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The need to build on recent progress

Dr Mohar, “fragmentation of services has

contributed, among other factors, to a fracture

in the referral of patients to early detection,

diagnosis and treatment”. Dr Vargas notes that

the “delays disrupt the cumulative effect of

treatment”. Mr Medici suggests “to create new

remuneration models in oncology, based on

performance, that encourage the provider to

achieve the best possible”.

The development of common practices and

standards, for the public sector and beyond,

can foster quality improvement. The ICP finds

that clinical guidelines for common types of

cancer (breast, lung, prostate and colorectal)

exist in four countries: Argentina, Chile,

Colombia and Peru. Quality is high on the

agenda in Argentina. “There is a new initiative

for implementing a quality control system for

all processes in cancer care,” says Dr Ismael.

No evidence-based clinical practice

guidelines^73 for care of common types of

cancer were observed in Bolivia, Ecuador,

Panama, Paraguay and Uruguay. “There is no

systematic continuous effort in developing

clinical guidelines,” notes Dr Ruales. Meanwhile,

this work has just begun in Paraguay: “We are

developing protocols for handling breast and

cervical cancer as a priority,” says Dr Mitsui.

In understanding to what extent countries

have adopted a patient-centred approach

to care, the ICP examined three factors.

First, it evaluated the existence of policies

for co-ordinated and integrated care with

multidisciplinary teams. These involve, for

example, the inclusion of psychological

therapy in cancer treatment. Such policies

are available in nine countries. Then, the ICP

examined the role of patient associations. We

found that patient associations participated

in cancer policy development in only seven

countries. Lastly, the ICP reviewed the

existence of guidelines for rehabilitation

or return to work for patient survivors.

Performance in this indicator is generally

weak, with most countries lacking policies in

this area. Chile is an exception, with dedicated

chapters on rehabilitation and life after cancer

in both in the Modelo de Gestión para el

Funcionamiento de la Red Oncológica de Chile

(Management Model for the Functioning of the

Oncologic Network)^74 and its new cancer plan

for 2018 -28.^75

(^73) These should include the systematic review of the evidence and set of recommendations based on the evidence and involving value judgments
regarding benefits and harms of specific interventions.
(^74) Ministerio de Salud, “Modelo de Gestión para el Funcionamiento de la Red Oncológica de Chile”, 2018.
(^75) Ministerio de Salud, “Plan Nacional de Cáncer 2018-2028”.