The war on cancer is neither won by politicians making hollow pre-electoral promises nor by the ministry responsible for health adopting half-baked piecemeal policies and neither by the present Administration blindly yielding to media coverage and NGOs' pressure to deliver the much-needed services.

It is won by designing a comprehensive national cancer plan, commissioned by the government, in consultation with all stakeholders, including the public. This would include a process of improvement of cancer-control programmes that identify outcomes, goals and objectives. Appropriate strategies, each accompanied by suitable process or service indicators, must also be introduced.

In July 2007, the Ministry of Health had published its National Cancer Plan For The Maltese Islands - A Consultation Document. To date, the ministry responsible for health has kept the public in the dark about progress made regarding service-delivery, what is not working well in implementation, what can be done to make it work better and what the priority strategies are for the coming year.

The national cancer plan speaks of the transfer of the Oncology Department from Sir Paul Boffa Hospital to the larger premises of Zammit Clapp Hospital. This plan was abandoned at the drop of a hat shortly after the last general election. Cancer patients will now have to wait another three years for the opening of the newly-designated cancer facility at Mater Dei Hospital, meaning a substantial delay in the introduction of a palliative care unit and the installation of the three high-energy containment bunkers to hold the radiotherapy linear accelerators.

No reference is made in the national cancer plan to the introduction of a PET scan service in Malta despite a 2006 report prepared for the previous Administration by Anthony Samuel, chairman of Medical Imagery, concerning the best way to introduce it. However, it is heartening to learn from comments made periodically by Parliamentary Secretary Joseph Cassar that the introduction of PET is in the pipeline. I suspect though that, in view of the newly-designated cancer facility at Mater Dei Hospital, cancer patients will need to wait at the very least another three years for its introduction.

Although the national cancer plan envisages a national screening programme for breast cancer it is silent on the implementation of a preventive screening programme for cervical and colorectal cancer. A European Commission report dated January 22, 2009 shows that only Malta, Romania and Slovenia are still planning to introduce breast cancer screening. Malta has no plans to implement preventive screening programmes for cervical and colorectal cancer.

No coordinated policy and guidance on new and emerging therapies and, in particular, high-cost drugs is given in the national cancer plan. Obviously, more research and public debate is needed about how to value marginal gains in survival with new cancer drugs and to assess costs to other cancer services and to the wider national health service.

The national cancer plan broadly speaks of a strategy for attracting, recruiting and training staff in all oncology disciplines, particularly surgical and radiology oncologists. However, no target date and time-frames are given for the implementation of this strategy. Sadly, this is a big let-down for cancer patients.

The need of establishing multi-disciplinary teams in oncology is rightly, albeit cursorily, mentioned in the national cancer plan. However, the national cancer plan falls short of determining how such teams, if they are to be effective, ought to be coordinated and backed up by administrative support.

Integrative medicine as a new model of health-care approach for cancer patients is conspicuous by its absence in the national cancer plan. Although integrative medicine is gaining momentum worldwide, it is still a taboo subject particularly among our medical oncologists and the Medical Council. Integrative medicine broadly employs modalities from both conventional medicine and complementary and alternative medicine.

National cancer plans are excellent guides for what a country should do to reduce the burden of cancer. Having a plan means that you intend to take action and to implement strategies in the plan. Our national cancer plan is working poorly. It is difficult to sustain the war on cancer without political will and leadership at the highest political level to invest in a cancer plan/strategy. The government is failing cancer patients. The government and the opposition need to join forces if we want to win the war on cancer.

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