David Feltl, M.D., Ph.D., MBA. Structure and organization of cancer care in the Czech Republic. Assessment of outputs and outcomes.

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1 David Feltl, M.D., Ph.D., MBA Structure and organization of cancer care in the Czech Republic. Assessment of outputs and outcomes.

2 Contents Cancer epidemiology in the Czech Republic National oncology program Preventive programs and screening Structure of cancer care Measurable outputs and outcomes, their implications Further directions in the Czech cancer care

3 Cancer epidemiology in the Czech Republic (2012)

4 Incidence of the most common tumors within our region (2012)

5 National Oncological Program Declared in 2006 under the auspices of Czech President Goals: to decrease cancer-related mortality to level up the quality of cancer care How can we reach the goals? preventive programs screening centralization of highly specialized and expensive cancer diagnostics and treatment continuous evaluation of indicators, outputs and outcomes

6 Preventive programs Primary prevention General practitioners, gynecologists, urologists Every 2 years physical examination, occult bleeding test, prostate examination, gynecological and breast examination

7 Screening (secondary prevention) Breast cancer Cervical cancer Colorectal cancer Screening support All programs have dedicated web portals with comprehensive information and contacts All potential clients receive personal invitation In screening programs with lower compliance (colorectal), information campaigns are being performed

8 Bowel tour

9 The results EUROCARE-5 study Comparison of two time periods ( and ) Big improvement of survival in most cancer types Czech results comparable with the most developed European countries Best results within the region of Central and Eastern Europe De Angelis, R. et al. (2013). Cancer survival in Europe by country and age: results of EUROCARE-5 a population-based study The Lancet Oncology DOI: /S (13)

10 Structure of cancer care Network of 13 Comprehensive Cancer Centers (CCC) Must fulfill personal/medical/technical criteria Most expensive cancer diagnostics and therapy is reimbursed only at these centers molecular genetics of tumors stereotactic radiotherapy targeted therapies (monoclonal antibodies etc.) Every CCC has its own network of cooperating hospitals and practices

11 Measurable outputs and outcomes Most important part of the oncology program are data You don t lead and influence if you don t measure! Several data sets National cancer registry Screening data (compliance, results) Use of expensive pharmaceuticals Survival data Important feedback for further development of cancer care both nationwide and regionally (single centers) Example: University Hospital Ostrava

12 Cancer patients treated between 2007 and 2012 Non-cancer patients N = (92,4 %) N = (100 %) Cancer patients N = (7,6 %) Pediatric Adult N = 759 (0,15 %) N = (7,4 %) Benign tumors N = (1,4 %) Malignant tumors N = (6,0 %)

13 Annual number of cancer patients in the University Hospital Ostrava compared to other centers breast (C50) prostate (C61) colon and rectum (C18-C21) lung (C33,C34) melanoma (C43) oral cavity and pharynx (C00-C14) uterus (C54,C55) kidney (C64) cervix (C53) thyroid (C73) brain and spine (C70-C72) non-hodgkin s lymphoma (C82-C85,C96) bladder (C67) ovarian (C56) larynx (C32) testis (C62) stomach (C16) pancreas (C25) esophagus (C15) myeloma (C90) Hodgkin s lymphoma (C81) sarcoma (C47,C49) liver (C22) leukemia (C91-C95) gallbladder (C23,C24) others Annual number of patients ranking

14 Cancer-specific 5-year survival. Comparison of the University Hospital Ostrava with other centers Diagnose Relativní 5leté přežití [%] 0% 20% 40% 60% 80% 100% Number of patients Δ Survival difference testis (C62) ,8% thyroid (C73) ,1% Hodgkin s lymphoma (C81) 107-5,3% breast (C50) ,2% prostate (C61) ,4% melanoma (C43) ,7% uterus (C54,C55) ,5% kidney (C64) ,6% cervix (C53) 644-3,0% bladder (C67) 406-2,1% sarcoma (C47,C49) ,7% chronic myeloid leukemia (C92.1) ,2% non-hodgkin s lymphoma (C82-C85,C96) ,1% colon and rectum (C18-C21) ,5% larynx (C32) ,8% ovarian (C56) ,6% chronic lymphocytic leukemia (C91.1) 31 +7,2% oral cavity and pharynx (C00-C14) ,3% multiple myeloma (C90) 72 +8,1% stomach (C16) ,2% brain and spine (C70-C72) ,5% acute leukemia * ,3% gallbladder (C23,C24) 52 +7,5% lung (C33,C34) ,3% esophagus (C15) ,5% liver (C22) 45 +3,5% pancreas (C25) 85 +1,6%

15 Implication for further directions in the Czech cancer care We need to strengthen the weakest link of the chain To improve survival, we have to: maximally support the Czech cancer registry as a excellent source of data increase compliance to the colorectal screening repeatedly collect survival data, observe trends, search for reasons audit centers with the worst survival data insure the continuity of the entire process

16 Thank you for your attention.

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