What need to be done Follow up waiting times for cancer treatment (and not only three cancer diagnoses) Increase work on cancer pathways with time schedules (including pathways for non-specific cancer symptoms) Need for more resources to reduce bottlenecks (specially in pathology and radiology) But also focus on organizational factors!!

23 Master thesis: Med blikk for helhet? : En kvalitativ undersøkelse av forløpstidenes betydning for organisering av kreftbehandling i sykehus» (Rognlie 2012) Need for organizational changes in the hospital Focus on leadership Importance of local organizational culture Organization that allows the clinical and radiological resources can be seen more as a whole Need to facilitate more exchange of experiences and knowledge on the organization of cancer treatment among the nation's hospitals. Listen to the patients!

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25 What need to be done Follow up waiting times for cancer treatment (and not only three cancer diagnoses) Increase work on cancer pathways with time schedules (including pathways for non-specific cancer symptoms) Need for more resources to reduce bottlenecks (specially in pathology and radiology) But also focus on organizational factors!! IT-system

26 IKT-utfordringer

27 What need to be done Follow up waiting times for cancer treatment (and not only three cancer diagnoses) Increase work on cancer pathways with time schedules (including pathways for non-specific cancer symptoms) Need for more resources to reduce bottlenecks (specially in pathology and radiology) But also focus on organizational factors!! IT-system Better quality on refferals from General Practitioners

28 Kompetanse hos fastlegen Tittel på 28

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30 What need to be done Follow up waiting times for cancer treatment (and not only three cancer diagnoses) Increase work on cancer pathways with time schedules (including pathways for non-specific cancer symptoms) Need for more resources to reduce bottlenecks (specially on pathology and radiology) But also focus on organizational factors!! IT-system Better quality on refferals from General Practitioners

31 Our vision Together we create hope!