2023-05-18 16:37:38
A working table is needed for the drafting of a regulation that makes the document operational. Every year in Italy 895 thousand hospitalizations, over four billion euros spent on hospitalizations
The National Oncological Plan (PON) 2023-2027 is an ambitious document, as demonstrated by the consensus received at the State-Regions conference. For too generic in the formulation of objectives e does not provide the necessary funding for their realisation. Faced with the recognition of the centrality of assistance to cancer patients, the concrete actions to be put in place are not defined, thus risking navigating by sight. The most critical aspects concern the regional cancer networksstill without dedicated resources, the tools to achieve the coverage foreseen for breast, colorectal and cervical cancer screenings are not indicated, there is no reference to the quality of surgical services in oncology and themodernization of the technology park does not contemplate the equipment for radiotherapy. Not only. The criteria for planning the implementation of are not defined molecular biology laboratories on the national territory and the necessary urgent regulatory interventions are not envisaged for the rehabilitation. Failure to define these aspects risks compromising patient care and their quality of life, as well as increasing the costs of the disease. To draw attention to the strategic importance of the PON and to the open critical issues in our country is la Italian Federation of Volunteer Associations in Oncology (Favo) on the occasion of the XVIII National Cancer Patient Day.
895,000 hospitalizations for cancer every year
Every year in Italy they register , with an annual expense for suns direct hospital costs of over 4 billion euros, to which must be added 2.5 billion outgoings for welfare services. For this Favo, together with the main scientific societies, asks to set up a working table for the drafting of an implementing regulation, structured and defined, which makes the NOP operational in the various areas; to identify and appoint a coordination group for the annual assessment of the indicators and their punctual publication and to define the operational tools which, on the basis of the monitoring and the annual indicators, allow proceeding with the necessary and timely corrective measures. Requests are contained in the 15th Report on the welfare condition of cancer patients 2023presented today at Palazzo Madama, as part of the celebration of the Day.
Activating oncological networks
To ensure the feasibility and alignment of our Plan with the European one, which is based on 3 pillars (Preventing the foreseeable; Optimizing diagnosis and treatment and Quality of life), the immediate activation of the regional oncological networks and the national network is absolutely essential of rare cancers, condition not for the overall care of cancer patients and to guarantee them the best possible quality of life – he explains Francesco DeLorenzo, president Favo -. In fact, clinical healing is often accompanied by physical and psychosocial disabilities, recoverable precisely through rehabilitation programs. This is necessary for give the healed person back a full and satisfying lifebut also a collective duty and responsibility to ensure the appropriate use of resources.
Work and rehabilitation
Think of the advantages of reintegrating a healed person into the world of work: the return to active life translates into savings on social security costs, at the same time helping to give substance to the condition of the healed – continues Elizabeth Iannelli, segretario Favo –. Cancers represent the main cause of the recognition of disability allowances and disability pensions, with a constantly growing trend in recent years. The inadequacies of the system in terms of rehabilitation have also been recognized by the European Union, which has put in place corrective actions of great importance. Italy too must adopt the regulatory provisions necessary for the right to oncological rehabilitation to be recognised, defining specific pathways according to each pathology and ensuring access through recognition in the Essential Levels of Assistance.
Program disease control within the NHS
The European Plan to fight against cancer, presented by the European Commission, reports for 2020 in the countries of the European Union 2.7 million cancer diagnoses and 1.3 million deaths from this pathology, estimating, in the absence of strategic interventions, a further increase in mortality of over 24% by 2035. Also in Italy in this perspective it is essential to plan within our National Health Service a cancer control strategy, with defined and above all feasible initiatives and objectives – he comments Carmine Pinto, presidente FICOG (Federation of Italian Cooperative Oncology Groups) –. This can be theopublic health objective for adequate cancer control at all stages of the disease. it is essential for public health to intervene in areas with repercussions on regional health systems, such as the implementation of oncological screening with regional objectives and temporal growth trends, the requalification of intermediate care and home assistance, psychological assistance and oncological rehabilitation .
Reduce cancer mortality
A 6-8% reduction in cancer mortality would result in Italy 10,000-14,000 fewer deaths each year. This can be the public health objective for an adequate cancer control strategy, which includes all phases, from primary prevention and public awareness, to screening, diagnostics and equity of access to the best treatments on the whole territory,” he says Saverio Cinieri, president of Aiom (Italian Association of Medical Oncology) –. In the NOP, much prominence is given to the regional oncological networks, although no mention is made of the general coordination of the networks, envisaged in the Document adopted by the State-Regions Conference on 17 April 2019. Furthermore, for the networks to achieve real efficiency, dedicated resources are needed which are not established by the NOP, starting from an assessment of needs and with direct spending autonomy. Central elements of the Regional Oncological Networks are i Diagnostic Therapeutic Assistance Pathwaysbut also in this case there is no information on the funding needed to cover the necessary figuressuch as clinical study coordinators, psychologists, nutritionists, physiatrists, social workers, professionals that today are lacking almost everywhere.
Precision oncology
Precision oncology, one of the most important innovations that is modifying patient prognosis, requires a bio-molecular characterization of tumors, to optimize the results of therapies in terms of efficacy and savings in toxicity – he underlines Nicola Normanno, president of IQN Path (International Quality Network for Pathology) -. The NOP lacks references for developing governance at national and regional level for molecular biology laboratories and, in particular, for carrying out next-generation gene sequencing tests. It is essential to define stringent criteria for the creation of molecular biology laboratories within the networks, which consider population volumes, logistics, test quality and IT platforms. Lastly, connection paths between networks and clinical research activities must be organised, to facilitate access by oncological patients to new therapies.
Radiotherapy and the right to be forgotten
The NOP does not envisage a plan to update the radiotherapy technology park, which instead requires technologies and human resources capable of offering adequate treatment throughout the country, in compliance with the principle of equity and to contain healthcare migrations which have a heavy impact on patients and caregivers – he says Cinzia Iotti, president of Airo (Italian Association of Radiotherapy and Clinical Oncology) -. The PON does not define what is meant by innovation nor does it mention an investment plan that takes into account the needs of the territory and the context in which the most innovative equipment should be located. People who live after a cancer diagnosis in Italy are rapidly increasing: from 2.5 million in 2006, their number exceeded 3.6 million in 2020. Almost a third, about a million citizens, can be considered cured – he says Giordano Beretta, president of the AIOM Foundation -. The strategic lines, with reference to the implementation of specific interventions for the protection and reintegration into work of patients, the recovered and the caregivers are still generic. The Oncological Plan does not even intervene on the request for a law on the right to be forgotten oncologicofor which the AIOM Foundation has promoted a national petition, which has already collected around 106 thousand signatures.
Rights of the sick
Favo born in 2003 and in 20 years of activity, in synergy with the institutions and scientific societies it has achieved important goals – concludes Francesco De Lorenzo -. We mention, among others, the right of cancer patients to be able to continue workingin the public and private sectors, through the reversible transformation of full-time into part-time, the reduction from one year to 30 days of the time required to obtain recognition of cancer disability, the formal recognition of the role of patient associations in regional networks at all levels and the necessary involvement of advocacy patient in the research activity. These results represent a real revolution in the way of conceiving oncological disease and above all we are happy to have made a decisive contribution to overcoming the “cancer equals death” stigma. The challenge for the future will be to consolidate these results.
May 18, 2023 (change May 18, 2023 | 16:56)
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