Cancer remains a major health care challenge in OECD countries and the financial burden associated with cancer is also growing. However, despite recent improvements in cancer treatment and prevention, countries are not doing as well as they could to fight the disease: an estimated one-third of cases could be cured if detected on time and adequately treated, and another one-third could be prevented entirely if more far-reaching public health measures were in place. Furthermore, cancer survival data show almost a four-fold difference across OECD countries. While some countries are lagging behind in cancer care performance, other countries have designed systems that make them global leaders in the fight against cancer.

Cancer remains a major health care challenge in all OECD countries. More than 5 million new cases of cancer are diagnosed every year in OECD countries, averaging about 261 cases per 100 000 people. Cancer is responsible for more than one-quarter of all deaths and, in terms of potential life years lost, is a bigger problem than heart attacks and strokes for both men and women.

sets out why it is important to study cancer care. It shows that cancer remains a major challenge in all OECD countries, not only in terms of the immense human costs, but also with respect to the financial costs to the health sector, to patients and their families and to the wider economy. It also demonstrates marked differences in survival. This suggests an urgent need to understand whether particular policy approaches are associated with better outcomes.The chapter also explains the conceptual framework used to explore this policy question. Country-level information on cancer care systems and relevant policy approaches are gathered from standardised questionnaires based on this framework and interviews with cancer experts.

The variations in cancer care outcomes and spending described in suggest cross-country differences in resources dedicated to cancer care, in cancer care practice and in the governance of cancer care systems. covers resources for cancer care, one of the important domains in assessing the performance of cancer care systems.This chapter illustrates the cross-national variations in the availability of resources for cancer care, such as pharmaceuticals, medical devices and specialised institutions and health professionals, along with related policy trends.

Besides providing an adequate level of cancer care resources and ensuring their adequate allocation, as discussed in , countries also aim to ensure that high-quality care is delivered throughout the various stages of the disease pathway. This chapter illustrates cross-country differences in cancer care practice, such as smoking reduction, screening, medical practices and waiting times. It also considers the various policy measures that countries have adopted, in addition to simply increasing resources, in their efforts to improve cancer care practice.

Over recent decades, countries have strengthened the governance of cancer care systems by introducing national cancer control programmes, and developing monitoring and quality assurance mechanisms. This chapter addresses the cross-country variation and trends related to governance surrounding cancer care.

This chapter describes the results of an exploratory analysis of the relation between cancer care system characteristics and cancer outcomes. It looks at the differences in cancer outcomes for breast, cervical, colorectal and lung cancer in 31 OECD countries for cancer patients followed-up between 2000 and 2002. The analysis tries to explain these differences through system characteristics related to the resources put into cancer care, the practice of cancer care and the governance of cancer care.

sets out what governments should do to reduce the burden of cancer and improve performance of cancer care systems in their countries. The recommendations are based on different approaches countries have taken in tackling cancer in terms of resources, practice and governance, and associations found between particular policy approaches and the best survival for breast, cervical, colorectal and lung cancer.

Sally Bullock, Australian Institute of Health and Welfare