A report written by Adriana Albini
Inefficient care is a leading factor in poorer outcomes for patients, with the World Health Organisation estimating that 40% of health spending is wasted through inefficiency. In cancer care this waste extends far beyond financial considerations; it impacts time, quality of life, and key opportunities for patients and their families.
All.Can is a global multi-stakeholder initiative focused on improving efficiency in cancer care and providing better outcomes for patients. By bringing together leading experts, policymakers, and patient representatives, it aims to identify and promote the best practices in cancer care, ensuring that resources are used efficiently and effectively for the benefit of all patients.
The All.Can Global Summit, held on September 16th in Geneva, served as a platform for exchanging strategies and identifying tangible, actionable steps to improve cancer care worldwide. Crucially, the summit launched the “All.Can Action Guide for Efficient Cancer Care: An Implementation Toolkit” (now available at the link below.) Developed through a collaboration between All.Can and the Health Care Systems and Services research unit at Amsterdam UMC’s Department of Public and Occupational Health, the Guide aims to support a wide range of stakeholders, including healthcare providers, policymakers, and patient organizations, in their efforts to implement more efficient practices within their respective health systems. It offers:
- A comprehensive toolkit. A range of essential tools, including guidance, resources, and recommendations, specifically designed to ensure that stakeholders across different roles and settings have access to tailored, practical information to improve cancer care efficiency.
- A personalised implementation approach. A flexible, non-linear navigation structure that allows users to focus on the most relevant content for their specific needs and contexts.
- A collaborative and evolving resource. Designed as a living tool, the guide encourages ongoing collaboration among users, fostering the exchange of experiences, best practices, and new insights.
The Action Guide employs a non-linear navigation structure, organised around three main entry points: WHY, WHAT, and HOW. This innovative approach allows users to explore the guide based on their specific needs and goals.
WHY: This section highlights why efficiency in cancer care is essential. It defines efficiency as a cross-cutting element of health system performance that needs to be measured at all levels—macro, meso, and micro—focusing on delivering the best possible care with available resources, prioritising patient and societal needs.
WHAT: This section explains the key metrics that should be prioritised to enhance efficiency. The metrics are grouped into three main clusters: timeliness of care, coordination of care, and patient-centeredness. Each cluster relates to health system components, allowing users to conceptualise and apply the metrics in their specific context.
HOW: This section offers a step-by-step implementation roadmap to support stakeholders in applying the efficiency metrics. It outlines five steps:
- Defining Shared Goals: Users start by setting clear and shared goals among stakeholders.
- Preparedness Checklist: A checklist helps assess readiness at the health system level, considering basic, intermediate, and advanced preconditions.
- Identifying Contextual Barriers and Facilitators: Based on interviews across the All.Can community, barriers and facilitators for each cluster were mapped using an implementation science framework.
- Stakeholder Involvement: The importance of involving all relevant stakeholders to ensure successful implementation.
The Guide builds upon the foundation of eight key cancer efficiency metrics, which were identified in a previous study conducted by the Health Value Alliance in partnership with the University of Southampton on behalf of All.Can, which are listed below.
- Time to diagnosis
- Percentage of cancers diagnosed through emergency presentation
- Primary care interval (number of days from date of first presentation in primary care with symptoms relevant to the final cancer diagnosis to date of first referral from primary care)
- Time from tissue diagnosis to treatment
- Percentage of patients documented as having seen a clinical nurse specialist
- Percentage of patients who received chemotherapy in the last 14 days of life
- Patient experience
- Patient involvement in decision making
These metrics provide a consensual starting point for the guide’s development, aiming to standardise and improve cancer care practices.
One point in the Guide that Cancerworld finds particularly important to implement is the development of Multidisciplinary tumour boards (MDTBs). These boards bring together professionals from various fields of expertise to collaboratively discuss cancer diagnoses and treatment options, ultimately reaching consensus on the most effective care plans for patients. MDTBs have been shown to significantly benefit oncology patients, leading to higher rates of accurate cancer staging and increased adherence to clinical guidelines.
The Guide also underlines the critical importance of patient-reported outcomes (PROs) and measures in cancer care. These tools are instrumental in facilitating shared decision-making, a process that fosters meaningful collaboration between patients and healthcare providers. By implementing these measures, patients are empowered to take an active, central role in decisions concerning their health. The Guide dedicates significant attention to two key types of patient-reported measures: Patient-Reported Experience Measures (PREMs) and Patient-Reported Outcome Measures (PROMs). PREMs are designed to capture patients’ perspectives on their care experiences, focusing on crucial dimensions such as quality of communication with care providers, accessibility and continuity of care, and overall satisfaction with the care provided. PROMs, on the other hand, evaluate patients’ symptoms and quality of life, often assessing pain levels, emotional well-being, and overall health status. Certain PROMs are designed for specific conditions, such as cancer. Cancer-specific PROMs are tailored to the symptoms most related to cancer and its specific diagnostic and treatment procedures.
Previous work conducted by All.Can was the starting point of this conceptualisation: All.Can efficiency metrics study and All.Can Heat Map.
Action Guide For Efficient Cancer Care
The Action Guide is a versatile resource designed to support implementation efforts across multiple levels of healthcare systems, from global to local. It provides evidence-based insights and actionable strategies tailored to diverse contexts, ensuring relevance for a wide range of stakeholders.
A key strength of the guide is its comprehensive analysis of efficiency metrics. These metrics are thoughtfully categorised according to health system domains, offering a structured approach to understanding and improving cancer care efficiency. Furthermore, the guide identifies relevant factors essential for implementing these metrics in different health systems, acknowledging the varied challenges and opportunities that exist across diverse healthcare landscapes.
The guide can now be freely downloaded here: Action Guide For Efficient Cancer Care
Click here to download the All-Can Summit Programme:
