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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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Parliamentary Group

Assembly of the Republic-Palace of S. Bento-1249-068 Lisbon-Phone: 21391 9233-Fax: 21391 7456 Email: gpcds@pp.


It recommends the Government to adopt urgent measures that decrease waiting times for oncological consultation and surgery and to improve quality and access

to oncological treatments.

Exhibition of Motives

In Portugal they die, annually, about 22,000 people who are victims of cancer, making it the

second cause of death after the cardio diseases and vascular brain.

There have already existed more than a five-year National Oncological Plan; there has already existed a Council

Oncological National directly dependent on the Minister of Health; and there is a

National coordination of Oncological Diseases, prioritised and directly dependent on the

High Commissioner of Health.

However, the rates of morbidity and mortality by malignant neoplasias,

particularly by female breast cancer, cervical cancer and colon cancer

and of the rectum, have not evidenced significant improvements in the national context .

According to the "Letter of Coimbra Principles", subscribed in November 2008 by the

President of the Portuguese Society of Oncology, by the College of the Specialty of

Medical Oncology and the College of the Specialty of Radiotherapy, " the mortality rate

by cancer recorded a continued increase in Portugal according to the studies

performed under the aegis of the IARC and published under the acronym EUROCARE (1, 2 and 3), contrary to the

which has been observed in most of the countries in the European space in which we enter. Only in the

last of these studies (the EUROCARE 4), published in 2007 in The Lancet Oncology se

observed, for the first time, a slight reversal of these figures ".

They refer to the experts who " our country presents still results suffering in what if

refers to the treatment of malignic neoplasias " .

And despite all the progress in the treatment of cancer, we know that about 50% of the

patients continue to not heal from their neoplasia and, at least those, lack them too

of specialized care directed at the comfort and promoters of Dignity until the end of

life. Such palliative care, a right that assists oncological patients in

suffering, are also manifestly insufficient for Portuguese patients.

It is to highlight three realities that, in accordance with the "Charter of Coimbra Principles",

contribute to the present situation by preventing a quality treatment:

1) The lack of expert professionals is touted as one of the most problems

graves. They are currently in activity only half of the specialists who would be

necessary to cope with the number of patients and it is expected that this deficiency will come to

aggravate in the coming years.

2) The lack of equipment in appropriate number, either in radiotherapy or 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 there being an increase in the response. In the

first half of 2008 there was an addition of 3 thousand patients on the waiting list for

surgery in relation to the same period of 2007, perdoing a total number of 22 thousand

oncological patients on hold. The waiting times for surgery and for the start of

radiotherapy often exceed the clinically acceptable deadlines.

In this sense, impose a review of the national strategic approach that vise

counteract the evolution of the existing reality . It has, inevitably, to be adopted a

integrated management of oncological disease that enables effective results in diagnosis and

treatment of cancer.

An effective organization of the provision of oncological health care must be composed

by an effective screening network and ensure timely access to specialist care.

Thus, the results of the traces must be sent, in real time, to the respective

health units allowing for an early diagnosis, multidisciplinary decisions and

prompt forwarding of the patient. Clinically acceptable waiting times

diverge as per the different pathologies, but it imposes to set maximum deadlines of

is expected to have surgery and for treatment, and these deadlines must be strictly adhered to.

Second to Normative Circular No. 14 /DSCS/DGID, of July 31, 2008, the model of

integrated management of the disease visa "reorganizing the provision of health care (...)"

ensuring that this " perform at the appropriate level and with the best use of resources,

thereby facilitating the access of citizens to highly differentiated health care,

for which a specific concentration of resources is required (infrastructures,

knowledge, skills) and the programming of necessary care ".

It is referred to, still, that " action should focus on diseases with high weight

budgetary, with serious repercussions at the social and economic level, by the early age,

severity and associated disability, and with needs for improving efficiency of the

coordination of care and unionization of professional practices ".

In this sense, and through the Normative Circular referred to above, the Directorate General of Health

(DGS) created the Centres of High Differentiation (CED) and the Treatment Centres (CT) .

The CED are " hospital services with high technical differentiation that develop

clinical and research skills with the aim of structuring the approach of the

diagnosis and overall and integral treatment of the patient with chronic disease ". These centres

have, inter alia, the following requirements:

-" Differential diagnostic capacity, follow-up of the evolution of chronic disease and

of its integral management, based on the search for the best results ";

-" Diagnostic capacity of diagnostics, consultancy / counselling, of

collaboration in the drafting, accession and dissemination of good practice guidelines and

implementation of result measures ";

-" Promote the appropriate multidisciplinary approach ";

-" They promote continuity of care through the articulation between the different levels of

health care ".

Already the CT " is a differentiated unit that, in articulation with the CED, develops a

determined medical or surgical treatment in an intensive and qualified manner ". These CT have

in view " the best provision of health care, through the guarantee of the

complementarity of care and its necessary coordination ", by competing with them:

-" Having a multidisciplinary team with full time dedication to CT ";

-" Be empowered and recognized by the respective CED with whom they articulate ";

-" To develop activities in an intensive and exclusive manner, in the area in which they were

recognized ".

Through the CED and CT, DGS has been developing work in the areas of the disease

renal chronicle and morbid obesity. But, incomprehensibly, there is no such

similar investment for Oncology .

Incidentally, according to the "Spring Report 2009", of the Portuguese Observatory of the

Health Systems (OPSS) in Portugal still exists a " excessive waiting time in the

malignonic neoplastic disease " which translates into an average wait for 102 days for a surgery,

against the 14 internationally recommended days. It is, even, highlighted that

" comparatively with the 14 days of waiting recommended by the Canadian Society

Surgery of Oncology, the waiting times practiced still require a considerable

improvement in the management of the whole process " .

The SIGIC Report for 2008 featured the following data on specialty

of oncology:

 10,000 patients with cancer were operated out of time;

 233 cancer patients died without getting surgery;

 In the IPO's of Lisbon and Porto 42% of the patients are operated above the times

maximal recommended;

 In Hospitals of the University of Coimbra 28.2% of the patients are operated above

of the recommended maximum times;

 The Garcia Hospital of Orta has an average wait of 86.5 days;

 At the Hospital of St. Teotonium, in Viseu, the waiting time is 56 days;

 At the Hospital of the Barlavento Algarvio the median is 126 days.

Of this data that here summarily presents itself, it is patented an inequality that

it stems from geographical criteria and which constitutes for us enormous concern.

Still according to this report from SIGIC the oncological specialties with greater

wait time are:

 Rarer malignant tumors and prostate cancer-average waiting time

greater than 2 months;

 Oncological pediatric surgery-in 2007 a median of the waiting time was 1

month, in 2008, was 4.17 months;

 Cancer of the colon and rectum, of the liver, the pancreas and the stomach;

It should still be pointed out that in 2008, 252,273 non-priority patients were operated in

time lower than the recommended average wait time. Of these, about 39,000 patients

were operated in less than 7 days.

The SIGIC Report's own Coordinator, Dr. Pedro Gomes, when commenting publicly

the data presented in the report stated that " if there is possible to be quick treatment in

unserious situations, it is not acceptable that the waiting times recommended in

oncology are not fulfilled. It is a moral imperative to treat the sick first

graves " . More yet, stated that " in some cases, the excessive waiting time can make the

difference between life and death; one needs to make a redefinition of the resources, there is

important regional discrepancies, the distribution of resources is not optimal for that

which is, nowadays, the demand in oncology " .

Last July, came public news giving account that thirteen of the fifty-five

hospitals with oncological treatment do not have a single oncology specialist.

In the SIGIC Report on the first half of 2009, the data for surgery

oncological are the following:

 Number of registered users: 3,613;

 Median wait time: 27 days;

 Number of entries in waiting list: 22,358;

 Number of patients operated in public hospitals: 20,300;

 Number of users operated in hospitals that are convening: 228;

 Median of the waiting time for prostate cancer: 41 days;

 Median wait time for malignated neoplasias of the " kidney or ureters or

bladder or urethra ": 32 days;

 The median of surgical waiting time for users with colon cancer and the

recto rose 15% and the number of operates came down 6.3%;

 Median wait time for " non-framing malignant neoplasias in others

groupings ": 44 days;

 In the region of Lisbon and Vale do Tejo is expected 29 days for oncological surgery, in the

Center 28, in North 25, at Alentejo 21 and in the Algarve 15 days.

One can thus observe that, despite the improvements, regional asymmetries persist and the

wait times continue above the recommended.

In the past Legislature the CDS-PP presented at the Parliamentary Committee on Health four

requirements requesting the hearing of the Minister of Health on the problems of the

oncology in Portugal. All these applications were rejected by the Party

Socialist .

The CDS-PP submitted, as yet, in March 2008, a Draft Resolution recommending

to the Government to immediately adopt a reform of the practice of oncology in Portugal .

In that initiative, concrete solutions and proposals have been put forward for a prevention,

diagnosis, treatment and follow-up of oncological patients with quality and

humanity. The Socialist party rejected the initiative of the CDS-PP .

The CDS-PP understands that one cannot sacrifice a single patient to inertia or disputes

ideological. The data on waiting lists, oncological treatments, the lack of

specialists, equipment and multidisciplinary teams, among so many others, are

too worrying.

We remind you that cancer is the second cause of death in Portugal.

The commitment of the CDS-PP is with the oncological patients and their families. In this

meaning, we believe that in this Legislature, it is indispensable to reintroduce this initiative.

By the exposed, the Assembly of the Republic, pursuant to Article 156º (b) of the

Constitution of the Portuguese Republic, deliberating to the Government:

1-May take the necessary steps to immediately provide an oncology specialist with the thirteen hospitals that are making oncological treatment without oncologists.

2-That adopt urgent measures that decrease the waiting times for oncological consultation and surgery and that improve the quality and access to oncological treatments, notably through properly protocoled and monitored countermeasures, with the social and private sectors.

3-A The immediate implementation of systematic screenings of cancer types with higher incidence in the Portuguese population: female breast cancer, cervical cancer and colon cancer and the rectum, susceptible to early diagnosis through population base screenings, covering the entire national territory.

4-A creation of an effective National Oncological Register, with data issuance in

real time that allow to estimate the incidence of malign-like neoplasias and survival at 5.

5-That ensures proper referencing of patients with malignant neoplasias.

6-That ensures the projection and planning of needs in the medium and long term,

in the entire national territory, in respect of human resources and necessary equipment in the area of oncology.

7-That ensures multidisciplinary teams, which can contemplate from the strand of prevention and screening to curative and palliative treatment in all hospitals with oncological treatment.

8-A The creation of High Differentiation Centres (CED) and Treatment Centres (CT), pursuant to the Normative Circular No. 14 /DSCS/DGID of July 31, 2008, of the Directorate General of Health, for confirmation multidisciplinary diagnosis and treatment of malign-like neoplasias.

9-A issuance, on the part of the Directorate General of Health, of organizational quality standards for CED and CT.

10-A dissemination of clinical guidance standards ("guidelines") for diagnosis and treatment of malignant neoplasias, particularly as for maximum waiting times, on the part of the Department of Quality in Health, created by Portaria No 155/2009 of February 10.

11-The increase in the training of specialists, in number, of Medical Oncology,

Radiotherapy and Pathological Anatomy, in keeping with the Department of Quality's projections in Health, so that it is possible to ensure the quality of care and its accessibility.

12-The strengthening of the clinical research strand in Oncology, key area for the improvement of the quality of the assistive, formative and organisational process of the Institutions.

13-A The issuance of an annual report on the traces, diagnostics and treatments of the malignancy neoplasias to be submitted to Parliament.

Palace of Saint Benedict, December 7, 2009.

The Deputies,