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Health systems, quality of health care, and translational cancer research: the role of the Istituto Superiore Sanità -Rome

Abstract

Faced with the challenge of ensuring high-quality and cost-effective health systems in the context of persistent financial crisis, a global strategy for cancer prevention and treatment represents a priority for public health bodies and governments. The key goals for the initiative are to define standards of cancer prevention and care while leveraging the continuous progress of biomedical research in the interest of public health. In Italy, the establishment of a network of Comprehensive Cancer Centres (CCC) named the Alliance Against Cancer (ACC) is an important initiative taken by the Ministry of Health to foster common strategies for enhancing the quality of oncology research and care at the national level. The Istituto Superiore di Sanità (ISS) has played an important role in supporting ACC activities through a special national program called ISS for ACC, launched by the Italian Ministry of Health in 2006. A similar role has been pursued in subsequent initiatives, including ISS support for a project aimed at providing international accreditation of the CCC of the ACC, funded by the Italian Ministry of Health. The results of this initiative, reported in the current issue of Tumori, are especially significant since specific indicators of quality for research and cancer care have been successfully defined for all the participating institutes. As the leading technical and scientific body of the Italian National Health Service, the ISS will continue to play a proactive role in supporting national networks and strategic national and international initiatives aimed at promoting public health.

Tumori 2015; 101(Suppl. 1): 67 - 68

Article Type: REVIEW

DOI:10.5301/tj.5000470

Authors

Walter Ricciardi

Article History

Disclosures

Financial support: None.
Conflict of interest: The author declare no conflict of interest.

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Healthcare systems in Europe are currently facing increasing challenges. While social and demographic pressures increase the demand for health care, and technological and scientific advances demand higher costs to support potentially more effective treatments, the current financial crisis in Europe is placing pressure on governments to reduce spending (1, 2). A major challenge is to ensure and improve the quality of health care systems while taking into consideration the reality of the financial sustainability of the national health systems. At the same time, attention is currently focused on how to exploit the enormous progress in biomedical research for the interest of public health. In fact, the impressive advances in understanding the molecular and genetic pathways underpinning human health and pathologic dysfunction has recently led to new tools, concepts, and perspectives for a personalized approach to prevent and treat human diseases (3).

Personalized medicine is an emerging approach to patient care in which an individual’s characteristics, including the genetic profile, can guide clinicians, aiming for the right treatment for the right patient at the right time (4). However, reaching this goal is a challenge and progress in this direction needs to take into account local realities, including the financial sustainability of the national health system (5). Improving the quality of the biomedical research, ensuring the translational impact of research on public health, and enhancing the standards for health care are all essential objectives instrumental for addressing this challenge. This is of special importance in oncology because of the great social and economic burden of cancer worldwide.

Cancer is a leading cause of death in Europe and in the economically developed countries, as well as in developing countries, where the cancer burden is increasing (6). For this reason, a global strategy for cancer prevention and treatment is a main priority at the national and international level for public health bodies (7). Over the last decades, many efforts have been made to better coordinate resources, research, and care in oncology in Europe. However, there is still too much fragmentation and duplication, and we are still facing the need of identifying well-defined and concerted standards of cancer care. In Italy, the establishment of the network of Comprehensive Cancer Centers (CCCs), the Alliance Against Cancer (ACC), has represented an important initiative undertaken by the Ministry of Health to avoid fragmentation and foster common strategies for enhancing the quality of research and care in oncology at the national level, with the purpose of playing a more ambitious role in the international landscape. In 2006, supporting the activities of ACC, a task was assigned by the Ministry of Health to the Istituto Superiore di Sanità (ISS) through the launch of the special national program “ISS per ACC,” which has resulted in several joint initiatives of the Italian CCCs at the national and European level. Among them is the joint initiative by the ISS, the Italian Ministry of Health, and ACC that led to the Italian coordination of the ERA-Net on Translational Cancer Research (TRANSCAN). This project has achieved important results in increasing cooperation among many European member states for funding high-quality transnational research projects in oncology and has also allowed the recent activation of a second-generation cofunded ERA-Net (TRANSCAN-2) coordinated by the Italian Ministry of Health. A pilot initiative regarding the accreditation of Italian CCCs according to the Organisation of European Cancer Institutes (OECI) model was launched in the context of the “ISS per ACC” program and allowed the design and finalization of the project “Tailored Accreditation Model for Comprehensive Cancer Centers: Validation through the Applicability of the Experimental OECI-Based Model to the Network of Cancer IRCCS of the Alliance Against Cancer,” funded by the Italian Ministry of Health, whose results are reported and discussed in detail in the current issue of Tumori.

The overall results achieved in the context of this project are of special importance, since specific indicators of quality important for care of cancer patients were successfully met by all 11 Italian CCCs participating in the OECI accreditation model. Such results support a leading role of the ACC in collaborative European research projects and in defining priorities for cancer research and care in Europe.

As the leading technical and scientific body of the Italian National Health Service, the ISS pays special attention to promote the activities of national networks such as ACC and, in particular, to support initiatives finalized to increase the quality of biomedical research and healthcare standards, with the additional goal of ensuring advice to policymakers on strategic public health issues. The ISS currently coordinates Italian participation in 3 European Research Infrastructures (RIs) of potential great importance for public health (European Bio-banking and Biomolecular Resources [BBMRI], European Clinical Research Infrastructures Network [ECRIN], and European Advanced Translational Research Infrastructure [EATRIS]), which have recently received the formal recognition of the European Research Infrastructure Consortium (ERIC) by the European Commission (8). This role has important implications both at a national level, where it is mandatory to ensure coordinated and qualified participation of many different institutions, and at a European level. The cancer community, including patients’ associations, is strongly involved in such initiatives. Notably, a national coordination for interconnected RIs is consistent with the European Commission policy, which oversees a strong ­interoperability among ­different RIs and continent-wide initiatives to face public health challenges.

The current global challenges in cancer call for special attention by governments on cancer prevention, by interacting with international agencies such as the International Agency for Research against Cancer in Lyon, and to the identification of realistic strategies for personalized management of cancer patients, which imply quality standards and attention to sustainability for the national health services.

From the national point of view, it should be noted that health services are decentralized in Italy from central to regional level of government and all stakeholders (national and regional) have their important relative weight. Thus, there is the urgency of finding well-established innovative solutions to rationalize integration of health knowledge into innovation, cost savings, and health improvement. Interposed between regions and Europe, the ISS can play a unique role in allowing coordinated participation of excellence centers and reference institutes/facilities located in different regions, with the objective to allow a major return through value generated by health innovation, healthcare optimization, and healthcare cost containment.

The ACC has recently redefined its main mission as a national network bridging research and cancer care (9). The CCCs of ACC as well as other institutions, including universities, actively involved in oncology can count on a proactive role of the ISS, in cooperation with the Italian Ministry of Health and all the other stakeholders, for supporting further initiatives aimed at enhancing the quality of cancer research and care.

Disclosures

Financial support: None.
Conflict of interest: The author declare no conflict of interest.
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Authors

Affiliations

  • President, Istituto Superiore di Sanità, Rome - Italy

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