in the WHO Global NCD Action Plan (Appendix 3 of the GAP:
breast cancer, colorectal cancer, cervical cancer, oral cancers
and leukaemia in children).
Emphasize the importance of Health Technology Assessment
(HTA) and the assessment of cost-effectiveness to increase value
in cancer care
We need to encourage the harmonization of market
authorization for new medicines based on safety and efficacy,
as well as their approval for reimbursement by national
health insurance systems based on cost-effectiveness and
other social and ethical criteria. The Task Force will aim for a
sensible (and sensitive) balance between all diseases,
including those that are not among the most prevalent, even
as we acknowledge that in many countries cancer is the
second, if not first, leading cause of premature death and
suffering. Porter's definition of value will be a useful tool in
this respect: "Value in any field must be defined around the
customer, not the supplier. Value must also be measured by
outputs not inputs. Hence it is patient health results that
matter, not the volume of services delivered. But results are
achieved at some cost. Therefore, the proper objective is…
patient health outcomes relative to the total cost (inputs).
Efficiency, then, is subsumed in the concept of value".8
Create and disseminate knowledge about clinical excellence for
cancer care and resource-adapted options for treatment
including a set of most cost-effective cancer medicines
Several partners including ASCO and ESMO publish
treatment guidelines that serve as standards of care that can
be adapted to local realities. While clinical practice
guidelines indicate necessary therapies, methodologies to
measure the clinical benefit of new drugs are being
developed to help policy-makers and institutions invest their
limited resources in the most value-added therapies and
technologies. A key ESMO contribution to the WHO
workplan is the data from ESMO projects like the
collaborative international opioid survey and its upcoming
anti-cancer medicines survey on the availability of some
common, affordable, medically necessary anti-cancer
medicines in several countries. While some medicine
shortages can be due to global, regional or local supply
issues, other factors also include national regulatory,
licensing and cost issues. The aim of the 2014 cancer
medicine landscape survey, first in Europe and then
worldwide, is to determine whether licensed medicines that
oncologists need to treat patients according to clinical
practice guidelines are actually available. This information
will allow the network to provide information about the
current status of gaps in access to cancer medicines which
will be an important contribution to the debate about priority
setting and resource allocation in cancer control.
In collaboration with our colleagues in low- and middleincome countries, we will discuss how to provide
to provide
recommendations to WHO on the Package of Essential Noncommunicable Disease Interventions
(PEN) on how to
integrate cancer into primary health care in low-resource
settings. Essentially, there needs to be a map that allows
decision-makers to translate knowledge of best diagnostic
practices into practical use in low- and middle-income
countries.
Create and disseminate best practices in developing resourceadapted health care
infrastructure including equipment
The Task Force will propose a hierarchy of cancer services
that provide priority recommendations on what cancer
services should be offered, beginning with countries where
no cancer infrastructure exists and extending to highly
developed health care systems, where an optimal level of
services should be offered.
Any recommendations need to be accompanied by capacity
building and training at the country level. All partners will be
encouraged to consider how they can mobilize their
membership and their parent institutions to provide
fellowships and training opportunities for physicians from
partner nations.
Support national cancer control programmes (NCCPs) at a
global, regional and country level
The Task Force structure is uniquely fitted to contribute to
and enhance the collective knowledge accumulated on
NCCPs globally, and to share best practices. On the one hand,
the UICC has assembled, through the International Cancer
Control Partnership (ICCP), a "one-stop-shop" for cancer
planners and cancer advocates worldwide, including a library
of materials for planners as well as a database of links to all
available cancer plans.10 ESMO, on the other hand, has close
ties with the European Union, whose Commission-funded
European Partnership for Action Against Cancer (EPAAC)
has specifically focused on NCCP development,
11 and is
expected to release European Guidelines on Quality NCCPs
by the end of the Partnership in 2014. Through the ICCP's
partnership with the American Cancer Society, SLACOM, the
International Cancer Control Congress Association (ICCCA),
and others, collaborations with the WHO Regional Offices in
Africa, the Americas, the Eastern Mediterranean and Europe;
and with ESMO's relationship with the European Union and
national medical oncology societies in Europe and elsewhere,
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CANCER CONTROL 2014 33