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HEALTHCARE 2012

MINISTRY OF HEALTH, SOCIAL SERVICES AND EQUALITY

HEALTHCARE 2012

MINISTRY OF HEALTH, SOCIAL SERVICES AND EQUALITY

MINISTERIO

DE SANIDAD, SERVICIOS SOCIALES

E IGUALDAD

GOBIERNO

DE ESPAÑA

MONITORING AND EVALUATION COMMITTEE

Scientific Coordinator:

Josep Maria Borrás Andrés

Institutional Committee:

Andalusia:

Alonso Redondo, Enrique

Aragon:

Tres Sánchez, Alejandro

Asturias (Principality of):

Palacio Vázquez, Isabel

Balearic Islands:

Ramos Monserrat, María

Canary Islands:

Reyes Melián, Juana María

Cantabria:

López Vega, José Manuel

Castile-La Mancha:

Gil Madre, Javier y Abarca López, Mª Jesús

Castile and Leon:

Villacorta González, Manuel

Catalonia:

Espinás Piñol, Josep Alfons

Community of Valencia:

Salas Trejo, Dolores

Extremadura:

Molinero San Antonio, Eva Mª

Galicia:

López López, Rafael

Madrid (Autonomous Community of):

González Navarro, Andrés

Murcia (Region de):

Navarrete Montoya, Agustín y Pérez Riquelme, Francisco

Navarre (Chartered Community):

Barricarte Gurrea, Aurelio

Basque Country:

Arteagoitia González, Mª Luisa y Llano Hernaiz, Josu Xavier

Rioja (La):

Cestafe Martínez, Adolfo

INGESA (Ceuta and Melilla):

Pupato Ferrari, Sara Cristina

Technical Committee:

Alba Conejo, Emilio

Spanish Society of Medical Oncology (SEOM)

Ascunce Elizaga, Nieves

Expert appointed by the Ministry of Health and Social Policy

Casamitjana Abella, Montserrat

Spanish Society of Epidemiology (SEE)

Colomer Bosch, Ramón

Spanish Society of Medical Oncology (SEOM)

Corral Romero, Carmen

Federation of Community Nursing and Primary Care Associations (FAECAP)

Fernández Marcos, Ana

Spanish Association Against Cancer (AEC)

Fisas Armengol, Adelaida

Spanish Federation of Parents of Children with Cancer (FEPNC)

Gatell Maza, Paz

Spanish Association of Oncology Nursing (SEEO)

Gimón Revuelta, Antonia

Spanish Breast Cancer Federation (FECMA)

Guillem Porta, Vicente

Expert appointed by the Ministry of Health and Social Policy

Herruzo Cabrera, Ismael

Spanish Society of Radiation Therapy Oncology (SEOR)

López Ibor, Blanca

Expert appointed by the Ministry of Health and Social Policy

Marzo Castillejo, Merce

Spanish Society of Family and Community Medicine (SEMFYC)

Ortiz Hurtado, Héctor

Spanish Association of Surgeons (AEC)

Pascual López, Antonio

Expert appointed by the Ministry of Health and Social Policy

Ramírez Puerta, Dulce

Spanish Society of Primary Care Physicians (SEMERGEN)

Ripoll Lozano, Miguel Ángel

Spanish Society of General Practitioners (SEMG)

Rodríguez Nebreda, Ángel

Spanish Association for Research on Ischemic Cardiopathy (ASEICA)

Ruano Raviña, Alberto

Spanish Society of Epidemiology (SEE)

Santos de Dios, Eugenio

Expert appointed by the Ministry of Health and Social Policy

External Expert Consulted

Díaz Rubio, Eduardo

Coordinator of first version of the Strategy

MINISTRY OF HEALTH AND SOCIAL POLICY

Directorate-General of the Qality Agency of the National Health System (SN S)

Rivero Corte, Pablo

Healthcare Planning and Quality Office

Colomer Revuelta, Concha

Abad Bassols, Ángel

Soria Núñez, Patricia

Gil Sevillano, María

Gómez González, Beatriz

Neves Silva, Priscila

Torres García, Susana

Vannereau Sánchez, Diego

Mayor de Frutos, Amparo

Observatory on Women's Health

López Rodríguez, Rosa Mª

Bueno Salinero, Rosalía

Health Information Institute

Ichaso Hernández-Rubio, Mª Santos

Directorate General of Professional Regulation, SNS Cohesion and High-Level Inspectorate

Crespo Sánchez-Eznarriaga, Belén

Directorate-General of Public Health

Lizarbe Alonso, Vicenta Mª

Cepeda Hurtado, Teresa

Rubio Colavida, Jesús Miguel

Spanish Food Safety and Nutrition Agency (AESAN)

Troncoso González, Ana Mª

Ballesteros Arribas, Juan Manuel

SPECIFIC TECHNICAL COLLABORATIONS (Preparation of the Chapter "Current Situation of Cancer in Spain") Aragonés Sanz, Nuria - Carlos III Health Institute-ISCIII) Cabanes Domenech, Anna (Carlos III Health Institute-ISCIII) López-Abente Ortega, Gonzalo - (Carlos III Health Institute-ISCII I) Pérez Gómez, Beatriz - (Carlos III Health Institute-ISCIII) Peris Bonet, Rafael - National Child Tumor Registry (RNTI-SEHOP), University of Valencia Pollán Santamaría, Marina - (Carlos III Health Institute-ISCII I)

Contents

Prologue 11

Introduction 13

Justification 17

Technical organizational note 19

1. Generalities 21

1.1. Methodology 21

1.2. Denitions of concepts 25

1.3. Current situation of Cancer in Spain 25

1.3.1. Incidence 26

1.3.2. Mortality 33

1.3.3. Comments on some specic tumors 45

1.3.4. Childhood tumors 57

1.4. Situation analysis by strategic line 63

1.4.1. Health Promotion and Protection 63

1.4.2. Early Detection 75

1.4.3. Adult care 80

1.4.4. Child and Adolescent care 84

1.4.5. Palliative care 88

1.4.6. Quality of life 90

1.4.7. Research 94

2. Strategy Execution 111

2.1. Health promotion and protection 111

2.2. Early detection 112

2.2.1. Breast cancer 112

2.2.2. Cervical cancer 114

2.2.3. Colorectal cancer 115

2.3. Adults care 117

2.4. Child and adolescent care 120

2.5. Palliative care 121

2.6. Quality of life 122

2.7. Research 123

3. Evaluation and the Strategy Information Systems 125

3.1. Introduction 125

3.2. Indicator table 126

3.3. Indicator data by line of strategy 128

3.3.1. Health promotion and protection 129

3.3.2. Early detection 132

3.3.3. Adult care 137

3.3.4. Child and adolescent care 140

3.3.5. Palliative care 141

3.3.6. Quality of life 144

3.3.7. Research 145

4. Index of Abbreviations and Acronyms 149

5. Bibliography 151

5.1. Situation of Cancer in Spain 151

5.2. Health Promotion and Protection 154

5.3. Early Detection 156

5.4. Adult Care 160

5.5. Child and Adolescent Care 162

5.6. Quality of Life 163

5.7. Research 164

Prologue

The present Cancer Strategy falls within the framework of the National Health System Quality Plan. The first version thereof was approved at the Na- tional Health System Interterritorial Council Meeting of March 2006 for the purpose of promoting the improvement of the quality of our health system One of the lines of action of this Plan is that of undertaking a review of the care-providing processes which are carried out in Spain on the patie nts who have highly prevalent diseases entailing a major social and economic burden, one of which is cancer. This Cancer Strategy is aimed at detecting the needs for preventing, diagnosing and treating this disease, as well as setting out working obj ectives and care-providing recommendations regarding which a consensus has been reached and which will be applicable to the entire National Health Syste m. This Strategy is the result of the cooperation among scientific societ ies, patient associations, expert professionals and representatives from all of the

Autonomous Communities.

In June 2008, the National Health System Interterritorial Council rendered its approval of the first Evaluation Report made by the Strat e- gy Monitoring and Evaluation Committee based on the data provided by the Healthcare Information Institute and by the Autonomous Communities proper. This first Evaluation has afforded the possibility of evaluating the indicators proposed and of reviewing the objectives and recommendations in terms of the new knowledge available. The update of the original Strategy document presented herein was prepared based on the conclusions of that first evaluation and the rev iew of the scientific evidence available. This Strategy means a chance to optimize the prevention, diagnosis and treatment of cancer, as well as to improve the cancer information and enhance cancer research. The aim is also to offer support at the national level in coordinating and carrying out health prevention and promotion plans or programs, as well as diagnostic means for the early detection of cancer and seeking pro- gressively more effective treatments. This Strategy includes seven (7) lines of action: health promotion and protection early detection, provision of care, palliative care, quality of life and research. Addressing cancer with precision requires a number of measures being taken to determine tested and proven criteria regarding which a consensu s is reached concerning the guidelines to be followed in any of the aforem en- tioned lines of strategy so as to achieve greater effectiveness and qual ity in dealing with this disease in all the health services comprising Spain' s health system. To this end, the document sets out a set of objectives and recom mendations aiming to contribute to improving the quality of the interven tions and results of the services and of the health care provided. Lastly, I would like to thank all those individuals and organization who have taken part in preparing this document, especially Dr. Josep María Bo- rrás Andrés, the scientific coordinator for this Strategy, given that without his dedication and effort, it would not have been possible to avail of a tool which will undoubtedly be contributing to improve the quality of the car e provided to cancer patients and their families.

Trinidad Jiménez García-Herrera

Minister of Health and Social Policy

Introduction

The Cancer Strategy of the Spanish National Health System proposed in fo- llowing in this document is based on two main lines. On one hand, the sc ien-quotesdbs_dbs24.pdfusesText_30

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