Exploring the link between cancer policies and cancer survival: a comparison of seven countries

Abstract Background Disparity in cancer survival across countries has been linked to variation in cancer policy delivery but there is lack of empirical evidence for this association. We traced the evolution of cancer policies in 20 jurisdictions in Australia, Canada, Denmark, Ireland, Norway, New Zealand and the UK since 1995 and present the findings of an exploratory analysis linking cancer policy consistency to cancer survival. Methods We systematically searched and analysed national/regional cancer plans and strategies, mapping timelines of cancer policy evolution. For 10 jurisdictions, evidence was synthesised into five categories: oversight function; cancer plan; implementation plan; budget for plan implementation; and evaluation. We assigned scores evaluating whether a category was present or absent, and weighted scores for consistency. Summed scores were correlated with trends in survival from seven cancers between 1995-2014. Results All ten jurisdictions had implemented a high-level structure overseeing, steering or delivering cancer control policies (1995 - 2014); all had also published at least one major cancer plan. There was great variation in oversight mechanisms, ranging from institutionalising cancer control (New South Wales, Ontario) to cancer steering groups or taskforces (Denmark, Northern Ireland, Wales). Frequency and consistency of cancer plans also varied, from a succession of plans that build on each other (Denmark, New South Wales, Ontario) to the publication of isolated plans (New Zealand, Northern Ireland). We found a positive, albeit weak, correlation of cancer policy consistency and improvements in survival over time for six of the seven cancers. Conclusions Jurisdictions that have implemented consistent cancer control policies over time tended to be more successful in improving survival for a wide range of cancers. Our findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes. Key messages • Sustained and consistent strategic cancer planning and investment are crucial for ensuring better patient outcomes, and this requires strong and sustained commitment at all levels. • The findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes.


Background:
Disparity in cancer survival across countries has been linked to variation in cancer policy delivery but there is lack of empirical evidence for this association. We traced the evolution of cancer policies in 20 jurisdictions in Australia, Canada, Denmark, Ireland, Norway, New Zealand and the UK since 1995 and present the findings of an exploratory analysis linking cancer policy consistency to cancer survival.

Methods:
We systematically searched and analysed national/regional cancer plans and strategies, mapping timelines of cancer policy evolution. For 10 jurisdictions, evidence was synthesised into five categories: oversight function; cancer plan; implementation plan; budget for plan implementation; and evaluation. We assigned scores evaluating whether a category was present or absent, and weighted scores for consistency. Summed scores were correlated with trends in survival from seven cancers between 1995-2014. Results: All ten jurisdictions had implemented a high-level structure overseeing, steering or delivering cancer control policies (1995 -2014); all had also published at least one major cancer plan. There was great variation in oversight mechanisms, ranging from institutionalising cancer control (New South Wales, Ontario) to cancer steering groups or taskforces (Denmark, Northern Ireland, Wales). Frequency and consistency of cancer plans also varied, from a succession of plans that build on each other (Denmark, New South Wales, Ontario) to the publication of isolated plans (New Zealand, Northern Ireland). We found a positive, albeit weak, correlation of cancer policy consistency and improvements in survival over time for six of the seven cancers.

Conclusions:
Jurisdictions that have implemented consistent cancer control policies over time tended to be more successful in improving survival for a wide range of cancers. Our findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes. Key messages: Sustained and consistent strategic cancer planning and investment are crucial for ensuring better patient outcomes, and this requires strong and sustained commitment at all levels.
The findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes.

Background:
The COVID-19 pandemic posed a substantial shock to health service provision, in particular regarding hospital services. The reasons and also rationales for reduced health service provision were manifold ranging from limited supply due to resource restrictions, limited demand in order to avoid infections or due to reduced incidence of various diseases, and postponement of elective services. Nevertheless, the provision of services for acute care at an adequate level is paramount to avoid patient harm.

Methods:
Hospital admissions were analysed via administrative DRG data reported by Austrian hospitals. We compared health service provision on a monthly basis between 01/2018 and 12/ 2021. Services were classified according to ICD-10 and encompassed admissions due to acute heart failure, stroke, accidents, knee and hip surgery and breast cancer surgery.

Results:
Our findings show that hospital admissions for acute heart failure decreased by up to 25% between 03/2020 and 05/2020. In contrast, no significant difference to the initial prepandemic levels could be observed in the later stages of the pandemic. Stroke admissions remained at the initial levels throughout the whole period of analysis, while a substantial decrease (up to 50%) in admissions because of accidents was observed whenever severe NPIs were in place. Knee and hip surgery levels dropped in line with increasing ICU occupancy rates caused by COVID-19 patients. Decreases in breast cancer surgery could only be observed (up to 20%) during the four months of the pandemic (03-06/2020).

Conclusions:
Our analysis provides an aggregated insight into service provision management in Austrian hospitals throughout the pandemic. While acute care was continuously provided for most areas of diseases and elective surgeries were widely postponed in line with pressure on ICU capacities, the decline in breast cancer surgery demands attention and further clarification of whether this decline was supply-or demanddriven. Key messages: During the pandemic inpatient acute care services were continuously provided for most diseases in Austrian hospitals while elective surgeries were postponed in line with pressure on ICU capacities. The pandemic posed a substantial challenge to service provision management in hospitals and unwarranted levels of service provision so far indicate areas of action for future (pandemic) preparedness.