BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPEAn improvement in strategic planning and the means to
collect data to inform it
National Cancer Control Plans and, ideally, a specific lung cancer control plan, should be in place,
regularly updated and properly funded. In the same way that cancer control plans can go into greater
detail than a general non-communicable disease (NCD) plan about the unique challenges of (and
solutions for) cancer, so lung cancer control plans are able to really focus on matters of importance
for improving the lives of lung cancer patients. They should be revised every five years to ensure that
they encompass the latest developments, and to be of any use they need to identify specific funding
sources. As a speaker during a recent political event in Norway stated, “a plan without a budget is a
vague idea.”
These national plans should become a meaningful part of how a country looks to improve both the
efficiency and effectiveness of care, as well as reducing the number of people who need care in the
first place. Although a plan does not guarantee action—as many of our participants noted—without
a plan, little co-ordinated action is likely to happen at all. Countries with devolved health systems
need to find workable solutions to ensure that their National Cancer Control Plan can be adopted to
ensure equitable care across every region in a country. To address the challenge of low health literacy
throughout Europe, health literacy strategies should be included in national plans.
Finally, one of the most important markers of a cancer care plan is that it includes an implementation
and evaluation plan. And to evaluate the impact of a plan, data is required. All countries had some
form of registry, but most participants acknowledged weakness either in geographic or clinical
coverage. Registries—and the real-world data that they collect—offer so much value to so many
stakeholders that it is short-sighted not to invest in them. To maximise their value, registry data,
generally anonymised, should also be available to those outside the healthcare system—whether freely
distributed or sold on the market.
A renewed focus on early detection, including an
assessment of the pros and cons of a national screening
programme
Lung cancer clinical guidelines should of course encompass all aspects of care through clear pathways
and quality indicators. Timeframes should also be embedded within the guidelines, as they serve as
critical benchmarks to evaluate performance. This is of the essence for lung cancer patients, where
late diagnosis is rife. Awareness needs to be improved throughout the primary care system to ensure
that high-risk patients are identified and obtain the necessary screening to ensure that the disease is
identified as early as possible.
Published evidence suggests that opportunities to maximise early diagnosis can be improved
with the use of diagnostic assessment clinics. These are locations where diagnostic testing and
multidisciplinary care can be provided in one place.28, 78