NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Cancer Control: Knowledge Into Action: WHO Guide for Effective Programmes: Module 4: Diagnosis and Treatment. Geneva: World Health Organization; 2008.

Cover of Cancer Control: Knowledge Into Action

Cancer Control: Knowledge Into Action: WHO Guide for Effective Programmes: Module 4: Diagnosis and Treatment.

Show details

PLANNING STEP 1: Where are we now?

The Planning module provides an overview of what to assess in relation to the overall cancer needs in the general population, the groups particularly at risk, and the existing plan and services for responding to those needs. This Diagnosis and treatment module provides more detailed information on how to assess the number of people in need of diagnosis and treatment, and the existing diagnostic and treatment policies and services.

ASSESS THE NUMBER OF CANCER PATIENTS IN NEED OF DIAGNOSIS AND TREATMENT

By assessing the number of people with curable cancers or cancers that are treatable but not curable, it is possible to estimate the number of patients who could benefit most from timely and adequate diagnostic and treatment services.

Performing such an assessment will provide responses to the following key questions:

  • Which are the most common cancer types that have high potential for being detected early and cured?
  • Which are the most frequent cancer types that, although disseminated or not amenable to early detection, have a high potential for being cured?
  • Which are the most frequent cancer types that are treatable but not curable?
  • What proportion of all paediatric cancers are curable?
  • What proportion of all paediatric cancers are treatable but not curable?
  • What proportion of all adult cancers are curable?
  • What proportion of all adult cancers are treatable but not curable?

For each common cancer type with a high potential for cure or for which treatment may prolong the patient's life considerably (for several years), it is important to determine the age, sex and geographical disparities in incidence, stage distribution, mortality and survival.

Table 1 provides a template for organizing the data obtained by the disease burden assessment and thereby identifying the most common types of curable cancers and cancers that are treatable but not curable. The necessary data can be derived according to the approaches described in the Planning module (see planning step 1, pages 14–15).

Table 1. The burden of curable cancers and cancers that are treatable but not curable: what to assess.

Table 1

The burden of curable cancers and cancers that are treatable but not curable: what to assess.

ASSESS THE EXISTING DIAGNOSIS AND TREATMENT PLAN AND ONGOING ACTIVITIES

In assessing the existing diagnosis and treatment plan and ongoing activities, it is important to recognize that diagnosis and treatment together constitute a complex component of overall cancer control which, in an ideal scenario at least, is closely allied to early detection and palliative care activities. Cancer diagnosis and treatment services are mainly available at the secondary and tertiary levels, and are usually provided by professionals from a great variety of disciplines and specialties.

Table 2 shows what to assess regarding the existing cancer diagnosis and treatment plan and ongoing activities. These aspects are discussed in more detail in the Planning module. The initial focus should be on the gap between what is needed to provide services to the population with curable cancers, and what is currently available.

Table 2. The diagnosis and treatment plan and related activities: what to assess.

Table 2

The diagnosis and treatment plan and related activities: what to assess.

Ask the following questions to assess the existing diagnosis and treatment service provision:

WHAT DIAGNOSIS AND TREATMENT SERVICES ARE AVAILABLE?

  • Are there diagnosis and treatment services for curable tumours? How are they organized?
  • Are the diagnosis and treatment services linked to early detection programmes?
  • Are the diagnosis and treatment services linked to palliative care?
  • What is the target population for the diagnosis and treatment programme? Does it explicitly include adults and children?
  • What diagnostic tests are recommended to confirm the diagnosis of specific types of curable cancers and of other common cancers that are treatable but not curable?
  • Are there clinical guidelines for the treatment of the curable cancers?
  • Are there clinical guidelines for the treatment of the cancers that are treatable but not curable?
  • Are there guidelines for the provision of patient information and support?
  • Are there guidelines for organizing treatment services for curable tumours?
  • Are there guidelines for organizing treatment services for the cancers that are treatable but not curable?
  • Do the organizational guidelines define the roles and functions of health-care providers at the different levels of care?
  • Are there systems to ensure regular monitoring and evaluation?
  • Do the monitoring and evaluation systems include adequate quality control of the diagnostic, treatment and follow-up methods?

HOW WELL ARE DIAGNOSIS AND TREATMENT PROGRAMMES DOING? HAVE MEASURES OF SERVICE DELIVERY QUALITY BEEN IDENTIFIED AND ARE THEY MONITORED REGULARLY?

Quality can either be assessed through a system model of inputs, processes, outputs and outcomes (short-, medium- and long-term) or by adopting a continuous quality improvement framework, composed of a number of quality dimensions that can be explored through questions such as the ones listed below:

  • Are all the diagnostic and treatment services accessible (ensuring coverage and timeliness) to the target population?
  • Are the services acceptable (ensuring providers' and patients' satisfaction) and appropriate (based on established standards) for the target groups?
  • Are the competencies (knowledge and skills) of the providers appropriate for the services needed?
  • Is there continuity (integration, coordination and ease of navigation) in the activities of the diagnosis and treatment programme?
  • Are the diagnostic and treatment services safe for providers, patients and the environment?
  • Are the diagnostic and treatment services effective (in terms of cure or improved survival) and efficient (providing the best results at the lowest cost)?

ASSESSING THE EFFECTIVENESS OF DIAGNOSTIC AND TREATMENT SERVICES

In the medium and long term, an effective diagnosis and treatment programme, with good coverage of the target groups, should result in:

  • improvement in 5- and 10-year survival and cure rates for patients with the targeted cancers;
  • improved quality of life for cancer survivors;
  • decreased mortality among patients with the targeted cancer types.

ASSESSING THE EFFICIENCY OF DIAGNOSIS AND TREATMENT PROGRAMMES

Diagnosis and treatment programmes can achieve very different results with the same level of resources. Programmes are particularly efficient if they target curable cancers.

It is unfortunately not rare, in low-resource settings, to see a local government investing in hugely expensive cancer treatments, such as bone marrow transplant units. Only a few very high-income patients will be able to afford such costly treatment, and their chances of survival will be low. The same level resources could, however, be used to treat hundreds of children, including those from low-income families, who have acute lymphatic leukaemia, for which cure rates are potentially over 80%.

Relevant questions to ask in order to assess the efficiency of diagnosis and treatment programmes are shown in Table 3.

Table 3. Questions to help assess the efficiency of cancer diagnosis and treatment programmes.

Table 3

Questions to help assess the efficiency of cancer diagnosis and treatment programmes.

ASSESSING PATIENT SAFETY IN DIAGNOSIS AND TREATMENT PROGRAMMES

Patient safety is achieved by avoiding, preventing or ameliorating adverse outcomes or injuries stemming from the processes of health care (WHO, 2005). In the United States of America, the National Cancer Institute has recommended common terminology for reporting adverse events, applicable to all oncology clinical trials regardless of chronicity of adverse events or modality of treatment. This terminology is useful in assessing the safety of all health-care interventions (National Cancer Institute, 2003).

To assess whether a diagnosis and treatment component is safe in a country or region, it is useful to pose the following questions:

HOW MANY PATIENTS PER YEAR EXPERIENCE MEDICAL ERRORS OR SUFFER INJURIES ASSOCIATED WITH THE DELIVERY OF DIAGNOSIS AND TREATMENT PROCEDURES?

When answering this question, it is instructive to consider any possible complications of diagnostic tests and treatment, medication errors, side-effects of medications, critical incidents and psychosocial consequences of treatment, and also any associated quality-of-life aspects.

WHAT ACTIONS ARE BEING TAKEN TO ENSURE PATIENT SAFETY IN RELATION TO THE DELIVERY OF DIAGNOSIS AND TREATMENT PROCEDURES?

  • Is there a system to identify medical errors and causes of patient injury?
  • Are practices being implemented that eliminate medical errors and systems-related risks and hazards?

For more information on patient safety, go to http://www.who.int/patientsafety/reporting_and_learning/en/

ASSESSING CUSTOMER SATISFACTION WITH DIAGNOSIS AND TREATMENT SERVICES

Customer satisfaction is the state of mind that customers (patients and their families) have when their expectations have been met or exceeded. Customer satisfaction is subjective.

To establish whether a diagnosis and treatment programme for cancer is producing customer satisfaction, it is useful to ask the following questions:

  • Do patients comply with treatment and follow-up?
  • Is customer satisfaction improving over time?
  • How many formal complaints have been received?
  • What are customers' expectations, preferences, needs and requirements?
  • Are the services designed to meet customers' expectations, preferences, needs and requirements?

ASSESS THE SOCIAL CONTEXT

The development of a diagnosis and treatment plan and programme requires a thorough understanding of the context. The integration of social context with the diagnosis and treatment plan will considerably enhance acceptance of the plan, both politically and socially. One way to do this is through an analysis of the strengths, weaknesses, opportunities and threats (SWOT analysis) of the existing plan and related activities.

During the course of a SWOT analysis, the following questions should be answered:

WHAT ARE THE STRENGTHS AND WEAKNESSES ASSOCIATED WITH PLAN DEVELOPMENT AND IMPLEMENTATION?

These are factors affected by internal forces, such as political support, leadership, stakeholders' involvement and resources available. For example, politicians and decision-makers are usually supportive of treatment services for cancer but they do not prioritize cost-effective and affordable treatments, and thus often neglect or overlook prevention, early detection, rehabilitation and palliative care.

WHAT ARE THE OPPORTUNITIES AND THREATS ASSOCIATED WITH PLAN DEVELOPMENT AND IMPLEMENTATION?

These are factors affected by external forces, such as the international cancer control agenda, the political and economic situation within the country, and the existence of other pressing health priorities. For example, the fact that WHO and its international partners are promoting a balanced approach to cancer control interventions – from prevention to end-of-life care – represents an opportunity to advocate for the development of more effective and efficient national policies for diagnosis and treatment.

For further information, including details of international organizations working in cancer diagnosis and treatment, go to http://www.who.int/cancer/modules/en/index.html

SELF-ASSESSMENT BY COUNTRIES

WHO has developed a set of self-assessment tools for assessing, at different levels of complexity, the population cancer needs and existing services. A description of the tools can be found in the Planning module.

Self-assessment tools, which can be adapted to country circumstances, are available from the WHO web site http://www.who.int/cancer/modules/en/index.html

The WHO web site also provides links to sources containing more specific tools for assessing the needs and existing services for diagnosis and treatment of cancer.

Copyright © World Health Organization 2008.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

Bookshelf ID: NBK179055

Views

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...