Greece

All.Can Greece was accepted by the All.Can international steering committee in April 2019.

Cancer care in Greece

Cancer remains the second leading cause of death in Greece, following cardiovascular diseases, accounting for roughly 25% of all deaths ¹. Lung cancer, colorectal cancer, breast cancer and prostate cancer are all included at the top-10 list of mortality causes in the country, regardless age and sex ².

According to the International Agency Research for Cancer data for 2020 , lung cancer remains the most frequent among all cancer cases with 13,9%, followed by colorectum cancer (12,2%), breast cancer (12%), prostate cancer (9,6%) and bladder cancer (8,7%).  More specifically, the share of deaths from lung cancer among men is the highest in whole Europe, reaching 9,4% in 2016, while the total number of deaths from lung cancer overpasses all European countries with similar population (Portugal, Belgium) lagging only behind Hungary ³.

Since 2010, Greece has suffered a prolonged financial crisis that has significantly reduced average income and the standard of living for millions of people. Moreover, public and private cut healthcare spending and budget containment, reduced to roughly 20% between 2010 and 2017 ⁴, resulted to the aggravation of an already impaired and insufficient health care system.

The International Agency Research for Cancer data for 2018  estimated that 67401 cases of newly diagnosed cancer would amount in 2018, a significant increase in comparison to 2012 (roughly 41000)⁵. On the other hand, and despite the financial crisis, scientific advances, improvement of prevention campaigns and new treatments have resulted to a remarkably proportional reduction of death rates in comparison to the overall newly diagnosed cases (33.288 people estimated that died in 2018 in comparison with 28500 in 2012)⁶. Nonetheless, problems such as inefficient management, delays and uneven access to cancer care and treatment remain.

All.Can Greece initiative

Taking into account the cancer profile of the country and considering that there will be increased demand  of cancer care services by growing numbers of an ageing population and that the structural weaknesses of the public healthcare system do not seem to be addressed promptly, the All.Can Greek platform, established by an initiative of the Hellenic Cancer Federation (ELLOK), has six main objectives:

• Focus on cancer patients’ needs and perspectives as the most effective way to measure and evaluate the effectiveness and better define the problems and inefficiencies of cancer care.
• Better and more efficient spending and use of available cancer care resources, according to what is most important to cancer patients.
• Improvement of efficiency in all stages of cancer care from diagnosis to treatment.
• Creation of partnerships and clusters that will be able to efficiently face the challenges of cancer care.
• Study and use of the All.Can patient survey results on the effectiveness of cancer care conducted by Hellenic Cancer Federation (2019-2020).
• Reliability, transparency, collaborative decision making, evidenced based cancer care.

Key milestones/activities and successes

2019 key milestones
From mid-December 2018 to mid-February 2019, the All.Can Greece Initiative conducted the All.Can Patient Survey in Greece. The survey clearly showcased cancer care’s main inefficiencies, as 640 respondents had answered questions concerning their cancer care and treatment experiences as well as the psychological, social and financial repercussions they have suffered after the initial diagnosis ⁷.

The first All.Can Greece members  meeting was held in February 2019, a second in March 2019 and a third one in July 2019, while a special press conference took place in April 2019 after the official approval of All.Can Greece by the Steering Committee of All.Can International.

On the second semester of 2019, special awareness raising events were held in Ioannina & Athens (October 2019), in Tripoli & Heraklion (November 2019) and in Athens (December 2019). On November 2019, the All.Can Greece participated in the Authentic Athens Marathon under the logo of All.Can Greece, while presentations in oncology congresses in Greece and abroad took place.

Deeming public awareness and information as a matter of utmost importance, the Greek All.Can initiative has steadily organized and supported an awareness and information campaign about the initiative through its social media and a special section on the Hellenic Cancer Federation website ⁸ .

2020 key milestones
Shortly after the outbreak of the pandemic, in April 2020, the All.Can Greece platform submitted to the Greek Ministry of Health policy recommendations to facilitate the access of cancer patients to cancer care and limit their exposure to the risk of infection. All.Can Greece stressed the need to adapt rules and procedures to the requirements of cancer care to ensure the continuity care for all cancer patients. All.Can Greece called the Ministry of Health and other pertinent authorities to adjust the measures taken to assure that access to cancer care is facilitated and delivered in in a proper and efficient way.

In summer 2020, All.Can Greece and data research company IQVIA Hellas conducted the 1^st phase of a patient attitude survey throughout Greece on the experiences and expectations of cancer patients and survivors during the first wave of Covid-19 pandemic. The survey recorded the patient’s experiences from their cancer care during the Covid-19 outbreak, generated valuable results for the Covid-19 impact on cancer care and highlighted the omissions and shortcomings in cancer care and treatment in Greece.

In October 2020, All.Can Greece launched its new website in Greek language, with all information concerning the Greek initiative, its history, as well as its actions, scope and objectives. Moreover, a new informational video about the All.Can initiative was launched in December.

On December 16^th, All.Can Greece organized a scientific webinar titled “Towards the optimal cancer care”. The webinar comprised two different sessions: a detailed presentation of All.Can Greece scope and actions and a session dedicated to the huge impact of Covid-19 on cancer care and the national health system titled “Covid-19 Pandemic: A big threat & a big opportunity”.

2021 key milestones
After consultation among All.Can Greece members, the Steering Committee (SC) prepared a detailed report on the major barriers to cancer care faced by cancer patients and clinicians, as well as on the impact of the Covid-19 pandemic on cancer care. The report was submitted to the Ministry of Health in March 2021, followed by a meeting with the then Deputy Minister of Health Mr. V. Kontozamanis. Among the recommendations submitted by All.Can Greece, the extension of the working hours of the Radiotherapy Depts. of public hospitals met the agreement of the Deputy Minister and was implemented in several hospitals. The extended working hours relieve the long waiting lists for radiotherapy but also allow working patients to schedule their treatment after working hours.

During spring 2021, All.Can Greece and IQVIA conducted the 2^nd phase of the survey on the experiences and perspectives of cancer patients and survivors during the 2nd & 3d wave of Covid-19 pandemic.

Moreover, in close collaboration with Piraeus University, All.Can Greece conducted two major white papers:

• Delays in starting radiation therapy: The White Paper includes, among other, a detailed mapping of public and private sector radiation therapy services in Greece and policy recommendations for their operational optimization.
• Delays from time of initial diagnosis to time of start of systemic or other cancer treatment, encompassing the current inefficiencies in the cancer pathway resulting in delays.

Both papers cover a large gap in tackling current insufficiencies and main causes of delays in cancer care and present sustainable policy recommendations and proposals. It is hoped that besides the extension of the working hours of the Radiotherapy Depts. of public hospitals, the Ministry of Health will consider positively the other recommendations submitted by All.Can Greece.

The two White Papers, were presented at the All.Can Greece July 2021 and at a press conference held in October 2021, and finally they were highlighted in a promotional video launched in November 2021.

During 2021, All.Can Greece was pleased to welcome two new members, namely Roche Hellas and Astrazeneca Hellas. Both companies have shown great interest to join Αll.Can Greece and contribute to its program.

Furthermore, All.Can Greece was invited to present its activities at the Hellenic Congress for Economics and Health Policies, on December 15, 2021. All.Can Greece was granted 90 minutes to present, in a session titled “Three Years All.Can Greece”, the achievements of its first three years and next steps ahead.

Lastly, continuing its role as a major oncology stakeholder, responsible for providing meticulous and detailed information on all matters concerning health & cancer treatment governance, All.Can Greece organized in December 2021 a virtual conference titled “Quality & Safety of Health Care Services in Oncology Hospitals”. The conference showcased the chronic problem of quality and safety of cancer care delivery in the health care system that has dramatically deteriorated during the Covid-19 pandemic. Moreover, during the conference there were presented recommendations and good practices for the improvement of the current policies and the tackling of inefficiencies that have led to the existing problems and omissions.

2022 key milestones
Following the implementation of the previous year’s actions and initiatives, All.Can Greece during 2022 remain focused on its basic and foremost objectives, that is the improvement of cancer care & treatment during all stages of the disease, the improvement of efficiency of health systems and the access of all cancer patients to state-of-the-art patient-centered treatment and care.

In June 22, All.Can Greece organised a scientific webinar entitled “Quality of Life of Cancer Patients – A cross-sectional approach” on June 22nd comprising lectures from physicians, psychologists, cancer patients’ advocates and university professors about all aspects concerning the quality of life of cancer patients in Greece. The webinar highlighted the major obstacles and omissions in the crucial and often overlooked matter of the quality of life of cancer patients.

In July, All.Can Greece welcomed its 17^th member, as the membership application of the Department of Radiology of the University General Hospital of Heraklion, Crete had been unanimously approved by the All.Can Greece Steering Committee.

During the second semester of 2022 All.Can Greece has compiled a white paper entitled “Policy Recommendations for the Cancer Care Control in Greece”.  The White paper, compiled by IQVIA with the support of All.Can Greece members, encompasses sustainable recommendations for the development of a National Cancer Care Plan and  for the improvement of oncological care in Greece.
The results of the survey were presented and in a press conference on 30 January 2023.

In between, All.Can Greece through its committee member Laboratory of Economics of the Kapodistrian University of Athens, conducted a nationwide survey for the quality of life of cancer patients in Greece. The survey, conducted in both electronic and written form, has been compiled by over 400 respondents, current or former cancer patients, throughout Greece. The scope of the survey was to record and evaluate multilevel different aspects concerning the quality of life of cancer patients and cancer survivors in Greece and to provide viable and sustainable recommendations for the improvement of their quality of life as well as the improvement of provided cancer care & treatment in a holistic and multidisciplinary way.

Last but not least, All.Can Greece organized a scientific webinar on 8 December 2022 entitled “Patients on the frontline of cancer research”.
The webinar’s target was to inform, sensitize and motivate cancer patients, health professionals, policymakers and the public on the significance of cancer patients’ participation in cancer research as well as the importance of the equal and unrestricted access to innovative state-of-the-art tech therapies.

Members

All.CanGreece platform started in 2018 on the initiative of the Hellenic Cancer Federation (ELLOK). Many relevant stakeholders – patient and research associations, universities, professional societies as well as funding and knowledge partners – responded positively.   All.Can Greece national platform comprises 17 participating organizations as of March 2023:

–Hellenic Cancer Federation

–Hellenic Society of Medical Oncology

–Hellenic Society of Surgical Oncology

–Hellenic Group of Young Oncologists

–Hellenic Society of Pathological Anatomy

–Hellenic Society of Radiotherapeutic Oncology

–Hellenic Nurses Association (Sector of Oncology)

–Hellenic Society of Haematology

–MBA Health, University of Athens

–Lab of Health Economics and Management, University of Piraeus

–Department of Radiology of the University General Hospital of Heraklion

–AMGEN

–Astrazeneca

–Bristol-Myers Squibb

–MSD Greece

–Roche Hellas

–IQVIA

The All.Can Greece steering committee consists of one representative of each participating member and is in charge of the planning, coordination and support of the Greek All.Can Initiative actions.

References

1. Health Systems in Transition, Vol. 19, No. 5 2017, Greece Health System Review, European Observatory on Health Systems & Policies Available here: https://www.euro.who.int/__data/assets/pdf_file/0006/373695/hit-greece-eng.pdf0006/373695/hit-greece-eng.pdf [accessed: October 2020]
2. 2017 Institute for Health Metrics & Evaluation, Greece Available here: http://www.healthdata.org/greece [accessed: July 2020]
3. Globocan: 2020 Greece, International Agency for Research on Cancer, W.H.O Available here: https://gco.iarc.fr/today/data/factsheets/populations/300-greece-fact-sheets.pdf [accessed: October 2020]
4. See ab. Ref. Nr 1
5. See ab. Ref. Nr 3
6. Cancer Index, Greece 2012 statistics, July 2020 & ab. Ref. Nr 3 Available here: http://www.cancerindex.org/Greece
7. Hellenic Cancer Federation, Presentation of the results of All.Can Survey Greece Available here: https://ellok.org/wp-content/uploads/2018/12/EN_IQVIA_apotelesmata_EN-1.pdf [accessed: April 2020]
8. Hellenic Cancer Federation, Presentation of All.Can Survey Greece Initiative Available here: https://ellok.org/all-can-greece/ [accessed: October 2020]