National Action Plan on Cancer Care

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 10

Abstract

Cabinet established the National Action Plan on Cancer Care for 2007-2011 that is intended to develop integrated, comprehensive, and coordinated cancer care nationwide. Among the various actions proposed, the plan gives priority to promoting integrated cancer care by diffusing radiotherapy and chemotherapy, diffusing comprehensive palliative care, and developing a cancer registry.

Purpose of health policy or idea

The National Action Plan on Cancer Care is a policy document established by the  Cabinet in June 2007, as stipulated by the Cancer Care Act 2006, and it sets out the intended outcomes and areas for action with specific policy directions for the next five years. These are:

1. Promoting more comprehensive cancer care with increased ntegration of     radiotherapy and chemotherapy;
2. Promoting a more integrated mix of curative and palliative care;
3. Improving access to quality cancer care countrywide;
4. Developing home care services to support cancer patients and their carers;
5. Enabling hospitals to deliver comprehensive and integrated care of high quality;
6. Promoting the utilization of screening tests for cancer;
7. Involving opinions of cancer patients and their carers into cancer care;
8. Enhancing clinical and epidemiological research; and
9. Building workforce capacity.

Main points

Main objectives

The National Action Plan on Cancer Care sets two overall objectives for the next ten years: prevention of death caused by cancer and alleviation of sufferings that cancer patients and their carers experience. As to the former objective, the plan set a target: 20 % reduction of the age-adjusted mortality rate for those aged below 75.

Type of incentives

The government is supposed to allocate funds effectively for improving quality of preventive and curative care such as training of human resources and establishing special units for cancer care. The financial measures would be gradually introduced into the budget controlled by the Ministry of Health, Labour and Welfare.

Non-financial incentives include the following measures: establishment of action plans for prefectures, which shall be coordinated with their health care delivery plans; setting targets as well as monitoring activities of health care providers in each prefecture, which shall be reported to the government; increasing information on cancer research institutions and transparency of research funds.

Groups affected

Health professions concerned with cancer care, hospitals, and home care providers, cancer patients and their carers, civil society, researchers

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Innovation - the policy is innovative, in Japan, because an inter-ministerial policy on a single disease which includes both research and clinical issues is new.

Controversy - the policy is generally supported by various parties, the media, and the health care professionals. Some arguments have been on detailed policies.

Systemic Impact - may be fundamental. If it succeeds, the government would develop similar policies on other diseases.

Visibility - it was paid some attention on this policy for public concern on cancer is generally high. Since it is not so controversial, however, visibility in general was not so high.

Transferability - policies on a single disease can be developed in other countries within their institutional arrangements.

Political and economic background

Since the late-1990s, cancer care has been a major public concern. Nevertheless, problems that patients experienced fostered civil actions to improve cancer care and gained the attention of the media. Since 2004 a catch phrase, "cancer refugee", coined to describe cancer patients facing difficulties to find reliable care providers, has been frequently used in the media and prevalent. Also, during the last decades, participation of patients in health policy making has increasingly been considered critical to make health care more "patient-centered".

Although, responding to the situation, the Ministry of Health, Labor and Welfare had developed a strategy against cancer, drastic political actions were needed to allocate additional resources for implementing the strategy. In 2006, the legislation of the National  Action Plan on Cancer Care Act was swiftly achieved through negotiation between the major political parties. This process took place in the last months of the Koizumi Administration when the national economy was fairly stable and good. Also, the bill was passed in the same Diet where the Health Care Act 2006 was legislated.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

Since cancer has been the top cause of death since the 1980s, the Government has promoted research and development on cancer, which has resulted in innovations in cancer treatment. However, until recently there have been few policies on the provision of cancer care to deliver the best cancer care available to the public except establishing the National Cancer Center, developing cancer screening programs and other minor programs.

The National Action Plan on Cancer Care combines various preceding policies relevant to cancer care, prevention, and research and also goes beyond them. However, ideas that have been introduced into the plan can also be found in other recent trends of health policy making, including more detailed planning, more concern with clinical issues, more concern with specialties of doctors, geographical equity of access, quality of care, patient reliance and patient involvement.

Initiators of idea/main actors

• Government

• Patients, Consumers

• Civil Society

• Scientific Community

• Media

• Political Parties

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Before the Cancer Care Bill 2006, a comprehensive 10-year strategy for cancer control had been established in 2004. The strategy set a priority on improving cancer care and promoting a social environment to support cancer care. Also, a task force of the Ministry of Health, Labour, and Welfare published a document on how to achieve equal access to cancer care of equal quality in 2005. The National Plan follows those policy documents and describes more practical measures that shall be implemented and monitored.

The organization of cancer patients has rapidly grown. They have published numerous documents and held large meetings, which were broadcasted or reported by the media. 

The National Cancer Center gradually developed a web site to communicate to professionals, patients, and civil societies. It published reliable and available data on cancer care.

Actors and positions

Government
The Cabinet Office	very supportive		strongly opposed
Ministry of Health, Labour , and Welfare	very supportive		strongly opposed
Patients, Consumers
Patient organization	very supportive		strongly opposed
Civil Society
Citizen organizatios	very supportive		strongly opposed
Scientific Community
National Cancer Centre	very supportive		strongly opposed
Media
Newspapers	very supportive		strongly opposed
Political Parties
Liberal Democratic Party	very supportive		strongly opposed
New Komei	very supportive		strongly opposed
Democratic Party	very supportive		strongly opposed

Influences in policy making and legislation

The Cancer Care Act bill  was submitted by the Democratic Party, the opposition party, followed by an alternative bill introduced by the ruling Liberal Democratic Party and New Komeito. Then both sides negotiated to build a compromised bill, which passed the Diet swiftly in June 2006.

The enacted law established the Council on Cancer Care and Prevention [note that this translation is made by the author, and is not a formal one], which is a permanent organization within the Ministry of Health, Labour and Welfare (MHLW) in charge of voicing their opinions on the National Action Plan on Cancer Care to the Minister of Health, Labour and Welfare. Members of the Council shall include representatives of cancer patients and their carers, health care professionals and specialists on cancer by law.

Following the broad strategy that the MHWL had already established in 2005 and recommendations that an ad-hoc committee on challenges in cancer care organized by the MHWL had made just before the act came into effect, the Council made a draft plan, which was endorsed by the Cabinet and reported to the Diet.

Legislative outcome

success

Actors and influence

Government
The Cabinet Office	very strong		none
Ministry of Health, Labour , and Welfare	very strong		none
Patients, Consumers
Patient organization	very strong		none
Civil Society
Citizen organizatios	very strong		none
Scientific Community
National Cancer Centre	very strong		none
Media
Newspapers	very strong		none
Political Parties
Liberal Democratic Party	very strong		none
New Komei	very strong		none
Democratic Party	very strong		none

Positions and Influences at a glance

Adoption and implementation

The Government increased the budget for improving cancer care from 41 billion yen in fiscal year 2006 to 53.4 billion yen in fiscal year 2007. Although research and development occupied two thirds of the budget, a significant amount of money is allocated to develop provision of integrated cancer care, to revise education and training on cancer care in medical schools and educational hospitals, and other measures.

The major actions stated in the plan can be summarized as follows:

1. diffusing integrated treatment with emphasis on appropriate usage of radiotherapy and chemotherapy, particularly at prefectural cancer centres and special functioning hospitals [note prefectural cancer centres are hospitals appointed by the MHLW to deliver quality cancer care, to develop cancer care, and to develop human resources for cancer care], by developing human resources such as oncologists and radiotherapists, organizations in universities and hospitals, and training programs;
2. making newly innovated pharmaceuticals and instruments more quickly available to patients by reinforcing organisations for investigation and thus evaluating new pharmaceuticals more speedily;
3. diffusing quality palliative care considering the physical and mental suffering of patients, by distributing knowledge and skills on palliative care to physicians and developing palliative care teams at hospitals;
4. developing support systems for cancer patients at home, by creating home care models to support them, increasing the number of nurse visits, and providing training programs to home care professionals;
5. developing and updating clinical guidelines and disseminating clinical information to health professions as well as patients;
6. developing a coordinated local delivery system of cancer care by defining agreed discharge processes for patients with common cancers among the providers involved;
7. strengthening the functions of local cancer centres by developing updated standards and monitoring their activities;
8. making people prepared for cancer prevention and treatment, by disseminating essential knowledge about cancer to the public through the internet, providing support counselling services with skilled counsellors nationwide, and increasing patient-centred information provided to cancer patients at hospitals;
9. increasing the number of hospitals, particularly among cancer centres, that participate in cancer registry, by announcing the importance of cancer registry to the public, monitoring activities at cancer centres, and training staff for cancer registry; and
10. promoting scientific research of cancer with more transparency to the public and more participation of patients.

 

The plan includes existing polices such as promoting healthy behaviour to prevent cancer and increasing the percentage of the population receiving timely cancer screenings.

Among the actions outlined in the plan, priority was given to the following three areas:

1. diffusing integrated treatment with emphasis on appropriate usage of radiotherapy and chemotherapy;
2. diffusing necessary palliative care to cancer patients from the beginning of treatment; and
3. promoting a countrywide cancer registry

At the local level, prefectures have the responsibility to develop their action plans on cancer care with reference to the National Action Plan. The prefectural action plans shall be coordinated with prefectural health care plans (see HPM 9/2007).

A national guideline on formulating prefectural health care plans includes descriptions on delivering cancer care.

Monitoring and evaluation

The implementation process is to be monitored adequately by the Government, for which the Minister has been granted authority to collect the necessary information.

The government shall evaluate the plan at least every five years in order to update and, if necessary, to revise it.

Results of evaluation

Not available yet.

Expected outcome

The National Action Plan on Cancer Care has established authority to improve national and local health care systems to foster more integrated and patient-centred cancer care. According to the plan, the MHLW can allocate more resources to national, prefectural, and local centres. In some policy areas, where numerical indicators are given, implementation will probably be given priority.

Some objectives of the plan can easily be implemented by financial measures through the MHLW such as training human resources and developing organization for cancer care. Other objectives will be difficult to achieve directly because they are concerned with behaviours of health professionals. However, the plan and the law probably have symbolic impacts on the behaviours of professionals and managers of health care providers to make themselves and their organization more evidence-based, integrated and patient-centred.

A missing policy so far is how to monitor patients' anxieties, experiences and satisfactions in cancer care, which might be represented by patients' organizations, although a national mechanism to collect such information seems necessary to evaluate the plan in terms of geographical equity.

There is a caveat: the plan apparently includes little measures to change university hospitals, which have been academic centres in cancer research. Moreover, most university hospitals have been excluded from cancer centres. This might make local coordination in cancer care difficult and degrade prefectural and local cancer centres.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

Quality and equity - the policy aims to improve quality of cancer care countrywide with specific objectives. Thus it may gradually improve quality of cancer care and increase geographical equity in access to quality services.

Efficiency - it is too early to rate the impact of this policy on efficiency. Quality improvement with geographical equity considerations may increase or decrease efficiency.

References

Sources of Information

Japanese Cabinet. National Action Plan on Cancer Care. Reported to the Diet in June 2007.

Cancer Care Act 2006.

Author/s and/or contributors to this survey

Ryozo Matsuda

Ryozo Matsuda is professor for commynity health and health policy at the College of Social Sciences, Ritsumeikan Univerisity. This report was written when he was a visiting fellow at LSE Health, London School of Economics and Political Science.

Suggested citation for this online article

Ryozo Matsuda: "National Action Plan on Cancer Care". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/jp/a10/5