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The development of cancer care in Sweden through innovation and triple-helix collaboration Jörgen Larsson Professor of Surgery Director International affairs Member of the Nobel Assembly 1996-2014 Karolinska University Hospital and Karolinska Institutet Agenda • Sweden and Swedish health care • Karolinska University Hospital and Karolinska Institutet • Quality registers in cancer • Regional cancer centers • Triple-helix innovation collaborations • The Swedish test bed for Innovative Radiotherapy OECD – Better Life Index • • • • • • Some results for Sweden: Life expectancy at birth: ~ 82 years (80) Daily smokers: 14% (21) Obesity rate: 13% (18) Good health: 80% (69) Satisfied with their lives: 85% (80) •(OECD average in parenthesis) Swedish health care • The government • establishes principles/guidelines • distributes responsibilities • supervises • allocates government grants • Decentralized system with 20 county councils/regions • Taxpayer-funded system • Every county council/region provide its residents health care of good quality and promote good health in the entire population – everyone has by law equal access to health care services • Costs ~10% of Gross Domestic Product (GDP) • 2010: 196 billion SEK (~23 billion Euro) 5 Karolinska University Hospital – one of the largest hospitals in Europe 1,6 million patient visits per year 15 500 employees 1,7 billion € turnover 2 500 researchers 2 400 scientific articles /year in cooperation with KI 1 145 million SEK external R&D contributions Karolinska University Hospital & Karolinska Institute • Close strategic partnership • Creates added value for each other and partners • An Academic Health care system including research and education of the highest international quality has been established Karolinska University Hospital has a central role to play in the development of Stockholm’s life sciences sector The role of quality registries in improving health care National Quality Registry for colorectal cancer • Prospectively registered data • 1995 rectal cancer • 2007 colon cancer • 6000 patients / year • All regions • >98 % coverage • Steering committee Improved treatment 1980-2013 • • • • Preoperative radiotherapy National Quality Registry New surgical techniques Multidisciplinary team assessment/care Prerequisites for registries in Sweden • Population 9.3 million • Registration of newborn, marriages and deaths since 400 years • Church responsible • Personal numbers since 1947 Quality control Annual reports • Patient and tumour characteristics • Treatment • Mortality • Complications • Patology • Longterm follow up • Survival Quality control Annual reports • Time trends • Comparison between hospitals and health care regions • Internal control • Research Ranking Summary The role of quality registries • Time trends • Comparison between hospitals and health care regions • Internal control • Research Continuous improvement Small, small steps lead to big leaps Regional Cancer Centers Some Swedish cancer data from 2011 Malignant cancer cases diagnosed Individuals living with cancer, diagnosed during 1958 – 2009 Individuals dead in cancer Risk of developing cancer before age 75 57 226 411 338 21 646 30 % Sweden comes out strong in most tumour groups… Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 | The Lancet, 2011-12-22 Challenges in cancer care and research We are not doing enough in prevention We have long and variable waiting times We lack an optimal patient focus and overall perspective and continuity We see a regional variation in patient care and results Patients are not sufficiently involved in care, relatives' role unclear In some aspects we have inequalities There is need for improved collaboration in cancer research Too few patients are enrolled in clinical trials Collaboration suboptimal between experimental research and clinicians Prevalence is a challenge for the health care system The number of visits to physicians increase more than the number of new patients diagnosed with cancer Antalet läkarbesök ökar mer än antalet nya cancerfall 300000 250000 200000 150000 100000 50000 0 1995 2009 Number of people living with cancer will more than double to 2030 - Every new cancer patient leads to an increasing number of visits to physicians and nurses due to an increased number of novel treatment possibilities A national cancer strategy for the future The strategy is aiming at five overarching goals: 1. Reduce risk of developing cancer 2009 2. Improve the quality in taking care of cancer patients from a patient´s perspective 3. Prolong cancer survival time and improve quality of life after a cancer diagnosis 4. Reduce regional differences in survival time after a cancer diagnosis 5. Reduce differences between population groups in morbidity and survival time. RCC - National Board (liasion group) Working/reference groups national collaboration is of great importance; • Screening • level of structuring/ organisation/centralisation • Novel drugs • Quality issues • National Guide lines (FU) IT and Data • Clinical trials (national network) - Specific resources - Biobanking North Uppsala Örebro Stockholm Gotland West Southeast South From a national cancer strategy to an evidence based cancer plan 2009 National cancer strategy Clear Guidelines Patients in focus • Relatives • Employees • Caregivers 2011 Regional cancer strategy Regional Parliament 2013 Regional cancer plan To implement the strategy With a patient perspective on an equal and fair cancer care Cancer plan 2013 - 2015 In June 2013 the county council declared unanimously the plan as the steering document for future development • Contains up to date descriptions of all cancer care pathways • SWOT analyses • Close to 150 actions needed to reach the goals of RCC Triple-helix Innovation collaboration Health care is in the driver seat within the triple helix model at Karolinska University Hospital Health Care Business Academia Health Care D A C E-Health Academia Industry Cell Therapy National test bed (e-Health) Research Development Health Care Associated Infections (HAI) Innovation Informatics test bed for future Heath care (ITH) National Test bed for Innovative Radiation therapy B A: GAP B: ANALYSIS C: DESIGN D: BENEFITS Karolinska’s contribution in a partnership Innovation Center Test beds The eco system – multiple cross roads National and international plattforms The university hospital’s full capabilities Academic partners The Karolinska brand What we believe an industry partner can contribute Complementary networks Complementary competencies Increased capabilities for external funding Fresh eyes and perspectives Access to prototype/ early stage equipment Complementary methods The Swedish test bed for Innovative Radiotherapy Swedish testbed for innovative radiotherapy A gateway to all Swedish university hospitals Partnership for radiotherapy of tomorrow Norrlands Linköping Örebro Akademiska Sahlgrenska Karolinska Skånes Swedish testbed for innovative radiotherapy Test bed – A common test environment Healthcare, academy and industry working together to develop innovations within radiotherapy • products • services • organizational solutions • business models Swedish testbed for innovative radiotherapy Forming a triple helix consortia – all university hospitals • RCC • 6 Companies Swedish testbed for innovative radiotherapy A gateway to all Swedish university hospitals Norrlands Linköping Örebro Akademiska National platform for • innovative radiation therapy • clinical multicenter studies • medtech Sahlgrenska Karolinska Skånes Swedish testbed for innovative radiotherapy What's in it for me ? Test environment MRI-based radiotherapy Better images of the tumour Quality assurance QA for MRI-based radiotherapy National database solution Comparable radiotherapy data Healthcare and industry driving innovation Karolinska University Hospital Sharing Competence for Life 40