The current status of cancer care in Taiwan

Chien-­‐Yuan  Wu  Director  of  Cancer  Prevention  and  Control  Division  

 Health  Promotion  Administration    Ministry  of  Health  and  Welfare,  Taiwan

Where is Taiwan? n  Taiwan is situated on the northeastern edge of the Pacific

Ocean, off the southeastern coast of the Chinese mainland. Located midway between Korea and Japan to the north and Philippines to the south.

n  Household registration has been implemented in Taiwan since 1906.

n  At the end of 2013, the total population of Taiwan was 23 millions.

Incidence and mortality, OECD countries

Source: 1. GLOBOCAN 2012, IARC 2. Taiwan caner Registry, 2010 3. Taiwan Death Statistics

Age-standardized rate (ASR), 1/100,000

Incidence rate Mortality rate

4

Burden of Cancers in Taiwan

Cancer , 130.4

Heart dis , 47.7

Stroke , 30.3

Pneumonia , 22.5Diabetes , 25.8

Injury , 22.4COPD , 14.9 Liver dis, 14.8

Suicide , 12.0Ch. Kidney dis , 11.9

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20

40

60

80

100

120

140

1986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013

Top 10 leading causes of death

Cancer has been the number 1 killer in Taiwan since 1982, accounting for 29% of total deaths and 11% of National Health Insurance expenditure in 2013.

age-standardized mortality rate (1/ 100,000)

Cancer control infrastructure

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n  Taiwan Cancer Registry, a population-based cancer registry, was founded in 1979, and Death Statistics.

n  Cancer Control Act, which came to effect in 2003, regulate hospitals with greater than 50-bed capacity, involved in cancer care, to participate in reporting all newly diagnosed malignant neoplasms to the registry. Eighty percent cancer patients are diagnosed and treated in these hospitals .

n  National Health Insurance was implemented since March 1995, with 99.5% coverage of the population.

n  National Cancer Control Programme is in place, now we are in the Phase Ш NCCP.

National Cancer Control Programme

Survivorship - Living With and Beyond Cancer. Life and health after a cancer diagnosis and once treatment is over (NCI, USA ) ; Living With and Beyond Cancer. (NHS, U.K.)

n  Taiwan Cancer Registry: 520,000 cancer survivors (474,000 are registered in the health insurance system who were issued catastrophic illness certificate). n  Diagnosis and treatment of cancer is covered by the national health insurance. Cancer patients with a catastrophic illness certificate, his/her co-payment can be exempt. n  The medical cost of cancer patients were 5 times higher than the average and accounts for 11% National Health Insurance Expenditure.

Cancer survivors in Taiwan

Cancer care and strategy

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adapted  from  the  NCI  figure  on  the  “Cancer  Control  Con6nuum”2  

U.S Cancer Control Continuum(1970-mid)

n  Long-term follow-up/ surveillance n  Late-effects management n  Rehabilitation n  Coping n  Health promotion & prevention

What survivors need

n  Anxiety & Depression n  Cognitive function n  Exercise n  Fatigue n  Immunizations and infections n  Pain n  Sexual function n  Sleep disorders

NCCN Guidelines for Survivorship

Hospital

NGO

HPA & NHIA

Comprehensive service network aimed at cancer patients

cancer patient service program hospital cancer care

quality improvement plan

one-stop window cancer services HPA: Health Promotion Administration

NHIA: National Health Insurance Administration

Strategies to improve Diagnosis and management

n  Accreditation for comprehensive cancer care quality p  Treating more than 500 new cancer cases/ yr p  Domains •  Organizational policy and management of cancer care quality and

clinical procedures •  Establish cancer registry long-form database for use in quality

improvement •  Provide diagnosis and tx according to evidence and guidelines •  Establish multi-disciplinary team care models •  Establish chemotherapy coherence and safety •  Establish clinical and pathological peer review mechanisms

n  Subsidy plan (pay for cancer care performance) Monitor improvement on quality of care, and pay for performance

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(national performance %)

Indications 2007- 2011

2011

1 The ratio of histological or cytological confirmation before surgery 84.3 88.6

2 The ratio of breast conserving surgery performed in stage I breast cancer 45.4 48.4

3 The ratio of post-operative radiotherpy in breast cancer underwent MRM with more than 3 positive nodes 85.3 85.9

4 The ratio of adjuvant chemotherapy in breast cancer patients with tumor bigger than 1cm and age under 60 96.8 97.1

5 The ratio of sentinel node sampling in stage 1 and 2 breast cancer 48.7 62.8

6 The ratio of post-operative radiotherpay in breast cancer underwent MRM with more than 4 positive nodes 49.7 55.9

Core measurement (Breast cancer) Breast cancer treatment core indicators all improve.

Distribution of hospitals with accreditation of the comprehensive cancer care quality

Note: 1.Medical Center 2.Regional Hospital

There are still 4 counties without any qualified hospital

No. of Hospitals

Patients not undergo treatment n  According to registry, 18% newly diagnosed patients did

not receive treatment within three months after diagnosis (patients above 80 y/o are excluded).

216 pa t ie nts

655pa t ie nts

213 pa t ie nts124 164 128

0%

2%

4%

6%

8%

10%

12%

14%

子宮

頸癌

肝癌

乳癌

肺癌

口腔

癌大

腸癌

1.2 ％

12.9 ％

5.9 ％

2.2 ％1.0 ％

Cervix Liver Breast Lung Mouth Colon

Every Life Counts! Cancer patient medical navigation service

n  Mission： p  Ensure golden timing for treatment p  Best medical service efficiency ( quality + hospice) p  Saving lives

n  Main target：Golden Decade Megaplan and 25 X 25 p  20% reduction on mortality rate by 2020 p  25% reduction on premature mortality rate by 2025 p  Extend lifespan, raise awareness for healthy living

n  Target： Newly diagnosed patients

Navigation program in hospitals

n  By care coordinator p  Require hospitals which participate

in our subsidy plan have care coordinators work as navigators.

n  By one-stop cancer resources center p  HPA supports P4P hospitals

to provide direct services to patients, include medical, mental social and other needs.

NGO’s as partners to provide patient support

n  Providing information n  counseling n  Emotional support n  Nutrition education n  Ward / home visit n  Instrument and material n  Day care n  Grief counseling n  Peer support n  Healing programmes