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Country/JA: Germany flag Germany
Action type: Program

Problem: The National Cancer Plan that was in 2008 focuses on high-quality care for cancer patients as one of the key priorities. The prerequisite for maintaining and improving high standards of oncological care is transparency about the performance and therapeutic outcomes of the treatment facilities.

Objective: The National Cancer Plan's "Quality Cycle Oncology" is intended to achieve the aforementioned goals: In the evidence-based guidelines of the oncology guideline programme, quality indicators and other recommendations are drawn up that are used for an indicator-based certification system for centres of the DKG and DKH. The results are evaluated annually via the nationally implemented cancer registries and the certification system and made available to both – the certified centres and the German guideline groups – with the focus on continuous quality improvement.

Implementation status: Fully implemented and ongoing


Key Contextual Factors

In Germany there is/are:

  • German National Cancer Plan since 2008.
  • The German Guideline Programme in Oncology, initiated by the Association of the Scientific Medical Societies in Germany (AWMF), the DKG and the DKH, which develops evidence-based guidelines and quality indicators.
  • The three-tier model of oncological care with certified centres of the DKG and DKH.
  • Cancer registries based on the “Cancer Screening and Registries Act” and the “Unified Collection and Merging of Cancer Registry Data Act”.

Key Components/Steps

  • The close cooperation of the political and scientific organisations involved has led to a nationwide implementation of the above mentioned “quality cycle” that covers >90% of tumour entities and >65% of the incident diseases.

Main Impacts / Added Value

  • The German Guideline Programme in Oncology has developed and continuously updates 27 evidence-based guidelines and 124 quality indicators. These are applied in >1,600 certified centres in 6 additional countries (AT, IT, LU, CH, RU and CN) to promote treatment in accordance with the guidelines (Oncomap, European Cancer Centres). The annual evaluations of the results are used, amongst other things, for the audit procedures on site to improve treatment (Plan-Do-Check-Act cycle) and for the guideline groups, which thus receive an overview of how the contents of the guideline are implemented in clinical care. Publications show that patient-relevant outcomes (mortality, morbidity) are improved when patients are treated in the structures of the “quality cycle” [see References].

Lessons Learned

  • The establishment of such a nationwide quality-assured care system in oncology requires the close and coordinated cooperation of all relevant institutions (Federal Ministry of Health, DKG, DKH, ADT, AWMF) within a common framework such as the National Cancer Plan.
  • The scientific experts and clinicians are involved in the system via the development of the guidelines, via the scientific societies, but also as partners in the Comprehensive Cancer Care Networks (“CCCNs”). Thus, the entire concept is a bottom-up approach, which was taken up and consolidated with the National Cancer Plan. This is an important factor for the acceptance and sustainable implementation of the quality cycle in oncology.