Instituto Nacional del Cáncer

Dra. Julia Ismael Septiembre 2018

The INC is responsible for the development and

implementation of health policies, as well as

the coordination of integrated actions for

cancer prevention and control in the country.

Objectives

• To contribute to the reduction of cancer

incidence and mortality in Argentina

•To improve the quality of life of cancer

patients.

Prevention, early detection and treatment

National screening programs

Testing the asymptomatic population to detect a

disease or a risk factor

CRC Mortality

Epidemiology: Mortality

Background: diagnosis of the situation 2011

• Absence of a programmatic framework

• Limited access and coverage of the target

population, mostly occassional screening.

• Underreporting / lack of identification of risk

groups

• Lack of an information system for program

monitoring and evaluation.

• Lack of practice guidelines

• Underutilization of physical resources.

• Underutilization of human resources.

Basic Conditions Screening Program

– High coverage of the target population

– Screening with good quality test

– Adequate treatment and monitoring of people with

precancerous lesions and cancer

Karsa L, Lignini TA, Patnick J et al. (2010) Best Pract Res Clin Gastroenterol; 24: 381-396

Average risk asymptomatic

without familial or personal history 50 - 75 y

High risk Symptomatic

Personal or familial history (adenoma, CCR, inflammatory disease)

VCC

UDV

Programmatic definitions

Main working lines of the PNCCR

Quality

• Human resources training

• Process quality control • Clinical Practice Guidelines

Monitoring

• Indicators

• Information System (SITAM).

Coverage

• Communication

• Reference – counter-referralm(1st y 2nd level)

• High screening coverage & access to treatment

Alta Cobertura del Tamizaje y acceso al tratamiento

and a

Quality

• Human resources training

• Process quality control

• Clinical Practice Guidelines

Alta Cobertura del Tamizaje y acceso al tratamiento

and a

Quality

• Human resources training

• Process quality control

• Clinical Practice Guidelines

Quality

• Human resources training

• Process quality control

• Clinical Practice Guidelines

Monitoring

• Indicators

• Information System (SITAM).

20

PNCCR

Coverage

• Communication

• Reference – counter-referralm(1st y 2nd level)

• High screening coverage & access to treatment

21

Hombres y Mujeres 50-75 años

c/cobertura pública de salud

F. riesgo y síntomas.

CAP

Riesgo incrementado

Población General Asintomática

Entrega de TSOMFI e indicaciones

Lectura

Devolución de la muestra

Colonoscopia

Gestión de Turnos

Unidad de Diagnóstico y

vigilancia

Coverage

• Communication

• Reference – counter-referralm(1st y 2nd level)

• High screening coverage & access to treatment

Communication strategies adapted to the characteristics of the population

Workshops with sanitary agents Equipment training of

health for active search

Navigation strategy For the search of person with pathological diagnosis and that require follow-up and treatment

Coverage

• Communication

• Reference – counter-referral (1st y 2nd level)

• High screening coverage & access to treatment

Screening program evolution TSOMFI 2014

PNCCR 23

2015

PNCCR

24

2016

25

2017

26

Total tests performed

27

0

2.000

4.000

6.000

8.000

10.000

12.000

14.000

16.000

2014 2015 2016 2017

Año

Can

tid

ad T

SOM

FI r

eal

izad

os

Cantidad TSOMFIrealizados por añoPO: 1.729.293

Results Indicator Acceptable

goal

Desirable

goal

2014 2015 2016

Coverage 40% 70% 3,4% Misiones

9,7% Tucumán

6,9% Misiones from the

beginning

12,5% Tucumán from the

beginning

8% Misiones from the

beginning

17,9% Tucumán from

the beginning

FIT + 4 - 11% first round 36% Misiones

23% Tucumán

25% Misiones

27% Tucumán

15% Misiones

17% Tucumán

Inadequate test 3% 1% 7% Misiones

3% Tucumán

4% Misiones

2% Tucumán

2% Misiones

2% Tucumán

Colonoscopy in

test +

70% 90% 40% Misiones

20% Tucumán

47% Misiones

37% Tucumán

78% Misiones

65% Tucumán

Delays after test

+

90% within 60

days

90% within 30

days

80% within 60 days in

Misiones

65% Tucumán

59% within 60 daysin

Misiones

39% Tucumán

19% within 60 daysiin

Misiones

27% Tucumán

Total Colonoscopy 16.230 Findings No findings

FIT + 2083 32,00% 65,34%

Average risk/no FIT 738 27,00% 70,73%

High risk 3197 43,32% 56,68%

Symptomatic 6559 34,00% 65,74%

Median 34,08 64,6225

Total Colonoscopy 16.230 Target

Complete 85,41% 90-95%

Complications 0,72% 0-0,35

Proper preparation 76,43%

Anesthesia 94,5% non

adenomatouspolyp32%

adenoma36%

advancedadenoma

2%

serrateadenoma

3%

cancer6%

IBD

5%

Other16%

PATHOLOGY

N 5.439

The pilot study provided a valuable systematization of health system requirements for the future work of implementation of CRC screening in Argentina that may be useful for other low and middle income countries with public health systems.

Getting our ducks in a row

Poné el carro en movimiento que los melones se acomodan solos

Implementation framework

Leon N, Schneider H, Daviaud E. Applying a framework for assessing the health system challenges to

scaling up mHealth in South Africa. BMC Medical Informatics and Decision Making. 2012;12:123

Stewardship

• Presence of political will to implement the project. Strategic leadership

• Commitment of relevant stakeholders

• Consensus and participation in the programme of national scientific societies

• Communication actions towards the community

Organizational

• Health personal training (CHWs, endoscopists)

• Definition of an active search strategy (relevance of CHWs’ role)

• Definition, characterization and consolidation of screening, diagnosis and treatment services network

• Diagnosis and treatment accessibility assurance (relevance of navigators’ role)

• Data collection system

Technical

• Consensus about the value and utility of the strategy

• Acceptability of the strategy

Financial • Sustainable financing availability

primary level of care

Integration of the programs

primary level of care

Muchas gracias!