The 2nd 10 year Plan of Cancer Control in Korea

8/8/2019 The 2nd 10 year Plan of Cancer Control in Korea

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National Cancer Center Korea

Eun-Cheol Park

The 2nd 10 year Plan

of Cancer Control in Korea

Implementation Cancer Control Program:

Accelerating integrated system in comprehensive cancer treatment


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Source: GOLOBOCAN 2002, IARC, 2004Korea Central Cancer Registry, 2002 (ICD-O2)Cause of Death, NSO, 2002 (ICD-10)

Incidence: 142,610

Mortality: 65,479Prevalence: 366,465

Cancer burden of Korea worldwide

Incidence: 10.9 million

Mortality: 6.7 millionPrevalence: 24.6 million


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Causes of death in Korea(%)

11.3%11.3%

28.0%28.0%

Source: Korea National Statistical Office, 2008


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Economic Burden of Cancer

US$ 11.3 Billion

Kim SG et al, 2008

US $ 14.1 Billion

2002 2005


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Cumulative Risk of Cancer in Korea

25.5 %25.5 %31.9%31.9%CumulativeRisk

82827575Life expectancy(2005)

FemaleFemaleMaleMaleTotalTotal

7979

29.6%29.6%

Source: Korea National Statistical Office, 2008


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Major Cancer Site, 2003-2005

Stomach(66.0)

Liver(44.9)

Lung(48.5)

Prostate(12.7)

Coloretum(37.9)

Bladder(9.3)

Gallbladder(8.0)

Pancreas(7.9)

Esophagus(7.4)

Non-Hodgkin Lymphoma(6.5)

Breast(37.5)

Stomach(34.1)

Thyroid(36.2)

Colorectum(28.0)

Lung(17.9)

Cervix(16.7)

Liver(14.7)

Gallbladder(8.1)

Pancreas(6.3)

Ovary(6.3)

Crude rate/100,000

Male Female


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Trend of major cancer death rates

male female

yearyear

Data source: Annual Report of Causes of Death, NSO

Age-standardized rate per 100,000


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Expected Cancer Cases

64.9%


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10 year Plan of Cancer Control


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Basic Principle of Cancer Control

Add effective distribution of therapeutic

resources and research

1/3: Early detection

Screening

1/3: PreventionAnti-smoking campaign

HBV vaccination

WHO, 2002

1/3: Palliative care


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10-Year Plan of Cancer Control

1st 10-Year Plan of CC (1996-2005)

Constructing Infra-structure of CC

Building Capacity of Cancer Control

Setting Program of Cancer Control

2nd 10-Year Plan of CC (2006-2015)

Operating CC Program effectively andefficiently


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Primary preventionPrimary prevention Early DetectionEarly Detection

Palliative carePalliative care Diagnosis & TreatmentDiagnosis & Treatment

Healthy Onset

Symptomatic

Expanding Capacities

Survival

Provide evidence for policy-

makers

Registry & Evaluation

Main

Program

Death

Reduction of Cancer BurdenReduction of Cancer Burden

Survive

Mortality Incidence

Understand cancer

biology/pathology

Develop new diagnosis &

treatment

Supportive

ProgramEducation & Advocating

Qualityof life

Basic / Translational / Clinical / PolicyResearch

2nd 10-Year Plan for Cancer Control (2006-2015)


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69,154

89,934

116.7116.7

/100,000/100,00094.194.1

/100,000/100,000

Objectives of 2nd 10-Year Plan (2006-2015)

MortalityMortality5,437


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Objectives of 2nd 10-Year Plan (2006-2015)

5YR Survival Rate5YR Survival Rate


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Primary Prevention: Anti-smoking program

Increase in Tax on Cigarettes

Anti-smoking campaign & education Ban on smoking in public places

Warning on cigarette packets Education program for youth

Say No campaign for second hand smoking

Prohibit promoting the sale of tobacco Ban on cigarette advertising

Prohibition of sales to teenagers


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n Smoking cessation counseling

by telephone since April 2006

ARS, On-line portal services

n Collaboration with 251 HealthCenters for pharmacotherapy :

NRT and Medical drug by all thehealth centers charge free

PP: Quitline service for smoking cessation


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PP: Smoking prevalence : Adults

Source: Ministry of Health & Welfare, Korean Association of Smoking & Health


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PP: Smoking prevalence : Youths

Source: Ministry of Health & Welfare, Korean Association of Smoking & Health


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PP: Hepatitis B vaccination

n HBV vaccination History in Korea 1985: Temporary basis

1995: Regular basis

(Nationwide childhood immunization)

Positive rate(%) of HBsAg


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PP: 10 Action Codes of Cancer Prevention


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Early Detection: Organized Cancer Screening

Nationwide organized cancer screening program

Managed by two systems Upper 50% contributors: National Health Insurance Screening Program

Lower 50% contributors & Medicaid: National Cancer ScreeningProgram

Level ofContribution

Medicaid

NationalHealth

Insurance50%

National Cancer Screening Program(NCSP)

NHI Cancer Screening

Stomach Liver Colorectum Breast Cervix


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ED: Population Coverage for NCSP

Source population for screening: 24.4 million Women 30 yrs and men 40 yrs

No. of persons covered by NSCP: 13.7 million

Coverage rate: 56%

12.7 million(52%)10.7 million

(44%) NHI Beneficiaries

(lower 50%)Medicaid recipients

1.0 million(4%)

NHI Beneficiaries(upper 50%)


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ED: Screening Guideline of NCSP

Cancer Age Interval Methods

Stomach 40 2 yrs Gastro-endoscopy or UGI

Liver 40high risk group*

6 mo Liver sonography & AFP

Colorectum 50 1 yrFOBT colonoscopy or DCBE

Breast 40, women 2 yrs Mamongraphy & CBE

Cervix 30, women 2 yrs Pap smear

* 40 & over with HBsAg positive or anti-HCV positive or liver cirrhosis


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ED: Participation Rate of NCSP

No.%


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ED: Cancer screening rates with recommendations

0

10

20

30

40

50

60

70

2004 2005 2006 2007 2008

%

Mean

Stomach

Liver

Colorectum

Breast

Cervix

Source: Korea National Cancer Screening Survey 2004-2008


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ED: Evaluating Cancer Screening Units

n 2006-2007

Enactment for Evaluation of Cancer Screening Unit (ECSU)passed by revision of Cancer Control Act (Oct. 28, 2006)

Model test with 5 hospitals Establishing three year period evaluation system

n 2008-2010

2008: evaluation of general hospitals

2009: evaluating of hospitals

2010: evaluating of clinics


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1) Ries LAG, et al (eds). SEER Cancer Statistics Review, 1975-2005, National Cancer Institute, 20082) National Cancer Center in Japan. Cancer Statistics in Japan, 2008

(Unit: %)

Korea(01-05)

USA 1)

(96-04)Japan 2)

(97-99)Eurocare 2)

(95-99)

Stomach 56.4 24.7 62.1 24.1

Lung 15.5 15.2 25.6 12.6Colorectum 64.8 64.4 65.2 53.5

Liver 18.9 11.7 23.1 8.6

Thyroid 98.1 96.9 92.4 86.5

Breast 87.3 88.7 85.5 81.1

Cervix uteri 81.1 71.2 71.5 66.5

All Cancers 52.2 65.3 54.3 51.9

Medical Care: 5Year Relative Survival rate


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MC: Cancer Patient Financial Aid Program

Financial support to the lower incomegroup

Medicaid

Participants of NCSP Under age 18

Provide 30-70% of out of pocket medical

expenditure


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MC: Challenges of Medical Care

Reducing variation of care quality

Assessment of quality including patientssatisfaction

Public reporting and Pay for performance(P4P)

Increasing benefit coverage of NationalHealth Insurance and the amount offinancial aid


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Palliative Care

Supporting hospice care of hospitals

Providing home-based care of PublicHealth Center

Providing education program to the healthcare providers for palliative care

Publishing cancer pain control guideline

for providers and patients


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for Health Care Providers for Patients

PC: Cancer Pain Control Guideline


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http://www.cancer.go.kr/

WebPortal CallCenter

1577-8899

Education & Advocating: NCIC

National Cancer Information Center(2005-)


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EA: NCIC

More than 30 education materials

Leaflet, booklet, panel and DVD

Distributing to public and professionals


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Research Institute Hospital National CancerControl ResearchInstitute

Expending Capacities: NCC

National Cancer Center


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1.Jeon-Nam

1.Gyeong-Nam

1.Jeon-Buk

2.Busan

2.Dae-Jeon

3.Chung-Buk

3.Kangwon

2.Daegu

NationalCancerCenter(NCC)

3.Jeju

YearFinancial & technical

supports

By MOHW (NCC)

& Regional Gov

2004

2005

2006

Constructing Infra-structure of CC

9 Regional Cancer Center


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Site-specific

CR

Regional CRsstart;1980Hospital

basedCR

Coverage:90%of

cancercases

SeoulBusan

DaeguGwangjuIncheonDaejeonUlsanJejudo

Headquarters:NCC

Coverage:50%of

population

8RegionalCancerRegistry

Breast,Cervix

KoreaCentralCancerRegistry

KCCR

SurveyforNHIclaims- MedicalRecord

reviewforunregisteredcancercases

Site-specificCancerRegistry

Registry & Evaluation: Cancer Registry

Cancer Registry


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RE: Cancer Registry

n Cancer Registry

IARC CI5 Vol. 9 web page (http://www-dep.iarc.fr/) (2007. 11)


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RE: Cancer Fact Book

n Cancer Fact Book

Palliative Care / Cancer Survivor

Cancer Burden

Cancer Prevention

Cancer Screening

Cancer Care Costs

Cancer Infrastructure

10 year Cancer Control Plan

2

3

4

5

1

6

7


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Develop new diagnosis & treatmentMethods, especially Anti-Cancer drug

Provide evidence for policy-making

Research

Evidence for program

Develop new technology

Primary PreventionEarly

Detection

Diagnosis

Treatment

Palliative

Care


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Key Success Factors

Fund

Tabaco sales tax by Health Promotion Act(1995)

15 cents / 1.5-2.0 dollars / pack (~2004)

35 cents / 1.9-2.5 dollars / pack (2005~) Fund(2008) : 1.9 billion US$

Long-term Plan

10-year Cancer Control Plan(1996~)

Cancer Registry

Since 1980


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Weakness

Government driven cancer control

Plan & fund from the Government

A few activities of cancer NGO

A few donation for cancer control

A few evidences of cancer controlprograms


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National Cancer Center Korea


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Brief History of NCC

1989. 12. Plan to Establish NCC Formulated by MOHW

2000. 01. National Cancer Center Act enacted

2001. 06. Inauguration Ceremony Held

2002. 03. Natl Screening Guideline for 5 Common

Cancers Developed2005. 04. Natl Cancer Control Institute Established

2005. 06. Research Building Completed

2005. 10. Vision 2020 Announced

2007. 03. Proton Therapy System Introduced2007. 06. Natl Cancer Prevention & Detection Building

Completed


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Vision Statement of NCC

We protect the people from cancer and give a hopeWe protect the people from cancer and give a hope

through innovative research, the best medical care,through innovative research, the best medical care,

support for efficient national cancer control programs,support for efficient national cancer control programs,

and education & training of cancer experts.and education & training of cancer experts.


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Functions of NCC Korea

Clinical guidelines developmentClinical guidelines development

Analysis/ problem finding/policy development

Analysis/ problem finding/policy development

Quality patient carethrough innovative

clinical practice

Support forNational cancer control

programs

Creating a new frontiersin cancer research

Research Institute

Hospital NCCI


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National Cancer Control Institute

Think-Tank for cancer control policy Planning and evaluating the National Cancer

Control Programs

Supporting National Cancer ControlPrograms Prevention, Screening, Palliative care

Operating Central Cancer Registry, NationalCancer Information Center(NCIC) andQuitline

Research for cancer control


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Direction of NCCP

Sharing with AsiaSharing with Asia


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Sharing with Asia

Asian Pacific Rim Region

2000

Incidence cases 3 M

Mortality cases 2 M

2050

Incidence cases 7.8 M (2.6 times) Mortality cases 5.7 M (2.9 times)

Source:YangBH,etal.2004


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Sharing with Asia

Sharing experiences of cancer control

Success and failure

Korea, Indonesia, Asian countries andIARC


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Thank your for your attentionThank your for your attention

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The 2nd 10 year Plan of Cancer Control in Korea