Dette er konklusionen i en videnskabelig artikel i British Journal of Cancer: Alt for mange danskere dør af kræft, og det diagnosticeres senere end i andre lande. Ville væsentlige offentlige figurer som Jakob Ejersbo og Tøger Seidenfaden have levet længere, hvis det ikke havde været for Danmarks forældede sundhedsvæsen, der gør alt for lidt ud af diagnosticering og tidlig behandling? Det er der i hvert fald meget, der tyder på:
Denmark has poorer 5-year survival rates than many other Western European countries, and cancer patients tend to have more advanced stages at diagnosis than those in other Scandinavian countries. Part of this may be due to delay in diagnosis. The aim of this paper is to give an overview of the initiatives currently underway to reduce delays. [...]
The findings from the EUROCARE studies suggest that Denmark, like the United Kingdom, has poorer 5-year survival rates across a range of cancer types than other Western European countries (Sant et al, 2001; Karim-Kos et al, 2008; Berrino et al, 2009; Verdecchia et al, 2009). Mortality rates from cancer are also high in Denmark (International Agency for Research on Cancer, 2007). These findings led to a major public debate and a sense of disappointment regarding Danish efforts to control cancer. As a result, a National Cancer Steering Group was established in 1998, chaired by the National Board of Health with representation from all relevant specialties. National Cancer Plans were developed by this steering group in 2000 and 2005, which analysed the possible problems and made recommendations in relation to prevention, diagnosis and treatment.
Cancer incidence in Denmark is relatively high, reflecting lifestyle factors, for example, a relatively high prevalence of smoking (44% of the population in 1987, and 34% in 2000 were daily smokers) (Ekholm et al, 2006). As a result, initiatives were launched to reduce smoking, increase exercise, promote healthier diets and reduce excessive exposure to ultraviolet light. A cervical screening programme had been running for several decades. Following the Cancer Plan in 2005, a national breast cancer screening programme was established. In 2008, a decision was made to set up a colorectal cancer screening programme, but this has not yet been implemented. To improve treatment, necessary but politically difficult decisions had to be taken to concentrate cancer-related surgical procedures in fewer hospital centres (Gøtrik and Hansen, 2001).
Another problem to be tackled was that Danish cancer patients seemed to have more advanced stages at diagnosis than those in other Scandinavian countries (Association of the Nordic Cancer Registries, 2007; Berrino et al, 2009). This may have been due to bottlenecks at different stages of the clinical pathway with long waits from first symptom to start of treatment. The second Danish National Cancer Plan addressed these issues, recommending pre-planned, well-structured clinical pathways without unnecessary waiting times for investigations and procedures.
This paper provides:
- an overview of the Danish healthcare system to help understand where delays may occur;
- a brief summary of what is known about different phases of delay for cancer patients and
- an outline of the actions currently being undertaken to reduce delays.
Det er da altid noget, at “in future, fast-track diagnosis and treatment will be provided for suspected cancers and access to general diagnostic investigations will be improved”, men for nogen er det nok lidt sent. Det er muligt, at vi danskere er vant til at tænke på det danske sundhedsvæsen som “et af verdens bedste”, men på nogle måder er det altså skandaløst dårligt og bagud. Det kan kun gå for langsomt med at få det rettet op.