“The Danish Model” - Improving cancer survival in Denmark

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Published: 12 Jul 2018
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Dr Lene Lundvall - University Hospital of Copenhagen, Copenhagen, Denmark

Dr Lundvall speaks with ecancer at BCGS 2018 about improving cancer care in Denmark.

She highlights centralisation of care centres and the development of guidelines for care, alongside the publication of cancer plans to guide improving resources and training.

Dr Lundvall reports an 8% improvement in survival in ovarian cancer. and other benefits seen across tumour types.

It’s a talk of improving cancer survival in Denmark and it’s all about getting organised as a country and centralisation and doing a lot of different things. It actually has taken about twenty years to get to where we are today. It’s across the whole country, it’s national, and it’s across all cancer types, not only gynae-oncology. But, of course, I’m talking about gynae-oncology today.

What was the process?

First of all we had a process coming from a bad prognosis and looking into this and trying to find out what was wrong. There were different things – the first one is centralisation lacked. We had operations, big operations, going on in nearly every hospital in the whole country and it had to be centralised. We could show with the numbers, survival numbers, that it was necessary to do something. The national Board of Health went into it and gradually we could get the number of departments doing especially ovarian cancer down from 52 to four. So now today it’s four centres in all of the country and everybody gets referred.

Then there was another thing is organising in having guidelines for everything and guidelines that actually people are doing what it says. Getting better at surgery. We also actually had four cancer plans within the last fifteen years and each plan has had a focus on different things. The first one was a lot about staff and equipment and so on, getting up to a good height, and the next one was on surgery and education of surgeons and so on. In the third plan we also had a big focus on the flow of the patient because we had a lot of waiting on examination and then waiting on OR. So we had to narrow it down and we have something called packages that was introduced in 2007 and we are still doing it. Then you have to make the whole thing from the patient is referred to the treatment is actually performed, for ovarian cancer if it’s surgery 24 days and chemotherapy 31 days, just one example. But every disease has its own package; this also had some impact.
Then you can say what was the effect of all this and we have actually for ovarian cancer made an 8% improvement in survival. It’s a small number but actually it’s a huge number, especially considering that it’s been a flat line like this for decades. So some effort has come out of it, some results have come out of it.

Has this impacted any other cancer types?

I can’t give you the figures but I know that it has had a great impact on lung cancer, which is a disease that’s really difficult and a lot of people die early. It’s had an effect there too that I know of. I know that centralisation had an effect on pancreatic cancer which has also a bad prognosis but also has been very centralised. That’s the two ones that I can just think of right now.

Was this in line with any differences in funding?

No, no, no, this is all on government. The government has also provided extra money during these plans because for every plan there would be a budget. For instance, equipment was lacking and there was a budget for this equipment, for radiation and scans and so on. So there was a budget but it’s all within the government.