Focus area 2: Norway will be a leading country in providing good patient pathways

Cancer patients constitute a large and heterogenous group ranging from people who need a lot of help to people who are largely self-sufficient. It is a goal that all of them should receive good follow-up during and after their cancer treatment, and that patients should be included in a cancer patient pathway when there is reason to suspect that they have cancer.

Cancer patients often go through a complex process involving contact with hospitals, their GP and other municipal health and care services. Achieving safe and secure services in a patient pathway requires good logistics and communication within and between the different treatment facilities and treatment levels in order to provide a coherent service.

Much of the long-term comprehensive follow-up of patients living with cancer will be based in the municipal health and care services. Many will be in need of services provided by the specialist health service and other welfare sectors at the same time. Persons with extensive and complex needs may be entitled to an individual plan and a coordinator. The Norwegian Directorate of Health’s guide concerning users with extensive and complex needs provides recommendations on how to organise follow-up for this user group. The contact physician scheme is followed up by the specialist health service.

Well organised, standardised patient pathways with recommended timeframes, cancer patient pathways, are intended to help to raise quality in Norwegian cancer care and improve predictability for patients. Patient pathways with recommended timeframes have been implemented in the health service for 26 different types of cancer. The purpose of the cancer patient pathways is to provide a well organised, comprehensive and predictable pathway for cancer patients, with no delays to their assessment, treatment and rehabilitation unless on medical grounds.

All cancer patients will be covered by the cancer pathway – home. The patient pathway is intended to help to ensure good structure and logistics in the health service as well as security and predictability for persons living with cancer and for people who have completed their cancer treatment.

The quality of patient pathways is followed up at all service levels based on relevant activity and quality data, as well as increased use of the national quality registries for cancer. National action programmes for cancer will be updated regularly with new knowledge and decisions in the Nye metoder (‘New methods’) national system for managed introduction of new methods in the specialist health service, and they will contain information about adapted treatment for elderly patients, rehabilitation and late effects.

Ten-year goal 6

All cancer patients should have access to a comprehensive cancer centre or a cancer centre

The goal is for all patients to be met by a health service that maintains high standards for prevention, diagnosis, treatment, follow-up, up-to-date knowledge and skills, and research. Good and precise diagnosis and investigation of cancer are crucial in order to be able to provide optimum treatment adapted to suit the individual patient. That is why all patients, regardless of their sex and where they live, should when necessary have access to all the expertise available at the regional level and equitable access to a comprehensive cancer centre (CCC) or a cancer centre (CC), or to a network of healthcare providers coordinated by a CCC/CC.

Radiology and pathology capacity is a bottleneck for the assessment and follow-up of cancer patients, as well as for research. Increased use of precision diagnostics, personalised treatment and clinical research will bring an increase in the number of tissue samples being collected and analysed. At the same time, radiology is used more in the diagnosis, treatment and follow-up of cancer patients, as well as in clinical research. This development will require good knowledge, good prioritisation of personnel resources and more use of digital aids and artificial intelligence in the years to come.

Elements of cancer treatment can be decentralised without compromising quality by linking hospitals by means of common procedures, identical or equivalent equipment, shared information systems and structured regional cooperation on individual patients. In this way, most of the assessment and follow-up work can be carried out locally, while the major hospitals can provide more advanced treatments (surgery, radiotherapy and particularly complicated pharmaceutical treatments). Structured collaboration must be established in order to ensure that the experts based at the regional hospitals are involved as relevant, regardless of where a patient lives, that it is clear which patients are to be treated where, and that the hospitals involved discuss individual patients in cases where there is room for doubt regarding which treatment facility should treat the patient.

All patients, regardless of their sex and where they live, should when necessary have access to all the expertise available at the regional level and equitable access to a comprehensive cancer centre (CCC) or a cancer centre (CC), or to a network of healthcare providers coordinated by a CCC/CC. In order to be accredited as a comprehensive cancer centre (CCC), the institution or collaborating entities must be able to meet set requirements for diagnosis and treatment to be provided to patients in all phases of the patient pathway. This applies to all services from prevention via screening, diagnosis and treatment to services for cancer survivors and end of life care for patients in need of palliative services. It includes equitable access to experimental treatment, and it requires the institution to engage in clinical and translational research activities as well as innovation in cancer treatment and diagnosis. In addition to patient treatment and research, a CCC’s area of responsibility also extends to continuing education and cancer specialisation courses for various healthcare professionals. The requirements for accreditation as a cancer centre (CC) are less strict than for a CCC in terms of such aspects as activity volume, highly specialist diagnostic infrastructure and research activity. A CCC is required to have a significantly higher volume of research activity than a CC, but is also subject to more requirements concerning types of basic research.

Oslo University Hospital Trust was accredited as a comprehensive cancer centre (CCC) in 2017 and re-accredited in 2023. So far, it is the only accredited centre in Norway. Akershus University Hospital Trust and Vestre Viken Hospital Trust are preparing to start the accreditation process to become cancer centres (CC). The other three regional health authorities in Norway have all started the process towards establishing a CCC.

Ten-year goal 7

All cancer patients will be included in the cancer pathway – home

The national patient pathways are now a well established feature of cancer treatment, and the national goals for these pathways will be continued. However, we see a need for additional efforts in the coming decade to ensure that all cancer patients are also covered by the cancer pathway – home in order to ensure good quality of life, health and coping, and to make sure that patients do not feel unsafe in connection with transitions between the different levels of the health service. This is becoming increasingly important as more people survive cancer.

The cancer pathway – home is intended to help to ensure good structure and logistics in the health service as well as security and predictability for persons living with cancer and for people who have completed their cancer treatment. The cancer pathway – home focuses on mapping patient needs in areas other than the actual cancer treatment, as well as follow-up after treatment. The pathway consists of three interaction points, one appointment with the specialist health service and two at the municipal level at 3–4 months and 12–18 months, respectively, after the time of diagnosis.

These interaction points are interviews with the patient and, if relevant, their next of kin, and includes mapping the patient’s needs. All patients diagnosed with cancer are included in this pathway, regardless of whether or not they are already covered by a diagnosis-specific cancer patient pathway and of whether the intention of their treatment is curative or palliative. Patients who suffer a relapse are also included in the patient pathway.

All the regional health authorities are working to establish a good structure for conducting the mapping interviews and following up the needs identified as described in the cancer pathway – home. Among other things, the Norwegian Directorate of Health will keep an eye on statistics showing how many patients in each region have completed a mapping of needs with the specialist health service. Not all patients want or need such an interview, but numbers are nonetheless expected to increase in the coming years. It is a natural choice for GPs to provide follow-up and conduct the interviews at the municipal level that form part of the patient pathway, but municipal authorities can decide to use other suitable healthcare professionals, such as a cancer nurse or coordinator.