Análisis y recomendaciones para la mejora de la gestión clínica y la atención del cáncer de mama metastásico en España / Analysis and recommendations for improved clinical management and care of metastatic breast cancer in Spain

El cáncer de mama metastásico (CMM) constituye la primera causa de muerte por cáncer entre las mujeres y plantea importantes retos en la práctica clínica y en la convivencia con la enfermedad para pacientes y familiares. Con la participación de un amplio panel de oncólogos médicos y representantes de pacientes, en este proyecto se analizaron los recursos (herramientas de planificación, registros de cáncer), proceso asistencial (diagnóstico, tratamiento, cuidados paliativos) y procesos transversales (atención psicosocial, hábitos de vida saludables, rol de las asociaciones de pacientes) en el abordaje del CMM en el contexto sanitario español. El trabajo realizado permitió identificar una serie de áreas de mejora y proponer 42 recomendaciones orientadas a mejorar la calidad asistencial y la atención de los pacientes con CMM y sus cuidadores organizadas en las siguientes áreas de acción: registros de cáncer, coordinación entre niveles asistenciales, diagnóstico de la metástasis, comunicación y habilidades interpersonales, accesibilidad a fármacos, ensayos clínicos, el papel de la enfermería en el CMM, cuidados paliativos, atención psicosocial y promoción de estilos de vida saludables. Estas recomendaciones, elaboradas desde una perspectiva integral y centradas en las características del entorno sanitario en España, ofrecen un punto de partida para la mejora de la calidad asistencial y pueden ser de gran valor en otros entornos sanitarios que se enfrenten a las mismas necesidades en el abordaje del CMM. (AU)

Metastatic breast cancer (MBC) is the first cause of cancer-related mortality among women and poses major challenges in clinical practice and for persons with the disease and their families. With the collaboration of a wide panel of medical oncologists and patient representatives, this project analysed the resources (planning tools, cancer registries), healthcare processes (diagnosis, treatment, palliative care) and related processes (psychosocial care, healthy lifestyles, role of patient associations) in the approach to MBC in the Spanish healthcare setting. The work carried out allowed identification a series of areas for improvement and a proposal for 42 recommendations aimed at improving healthcare quality and the care of patients with MBC and their carers organized in the following areas: cancer registries, liaison between healthcare levels, diagnosis of metastasis, communication and interpersonal skills, drug access, clinical trials, the role of nurses in MBC, palliative care, psychosocial care, and promotion of healthy lifestyles. These recommendations, drafted from an integrated perspective and based on the characteristics of the Spanish healthcare setting, provide a springboard for healthcare improvement and could be of strong value to other healthcare settings facing the same challenges in the approach to MBC. (AU)

The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS).

Earlier activities on health technology assessment (HTA) started in Spain around 1984, with the creation of a National Advisory Board on HTA, and the development of national and regional HTA organizations in the early 1990s. In 2012, the Spanish Health Ministry established the Spanish Network for Health Technology Assessment of the National Health System (RedETS); funded at national level and including all public HTA organizations at national and regional levels. RedETSis focused on the assessment of nondrug health technologies to inform the revision (approval and funding or disinvestment) of the Benefit Portfolio of the Spanish NHS. In parallel with European Network for Health Technology Assessment (EUnetHTA), RedETS has been setting-up and sharing common procedures and methodological guidelines to ensure effective cooperation and mutual recognition of the scientific and technical production in HTA. The output of RedETS is fifty to sixty annual reports, including the production of full HTA reports, Clinical Practice Guidelines, methodological guidance reports, relative effectiveness assessments, tools to support shared decision making between patients and healthcare professionals, and monitoring studies. The HTA assessments requested by the Regional Health Authorities are the biggest component of the annual RedETS working plan. These assessment needs are identified according to a yearly process and prioritized by a Commission composed of representatives from all Spanish regions with the aid of the PRITEC tool. The objectives of this study are to report and update the normative and organizational state of HTA in Spain; describing noteworthy advances witnessed over the past 10 years, as well as discussing existing challenges.