Recommends To The Government To Adopt Urgent Measures To Reduce Wait Times For Cancer Surgery And Consultation And To Improve The Quality And Access To Cancer Treatments

Original Language Title: Recomenda ao Governo que adopte medidas urgentes que diminuam os tempos de espera para consulta e cirurgia oncológica e que melhorem a qualidade e o acesso aos tratamentos oncológicos

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Group Group Parliament – Palace of Saint Benedict-1249-068 Lisboa-Phone:-Fax: 21 391 7456 21 391 9233 Email: – MOTION for a RESOLUTION paragraph 28/XI/1st Recommends the Government to adopt urgent measures to reduce wait times for cancer surgery and consultation and to improve the quality and access to cancer treatments.
Explanatory statement In Portugal die each year, about 22,000 people victims of cancer, making it the second most common cause of death after cardio and vascular brain diseases.

Have there been more than a five year National Cancer Plan; ever a National Cancer Council directly dependent of the Ministry of health; and there is a national coordination of oncological Diseases priority and directly dependent on the High Commissioner of health.

However, the rates of morbidity and mortality from malignant neoplasms, especially for female breast cancer, cervical cancer and cancer of the colon and rectum, don't have shown significant improvements in the national context.

According to the Charter of principles of Chen ", signed in November 2008 by the President of the Portuguese society of Oncology, by the College of medical oncology and specialty by specialty College of Radiation," the cancer mortality rate has registered a continued increase in Portugal according to the studies carried out under the aegis of ACRAN and published under the symbol EUROCARE (1 , 2 and 3), contrary to what is observed in most of the European countries in which we operate. Only in the last of these studies (the EUROCARE 4), published in 2007 in The Lancet Oncology, was observed for the first time, a slight reversal of these numbers. "

Refer to the experts that "our country still shows poor results with regard to the treatment of malignant neoplasms".

And, despite all the progress in the treatment of cancer, we know that approximately 50% of patients are still not heal of your and neoplasia, at least those, lack specialized care also to the comfort and promoters of Dignity until the end of life. These palliative care, a right of cancer patients in pain, are also manifestly insufficient for the sick.

The following should be noted three realities that, in accordance with the "principles of Chen", contributing to the present situation, preventing a quality treatment: 1) the lack of professional experts is singled out as one of the most serious problems. Currently, they are active only half of the experts that would be needed to cope with the number of patients and it is anticipated that this shortage will worsen in the coming years.
2) the lack of equipment in adequate number, in radiation therapy, either in structures for the administration of chemotherapy, to cope with the estimated increase of incidence of oncological diseases, as well as the implications that new technologies.
3) the increase in waiting lists, without an increase in the response. In the first half of 2008 there was an increase of 3000 patients on the waiting list for surgery as compared to the same period in 2007, making a total number of cancer patients waiting 22000. Waiting times for surgery and for beginning radiotherapy often exceed the time limits clinically acceptable.

In this regard, a review of the national strategic approach aimed at countering the evolution of existing reality. Has, inevitably, to be adopted an integrated management of the oncological disease that allows effective results in the diagnosis and treatment of cancer.

An effective organization of the provision of cancer care must be composed of a network of effective screening and ensure timely access to specialist care. Thus, the results of the surveys shall be sent in real time to the respective health units enabling an early diagnosis, multidisciplinary and immediate forwarding decisions. The clinically acceptable wait times differ according to the different pathologies, but we must establish maximum periods of waiting for surgery and treatment, and should these deadlines be strictly complied with.

According to the normative Circular 14/DSCS/DGID, of 31 July 2008, the integrated management model of the disease aims to "reorganize the delivery of health care (...)" ensuring that this takes place at the appropriate level and with the best use of resources, facilitating the access of citizens to health care highly differentiated, for which there is a need for a specific concentration of resources (infrastructure , knowledge, competencies) and the schedule of care ".

It is said that "the action should focus on diseases with high weight, with serious social and economic repercussions, the precocity, severity and disability associated with, and in need of improvement of efficiency of care coordination and standardisation of professional practice".

In this sense, and through Normative Circular referred to above, the Directorate-General of health (DGS) created the High Differentiation centers (EDC) and the treatment centers (CT).

The CED are "hospital services with high technical differentiation they develop clinical and research skills with the aim of structuring the approach to the diagnosis and treatment of the patient with integral global chronic disease". These centers have in particular the following requirements:-"differentiated diagnostic Capacity, following the evolution of chronic illness and your integrated management, based on the search for the best results";
-"Capacity for confirmation of diagnosis, consultation/counseling, of collaboration in the development, support and dissemination of good practice guidelines and to implement outcome measures";
-"Promote appropriate multi-disciplinary approach";
-"Promote continuity of care through the articulation between the different levels of health care".

Already the CT "is a different unit that, in conjunction with the CED, develops a certain medical treatment or surgical intensive and qualified". These CT aim at "the best health care, by ensuring the complementarity of your care and the necessary coordination", racing them:-"Have a multidisciplinary team with full-time dedication to CT";
-"Be authorized and recognized by the CED who fit together";

-"Developing intensively and exclusive activities, in the area in which they have been recognised."

Through EDC and the CT, the DGS has developed work in the areas of chronic kidney disease and morbid obesity. But, understandably, there is no similar investment in Oncology.

In fact, according to the "2009 spring report", the Portuguese Health systems Observatory (OPSS) in Portugal there is still an "excessive waiting time in malignant neoplastic disease" which translates into an average of 102 days waiting for surgery, against the 14 days internationally recommended. It is also highlighted that "compared with the 14 day wait recommended by the Canadian Society of Oncology, Surgery wait times practiced still require considerable improvement in the management of the whole process."

SIGIC's report for 2008 showed the following data about the specialty of Oncology:  10,000 cancer patients were operated outside the term;  233 patients with cancer died without getting a surgery;  In IPO's of Lisbon and of Porto 42% of patients are operated above the recommended maximum time;  In Hospitais da Universidade de Coimbra 28.2% of patients are operated above the recommended maximum time;  the Hospital Garcia de Orta has an average 86.5 waiting days;  in the Hospital of São Teotónio, Viseu, the waiting time is 56 days;  at the Hospital of the western Algarve the median is 126 days.

These data are presented briefly here, is an inequality which patent stems from geographical criteria and that is a huge concern for us.

According to this report by SIGIC oncological specialties with longer waits are:  malignant tumors and prostate cancer-the average waiting time of more than 2 months;  oncologic Pediatric Surgery-in 2007 the median waiting time was 1 month, in 2008, was 4.17 months;  colon cancer and rectum, liver, pancreas and stomach; It should also be pointed out that, in 2008, 252,273 non-priority patients were operated on time less than the average wait time recommended. Of these, about 39,000 patients were operated in less than 7 days.

Report of the coordinator himself SIGIC, Dr. Pedro Garcia, commenting publicly the data presented in the report stated that "If you can be quick treatment in severe situations, it is not acceptable that the recommended wait times in Oncology are not fulfilled. It is a moral imperative to treat more severe patients first ". Furthermore, it stated that "in some cases, the excessive waiting time can make the difference between life and death; a redefinition of features, there are significant regional discrepancies, the distribution of resources is not ideal for the one who is, nowadays, the search in Oncology ".

Last July, have been made public news realizing that thirteen of the 55 hospitals with cancer treatment have not a single specialist in Oncology.

SIGIC's report on the first half of 2009, data for oncologic surgery are as follows:  number of registered users: 3,613;  median waiting time: 27 days;  number of entries in the waiting list: 22,358;  number of operated patients in public hospitals: 20,300;  number of users operated hospitals contracted: 228;  the Median waiting time for prostate cancer: 41 days;  the Median waiting time for malignant neoplasms of "kidney or ureter or bladder or urethra": 32 days;  the median of surgical wait time for users with cancer of the colon and rectum went up 15%, and the number of operated went down 6.3%;  the Median waiting time for "malignant neoplasm not suitable in other groupings": 44 days;  in the region of Lisbon and Tagus Valley is expected to be 29 days for oncologic surgery, in the Center, 25, 28 in the Alentejo and the Algarve 15 21 days.

One can thus note that, despite the improvements, the regional imbalances persist and wait times are still above those recommended.

In the last parliamentary term the CDS-PP presented in four health requirements parliamentary Committee asking for the hearing of the Minister of health on the problems of Oncology in Portugal. All these requests were rejected by the Socialist Party.

The CDS-PP presented, yet, in March 2008, a draft resolution recommending the Government to adopt an immediate reform of the practice of Oncology in Portugal. In this initiative, and solutions were presented some practical proposals for prevention, diagnosis, treatment and follow-up of cancer patients with quality and humanity. The Socialist Party rejected the initiative of the CDS-PP.

The CDS-PP understands that you can't sacrifice a single sick to inertia or ideological disputes. Data relating to waiting lists, to cancer treatments, lack of specialists, equipment and multidisciplinary teams, among many others, are too worrisome.

Please note that cancer is the second most common cause of death in Portugal.

The commitment of the CDS-PP's with cancer patients and their families. In this sense, we understand that, in this parliamentary term, it is necessary to reintroduce this initiative.

Therefore, the Assembly of the Republic, in accordance with point (b)) of article 156 of the Constitution of the Portuguese Republic, decides to recommend to the Government: 1-to take the necessary measures in order to provide, immediately, a specialist in oncology the thirteen hospitals that are cancer treatment without oncologists.

2-to adopt urgent measures to reduce wait times for cancer surgery and consultation and to improve the quality and access to cancer treatments, in particular by means of contractualisation properly filed and monitored, with the social and private sectors.
3-the immediate implementation of the systematic screening of the types of cancer with the highest incidence in the Portuguese population: female breast cancer, cervical cancer and cancer of the colon and rectum which early diagnosis through population-based surveys, covering the entire national territory.
4-the creation of an effective National Cancer Registry, with real-time data that allow to estimate the incidence of malignant neoplasms and survival at 5 years.
5-ensuring appropriate referral of patients with malignant neoplasms.
6-to ensure the design and planning of the needs in the medium and long term, throughout the national territory, in the area of human resources and equipment needed in the area of Oncology.

7-to ensure multidisciplinary teams, they can contemplate from the aspect of prevention and screening to curative treatment and palliative in all hospitals with cancer treatment.
8-creating High centers (EDC) Differentiation and treatment centers (TC), in accordance with Circular nº 14/DSCS/DGID, of 31 July 2008, the Directorate-General of health, to multidisciplinary diagnostic confirmation and treatment of malignant neoplasms.
9-issuing, by the Directorate-General of health, organizational quality standards for the CED and CT. 10-the dissemination of clinical guidelines ("guidelines") for diagnosis and treatment of malignant neoplasms, particularly with regard to maximum waiting times, by the Department of Health Quality, created by Ordinance No. 155/2009 of 10 February.
11-increased training of specialists, in number, of medical oncology, radiation oncology and pathology, in accordance with the projections of the Department of Health Quality, in order to ensure the quality of care and your accessibility.
12-the strengthening of clinical research in Oncology, fundamental area for the improvement of the quality of the care process, organisational and training institutions.
13-the issuance of an annual report on the scans, diagnoses and treatment of malignant neoplasms to Parliament.

São Bento Palace, 7 December 2009.


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