Full text of the National Cancer Control Programme of the Czech Republic

Targets

• Lowering cancer incidence and mortality rates in the Czech Republic.
• Prolonging life and improving the quality of life of cancer patients.
• Ensuring the availability of highly specialised cancer care.
• Rationalisation of cost planning for cancer diagnosis and treatment.

Strategy

• Fight against cancer as part of the national and regional political agenda.
• Fight against cancer as a lifelong concern of the general and professional public – cancer prevention and comprehensive cancer care.
• International cooperation and harmonisation of cancer care within the EU and WHO.
• Sustainability of the cancer programme through cost control and close cooperation with healthcare payers.
• Strengthening the position of the field of medical and radiation oncology as an independent medical specialty in terms of education, clinical and research, strengthening the clear position of the field as a guarantor of good clinical practice in comprehensive and multidisciplinary cancer care.
• Establishing and continuously evaluating indicators of the quality of care provided in oncology.

The National Cancer Control Programme is a principal theme for all cancer centres in all regions of the Czech Republic; its main purpose is to achieve and sustain the improvement of cancer care evenly throughout the Czech Republic.

The basic goal of the Czech Society for Oncology (CSO) still is and will remain the concept of the field, which is based on the provisions of the Czech National Cancer Control Programme.

The strategic programme of the already existing and still improving concept of oncology in the Czech Republic helps communication with all involved entities and the general public. The communication is also used for contact with the professional and general public through the website www.linkos.cz.

The concept is based on a strong network of Comprehensive Cancer Centres (CCCs), which are the highest and unquestionable organisational units for cancer care in the Czech Republic. The basis of the National Cancer Control Programme is to ensure equal access to cancer care and information in all regions through the above-mentioned network of cancer centres. The network of Comprehensive Cancer Centres (CCCs) concentrates highly specialised care for cancer patients in the areas of diagnostics, surgical, radiation and pharmacological treatment, followed by palliative care in all areas, as well as psychosocial care. The existence of a highly specialised network of CCCs does not call into question the existence and importance of regional centres that provide early detection, treatment of less severe malignancies and follow-up care. Intensive cooperation between CCCs and regional centres is essential for the proper provision of care for cancer patients.

Network of Comprehensive Cancer Centres (CCCs)

The network of CCCs is the backbone of care, the function and roles of CCCs are:

• Adherence to established clinical guidelines (standards) for individual diagnoses, stages of disease.
• Obligation of multidisciplinary approach, multidisciplinary teams (MDT) in each CCC, with continuity being ensured, and with obligation to refer patients from regional healthcare facilities.
• Determination of the diagnostic and therapeutic plan within the MDT, followed by determination whether the implementation of treatment will take place in a CCC or in a regional healthcare facility.
• Implementation of highly specialised care in the CCC with a defined number of surgical, urological and gynaecological procedures. The follow-up will take place at CCCs, regional healthcare facilities and in GP surgeries.

Institute of National Cancer Centres (NCCs)

• In cooperation with CCCs, NCCs coordinate their activities to standardise clinical guidelines for rare cancers.
• They facilitate international collaboration in care of rare cancers within the existing involvement in international structures.

Regional Cancer Groups (RCGs)

• Providers of acute inpatient cancer care
• Directly linked to a specific CCC, with an obligation to participate in the MDT
• Obligation to refer patients indicated for highly specialised care to CCC

The general practitioner as part of the organisation and concept of cancer care

• The general practitioner as part of the organisation and concept of cancer care
• The aim is to establish close cooperation between oncologists and general practitioners
• Speeding up the diagnosis process
• Cooperation in ongoing therapy
• Involvement in cancer screening programmes, searching for second and other malignancies
• Collaboration in palliative and supportive care
• Psychosocial issues
• Hospice (home) care of the dying patients

From 2021 onwards, the NOP clearly builds on the concept and strategy for cancer care in 2013–2020. The trend of development of cancer care in the evaluation of treatment results and quality of care provided to patients justifies the Czech Society for Oncology (CSO) to continue the established organisation with dominance and emphasis on centralisation, prevention, early detection, early diagnosis and standardised treatment with the aim of sustainability and improvement of quality of life of cancer patients and those who can be considered cured.

In these principles, the Czech National Cancer Control Programme is fully in line with the Europe's Beating Cancer Plan – the 4 key factors of the European approach to fighting cancer. The basis is:

• Prevention
• Early detection
• Diagnosis and treatment
• Quality of life for cancer patients and survivors

Czech National Cancer Control Programme from 2021 onwards – a summary

Targets

• The objectives of the CCCs, as defined in the introduction, remain valid and their relevance does not change in the future.
• Prevention is a fundamental principle that is supported by oncologists, even if it is not fully implemented by them. It is a societal, political and individual problem in the country. The dominant role in prevention is played by general practitioners.
• Prolonging and improving the quality of life is a clear objective.
• Cost sustainability while maintaining standardisation and quality of care remains an issue.
• The new goal is the widespread implementation of new biotechnologies, determination of prognostic and predictive factors, introduction of breakthrough systemic tumour-agnostic treatment and curative immunotherapy.
• The main emphasis in treatment individualisation is the full functionality of multidisciplinary teams, with the clinical oncologist having the main responsibility for the indication and application of systemic therapy. The clinical oncologist is the lead physician of the MDT, which guarantees a comprehensive approach and does not risk atomisation of the field.
• The centralisation of oncological care implemented by the CCC network is clearly the right way to cover the whole country with adequate cancer care.

Strategy

• In the area of strategy, the above-mentioned pathways to implementing quality cancer care also remain valid.
• In the area of strategy, the CSO considers the digitisation of data, electronic documentation, which will simplify the function of the MDT, to be important.
• Multidisciplinary care, availability of innovative effective cancer treatment, connection of the national network of CCCs to the European networks, as is already the case in the treatment of rare diseases, remain a necessity.
• Participation in clinical trials in randomised multicentre studies.
• High quality collaboration with ministries of health, education, medical faculties and payers of care.
• Expanding excellent collaboration with general practitioners.
• Equal quality communication and collaboration with patient representatives.
• Self-evaluation, regularly assessing the quality of care provided in comparison to the world.
• Supporting the building of outpatient, inpatient and home palliative care facilities linked to CCCs.
• Maintaining the continuity of the Czech National Cancer Registry (CNCR).
• Support and active participation in basic and applied cancer research.
• Participation in the improvement of education in oncology, involvement of international activities in the educational process of oncology staff.