The current status of cancer care in Taiwan Chien- Yuan Wu Director of Cancer Prevention and Control Division Health Promotion Administration Ministry of Health and Welfare, Taiwan
Where is Taiwan? n Taiwan is situated on the northeastern edge of the Pacific Ocean, off the southeastern coast of the Chinese mainland. Located midway between Korea and Japan to the north and Philippines to the south. n Household registration has been implemented in Taiwan since 1906. n At the end of 2013, the total population of Taiwan was 23 millions.
Incidence and mortality, OECD countries Incidence rate Mortality rate Source: 1. GLOBOCAN 2012, IARC 2. Taiwan caner Registry, 2010 3. Taiwan Death Statistics Age-standardized rate (ASR), 1/100,000
Burden of Cancers in Taiwan age-standardized mortality rate (1/ 100,000) 140 Top 10 leading causes of death Cancer, 130.4 120 100 80 60 40 20-1986 1987 Cancer has been the number 1 killer in Taiwan since 1982, accounting for 29% of total deaths and 11% of National Health Insurance expenditure in 2013. 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Heart dis, 47.7 Stroke, 30.3 Diabetes, 25.8 Pneum onia, 22.5 Injury, 22.4 COPD, 14.9 Liver dis, 14.8 Suicide, 12.0 Ch. Kidney dis, 11.9 4
Cancer control infrastructure n n n n Taiwan Cancer Registry, a population-based cancer registry, was founded in 1979, and Death Statistics. Cancer Control Act, which came to effect in 2003, regulate hospitals with greater than 50-bed capacity, involved in cancer care, to participate in reporting all newly diagnosed malignant neoplasms to the registry. Eighty percent cancer patients are diagnosed and treated in these hospitals. National Health Insurance was implemented since March 1995, with 99.5% coverage of the population. National Cancer Control Programme is in place, now we are in the Phase Ш NCCP. 5
National Cancer Control Programme
Cancer survivors in Taiwan Survivorship - Living With and Beyond Cancer. Life and health after a cancer diagnosis and once treatment is over (NCI, USA ) ; Living With and Beyond Cancer. (NHS, U.K.) n Taiwan Cancer Registry: 520,000 cancer survivors (474,000 are registered in the health insurance system who were issued catastrophic illness certificate). n Diagnosis and treatment of cancer is covered by the national health insurance. Cancer patients with a catastrophic illness certificate, his/her copayment can be exempt. n The medical cost of cancer patients were 5 times higher than the average and accounts for 11% National Health Insurance Expenditure.
Cancer care and strategy 8
U.S Cancer Control Continuum(1970-mid) adapted from the NCI figure on the Cancer Control Con6nuum 2
What survivors need n Long-term follow-up/ surveillance n Late-effects management n Rehabilitation n Coping n Health promotion & prevention
NCCN Guidelines for Survivorship n Anxiety & Depression n Cognitive function n Exercise n Fatigue n Immunizations and infections n Pain n Sexual function n Sleep disorders
Comprehensive service network aimed at cancer patients cancer patient service program HPA & NHIA hospital cancer care quality improvement plan NGO Hospital one-stop window cancer services HPA: Health Promotion Administration NHIA: National Health Insurance Administration
Strategies to improve Diagnosis and management n n Accreditation for comprehensive cancer care quality p p Treating more than 500 new cancer cases/ yr Domains Organizational policy and management of cancer care quality and clinical procedures Establish cancer registry long-form database for use in quality improvement Provide diagnosis and tx according to evidence and guidelines Establish multi-disciplinary team care models Establish chemotherapy coherence and safety Establish clinical and pathological peer review mechanisms Subsidy plan (pay for cancer care performance) Monitor improvement on quality of care, and pay for performance 13
Core measurement (Breast cancer) Breast cancer treatment core indicators all improve. (national performance %) Indications 2007-2011 2011 1 The ratio of histological or cytological confirmation before surgery 84.3 88.6 2 The ratio of breast conserving surgery performed in stage I breast cancer 45.4 48.4 3 4 The ratio of post-operative radiotherpy in breast cancer underwent MRM with more than 3 positive nodes The ratio of adjuvant chemotherapy in breast cancer patients with tumor bigger than 1cm and age under 60 85.3 85.9 96.8 97.1 5 The ratio of sentinel node sampling in stage 1 and 2 breast cancer 48.7 62.8 6 The ratio of post-operative radiotherpay in breast cancer underwent MRM with more than 4 positive nodes 49.7 55.9
Distribution of hospitals with accreditation of the comprehensive cancer care quality There are still 4 counties without any qualified hospital Note: 1.Medical Center 2.Regional Hospital No. of Hospitals
Patients not undergo treatment n According to registry, 18% newly diagnosed patients did not receive treatment within three months after diagnosis (patients above 80 y/o are excluded). 14% 12% 10% 8% 6% 4% 2% 0% 216 patients 子 宮 頸 癌 12.9 % 655patients 肝 癌 5.9 % 213 patients 乳 癌 2.2 % 肺 癌 1.2 % 1.0 % 124 164 128 Cervix Liver Breast Lung Mouth Colon 口 腔 癌 大 腸 癌
Every Life Counts! Cancer patient medical navigation service n Mission: p Ensure golden timing for treatment p p Best medical service efficiency ( quality + hospice) Saving lives n Main target:golden Decade Megaplan and 25 X 25 p 20% reduction on mortality rate by 2020 p 25% reduction on premature mortality rate by 2025 n p Extend lifespan, raise awareness for healthy living Target: Newly diagnosed patients
Navigation program in hospitals n By care coordinator p Require hospitals which participate in our subsidy plan have care coordinators work as navigators. n By one-stop cancer resources center p HPA supports P4P hospitals to provide direct services to patients, include medical, mental social and other needs.
NGO s as partners to provide patient support n Providing information n counseling n Emotional support n Nutrition education n Ward / home visit n Instrument and material n Day care n Grief counseling n Peer support n Healing programmes